Female Athletes With ‘Too Much’ Testosterone Forced to Undergo Genital Surgery and Hormone Therapy

Dutee Chand is really fast.

In 2012, she ran 100 meters in 11.8 seconds and won the Indian national championship for girls under 18. But Chand won't be able to compete in the Commonwealth Games in Glasgow, where opening ceremonies were under way Wednesday, because she tested positive for a condition called hyperandrogenism, a team of sports officials decided last week. Chand's level of androgen—the hormones including testosterone that control the development of male sexual characteristics but are present in both males and females—is too high, according to the Sports Authority of India.

The International Association of Athletics Federations and the International Olympic Commission have standards for "normal" levels of testosterone in men and women. These organizations believe that the amount of testosterone that naturally occurs in Chand's body gives her an unfair advantage over other female athletes.

To be clear, this is not about doping. The tests for steroid use are different from those that determine chromosomes or testosterone levels. Chand had been a top-performing athlete in India for several years before the Athletics Federation of India requested that her androgen levels be tested. Beyond landing in the spotlight with her impressive wins, it's unclear why she drew suspicion before the Commonwealth Games, where athletes from 71 countries and territories will compete.

"I am completely shattered over the development. I am an athlete and wanted to bring glory to my country. All my efforts have gone astray," Chand, who is the daughter of impoverished weavers from Odisha on the east coast of India, told reporters after being disqualified.

The SAI has made it clear that the tests "do not determine her gender" and said in a statement that it has banned gender verification testing.

Because of a fear that male athletes would compete as women to have an unfair advantage, many athletic organizations give female athletes a blood test to determine their chromosomes. In the past, women whose results were deemed abnormal were forced to submit to a genital and clinical exam to prove they were female. In 2012, before the London Olympics, the IOC policy changed from "sex testing" female athletes in this fashion to disqualifying athletes based on testosterone levels.

Despite the organization's insistence that Chand was not tested for her gender, she will not be allowed to compete until she has medical intervention to lower her androgen levels.

The therapy can sometimes involve invasive surgeries like clitoral reduction or removal of internal testes and is based on the idea that higher testosterone or androgen levels improve athletic ability. The assumption is not backed up by science, however. A study in the Journal of Clinical Endocrinology of more than 600 elite athletes found that the ranges of hormone levels for men and women were different from normal ranges, and the IOC's "definition of a woman as one who has a 'normal' testosterone level is untenable."

While men typically both have more testosterone than women and outperform them in sports, a higher-than-average testosterone level doesn't mean that a woman is male, and it doesn't necessarily make her a better athlete.

More important, perhaps, research suggests that testosterone levels do not determine sex. Both men and women frequently have testosterone levels in the range of the opposite sex. In the Journal of Clinical Endocrinology study, more than 16.5 percent of male athletes had testosterone levels below those of an average male.

Opponents of these standards have argued that rather than leveling the playing field, hormone testing forces successful female athletes to put their careers on hold while they submit to intrusive medical procedures. These procedures are required not because they're medically necessary but because it's assumed these women's testosterone levels give them an advantage in competitions.

Progress has been made in the way the IOC and other international athletic organizations view gender—transgender women are now allowed to compete in the Olympics provided they've been taking estrogen for at least two years. But it remains to be seen whether international sports organizations will accept that female athletes with higher testosterone levels are still female.