The International Association of Athletics Federations (IAAF) has approved new competition regulations that are understood to seek to limit the amount of natural (endogenous) testosterone female athletes are permitted in certain events. The regulations are not new, as a draft was submitted to the Court of Arbitration for Sport (CAS) in September last year as part of the Dutee Chand case. Due to a January CAS ruling, the IAAF’s submission of the new competition regulations to the CAS would mean that Chand’s case is terminated.

At its recent meeting, the IAAF Council approved a request to revise the competition regulations for track events from 400m up to one and including one mile. “We have always believed that testosterone, either naturally produced or artificially inserted into the body, provides significant performance advantages”, said IAAF President Sebastian Coe in a statement.

However despite the IAAF’s efforts, it has not been able to support this proposition with scientific evidence. The CAS has found that female athletes in certain events enjoy a performance advantage. However – and this is critical – it has not found that females with elevated natural testosterone enjoy such a significant advantage that it is necessary to exclude them from female competition.

The 2015 Chand case resulted in the CAS suspending the IAAF’s Hyperandrogenism Regulations, which excluded female athletes with endogenous testosterone levels in serum of over 10nmol/L from female competition. In its ruling, the CAS’s main area of concern was whether the degree of advantage from that endogenous testosterone was equivalent to the advantage that a male athlete has over a female athlete.

As can be seen on the right, the CAS puts this at between 10% and 12%. Studies conducted by the IAAF found that female athletes with elevated testosterone enjoyed an advantage of between 1.78% and 4.53% in five athletics disciplines, none of which are Chand’s. In January, the CAS ruled that the Hyperandrogenism Regulations remained suspended, but that the IAAF’s studies were designed to support both the original Regulations, and the revised competition regulations submitted to it on 29 September last year.

‘The Panel has made no ruling on the sufficiency of that evidence’, the CAS stated. ‘If the IAAF withdraws the Hyperandrogenism Regulations and/or replaces them with the proposed draft regulations it has submitted, then these proceedings will be terminated’.

However, the IAAF has yet to submit the new competition regulations to CAS. ‘Following some further drafting the regulations will be communicated to CAS before being released’, reads the IAAF statement. ‘It is anticipated that the regulations to go into effect on 1 November 2018’.

Background

Dutee Chand is an Indian sprinter who challenged the Athletics Federation of India’s (AFI) decision to ban her for failing to comply with the IAAF’s Hyperandrogenism Regulations. The ban meant that she missed out on team selection for the Glasgow 2014 Commonwealth Games.

As a consequence of Chand’s case, on 24 July 2015, the CAS suspended the IAAF’s Hyperandrogenism Regulations ‘for no longer than two years’. The CAS Panel was unable to conclude that hyperandrogenic female athletes benefit from such a significant performance advantage that it is necessary to exclude them from female competition.

After the CAS’s maximum two year suspension expired, on 28 July last year the CAS gave the IAAF until the end of September 2017 to file scientific evidence to support the Hyperandrogenism Regulations, otherwise they would be declared void. The CAS said that the extension was due ‘to the agreement of the parties’ involved in the case. Scientific evidence was apparently filed by the IAAF on 29 September last year.

IAAF studies

‘In July 2015 the Court of Arbitration for Sport asked the IAAF to provide further evidence as to the degree of performance advantage that hyperandrogenic female athletes have over athletes with normal testosterone levels’, reads the IAAF’s statement. That evidence involves a study (PDF below) published by the IAAF in March last year, as well as two additional pieces of supporting evidence (PDFs below), which are analysed in detail here.

The IAAF study involved 2,127 athletes (795 male; 1,332 female) that had competed at the Daegu 2011 and Moscow 2013 IAAF World Championships. In short, it found that women with the highest free testosterone (fT) levels performed ‘significantly better’ in the 400m, 400m hurdles, 800m, hammer throw and pole vault. Chand is a sprinter.

Authors of the studies

The Study was authored by Stéphane Bermon and Pierre-Yves Garnier. Bermon was a member of the International Olympic Committee (IOC) and IAAF Working Groups on hyperadnrogenic female athletes and transgender athletes. He has also been a member of the IAAF’s Medical & Anti-Doping Commission and gave evidence on behalf of the IAAF in the Chand case.

Dr. Pierre-Yves Garnier is Medical & Scientific Senior Manager at the IAAF. In January this year, he was sanctioned by the IAAF Ethics Board for receiving illicit cash payments from Papa Massata Diack, son of former IAAF President Lamine Diack, in 2013. PM Diack has denied ever giving the money to Garnier.

Doping issues

It has been alleged that significant doping may have taken place at both the Daegu and Moscow Worlds. As such, whether the fT levels of female athletes at either event can be relied on as being endogenous, or ‘natural’, is open to debate.

The Tübingen Study (PDF) below found that between 29% and 34% of the 1,800 athletes taking part in the Daegu Worlds had doped during the previous year. Papa Massata Diack has admitted that the IAAF held back on announcing a number of doping positives ahead of the Moscow 2013 Worlds, which could mean that athletes who had doped competed.

The IAAF study found that athletes with elevated testosterone levels performed better in the 400m, 400m hurdles, 800m, hammer throw and pole vault. However the revised IAAF competition regulations appear to cover all track events from 400m up to and including the 1,500m and the mile, despite no evidence being found that women with elevated endogenous testosterone performed better in these last two events. Notably, the hammer throw and pole vault do not appear to be included, despite the IAAF’s own evidence indicating that women with elevated testosterone performed better in those events.

‘Our study design cannot provide evidence for causality between androgen levels and athletic performance, but can indicate associations between androgen concentrations and athletic performance’, reads the IAAF study. This appears to recognise that the improved performance of females with elevated endogenous testosterone could be due to other factors, such as muscle development. It is understood due to evidence submitted as part of Kristen Worley’s case that androgen receptors, which control the uptake of testosterone, perform differently amongst individuals.

For example, Chand is understood to have Androgen Insensitivity Syndrome (AIS), which means that her body does not respond to testosterone. Her body cannot get any performance advantage from her elevated endogenous testosterone, yet she is banned because of it.

Case closed

In 2015, the CAS suspended the IAAF’s Hyperandrogenism Regulations because the IAAF could not provide scientific evidence that women with elevated endogenous testosterone enjoyed a significant performance advantage. The CAS later ruled that should the IAAF replace the Hyperandrogenism Regulations with new regulations it submitted to them by 19 June this year, then Chand’s case would be dismissed.

In effect, the CAS appears to have allowed the IAAF to close a case brought by an athlete against Regulations it has suspended as unscientific by promulgating new regulations. Just because the IAAF has promulgated new regulations doesn’t mean that Chand has not been harmed through exclusion.

Coe’s statement highlights that the new competition regulations, which have not been published, are likely to be just as arbitrary as the original Hyperandrogenism Regulations. “We have always believed that testosterone, either naturally produced or artificially inserted into the body, provides significant performance advantages”, he said. The fact that he uses the language “believed” is perhaps an acknowledgement of the IAAF’s lack of scientific proof to back their policies.

‘Male sprinters showed higher values for fT than male athletes in other events’, concluded the IAAF’s study, suggesting that higher endogenous testosterone enables males to run faster. The study didn’t find that male athletes with elevated endogenous testosterone performed better than their competitors in any event, however.

It is understood that XX chromosome (female) androgen receptors are more sensitive to changes in testosterone levels than XY chromosome (male) androgen receptors, which could explain why some women with elevated testosterone appear to perform better. However, the IAAF has yet to prove that the level of advantage enjoyed by females with elevated testosterone is greater than that enjoyed by, for example, Nicole Cooke, Lindey Vonn, or Serena Williams due to their unique physiologies. Should we also sanction them for the natural physiological advantage that they enjoy?

Chand has AIS, which means that she cannot derive a performance advantage from her elevated endogenous testosterone levels. Yet she was sanctioned for enjoying an unfair advantage. The CAS has already ruled that the Regulations that sanctioned her were unfair, as they were not based on any science.

Despite the IAAF’s new competition regulations, it would appear that she still has a case. The CAS admits it has not ruled on the sufficiency of the IAAF’s scientific evidence, yet it appears to have allowed the IAAF’s submission of these regulations to close Chand’s case, after twice extending a deadline for the IAAF to provide such scientific evidence. On the face of it, this does not appear to be normal jurisprudence.