The International Association of Athletics Federations (IAAF) used decreases in the performance of athletes medically harmed because of its Regulations on gender to support its DSD Regulations. Four young athletes, who were 18, 20, 20 and 21, were told that they needed to lower their testosterone levels in order to compete at the London 2012 Olympics, and a gonadectomy (removal of internal testicles) would help them do that. 

The surgery was carried out on the athletes under the IAAF’s Hyperandrogenism Regulations, the forerunner to the Eligibility Regulations for the Female Classification (Athletes with differences of sex development (DSD)) Regulations – to give the DSD Regulations their official name. An extraordinary documentary (video below) has shown the serious health complications suffered by two athletes who were operated on as a result of the Hyperandrogenism Regulations.

The Sports Integrity Initiative first reported on the surgery carried out on the four young athletes in 2015. The IAAF initially denied that such surgery had taken place. However, a 2013 Study (PDF below) showed that it did take place. One of the authors of that Study is Dr. Stéphane Bermon, a member of the IAAF’s Health and Science Department.

The IAAF also denied that it had performed surgery on the athletes. In the above video, IAAF President Sebastian Coe denies that surgery would have been proposed as an option. Coe promoted Dr. Bermon from his position as an Advisor to head the IAAF Health and Science Department.

In the video, three athletes recount how they were told that surgery would allow them to compete. One athlete, who asked to remain anonymous, alleges that the IAAF wanted her to bear the costs of her surgery.

“They approached me saying that my body had a hormonal problem and that I have to undergo surgery”, said Dutee Chand, whose challenge to the Hyperandrogenism Regulations at the Court of Arbitration for Sport (CAS) led to the IAAF withdrawing them, indirectly leading to the promulgation of the DSD Regulations. “They said that I could return to the track provided I went for surgery or else I would not be allowed to run again. I had no problems, but I was being advised to take medicines or undergo surgery. But when I have no health issues and my running is also not affected, why should I choose any of these options? So I decided to challenge the rules.”

Other athletes were woefully ill informed about the reasons for the surgery and potential complications from it, the video alleges. “I did not know exactly what they did”, states ‘Lara’, the anonymous athlete in the video. “Nobody explained it properly to me”.

Thomas Seppel, a hormonal specialist with Endocrinology Mönchengladbach, told the documentary makers that ‘Lara’ should have undergone hormonal treatment after such an operation. He said that as well as physical symptoms such as osteoporosis and a weakened skeletal system, ‘Lara’ would have experienced an impact on her psyche.

‘Lara’ said that she had often contemplated suicide, and that she often wished that she had died on the operating table, as then people would have been forced to take responsibility for what they had done to her. Of course, such symptoms made competitive sport impossible.

Annet Negesa, the winner of the 800m in the 2011 African Games and a Ugandan medal hope for London 2012, tells the documentary makers that surgery was the only option mentioned to her. She underwent an operation in Kampala, and was told that she would receive an injection to pull out the extra testosterone. After the treatment, she noticed cuts made in her body to remove internal testicles.

She showed the documentary makers her hospital discharge report, which they said showed that Kampala surgeons were in contact with IAAF physicians, including Dr. Bermon. She didn’t receive any contact from the IAAF or Kampala physicians post surgery, and became so sick she thought she was going to die. She now suffers with joint pain and has issues with standing for long periods. Of course, competitive sport is impossible for her. Caster Semenya told the documentary makers that she was also advised to undergo surgery.

The IAAF may not have performed the surgery on the athletes or told them that surgery would allow them to compete, but surgeons and officials implementing IAAF rules appear to have told athletes that. It would also appear that athletes received little or no post-operation medical care. 

This is shocking enough. However, the IAAF measured a reduction in performance of three of the four athletes in order to provide support for its DSD Regulations, which replaced the Hyperandrogenism Regulations. 

Medically damaged athletes run slower

Observational data reported by Bermon on the performances of DSD athletes before the Hyperandrogenism Regulations were in place; and after DSD athletes were required to suppress their testosterone levels to below 10nmol/L showed a drop in performance of 5.7%. Of course it did. If you medicate somebody’s natural hormonal balance, they will run slower.

It is understood that part of this evidence, contained in a 2017 Opinion Paper (PDF below) was based on three of the four young athletes who underwent surgical procedures ahead of London 2012. The IAAF argued that this was ‘not true in all of the cases reported’. But within the subtle wording of that denial is an admission that some of the evidence was based on the three young athletes that underwent surgical procedures.

In addition, a source has alleged that the performance times of only three of the four athletes were used because one – remarkably – showed an improvement in performance, post surgery. It is also understood that the IAAF cherry picked the performance times from other athletes that backed its proposition.

This undermines the IAAF’s entire argument that lowering elevated endogenous testosterone compensates for the boost it has given to the physiology of 46 XY DSD athletes from puberty onwards. And it would appear that new research supports the idea that lowering elevated endogenous testosterone doesn’t have a dramatic impact on the physiology of 46 XY DSD athletes.

The research (PDF below) has led to reports that the International Olympic Committee (IOC) has decided to delay the revision of its Transgender Guidelines, which apply to 46 XY males that wish to compete in female competition. However, it is important to point out that the subjects of the Study were understood to be pre-operation. ‘At the time of inclusion, all participants had been accepted to start gender-affirming medical interventions’, it reads.

This is crucial. The subjects of the above study still have the ability to produce the testosterone needed by their XY physiology, as they have not undergone a gonadectomy. Their testicles have not been removed, and so therefore they still have the ability to produce the hormones their physiology requires.

The four young athletes who underwent a gonadectomy ahead of the London 2012 Olympics cannot produce any testosterone. Unless they undergo hormone replacement therapy, serious health complications can arise, as the above documentary illustrates in detail. Kristen Worley cannot produce any testosterone, as she has transitioned to become a female athlete through surgery. She also suffered serious health complications as a result of being required to reduce her endogenous testosterone to levels that were inappropriate for her XY physiology.

The IOC Transgender Guidelines set an upper limit of 10nmol/L on endogenous testosterone. The limit under the DSD Regulations is half that. The above Study raises questions as to whether the reduction to 10nmol/L has any effect on the physiology of 46 XY athletes. The next step for the IOC therefore appears obvious.

In redacted sections of the CAS judgment in Semenya’s case, the IAAF asserted that performance reductions experienced by 46 XY DSD Regulations proved the legitimacy of its methods. Questions were also raised about the legitimacy of the IAAF’s evidence in support of the DSD Regulations, pre-CAS, post-CAS, and during Semenya’s challenge to them. It now appears that at least part of that evidence was based on athletes that have been medically harmed.

Bermon asserts a 5.7% performance drop in athletes undergoing testosterone suppression is evidence of the logic behind the @iaaforg #DSDRegulations. The IAAF has admitted that some of this evidence involves the young athletes on whom surgery was performed ahead of #London2012… pic.twitter.com/p2EQ6Ad4sF

— Sports Integrity SII (@Sport_Integrity) June 25, 2019

Sport’s rules have made these four young athletes ill, and yet sport has used their decline in performance to support Regulations that are likely to make more 46 XY DSD women ill. The CAS has supported regulations that can medically harm athletes in the support of a level playing field that doesn’t exist. The Swiss Federal Tribunal should take note.

• Andy Brown, the Editor of The Sports Integrity Initiative, will be speaking alongside experts Roger Pielke Jr. and Madeleine Pape in a session entitled ‘The Caster Semenya debate: what it means to athletes’ at Play The Game 2019 in Colorado Springs, 13-16 October 2019. His presentation will be entitled: ‘How the IAAF framed the debate to defeat Caster Semenya’s challenge to the DSD Regulations’. Click here for a programme overview.