TEDxUCLA 2014: Open 2.0

Fair game?


About Eric

Eric Vilain is a Fellow of the American College of Medical Genetics, and a member of numerous professional committees, including those related to the care of intersex individuals. He is an adviser to the International Olympic Committee for issues of gender and eligibility in Sports.


Imagine you’re on the track running the 100 meter hurdles and the hurdles are pretty hard to pass, but you’re doing pretty good. And you think you’re going to win.

And then suddenly on the side, you see a giant person passing those hurdles with a lot of ease. And you think, “That’s unfair! The legs are too long!”

But how can you complain about physical characteristics of someone who is better adapted to sports? Are you going to complain that you’re too short to play basketball?

We all love sports. We all love these moments of intense athletic effort. We we all love the ecstacy of victory. But we all want sport to be fair.

And of course, it’s a huge mistake. Elite sports are inherently unfair. And athletes who are very special are a little bit of genetic oddities, and sports do not categorize by physical characteristics, apart in combat sports — weight — but with one big exception. That’s sex.

And from the beginning of times, sexes have been segregated in sports. And now if you had men and women compete together, men in almost all the sports would almost always win. And sports authorities have spent considerable resources trying to make sure that athletes competing in the female category are really female.

I want to take you back to the 1980s and to tell you a story about how science was misused for sports policy. And I want to introduce you to Maria Patino on the left. She was, in the early 80s, the fastest Spanish hurdler, 100 meter. And she had been selected to come to the 1983 Helsinki first World Championships in athletics in Finland.

And she was very excited. Those were really amazing times. She saw the rise of Carl Lewis for his first medal in 100 meters and long jump. And she was so proud to represent Spain.

And like all elite female athletes at the time, she had to undergo a sex test. And what it was, it was indirectly counting the number of X chromosomes, and if the test showed up one X chromosome that implied that the athlete was XY, therefore a man. And if the test showed two X chromosomes, it implied that the athlete was XX, therefore a woman.

And like all elite women athletes, Maria also had to carry a card. A certificate of femininity, if you will, that actually demonstrated that she was indeed able to compete with other women.

Wow, a certificate to show that you are a woman. That sounds pretty odd, but that was routine business and Maria didn’t care. She was too focused on her running and too happy to be an international athlete.

So two years later, she was invited at the World University Games in Kobe, Japan, and there in the plane she realizes that her certificate has been left back in Spain. Not a problem, she was told. Just go to the medical office and redo the test and everything would be okay. And so she did.

But the next day the doctor comes and says, “You didn’t pass the test. You’re not really a woman, you can’t compete with the other women.” And her coach tells her you’re gonna need to fake an injury.

And on the day of the competitions, she’s on the sidelines and she’s crying with her fake bandage. And everyone thinks that’s because she’s in pain. But she’s crying because she’s sad not to be able to do what she loves: running. She’s crying because she’s confused. “What’s wrong with me? Why are they telling me I’m not a woman? I’ve always felt like a woman.”

And a few weeks later, back in Spain, the international scandal erupts all over the media, and she is accused to have unfairly participated to those women’s games.

But the remarkable thing about Mary is she didn’t quit. She wanted to understand. She figured out that she had a condition called complete androgen insensitivity syndrome. That she indeed had the male chromosome, the Y chromosome. That she indeed had high levels of the male hormone testosterone. But it was ineffective because of a mutation in the receptor for this hormone. And that explained why she had completely female appearance.

And then she wanted to fight back. She became a scholar, a professor of sports education, at the University of Vigo in Spain. And we became friends. She, the athlete that was wronged by genetic testing, and me, the geneticist. And here we are at the International Olympic Committee headquarters in Lausanne, Switzerland, where we’re trying to work on improving sports policy.

And because of her story, this triggered a number of policy changes that actually culminated in 1999 with the abandonment of all genetic sex testing in all competitions, starting with the Sydney Olympics in 2000. And everything seems to be okay.

And fast forward 10 years later, and another scandal erupts. Caster Semenya, South African athlete, 800 meters winner. And very rapidly, the media, the competitors challenge her and say, “There is something wrong. This is not really a woman.” She is accused of being a hermaphrodite. And in some of the most venomous article, articles she’s actually seen with this very masculine pose, flexing her arms.

And she also fought back through the media in this South African magazine. She is displayed with all the attributes of femininity: her hair is longer, she’s made up, she wears jewelry, her nails are painted. And all this to show that the rage against her in the first place was really about her physical appearance.

And I want to just show you three different perspectives about women athletes in 800 meters. First, we talked about Caster Semenya. And everyone thinks that she won and blew this record. But she was not even the top 10 women. Of course, she would run faster than any of you in the audience, but we’re talking world championship here.

And in fact, a year earlier, there was another woman, Pamela Jelimo from Kenya. She was number three, running faster than Caster and only a few sports aficionados heard about her. Maybe because her physical appearance did not raise any eyebrows.

And then there is number one, number one since 1983: Jarmila Kratochvilova from the Czech Republic. In fact, she is the longest holder of a world record in all track and field. And there have been numerous rumors about her use of performance-enhancing drugs, explaining not only her amazing time, but also her physical appearance.

So there you have it. Three different women athletes, three different physiques, and different views and opinions of the public, depending on whether an invisible threshold of femininity has been crossed.

So the debate over sex testing has been raging with two camps: people saying it has to be about biology, one has to find some biological parameter that says if a woman is eligible or not. The other camp says, well, it’s about self-identity. In other words, if an athlete declares that she’s a woman, there she is eligible to be a woman, no questions asked, no test done.

But it’s not that simple. There are a number of situations, intermittent situations, intersexuality, also called disorders of sex development in which gonads, sex, chromosomes, genitalia are atypical. And we can ask the question, well, do those situations provide an advantage in athletics? And actually we can answer this question because we do have data.

We can ask, for instance, how many women did have the Y chromosome, the male chromosome, in Olympics? And because of all these certificates of femininity, we can answer this question from the 1972 Munich Olympics all the way to the 1996 Atlanta Olympics. We can count. And on average, amongst Olympian women, one in 421 carried a Y chromosome.

That doesn’t sound like much. But what about in the general population of women? One in 20,000. Well, that’s considerably less. Maybe because having a Y chromosome makes you gain a little bit of athletic advantage.

And what about testosterone, the male hormone? In intersex situation, it’s often higher than the typical range in women. Why does it matter? Well, because testosterone builds muscle and men and women have developed the very different muscle mass because of different testosterone levels.

And in fact it’s so different that it almost does not overlap in the general population. In pink, the female range, very different than in blue, the main range, with this huge gap in between, this no man’s land — or should I say this no woman’s land — where some intersex individuals testosterone level lie.

So doesn’t your sexuality provide an advantage in athletics? Well, the answer is probably. But really the question is, is it fair?

Well, there are lots of things that are unfair in sports. For example, geography. Let’s look at two countries: Norway, about five million citizens. Singapore, about five million citizens. And let’s look at the medal count of the last Winter Olympics in Sochi, Russia. Norway, 26 medals, including eleven golds. That’s pretty good. Singapore? Nothing. Geography can be a killer.

And what about genetics? Well, I’ll tell you two of the most famous examples of genetic advantages in sports. This is Eero Mantyranta. He’s from Finland. He’s a gold medalist in cross-country skiing, and he’s affected with a genetic disorder called congenital polycythemia.

What he has is a mutation in the receptor for EPO — yes, the doping agent — but it’s all inside. And what it does to him is it increases considerably his oxygen-carrying capacity of his blood, making him really well suited for endurance sports such as cross-country skiing.

And this is Flo Hyman, an outstanding volleyball player, silver medalist in 1984 LA Games. And she had a condition called Marfan syndrome due to a mutation in a protein in her connective tissue, making her much taller than average, thinner with long arms and long fingers, very well suited for volleyball. She also unfortunately suffered from other complications of Marfan syndrome and died tragically during a volleyball game of a cardiovascular problem caused by Marfan syndrome.

So there are a lot of genetic conditions that provide advantages in athletics, but there are no different categories for each genetic variance. Everyone plays together, and sports celebrate natural abilities, which is a politically correct way to say that sports celebrate genetic inequalities.

But what about sex, where there are two categories? And what about intersexuality? Is it unfair? Well, it’s complicated. So we have a problem, a very big problem. What are we going to do?

And so I spent a lot of time and energy with outstanding scientists, with Maria Patino, with sports officials, trying to come up with a policy that would be quite inclusive, that would be scientifically sound, and that would be consensual.

And in 2011, the Medical Commission of the International Olympic Committee came up with a simple, maybe too simplistic policy that says, well, if it’s all about differences in testosterone or mostly about it, we’re going to allow women athletes who have levels of testosterone outside the female range, outside the pink box, to compete with women. But we’re going to instate a threshold right at the lower limit of the male range. And also, we’re going to allow athletes with any evidence of resistance to androgens, like Maria Patino, to compete in the female category.

Well this policy has a couple of advantages. First it recognizes that yes, intersexuality cases, higher testosterone does provide an advantage, but no more of an advantage than other genetic advantages that other athletes enjoy. The second thing is it’s not about identity anymore. It doesn’t define an athlete as male or female. It’s just a biological parameter, unlike the certificate of femininity used to do.

But the sports authorities are going to face a lot of other issues. It doesn’t solve everything. The validity of the test of testosterone needs to improve. It’s hard to measure. It needs to be done at resting conditions. Also, the way the screening is done needs to be equalized and needs to be more universal to avoid those kinds of finger-pointing that happened and devastated the psyche of Caster Semenya. And of course, privacy concerns of athletes should be paramount.

But the main problems that the sports authorities are going to face in an ever-changing society are going to be social and gender-related. A number of countries allow a third gender or legal third gender. German and Australian passports now have an X category in addition to male and female. What if some of those individuals are elite athletes? Who are they going to compete with?

Facebook allowed its users to choose genders other than male and female and not just one X, but over 50 different choices are now allowed. And if this is the future of gender identification in our world, well sports authorities are going to face a really tough challenge to maintain a binary system and yet being socially appropriate.

So I’ll end by asking you a simple question: what is the fastest time for a marathon? Is it about two hours, or is a little bit more than one hour?

And most people would say, well, it’s probably about two hours. And, and in fact, Wilson Kipsang would say yes, it is. But it could also be a little bit more than one hour, as Josh Cassidy would tell you.

And as one of my students recently told me, “But that’s unfair!” And I said why? And the answer came, an obvious answer for a marathon running. “Because he has no legs!” Thank you very much.