https://orcid.org/0000-0003-1300-4441
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Abstract
Regulations implemented by World Athletics (WA) require female athletes with differences of sexual development to suppress their blood testosterone levels in order to participate in certain women’s sporting competitions. These regulations have been justified by reference to fairness. In this paper, we reconstruct WA’s understanding of fairness, which requires a “level playing field” where no athlete should have a significant performance advantage based on factors other than talent, dedication, and hard work over an average athlete in their category. We demonstrate that by placing regulations only on testosterone levels, while ignoring physical as well as socioeconomic advantages, WA consistently fails to meet its own definition of fairness. We then discuss several ways in which this definition could be met. Our analysis shows that a categorical system, in which athletes are divided into categories based on properties leading to significant performance advantages, is best suited for meeting WA’s definition of fairness.
ACKNOWLEDGMENTS
The authors thank Brian Earp, Mirjam Faissner, Lydia Schneider-Reuter and the audience at a Work in Progress Seminar at NYU’s Center for Bioethics for helpful comments on earlier versions of the manuscript.
DISCLOSURE STATEMENT
The authors report no conflict of interest.
Notes
1 In women with androgen insensitivity syndrome, a receptor defect prohibits testosterone from causing the usual cellular response. Therefore, higher levels of testosterone do not lead to the development of typically male characteristics in such individuals.
2 DSD with (partially) intact androgen sensitivity and hyperandrogenism mentioned by WA’s current regulations include 5α-reductase type 2 deficiency, partial androgen insensitivity syndrome, 17β-hydroxysteroid dehydrogenase type 3 deficiency, ovotesticular DSD or “any other genetic disorder involving disordered gonadal steroidogenesis” (World Athletics Citation2023a).
3 WA does not specify why women with PCOS may have testosterone levels above 2.5nmol/L while women with DSD may not, if it is assumed that such testosterone levels lead to a significant performance advantage – especially given that women with PCOS are overrepresented in sports (Hagmar et al. Citation2009) and that having PCOS may improve performance (Rickenlund et al. Citation2003).