Dutee Chand (Manjunath Kiran/AFP/Getty Images)
Sprinter Dutee Chand has been banned from competing in track-and-field because her body produces abnormally high levels of testosterone as reported in The New York Times. Chand is India’s 100-meter, under 18 champion and was an Olympic hopeful, but after an official or a competitor at the Asian Junior Athletics Championships in June requested that Chand be tested for hyperandrogenism, she was pulled from the sport. Chand had won two gold medals at the event.
It was found that Chand has a condition which causes her body to produce more testosterone than what is considered the normal range for women. Chand’s case is not unique. Recent studies have shown that hyperandrogenism may be overrepresented among female athletes compared to the general population. Four female athletes were pulled from the 2012 London Olympics and taken to France for testing. All of them, like Chand, came from rural regions of developing countries. The London athletes were told to undergo surgery if they wanted to compete. The International Association of Athletics Federations (I.A.A.F.) deemed that Chand cannot compete unless she takes hormone suppressing drugs or has surgery. Chand is contesting this stating that she should not have to change her body.
From a bioethics standpoint, there are several issues that are cause for concern regarding Chand’s case: 1) It is one thing to ban performance enhancers. It is another to require performance “diminishers” to change someone’s natural abilities. 2) Elite athletes are, by definition, not within the range of normal. Why are some genetic abnormalities allowed, but others are not? 3) What is the purpose of sport if it is not to celebrate God-given abilities coupled with training and hard work?
Chand has always considered herself a female and for all intents and purposes is female, but her body produces more testosterone than most females do. Her diagnosis of hyperandrogenism does not necessarily mean that she had an additional Y chromosome, as in Klinefelter syndrome, or a segment of a Y chromosome attached to one of her X chromosomes, as in De la Chappelle syndrome. It just means that her body produces significantly more testosterone. Furthermore, while synthetic testosterone, often taken for doping, confers an unnatural athletic advantage, the science on how naturally produced testosterone caused by hyperandrogenism and some of these other syndromes is still unknown. David Epstein, in his book The Sports Gene, cites Spanish hurdler Maria Jose Martinez-Patino as an example of this. She had De la Chappelle syndrome so her body was producing male levels of testosterone. However, she developed fully female because her body also had androgen insensitivity, which means her body does not respond to testosterone. Hormones, like testosterone, are chemical signals, and in people with androgen insensitivity, their body does not seem to read the signal. Her success as a hurdler, Epstein argues, is likely due to something else.
Epstein spoke with two endocrinologists who believe that androgen insensitivity is likely overrepresented in both sports and modeling. Even though their bodies do not respond to testosterone, they do seem to exhibit certain physical features. In women with high testosterone but androgen insensitivity, their arms and legs tend to be longer than the average female, and they tend to be a couple of inches taller than average female height. Because they do not respond to testosterone, they are feminine, but this added height and limb length can be an athletic advantage in certain sports.
Epstein interviewed Jeff Brown, an endocrinologist who works with top athletes in the U.S., several of whom are Olympic gold medalists. Dr. Brown reports that several of his female athletes have partial 21-hydroxylase deficiency, which is genetically passed down from the parents, and can cause an overproduction of testosterone. Women with low-level 21-hydroxylase deficiency develop normal ovaries and uterus, but their bodies produce more testosterone. How that testosterone is read by the body is still unclear. As a note, men can have 21-hydroxylase deficiency, but its effects are less dramatic.
Interestingly Dr. Brown points out that the endocrine system of elite athletes, in general, differs noticeably from those of most adults. He points out that there are many things about the bodies of elite athletes that are different from most people. This brings up the second issue with Chand’s case. By definition, elite athletes are rare. Once we start talking about the upper echelons of athletic performance, it is often the rare combination of genetics, work ethic, and opportunity that allows an athlete to become elite.
Consider the example of arm span in the NBA. It is a given that a six-foot male is considered “short” in the NBA. In general, most NBA players are taller than average. But being over six-feet tall is not as rare as having an arm span that is longer than height. This rare trait is overrepresented in the NBA. Normal adults have an arm span that is roughly equivalent to their height. In the NBA, most players have an arm span that is significantly longer than their height. For example, Kevin Durant is 6’9” but has a reported wingspan of 7’4”. LeBron James is 6’7.25” with a wingspan of 7’0.25”. Michael Jordan is 6’6” with a reported wingspan of 6’11.5” (Statistics are from NBA.com and wikiepedia.org). Longer arm span means that these athletes actually have a taller effective height.
Pertinent to the topic, NBA players are not asked to do something about their arm span in order to compete in the Olympics or play competitive, professional basketball. One possible exception is Baylor University’s Isaiah Austin. His basketball career was cut short when pre-draft testing found that he had Marfan syndrome, deeming him ineligible to play basketball competitively. One of the symptoms of Marfan syndrome is tallness and an elongation of arms and fingers due to weak connective tissues in the joints. It also gave Austin a longer wingspan than height, likely giving him an advantage on the court. However, the difference between Austin’s case and Chand’s is that the effects of Marfan syndrome are well-known. Marfan syndrome can endanger an athlete because it affects the heart, eyes, circulatory system, and the skeletal structure. Austin was told that he had an enlarged heart and extreme physical exertion could kill him. Chand’s condition does not pose a known health risk.
The NBA is only one example. Genetic aberrations are seen in many other sports, yet these people are not asked to undergo chemical or surgical alterations to conform to certain notions of “normal.” Indeed, in the case of using performance enhancing drugs, which are illegal, the point is to synthetically procure what one was not given naturally. The point is to become “like” someone who is rare so that you can win.
Finally, Chand’s case brings up a larger philosophical question of the purpose of sport. Pierre Coubertin, who was instrumental in re-inventing the modern Olympic movement, considered athletic training part of the cultivation of virtues. He takes a post-Enlightenment, humanist perspective that stems from the pre-modern Judeo-Christian idea that all people are of equal moral worth, although not all are of equal capability. For Coubertin, the point was not winning-at-all-costs, but becoming a better person through discipline, integrity, self-control, hard work, and perseverance. However, given equal training and opportunity, if one athlete has bad knees and the other does not, then the one with better knees will prevail. Coubertin’s perspective would have little to say about an athlete like Chand. Presumably, the emphasis would be on whether she was cultivating a virtuous character.
For some, sport is about showing off technological prowess, which is often tied to a sense of nationalism when played on a global stage. Oftentimes, this view does not see using performance enhancers as a problem because it is considered part of training with the best technology possible. The competition is not just between individual athletes, but between countries. The question isn’t which athlete won the gold, but how many gold medals did a particular country receive. The accumulated successes reflect back on the country’s resources, politics, training, and technological capabilities. From this perspective, it is in the competing countries’ interest to make sure that the competitors are homogenous. This would mean that an athlete like Chand would be excluded because she does not fall within the “norm” and therefore provides one country with an unfair advantage over another.
Finally, another perspective is that sport is about admiring individual differences and God-given abilities. From this perspective, demanding that an athlete chemically or surgically “normalize” herself would constitute cheating because she would be altering herself from how she was born in a way that is meant to change her athletic performance. Incidentally, using performance enhancing drugs would also be unethical for the same reasons, but rather than attempting to normalize the athlete, those that use PEDs are intentionally trying to make themselves above the norm. This perspective would include Chand in world-class competition. Whether she should compete with men or women is another debate, perhaps one that calls into question some notions of gender segregation in sports.
Sports is an age-old social sphere that, in many ways, reflects something about our cultural values. Chand’s body is not within the “norm,” but most elite-level, world-class athletes are not, in one way or another, within the norm either. It is unfortunate that rather than celebrating her distinctive qualities and abilities as a sprinter, she is treated as less-than-adequate for physical qualities that are not under her control. Furthermore, one has to wonder why Chand’s particular physical qualities are considered something to be “fixed” rather than a gift to be celebrated.