Farewell hyperandrogenism, hello DSD

DSD: Differences in Sexual Development. That's the new IAAF-endorsed terminology. Although it sounds a little bit "politically correct" it was necessary given the succession of events and the somewhat tarnished "hyperandrogenism" term. Everything started with the meteoric rise of C. Semenya to a world title in 2009. It became clear that women who were not 100 % women had an unfair advantage over the rest and this led the IAAF to create a hyperandrogen policy in 2011. To be able to participate in women's events all participants had to comply with the upper limit of testosterone concentration of 10 nmol/L. However that rule was challenged at the Court of Arbitration for Sport (CAS), in 2014, by the indian sprinter D. Chand, and the decision of the court was that the hyperandrogenism regulations could not be applied, as of July 2015, more studies being mandatory. A two years' span was deemed necessary for the IAAF to present solid scientific arguments in order to support the well-founded of hyperandrogenism regulations. These studies were completed last year and the new regulations have just appeared. In what follows  will try to summarise them and add some comments. 

D. Chand (right). It all started with her

A famous ancient greek dictum ουδεν κακον αμιγες καλου states (loosely) that something good can arise even from a bad situation. This is the case with the whole hyperandrogenism saga. While the ruling of the CAS allowed some athletes to reap (temporarily) profit from their abnormal situation, this paved the road for a much stricter regulation which, hopefully, will level the playing field for women's competitions. 

The new Regulations will come into effect on the 1st of November 2018. The new notion of restricted events is introduced. It refers to the events from 400 m to the mile (including hurdles, relays and combined events). 

The new text stipulates that

If a female athlete wishing to participate in a Restricted Event at an International Competition has a DSD that results in levels of circulating testosterone greater than 5 nmol/L, and her androgen receptors function properly, such that those elevated levels of circulating testosterone have a material androgenising effect (a Relevant Athlete), she must reduce those levels down below 5 nmol/L for six months (e.g., by use of hormonal contraceptives) before competing in such events, and must maintain them below that level until she no longer wishes to participate in Restricted Events at International Competitions.

The six months period is introduced so as to minimise any lingering advantages. Athletes with DSD who do not wish to bring their testosterone level below the 5 nmol/L threshold can still compete as female to a) non-international competitions (without restriction) and b) to international competitions but not to restricted events. Obviously they can compete freely as male or intersex (if the latter classification exists).

I find the notion of restricted events a tad too conservative to my taste. Although the studies show that advantages conferred on certain DSD athletes are of greatest effect in middle distance track events I would have opted for a broader application of the restrictions. Still lowering the threshold from 10 nmol/L to 5 is great step towards playing-field leveling and thus I will stop nagging. 

The IAAF presentation text goes back to the Court of Arbitration for Sport decision and points out that, while unfavourable for the IAAF, that decision did agree with the basic premises behind the hyperandrogenism regulation. In fact the CAS recognised that men have significant advantages in size, strength and power over women and thus competition between male and female athletes would be unfair and in fact meaningless. On the other hand biological sex is an umbrella term, including distinct aspects of chromosomal, gonadal, hormonal and phenotypic sex and some individuals may have differences of sex development. Among these individuals some, apparently female, may have levels of circulating testosterone well above the normal female range, into and even exceeding the normal male range. So, limitations are necessary in order to level the field for women's competitions. The CAS decision was based more on the fact that the hyperandrogenism regulation did not rely on solid scientific findings. This has now been remedied.

Most females (including elite female athletes3) have low levels of testosterone circulating naturally in their bodies (0.12 to 1.79 nmol/L in blood). For males, after puberty, the normal testosterone range is much higher (7.7 – 29.4 nmol/L). Several studies have shown that high levels of natural testosterone, provided the persons are sensitive to androgens, do increase their muscle mass and strength, as well as their levels of circulating haemoglobin, and so significantly enhance their sporting potential. Indeed, increasing testosterone levels in women from 0.9 nmol/L to just 7.3 nmol/L increases muscle mass by 4% and muscle strength by 12‐26 %; while increasing it to 5, 7, 10 and 19 nmol/L respectively increases circulating haemoglobin by 6.5 %, 7.8 %, 8.9 % and 11 % respectively. The ergogenic advantage in having circulating testosterone levels in the normal male range rather than in the normal female range is greater than 9 %. This is an eminently interesting fiding since male-female performance differences are around 10 %. To put it in a nutshell, if women have a male-level concentration of testosterone they are practically men.

J. Jozwik, 5th at the 2016 Olympics 800 m,declared:

I feel like a silver medalist (a direct gibe at the trio

Semenya, Niyonsaba and Wambui)

These findings led the IAAF to propose the DSD regulation according to which no female may have serum levels of testosterone of 5 nmol/L and above. As I have already pointed out, the important gain from the 2 years' regulation hiatus was that the threshold was brought down from 10 to just 5 nmol/L. It was based on the observation that women with polycystic ovary syndrome (PCOS) could have circulating testosterone as high as 4.8 nmol/L but not beyond. So, the only female athletes competing with levels above 5 nmol/L would be intersex/DSD athletes, doped athletes, and athletes with adrenal or ovarian tumours. In fact, below 5 nmol/L, there is limited evidence of any material testosterone dose‐response. But, most important, an increase in circulating testosterone from normal female range up to between 5 and 10 nmol/L delivers a clear performance advantage (according to the studies, a 4.4% increase in muscle mass, a 12‐26% increase in muscle strength, and a 7.8% increase in haemoglobin)

The IAAF regulation goes to great pains to assure everybody that respecting the athlete's dignity is paramount. Nobody is questioning the sex or gender identity of female athletes with DSDs. For the protection of the athletes only the IAAF Medical Manager may initiate an investigation (and the national federation are not allowed to take measures). No "witch-hunt" will take place, based on the masculine appearance of some women. And of course, no surgery will ever be required, in order to regulate the testosterone, but just a hormonal treatment.

With the new regulation in place we will not have the right to 

make comments on the masculine appearance of Kratoshvilova

What I did like was that the IAAF did not evade the tricky question:
All elite athletes have natural genetic and/or biological advantages (e.g., height, lung capacity, etc). The IAAF does not stop them reaping the benefits of those advantages, so why deny DSD athletes the benefit of their natural levels of circulating testosterone?
The official answer to this was that to the best of the present knowledge, there is no other genetic or biological trait encountered in female athletics that confers such a huge performance advantage. While the sport has never considered that competing against an athlete with any other type of genetic or biological advantage was not fair and meaningful (in fact athletics do not introduce any categories other than age-based ones) the DSD case is particular. One could discuss to no end the importance of biological advantages but the main point of the DS regulation, i.e. no other trait confers such a huge advantage, is undisputable.

Commonwealth Games: some thoughts

This is not a full report on the 21st Commonwealth Games. Usually I do not pay much attention to CG. But this being a slow moment between the indoor and outdoor athletics season I did follow them and decided to share some thoughts with you.

First of all the jamaican sprint supremacy looks as if it is a thing of the past. Y. Blake was the favourite for men's 100 m and he managed just barely a third place. And, please, do not start discussing his slow start in the final: Simbine (who won) was even slower.

Simbine won while Blake was (almost) an "also-ran"

I have been following J. Richards since last year's world championships. He did not disappoint in Australia winning the 200 m race by a comfortable margin. The ones who did disappoint were C. Munyai (10th all-time performer with his, last month's, 19.69 s performance) and W. Weir (2012 world vice-champion): they finished 4th and 7th respectively.

J. Richards winning the 200 m final

I. Makwala dominated the 400 m but I cannot explain the counter-performance of the promising grenadian B. Taplin (a 44.38 s performer) who was fighting for the silver medal but faded over the last 20 metres to 5th place.

Last year I was impressed by J. Cheptegei who won the silver medal over 10 km in the World Championships. This year he dominated the long distances of the Commonwealth Games winning both the 5 and the 10 km races. I am sure the young ugandan is the next big name for these distances: kenyans beware.

It's been years since we have last seen a kenyan medal sweep in men's 3000 m steeple race. They managed it at this year's CG led by the world and olympic champion C. Kipruto.

Despite the absence of O. McLeod, Jamaica won the 110 m hurdles, with R. Levy (and it was in fact a double since H. Parchment was second). M. Trajkovic of Cyprus lost the bronze medal at the last hurdle. Still he was the first european and so I am quite confident for this year's continental championships.

Trajkovic (left) is looking to his right 

(but unfortunately the danger came from the left)

K. McMaster, confirmed his supremacy over the low hurdles winning in an exemplary race. Ex-world champion N. Bett opted for a suicidal tactic and ended up without forces over the last stretch fading to last place.

McMaster wins the 400 m hurdles while Bett (left) is struggling

At long last F. Dacres won a major title (Well, to be fair, he was pan-american champion in 2015, but he was not living up to expectations since that time). As a matter of fact I was worried when he threw 69.83 m in February but he was on top of his discipline in Australia. A. Parellis of Cyprus was 3rd pursuing his CG success (2nd in 2014 and 4th in 2010).

The three discys medalists: Parellis, Dacres and Smikle

T. Walsh won the shot put. If anybody can break the loooong-standing world record that's Walsh. Twenty year old N. Chopra, of India, won the javelin with an excellent 86.47 m throw (just one cm less than his PB). J. Yego, ex-world champion winner of the last CG, could not qualify for the final while K. Walcott, ex-olympic champion and silver medalist 4 years ago, was not present.

Men's decathlon was suspenseful. D. Warner, ex-world vice champion and olympic bronze medalist, winner of the last CG was leading the competition when he no-heighted at pole vault. I cannot understand why did he have to start at 4.50 m. The first available height was a mere 2.90 m with a 10 cm progression after this. He could easily have made a jump at 4 m securing victory but instead chose to start at a height that turned out to be fatal. While perusing the results I spotted another athlete who dropped out at pole vault: A. Nyamadi from Ghana. He does not have any registered try (his PB is 4.40 m from last year) so I gather that he must have hurt himself in the warm-up and dropped out of the competition. I looked up his performances (he is an african vice-champion and has a 7811 PB) but what I found really impressive is his personal best over 1500 m: 3:56.33. Of course, it was not obtained in a decathlon (he ran around 4:30 in the three african championships he participated in) but still it's a great performance. (C. Beach's 1:47.36 over 800 m is even more impressive, scoring 1100 points, compared to 900 for Nyamadi's 1500 m).

Atsu Nyamadi competing at the 21st Commonwealth Games

Once Warner was eliminated, the way was paved for L. Victor who secured his victory with an excellent 70+ m throw in javelin. The second grenadian decathlete, K. Felix, who was 3rd four years ago, could only finish 4th, due in part to the way-below-par 1.95 m in high jump.

The two grenadian decathletes at the end of their effort

The men's 4x400 m was a superb race. Botswana won in the end thanks to a great anchor by Makwala but, for me, the most impressive leg was J. Richards' one for Trinidad and Tobacco. Still, it was not sufficient for a medal. Once more, N. Bett, who was anchoring for Kenya, faded over the last stretch. (Kenya was subsequently disqualified for the same mistake that costed a medal to Jamaica's women's team at this year's World Indoors: the third relay runner not respecting the position at which the judges had placed him).

Women's 200 m was a major surprise, not as far a S. Miller-Uibo's victory is concerned but for the fact that E. Thompson (olympic champion over 100 and 200 m and 4th performer of all time in 200 m) did not manage to win a medal. 

Miller-Uibo winning the 200 m. (I could find a frame with Thompson)

A. Montsho won the 400 m. It's a pity that the program made it impossible for Miller-Uibo to try a double. It would have been a great duel. Montsho went on to run a fantastic anchor in the 4x400 m putting Botswana on the podium. 

Botswana's team celebrating the relay bronze medal

Unfortunately cypriot E. Artymata could not make it to the final: she ran a 52.38 s in the semis while a time below 52 s was necessary for the qualification. (She has a 51.61 s record from last year but the CG were apparently a tad too early in the season for her).

Eleni Artymata in her 400 m semi-final

In case you were wondering, C. Semenya won both the 800 m and the 1500 m. And M. Wanbui was second in the 800. Fortunately Burundi is not yet a member of the Commonwealth, otherwise we would have had F. Niyonsaba on the podium as well. My only consolation was that B. Chepkoech won the  silver medal in the longer distance. A versatile runner indeed.

The women's 1500 final. Spot the intruder

The 3000 m steeple saw the surprising victory of a jamaican athlete, A. Praught. With a devastating finish (which reminded me of those of M. Mekhissi-Benabbad) she did not leave any chance to the kenyan runners. 

At this moment Praught knows she is going to win

S. Pearson could not defend her (double) CG title in the 100 m hurdles race. In her absence the title went to O. Amusan of Nigeria, winner of the 2015 All-African Games. 

Amusan celebrating in what becomes a trend for female hurdlers

The pole vault competition was a most interesting one with A. Newman prevailing over, olympic medalist, E. McCartney thanks to a risky strategy that paid out (and a PB of 4.75 m).

In the shot put V. Adams (referred to in the results as "Dame Valerie Adams") was leading (just barely) up the 5th throw when D. Thomas-Dodd released a massive 19.36 m winning the contest for Jamaica. An interesting observation is that once more we had two spinners on the podium (Thomas-Dodd and bronze medalist B. Crew from Canada).

V. Adams accompanied by the two spinners

D. Stevens, the 2009 world champion, won the discus by an almost 8 m margin at 68.26. K. Mitchell won gold for Australia in the javelin with a throw of 68.92 m. The heptathlon title went to the favourite K. Johnson-Thompson but I find her performance of 6255 points quite disappointing.

Jamaica lost the women's 4x100 m relay but they managed to win the 4x400 m one after an exciting race, with Nigeria second and Botswana, thanks to the anchor of Montsho, third.

Jamaica winning the 4x400 m relay

What I found particularly interesting was that just after the competitions were over the results were collected, by sport, in a very detailed results book. If you are interested you can download the athletics one here. It is extremely complete (the only thing that is missing are nice photos but Google can help you with those).