New IAAF Testosterone Regulations are Bigoted and Targeted
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New IAAF Testosterone Regulations are Bigoted and Targeted

New IAAF Testosterone Regulations are Bigoted and Targeted by Andrew

Last week the International Association of Athletics Federations (IAAF) released new regulations for women's events titled Female Classification (Athletes with Differences of Sex Development). These regulations are currently valid and the new testosterone limits will be enforced beginning on November 1, 2018. The IAAF claims these new regulations are designed to ensure "fair play" in women's competition.

That is not what the IAAF has accomplished. Instead, this policy selectively utilizes the inconclusive and suspect science on which it is based and is broadly discriminatory against gender diverse athletes including non-binary athletes, trans athletes, and especially athletes with intersex traits. The policy is significantly and clearly designed to target specific athletes. It is sexist, racist, and queerphobic. Simply put, it violates the human rights of gender diverse athletes while achieving little fairness.

21st Century Gender Regulations: How We Got Here

Gender regulations in women's sports have a tradition that stretches back decades. These new regulations are the result of an almost decade-long process to implement a new form of gender testing in elite international women's track and field events. While the IAAF abandoned mandatory gender testing of all women athletes in 1999, gender diverse athletes continued to challenge the narrow and arbitrary binary division of sports and as such have been subject to further scrutiny and testing.

Caster Semenya's victorious emergence on the international track scene as an 18-year-old in 2009 immediately reinvigorated debate about just who was feminine enough to participate in women's sports. In the aftermath of her world championship win in the 800 meters in 2009, then-IAAF President Pierre Wiesse remarked "She is a woman, but perhaps not 100 per cent." That bigotry has been present in her fellow competitors, track officials, sports media, and sports fans throughout her career.

The IAAF response to Semenya's win was marked by misogyny and racism; they opted to require a sex verification test for Semenya. As I wrote previously here at the Victory Press:

[The IAAF's] handling of her case was appalling; news that the organization had required the test for Semenya broke hours before the 800 meter final. The IAAF clarified that the tests were required not because of doping concerns but because the sporting body wanted to determine whether she had an 'unfair advantage.' Semenya's results were not publicly revealed, though were widely leaked in the press. After an eleven-month break from competition, she was cleared to compete again in July 2010.

In 2011, the IAAF adopted new regulations (largely in response to Semenya's excellence) which declared athletes ineligible to compete in women's events if they had testosterone levels in the typical male range (unless the athletes in question had full androgen resistance or underwent medical treatment to reduce testosterone levels). Under these restrictions, Semenya won silver in the 800-meter at the London Olympics in 2012. The gold medalist, Mariya Savinova, questioned Semenya's gender with a dismissive "Just look at her." Semenya would eventually be awarded gold, a medal she rightly deserved, because Savinova admitted to using a banned substance, oxandrolone. In 2015, WADA recommended Savinova receive a lifetime ban, and in 2017, the Court of Arbitration for Sport (CAS) stripped her of her 2012 gold medal and banned her for four years because of doping infractions. The result was a belated Olympic title for Semenya, achieved while compliant with 2011's IAAF Regulations Governing Eligibility of Females with Hyperandrogenism to Compete in Women's Competition and IOC Regulations on Female Hyperandrogenism.

In 2015, Indian sprinter Dutee Chand challenged the validity of the IAAF's 2011 policy regarding hyperandrogenism at CAS. CAS suspended the hyperandrogenism regulation for women athletes participating in IAAF events because insufficient scientific evidence existed to connect higher testosterone levels in women with athletic advantages. The ruling was not abolished, but gave the IAAF two years, until 2017, to provide CAS with additional proof that higher testosterone levels in women athletes constitutes an unfair advantage. The 2018 IAAF regulations were developed as a response to the 2015 CAS ruling.

The 2018 Regulations

Regulation Overview

The 2018 IAAF regulations are more specific than previous IAAF regulations. The new rules are based largely on findings released last summer titled "Serum androgen levels and their relation to performance in track and field: mass spectrometry results from 2127 observations in male and female elite athletes" by doctors Stéphane Bermon and Pierre-Yves Garnier. First published in the British Journal of Sports Medicine, the Bermon and Garnier study was jointly commissioned by the IAAF and WADA.

Dr. Bermon appeared as a witness during the Chand case and is a member of the IAAF's working committees on hyperandrogenism. Bermon was at one time the IAAF's medical director and in 2013, during his time at that post, he co-authored a report on four women athletes between 18 and 21 years of age "from rural and mountainous regions of developing countries" who were sent to an IAAF specialist centre in France for evaluation for hyperandrogenism. The athletes had medically unnecessary surgeries including gonadectomy, partial clitoridectomy, and feminizing vaginoplasty.

As Katrina Karkazis and Rebecca Jordan-Young observe in their paper "The Powers of Testosterone: Obscuring Race and Regional Bias in the Regulation of Women Athletes":

The genital surgeries described in the report suggest that something beyond T and athletic performance motivates the regulation, and indicate that it's not just compliance with the T regulation that drives interventions.

These procedures were objectively medically unnecessary, and in addition, Bermon breached IAAF regulations of "respect for confidentiality in the medical process and the need to avoid public exposure of young females with hyperandrogenism who may be psychologically vulnerable." Bermon's actions show both an inability to consider the well-being of intersex athletes at the heart of these regulations and a willingness to use marginalized individuals to further his reputation. At the very least, such a transgression while representing the IAAF in such a senior position should have disqualified him from participating further in the regulation process.

"Serum androgen levels" is Berman and Garnier's written analysis of their study of T levels in men and women athletes who competed at both the 2011 IAAF World Championships and the 2013 IAAF World Championships. The study analyzes "1332 observations of elite female athletes and 795 observations of elite male athletes—a total of 2127 observations." Each athlete observed gave a blood sample for the study. What Drs. Bermon and Garnier found was that in 5 of 21 different women's track and field events "When compared with the lowest female fT tertile, women with the highest fT tertile performed significantly (p<0.05) better in 400 m, 400 m hurdles, 800 m, hammer throw, and pole vault with margins of 2.73%, 2.78%, 1.78%, 4.53%, and 2.94%, respectively." The IAAF largely tailored its regulations to these findings, lowering the acceptable blood testosterone levels for athletes participating in specific women's events to no more than 5 nmol/L (previously the maximum was 10 nmol/L).

But not everyone agrees with their analysis. Simon Franklin et al. published "What statistical data of observational performance can tell us and what they cannot: the case of Dutee Chand v. AFI & IAAF", also in the British Journal of Sports Medicine, in February 2018. The authors contend that "the evidence put forward by Bermon and Garnier is not sufficient to sustain even draft revised regulations applying only to specific events. Our reanalysis of the available data by Bermon and Garnier suggests, at the very least, that further analysis is required to establish the claims made in the paper." Franklin et al. suggest that given the implications of the Bermon and Garnier study, the raw data from the study should be made public for other researchers to analyze.

The trio conclude that:

...given the sample sizes used for each event, and the number of statistical tests conducted by the authors, any particular significant result in an event is more likely to have arisen by chance. Unfortunately, without publicly available raw data, it is not possible to perform all the desired robustness checks on the data. In lieu of access to such data, we performed a Fisher's combination test using the P values calculated from the published data. After performing such a test, we were unable to reject the global null hypothesis that all null hypothesis are true, that is, the pattern of P values is not inconsistent with there being no advantage to high fT women, in any one of the events. In simpler terms: it is reasonably likely that the correlations present in the paper (even the largest ones) occurred by chance.

Given the number of tests performed, the few significant findings detected could have arisen without there being a true correlation between testosterone and performance for female athletes. To avoid these chance findings (also known as false positives), appropriate multiple hypothesis testing corrections ought to be applied.

Our reanalysis of the data... suggests that this correction would not yield a robust and significant correlation in any event. Given these findings, we believe that it is scientifically incorrect to draw the conclusions in the Bermon and Garnier paper from the statistical results presented.

The authors assert the IAAF should not have proceeded to regulate T-levels in women's competition: "In other words: it is likely that the correlations presented in the paper occurred simply by chance. Therefore, we cautioned researchers, practitioners and regulators interpret the statistical results in Bermon and Garnier 2017 with extreme caution. Exactly the opposite of what the IAAF have done."

The new regulations are as follows:

  • 2. Special Eligibility Requirements for Restricted Events at International Competitions
  • 2.1 The special eligibility requirements set out in clause 2.3, below, apply only to participation by a Relevant Athlete in the female classification in a Restricted Event at an International Competition. They do not apply to any other athletes, or to any other events, or to any other competition (although if a Relevant Athlete does not meet the Eligibility Conditions then she will not be eligible to set a World Record in a Restricted Event at a competition that is not an International Competition).
  • 2.2 For these purposes:
    A Relevant Athlete is an athlete who meets each of the following three criteria:
    • (i) she has one of the following DSDs:
    • (A) 5α‐reductase type 2 deficiency;
    • (B) partial androgen insensitivity syndrome (PAIS);
    • (C) 17β‐hydroxysteroid dehydrogenase type 3 (17β‐ HSD3) deficiency;
    • (D) congenital adrenal hyperplasia;
    • (E) 3β‐hydroxysteroid dehydrogenase deficiency;
    • (F) ovotesticular DSD; or
    • (G) any other genetic disorder involving disordered gonadal steroidogenesis; and
    • (ii) as a result, she has circulating testosterone levels in blood of five (5) nmol/L or above; and
    • (iii) she has sufficient androgen sensitivity for those levels of testosterone to have a material androgenising effect.

    Restricted Events are 400m races, 400m hurdles races, 800m races, 1500m races, one mile races, and all other Track Events over distances between 400m and one mile (inclusive), whether run alone or as part of a relay event or a Combined Event.
  • 2.3 To be eligible to compete in the female classification in a Restricted Event at an International Competition, or to set a World Record in a competition that is not an International Competition, a Relevant Athlete must meet each of the following conditions (the Eligibility Conditions):
    • She must be recognised at law either as female or as intersex (or equivalent);
    • She must reduce her blood testosterone level to below five (5) nmol/L for a continuous period of at least six months (e.g., by use of hormonal contraceptives); and
    • Thereafter she must maintain her blood testosterone level below five (5) nmol/L continuously (i.e., whether she is in competition or out of competition) for so long as she wishes to maintain eligibility to compete in the female classification in Restricted Events at International Competitions (or to set a World Record in a Restricted Event at a competition that is not an International Competition).

Additional clauses stipulate that "surgical anatomical changes are not required in any circumstances" (2.4), that no athlete will be "forced to undergo any assessment and/or treatment" and that it is "the athlete's responsibility, in close consultation with her medical team, to decide whether or not to proceed with any assessment and/or treatment" (2.5), and that a Relevant Athlete who does not meet the Eligibility Conditions may participate in all track and field events other than the Restricted Events, "in the male classification, at all competitions" or "in any applicable intersex or similar classification that may be offered, at all competitions (2.6).

What it means for athletes in women's competitions

Hyperandrogenism vs. Disorders of Sexual Development (DSD)

Previous IAAF (and IOC) regulations regarding T-levels in athletes who compete in women's sports focused on athletes with hyperandrogenism. But hyperandrogenism is a term to describe "excessive levels of androgens" in afab folks that can have several causes, most commonly PCOS. In the latest set of regulations released by the IAAF, that focus has narrowed to athletes with a DSD, a medical term to describe intersex traits.

In its "Explanatory Notes" for the new regulations, the IAAF clarified this change:

It would be misleading to suggest that the Regulations apply to all female athletes with hyperandrogenism, because in normal medical parlance that would include women with polycystic ovary syndrome (PCOS), but the levels of circulating testosterone of such athletes would be less than 5 nmol/L, and therefore they will not be covered by the new Regulations.

By dividing up the medical conditions that comprise hyperandrogenism, the IAAF is able to group together "average" women and athletes with PCOS, while grouping together anyone with a T level higher than 5 nmol/L as both having an "unfair advantage" and serious health concerns. They make a point afab people with DSDs have something wrong with them: "Therefore, the only female athletes competing with levels about 5 nmol/L would be intersex/DSD athletes, doped athletes, and athletes with adrenal or ovarian tumours." This positions the IAAF policy of regulating T-levels as also being a policy of health and safety. This suggests that "normal" women have nothing to fear by this policy.

But as we have seen in recent IAAF history, especially in the case of the four young athletes sent to the assessment facility in France, the health and well-being of athletes is not the primary goal of treatment for hyperandrogenism in the IAAF's view. Treatment, if implemented, should meet the individual's needs, including doing nothing. Higher-than-expected T-levels in afab folks is not in and of itself an indication of any illness. The primary concern with these treatments is maintaining binary gender: "Health worries about high T are a post-hoc justification for continuing concerns about how to 'deal' with 'ambiguous gender cases.'"

Why are athletes with a DSD considered to have a greater advantage than those with PCOS? Because DSD athletes typically have T levels between 5 nmol/L and 10 nmol/L "while women with PCOS could have circulating testosterone as high as 4.8 nmol/L." According to IAAF scientists, "(a) below 5 nmol/L, there is limited evidence of any material testosterone dose-response; but (b) an increase in circulating testosterone from normal female range up to between 5 and 10 nmol/L delivers a clear performance advantage."

This situates athletes with PCOS as both being outside the average female range (upper limit of 3.0 nmol/L, though the newest IAAF regulations have revised that average range to 0.12 to 1.79 nmol/L for women) yet not the beneficiaries of athletic advantage.

Despite the numbers the IAAF presents detailing how athletes with PCOS occupy this liminal space, I suspect part of the reason for this new division is the sheer numbers of afab people with PCOS. Between 5% and 10% of folks who can bear children have PCOS. Some studies have put that number as high as 20%. Such numbers make it harder for the IAAF to suggest that athletes with hyperandrogenism are represented at considerably higher rates in elite competition than they are in the general population. In previous regulations, hyperandrogenism and intersex were used interchangeably. By removing PCOS (and its medical connection to hyperandrogenism) from their regulations' language and instead naming specific DSDs, the IAAF has made clear its regulations are designed to find and punish intersex athletes.

The common nature of PCOS in afab individuals should make it perfectly clear that the narrow descriptions of sex characteristics that inform popular notions of binary sex and gender are simply inaccurate and incongruous.

The IAAF has changed average T-levels for men and women
Prior to these most recent regulations, the IAAF (and other international sporting bodies) considered 0.1 to 2.8 nmol/L to be the "normal female range" for T-levels and the "normal male range" to be between 10 nmol/L and 35 nmol/L. Those averages have been lowered. The IAAF now considers that 0.12 to 1.79 nmol/L is the "normal female range" and 7.7 to 29.4 nmol/L is the "normal male range". The numbers are taken from the Bermon and Garnier study and might hold up to further scrutiny but the IAAF's readiness to roll with new numbers also illustrates a vested interested in narrowly defining T-levels as they relate to "designating" women. Lowering the lower end of the average male range makes it easier to classify women athletes with a DSD and a T-range between 5 and 10 nmol/L as "in the male range" and therefore ineligible or possessing an "unfair advantage."

A lower "normal female range" is consistent with a regulatory body that views women's and afab folks' bodies as fundamentally lesser. Smaller, weaker, less able to achieve sporting greatness. A lower "normal female range" is consistent with a regulatory organization that views women's bodies through a lens of weakness and frailty, ignoring the tremendous variety and diversity of women athletes.

Ultimately, the classification of "average ranges" for hormones that everyone produces naturally is ridiculous when it comes to sports. The male range allows for variation and difference and some athletes who compete in men's sporting events have T-levels that fall below the "average male range." If the IAAF has proved anything, it's that women also have a similar diversity of T-level range, but that range isn't and shouldn't be disqualifying -- from competition or for gender.

What about hammer throw?
The Berman and Garnier study identified 5 events in which athletes competing in women's events with higher T-levels had an advantage. But two –- hammer throw and pole vault -– didn't make the IAAF's list of Restricted Events despite showing the highest percentage of advantage in the study. At 4.53%, hammer throw is about 1.5% higher than any of the other events flagged as showing a notable difference. Out of the five events, Semenya's main event, the 800-meter race, shows the least at 1.78%. None of these percentages come close to the 10-12% result gap between men's and women's competition despite the IAAF's preamble that "men have significant advantages in size, strength, and power over women, due in large part to men's much higher levels of circulating testosterone from puberty onwards."

T-levels are the only natural "advantage" the IAAF is interested in regulating, no other natural physical advantages face such scrutiny. For example, the IAAF is not interested in socioeconomic factors that may lead to performance benefits or a lengthy history of racism, sexism, and queerphobia that have pushed women athletes to the margins of the sporting world. There's clearly more to the question than testosterone -- yet the IAAF is not interested in addressing other gaps.

Ignoring the higher results of the field sports to focus on the middle distance track events brings the focus back to Semenya. Semenya's main event may be the 800-meter, but she also runs the 400-meter, the 1500-meter, and relay events. These are the events the IAAF is restricting, while ignoring pole vaulting and hammer throw. The 1500m showed no advantage, yet was included in the list and the mile was not even tested. In response, Semenya has indicated she's interested in trying longer races like the 5000-meter and 10,000-meter events.

In a blog post for the British Journal of Sports Medicine, Simon Franklin et al. question the interpretation of findings on which the new regulations are based, concluding, "This, obviously, seems like a very arbitrary and selective way in which to apply regulations, and seems targeted towards Caster Semenya. Further, even if the ruling had applied only to the 400m and 800m, and not the 1500 meters, such a selection of events would be entirely arbitrary."

IAAF leaders have been preoccupied with Semenya her entire career, but not because she's a track star and a two-time defending Olympic title holder. While Weisse's comments were blatantly offensive, current IAAF president, former British track star and Olympic champ in the 800-meter, Sebastian Coe, has also taken to voicing his displeasure at inopportune times. At the beginning of the 2016 Summer Games, Coe commented that he was surprised by the CAS decision and then defended the IAAF's handling of the subject of hyperandrogenism while paternalistically emphasizing the need to appeal its ruling: "But we need to remember these are human beings. This is a sensitive subject, they are athletes, they are daughters, they are sisters and we need to be very clear about this. We will treat this sensitively. We need to go back to CAS and we have the right people looking at this." Hours before the women's 800-meter final in Rio, Lord Coe reiterated that the IOC would be challenging CAS's ruling on the Chand case.

Even the release of the IAAF's latest regulations occurred as Semenya triumphed at the Commonwealth Games, as The Guardian wrote:

The IAAF vehemently defended the 2011 regulation as science, not sex testing, but this was never about science. This regulation is about targeting and impeding a few exceptional women of colour from the global south, especially Caster Semenya. It was a particularly cruel jab to release it on the heels of her 800m and 1500m wins at the Commonwealth Games.

While these regulations affect hundreds of athletes, the media and institutional focus remains on Semenya. Tokozile Xasa, the South African minister for sport, described the rule change as the "Caster Semenya Regulations as they are designed to disadvantage Caster in her career".

The "scientific" opinions of the IAAF scientists seem blatantly influenced by Western, white perspectives on gender and race
The scientists writing these regulations, creating these studies, and analyzing the results view women and femininity through race. At the ICSEMIS conference a week before the 2012 Olympics where the then-current IOC testosterone regulations were officially unveiled, Dr. Berman gave a presentation in which he presented Goya's La Maja Desnuda as the ideal female form and a picture of Kenneth "Flex" Wheeler as the ideal masculine body.

Karkaszis and Jordan-Young write:

We do not think we were alone in our surprise when La Maja Desnuda was the image Bermon displayed as "the female phenotype" in a talk about elite women athletes, nor that he paired it with that of a 20th century 'roided out male bodybuilder. Though Bermon acknowledged that he 'took some extreme examples,' even alluding to Wheeler's myostatin-inhibiting gene mutation (which allows for nearly unlimited muscle growth), he hewed closely to these two images as evidence of what should be considered "normal male and female."

Meanwhile, the ideal female phenotype Bermon presented was not a woman per se, but an artistic interpretation of one. His choice of Wheeler as the archetypal normal male was also ironic given that Wheeler is widely known to have doped for nearly two decades.

The point Karkazis and Jordan-Young make, and make well, is that the IAAF's "science" is often built on the biases of the individual experts doing the work, not objective analysis:

Reference to testosterone is all it took to transform a conversation about stereotyped cultural images into a supposedly scientific presentation. In a series of moves so familiar they can be hard to see, Bermon built up an argument about sexual dimorphism -- the idea that the sexes represent two distinct, non-overlapping forms -- and the possibility of reading not just athleticism but T from the body's superficial appearance. If high T is what causes Flex Wheeler's muscles to bulge and strain, low T must be responsible for La Maja's lack of muscular definition, her eroticized softness, her pose that relishes in its own idleness. But what does T have to do with her whiteness?

Bermon did not make the explicit claim that T is what caused Flex's darkness, nor lack of T La Maja's lightness. But insisting that T is what drives the difference in the male and female phenotype, and presenting these as black and white, respectively, nonetheless attaches T to a package of existing associations about race and gender. While Bermon probably did not consciously or deliberately choose the image of a white woman for this presentation, it could hardly have been an accident, either: whiteness is an essential part of the traditional image of ideal femininity in the West. Similarly, the choice of a black male bodybuilder to show the "extreme phenotype" of masculinity ties into longstanding associations of black men with hypermasculinity, and blackness in general with athleticism.

South Africa's parliamentary spokesperson Moloto Mothapo had this to say in response to the new IAAF regulations: "Physiques of African women have and continue to suffer unjustified and racially humiliating scrutiny and mockery. This must stop…. Such an act should be rejected with the contempt it deserves as it threatens, not just Caster's career, but the sacrosanct principles of fairness, justice and equality in sports."

The return of mandatory gender testing to women's track and field
While the IAAF abandoned mandatory gender testing at its events in 1999, testing of specific athletes (such as those with or suspected of having hyperandrogenism) was still possible as the IAAF reserved the right to test individual athletes. The regulation changes announced this week have quietly brought back one of sport's most sexist policies: the mandatory gender verification of women athletes.

It's likely that there are many elite women athletes unaware that the IAAF's new regulations have brought this change. But it is important that athletes and fans alike know that athletes competing in women's Restricted Events at IAAF sanctioned competitions are now subject to gender testing -– all athletes.

In Section 3 "Assessment of Cases" in Eligibility Regulations for the Female Classification (Athletes with Differences of Sex Development), the IAAF establishes the parameters for determining who is a Relevant Athlete (that is, an athlete subject to the T-level restrictions in the specified events). Clause 3.2 is particularly problematic:

In addition, the IAAF Medical Manager may investigate at any time (including, without limitation, through analysis of blood and/or urine samples collected from athletes who are competing or entered to compete in the female classification in a Restricted Event at an International Competition) whether any athlete who has not advised the IAAF Medical Manager in accordance with clause 3.1 may be a Relevant Athlete whose case requires assessment under these Regulations. The Relevant Athlete agrees to provide samples for this purpose, and also agrees that any samples she provides or has previously provided for anti-doping purposes and/or any anti-doping data relating to her may also be used for this purpose.

As things now stand, simply running an event like the women's 800 meter and submitting to mandated doping tests opens any athlete to sex verification. The IAAF moved away from mandatory gender testing at the turn of the century because it was correctly seen by many as faulty and a violation of an athlete's human rights. To return to such a state is a mistake.

Minors are subject to these restrictions
All elite level athletes are subject to these restrictions while taking part in IAAF sanctioned events, including minors. Given the IAAF's previous inability to keep such investigations and gender verification results private and the resulting public scrutiny placed on the athlete, it's important people know that minors also have to comply with these regulations at the national and international level.

Prior to conducting the Level 1 Assessment, the examining physician will explain to the athlete the purpose of the assessment, the nature of the testing to be conducted, and the potential consequences both for the athlete's health and for her eligibility under the Regulations. Where the athlete is a minor, the examining physician will provide such explanation to the athlete's parents or legal guardian(s). The examining physician will satisfy him/herself that the fully informed consent of the athlete (or athlete's parents or legal guardian(s), where the athlete is a minor) has been obtained before starting the Level 1 Assessment.

"Appendix 3 – Framework for Assessment of Cases" makes provisions for the athlete's guardian(s) to provide informed consent for various assessment and treatment stages. The emphasis on informed consent is excellent, especially in light of recent testing and treatment cases in which athletes were not informed about the true purpose of the medical testing they were undergoing and were subjected to unnecessary medical procedures as part of IAAF policy compliance. However, Appendix 3.5 does not make clear if the athlete's physician has to inform the athlete herself if she is a minor. It's certainly possible the parents or guardians of an elite international athlete would make health care decisions based on her athletic eligibility rather than her health or her wishes. Regardless, athletes who are minors, like all athletes, deserve to have their bodily autonomy respected.

Intersex tax
Under Chapter "3E. Costs" the IAAF outlines who is responsible for the costs of this program. While clause 3.15 states the IAAF is responsible for assessment and diagnosis (how generous), the costs associated with maintaining eligibility fall on the athlete.

Clause 316 states "The athlete will bear the costs of her personal physician(s) and of any treatment prescribed for her by her personal physician(s), including any treatment required to satisfy the Eligibility Conditions, as well as the costs of providing the evidence of continuing satisfaction of the Eligibility Conditions requested by the IAAF Medical Manager in accordance with clause 3.12(a)."

Simply put, the IAAF has placed an additional financial burden on athletes with intersex traits. These athletes will be financially punished for the rest of their careers because they aren't cisnormative.

What impact will this have?

First and foremost, this will target and harm women athletes, intersex athletes, gender diverse athletes, trans and nonbinary athletes, athletes with intersex traits, athletes with DSDs, and athletes with hyperandrogenism. It places a significant and unnecessary burden on intersex athletes. This regulation has the potential to ruin careers and force athletes to prioritize eligibility requirements when making health care decisions. These regulations will likely result in athletes choosing medical treatments they neither want nor medically need.

The IAAF has always been a leader in violating the human rights of athletes competing in women's events. The organization instituted the first mandatory sex test for women athletes in 1950 and were the first to implement testing at competition in 1966. The IOC has often followed the IAAF lead and worked closely with the track and field organization to create gender regulation. This was the case in 2011 and 2012 when drafting rules for athletes with hyperandrogenism.

In the wake of last week's release, Sebastian Coe emphasized the leadership role the IAAF plays: "I am confident that we have spent a lot of time and effort on this and the analysis has been very thorough... I am comfortable that we have done everything that we need to do to properly make judgement on this. We're not keeping this to ourselves. We've shared this all with the IOC and we've had discussions with the IOC."

There should be legitimate concern that the IOC will follow the IAAF's lead here, and set back gender inclusion policies in sports on an even wider scale. It might seem obvious to many that these regulations violate the human rights of many athletes; however, the IOC has never been all that concerned with doing the right thing. While the regulatory scope is currently narrow, Lord Coe has indicated the IAAF is open to expanding the list of Restricted Events in the future. There is a core of deeply committed people who have considerable power in sports pushing these regulations.

The IAAF (and IOC) will face greater scrutiny. Steve Cornelius, appointed to the IAAF Disciplinary Tribunal in 2017, resigned in the wake of these new regulations. His resignation letter to Lord Coe is worth reading:

Sadly, I cannot in good conscience continue to associate myself with an organization which insists on ostracising certain individuals, all of them female, for no reason other than being what they were born to be. The adoption of the new eligibility regulations for female classification is based on the same kind of ideology that has led to some of the worst injustices and atrocities in the history of our planet.

How the IAAF Council can, in the 21st Century, when we are meant to be more tolerant and aware of fundamental human rights, even contemplate these kinds of objectionable regulations, is a sad reflection on the fact that the antiquated views of the 'old' scandal-hit IAAF, still prevails and that your promises of reform have been empty indeed. There is much dishonesty in the way in which the IAAF have continued to deal with a matter that should never even have been addressed by it in the first place. I am confident that history will judge you and the members of the IAAF Council harshly for choosing to go down this route.

On deep moral grounds I cannot see myself being part of a system in which I may well be called upon to apply regulations which I deem to be fundamentally flawed and most likely unlawful in various jurisdictions across the globe. It would also be unethical for me to devote time an energy to expose the warped ideology behind the new regulations while serving on the Disciplinary Tribunal. It is for these reasons that I have decided to tender my resignation from the IAAF Disciplinary Tribunal, effective immediately.

Many subject experts are critically evaluating the Bermon and Garnier numbers and revealing significant gaps in their research and findings. These are three articles on that subject that are worth reading:

These regulations will be condemned and challenged by individuals and national sporting bodies. The Canadian Centre for Ethics in Sports (CCES) and the Canadian Association for the Advancement of Women in Sport and Physical Activity (CAAWS) jointly condemned the new rules, stating "the preoccupation with establishing a standard of 'femaleness' is offensive and inappropriate." The government of South Africa will almost surely challenge these regulations. The IAAF will likely face challenges at national championships and international events in nations with clear laws against gender discrimination and protections for intersex and gender diverse people.

Ultimately, the IAAF's new regulations will fail. The regulations will fail because policy designed around proving a narrowly-defined womanhood in sports has always failed and has always violated the human rights of the athletes in question. The "nude parades" of the 1960's failed to determine "unfair advantage" and were a violation. The various types of chromosomal testing of the 1960's, 1970's, 1980's, and 1990's failed to determine "unfair advantage" and were a violation. Testing testosterone levels has also failed to determine "unfair advantage" and violates athletes' human rights.

The IAAF is preoccupied with the question of "fairness" and "unfair advantage" in women's sports. But it never considers that it has a responsibility to all women athletes, indeed, all athletes, and this includes athletes with intersex traits. What fairness has the IAAF achieved for intersex athletes, gender diverse athletes, athletes with a DSD, or athletes with hyperandrogenism? Or is it in fact not meant to be fair to everyone?

Use DocumentCloud to browse, search, and read the new IAAF regulations

(Photo: Citizen59/Flickr)