Well, we don’t know because the necessary detailed information has not been released. I do not personally know the Caster Semenya story, medically or biologically speaking, but there has been a lot of discussion and apparently wild speculation on this, and I may have a thing or two to help clarify.


If the reports we are hearing are true, Semenya is fairly likely to be an individual with Androgen Insensitivity Syndrome. This may be wrong. So, I’ll tell you a little about AIS and then you can disconnect your knowledge of AIS from Semenya, or connect it up, as appropriate, later on.

It has been suggested, compassionately, that this is none of anyone’s business, that she self identifies as a female, and that this should all just be dropped. I sort of agree, but this may be little more than wishful thinking and is probably inappropriate for a number of reasons. It seems that we do divide sports into male and female, and if simple self identification was the criterion for which league one plays in, then there would be numerous men trying to play in women’s leagues and not just to get access to the locker room.

Really, the statements that Semenya is “a hermaphrodyte” or that “Semenya can say she’s a girl and that makes her a girl” are both born of ignorance. First of all, almost nobody is ever a “hermaphrodyte.” That is a specific condition that is very very very unlikely to occur. A more general word that may be appropriate is “intersex.” The sports-gender of a person who is intersex is a perfectly valid question to ask given legal and other ramifications. At the same time, it would be nice to have a little more understanding of the simple fact that far more people than most realize are in some way non-normative in sex/gender, and either ignoring that or thinking it is strange or bad in any way is unacceptable.

Let me say up front that to my knowledge, most people who have “complete AIS” identify as female.

Androgen insensitivity means that the receptor sites that exist on cells to which androgen hormones bind do not hook up right with the androgens. This, then, means that the androgens do nothing at all. This is caused by a mutation in the AR gene.

There are press reports that Semenya has internal male sex organs, and that they are pumping out large amounts of testosterone. That is the ‘evidence’ I used to guess that she has complete AIS.

A person with AIS has an XY chromosomal complement. However, since there are no receptor sites for androgen, the development of secondary male sexual characteristics does not happen. The “Wolffian ducts” which otherwise would have developed, along with other tissues, to form seminal vesicles, a penis, a scrotum, and so on simply do not change from the condition in which they are initially formed in embryonic development.

(This is true in females in general. But the tissues are really really small so don’t try to find them!)

Testes exist in the AIS person because the undifferentiated gonad … that would eventually become testes or ovaries, depending on development … become testes not from the activities of androgen, but because of the activities of another hormone. Meanwhile, all the regular “female plumbing” and other female secondary sexual characteristics develops externally, because that is a sort of default developmental trajectory and this is what you get in the absence of androgen. But, internal female plumbing (fallopian tubes, the inner two thirds or so of the vagina, a uterus) is actually repressed in development because these structures arise from a set of tissues called the Müllerian ducts. These tissues are destroyed in a typical XY person by the product of one of the male sex determining genes that specifically targets them.

So, an AIS person has internal testes, no internal sexual plumbing to speak of, and an externally female body with a “blind vagina” (I think they still call it that). But why all the testosterone production?

Because, as is the case with many hormonal systems, there is a feedback system that causes hormones to be produced up to a point, then detectors in the body notice the level of the hormone go up, and a signal is sent out to stop producing the hormone. This is like a thermostat keeping the temperature in your house uniform by detecting increases or decreases in temperature and calling for the furnace or AC to turn off or on as need.

But the AIS person does not have androgen receptors. So the bits of this system that would detect the large amounts of testosterone, and send the “that’s enough already!” signal to the testes, don’t work.

Testes working overtime like this in an AIS person are a serious medical risk. As soon as it is determined that a person has AIS the testes are usually scheduled for removal.

By the same token, this testosterone is not doing anything androgen-like in an AIS person. If Semenya is a typical complete AIS person, there is no help from the testosterone. This runner is not getting any kind of natural steroid treatment from these testes.

As I said above, AIS people typically self identify as female. They can not have offspring. Sexual intercourse is limited because of the ‘blind vagina” but this is fixable with surgery. Removal of the testes and ‘fixing’ of the blind vagina are not normally considered “gender reassignment.” The testes removal is more of a life and death thing … there is a high risk of cancer without that surgery.

So, yes, if Semenya has total AIS, then she’s a girl. And a pretty fast one, it would appear, owing to her prowess as an athlete, not to any features of AIS.

Comments

  1. #1 Rick MacPherson
    September 11, 2009

    good, quick work on the presumed science behind the story, greg…

    but i’m still left with the same conclusion that i saw from other thinkers on this issue:

    semenya identifies as female, has lived her life as female, and her elevated testosterone production is a biological anomaly that gives her an edge, the same way longer legs might…

    it’s a contest to see who’s the fastest female runner… she is a female runner… of the female runners who participated, she is the fastest… the end… give her her damn medal…

  2. #2 "GrrlScientist"
    September 11, 2009

    but i thought they did give her the medal because she had not made an attempt to deceive anyone, she was as much in the dark as everyone else.

  3. #3 Badger3k
    September 11, 2009

    This is extremely interesting and informative – a lot of material I never knew about, but it would help if you could at least link or reference a story (or a blog post you did?) with information on who this person is. All I can gather is that (I’ll go with) she is a runner and there is some problem with a medal for something. Some background would help people new to the story. Thanks.

  4. #4 Sivi Volk
    September 11, 2009

    Huh. I’ve known about intersexed individuals (and known a few), but I had always thought the ultimate determiner of sex (not gender) was chromosomal (ignoring XO, XXY, etc).

    Knowing thei\re are these hormonal mutations that can make someone who is XY essentially female is neat. Is there much study on neural development and social factors involved in AIS? I’m in neuroscience and most studies divide up people by gender. Conditions like this would provide an excellent opportunity to try to see what sex differences are hormonal, as well as which neuropsychcological differences maybe be due to largely social constructs.

  5. #5 The Science Pundit
    September 11, 2009

    Thanks Greg,

    We’ll see what information arises as this plays out, but I’m better informed because of this post.

    ~Javier

  6. #6 Mr. B
    September 11, 2009

    AIS and other intersex conditions are very interesting, and it will be interesting to see how this story develops and how people react based on the results of a DNA test (and I suspect the response from a lot of people will simply be “She’s a man” if the DNA comes back with an XY result, which does ignore a lot of the other issues).

    For those interested in intersex conditions, Jeffrey Eugenides’ novel Middlesex is a great literary treatment of the subject (and some other issues), with a protagonist with 5-alpha reductase deficiency syndrome who is XY, grows up as a female, and changes genders back to male once he discovers that information. There is also another minor character who has AIS. Highly recommended.

  7. #7 Greg Laden
    September 11, 2009

    [1] Rick: Actually, if she is total AIS then you can’t conclude that the testosterone gives her an edge. That testosterone would have no more effect in her body than if it were in a bottle on the other side of the planet!

    Grrl: I think that is correct.

    Badger: Well, I saw it on TV. But you can try this!
    :)

    Sivi[4]: There is no particular reason that XX/XY would be the ultimate determiner no matter what. Well, you have to define what you mean by “determine.” In the science, “determine” means to make it happen physiologically. In law, I imagine “determine” means to make a legal or social decision. In the case of the latter, I believe total AIS generally = females.

    Regarding neurological effects: Excellent question!!!! I was wondering if anyone was going to ask that.

    The thing is that one particular step that is thought to be a masculinization of the brain would happen anyway in AIS people with functioning alpha-feto-protein (probably). So complete AIS individuals probably have brains that have this one masculinization thing that happened that does not involve testosterone. So, in theory, they could be “a man trapped in a woman’s body.”

    The thing is that there are so many other factors involved, including the oft bungled traumatic effects of everyone running around panicking when it is discovered that little Michelle has testes, and the blind vagina and all, that this one small step towards manhood may be irrelevant.

    I don’t know of any good recent studies on the psychology and neurology of AIS individuals.

  8. #8 nyb
    September 11, 2009

    Thanks for the interesting information about AIS.

    But the idea that men would choose to become women in order to play on women’s teams?

    Yeah right.

    Gender transition ain’t no walk in the park. People don’t do it for the money or the medals or the sponsorship deals.

  9. #9 Matt Springer
    September 11, 2009

    Extremely interesting post. I’d been curious as to how this would turn out, and it’s fascinating to hear some of the possible biology behind it.

    NYB: The issue isn’t people making full-bore transitions, it’s some guy at a track meet saying “BTW I self-identify as a female for the next 4 hours” in order to compete in a more favorable division. The point is that self-identification alone isn’t going to cut it.

  10. #10 platipus
    September 11, 2009

    Nice post — there’s so much misinformation floating around about this.

    One thing I didn’t see you mention, though — there are different grades of androgen insensitivity syndrome. Specfically, there are 7 medically recognized categories. Grade 1 is the mildest, and people with it are basically slightly undervirilized males. The usual reason it comes to the attention of a doctor is fertility issues.

    Grade 7 is the complete form, which you described. The thing is, though, if she had the complete form she’d be at a disadvatange athletically, since a normal woman’s body makes some T and does respond to it. Also people with CAIS (complete-AIS) are typically “hyper-female” looking, since, again, a normal woman is slightly masculinized in comparison. (Suposedly, CAIS women are over-represented in modelling.)

    So, from grades 1 to 6 it’s PAIS. Obviously a lot of speculating going on here, but it seems she’d be around grade 6 — appears female (genitally), and has some response to testosterone. Someone with that would not be able to look in their pants and think they were male (and neither would anybody else).

    The grades are in terms of genial development, for better or worse:

    Grade 1 PAIS: appears male, infertility
    Grade 2 PAIS: appears male, hypospadias
    Grade 3 to 4: labia fused to form the beginnings of a scrotal sack and an enlarged clitoris
    Grade 5: PAIS: has the labia partially fused with an enlarged clitoris
    Grade 6: PAIS: appears female + pubic/underarm hair
    Grade 7: CAIS: appears female but w/o pubic/underarm hair

  11. #11 MaryL
    September 11, 2009

    “There are press reports that Semenya has internal male sex organs, and that they are pumping out large amounts of testosterone. That is the ‘evidence’ I used to guess that she has complete AIS.”

    If those reports are true, CAIS isn’t the only possibility. AIS runs along a spectrum, with varying levels of insensitivity to testosterone. The complete insensitivity found in CAIS means that CAIS women tend to have bodies that are very feminine in many ways because they are still responding to the trickle of estrogen their bodies naturally produce but don’t respond to testosterone at all. They often have hourglass shapes, have scanty or no body hair, and find it difficult to put on muscle.

    Semenya is lean and leggy, with a deep voice. I find it difficult to believe that she has CAIS, although she may still have partial AIS (PAIS). This page gives an excellent summary of how AIS can present, and the organization’s sample newsletter (PDF) gives a lot more detail about the genital variations and the many ways in which these women find their lives challenging.

  12. #12 Greg Laden
    September 11, 2009

    We can’t know if it is PAIS or what grade. That fact that this seems to be a surprise and that the testes are “pumping out testosterone” if true suggest to me complete AIS. But again, we are speculating

  13. #13 NewEnglandBob
    September 11, 2009

    I saw a news story on this earlier. I think it was CNN and they said almost EXACTLY what you said Greg.

    She is then female and has not tried to deceive by taking any hormones or any other drugs. She should keep any medals.

  14. #14 travc
    September 11, 2009

    Greg, Excellent job.

    You should send this to a bunch of sports, science writers, and maybe a newspaper or three. I’m serious. Explaining this topic could easily go very wrong and I’m dreading the imminent ‘news’ coverage.

  15. #15 robert
    September 11, 2009

    This is a rather informative article but there is another possibility of Semenya having both XX and XY chromosomes. There has already been such an intersexed Olympic Champion, Stella Walsh, in the 100 meters in 1932. Regardless, Semenya is receivng the anabolic benefits of elavated testosterone levels.

  16. #16 Greg Laden
    September 11, 2009

    Regardless, Semenya is receiving the anabolic benefits of elevated testosterone levels.

    This is exactly the kind of uninformed statement that I’m trying to suggest we avoid. And no, it is not the case that a person you hear to be “intersex” can have just whatever chromosomal or endocrine arrangement you also happen to have randomly heard of!

    Stella Walsh was probably a chimeric male. Totally, utterly different situation.

  17. #17 Troy
    September 11, 2009

    I’m a little hazy on how exactly testosterone affects muscle growth, but I’m gathering from what’s been said here that testosterone doesn’t, itself, build muscle, but that it triggers the biological processes that do, and in the case of a full AIS the triggers are ignored, in which case AIS would be a detriment to her in regards to muscle building, and not any sort of advantage.

    Her “gender identification” is also irrelevant, we don’t separate the genders because some female gymnast might freak at seeing a Willie in the locker room, we do so because there are genuine physical differences in the bodies of men and women. Saying that she considers herself a woman and so everything is fair is about on level as saying that a boxers weight class should be determined by how big he feels.

    I know there are plenty of historical reasons for the gender division in sports, but the only consistent reason anyone ever gives for keeping them is the greater ease male athletes have in gaining and maintaining muscle mass, of course this may all be my perception, and total bs, but why else keep the division?

  18. #18 Greg Laden
    September 11, 2009

    There are multiple hormones that ‘grow’ muscle (there are different kinds of muscle growth) and testosterone is one of them, but only one.

    But yes, typical XY males can grow more muscle, and in less time, than typical XX females. Also, males and females are different on average in certain body proportions and overall size. Imagine how difficult it would be to raise a full blown football team of women at a university of 20 to 40 thousands students, as sort of thought experiment, who would have the same overall body size and strength distribution as males in the same context. It would be difficult.

  19. #19 Jeannie
    September 11, 2009

    Wouldn’t she more suitably be categorized as Swyer syndrome ? Or more rarely encountered XX/XY chimera.

  20. #20 Greg Laden
    September 11, 2009

    If the press reports are correct, then no. Swyer syndrome involves agenesis of any functional gonads.

    I”m not sure how rare xx/xy is, but I don’t see how that would be the case either.

  21. #21 platipus
    September 12, 2009

    The testosterone production happens in all grades of AIS, it’s not specific to CAIS. The pituitary senses T levels by using the same defective receptors as the rest of the body, and so under-estimates and thus oversupplies LH, driving up T levels. –Which ironically can lead to some feminisation at puberty via peripheral conversion. Another reason for her to believe she was normally female.

    And, it would still be a surprise even if it is PAIS; grade > 5 has no external manifestations that aren’t female.

  22. #22 Greg Laden
    September 12, 2009

    The testosterone production happens in all grades of AIS, it’s not specific to CAIS We are getting increasingly speculative here, but … what I said was that the “large quantities” clue is a tipoff to an unregulated gonad, suggesting cAIS. I’m not talking about whether or not androgens are produced.

    Almost complete AIS is almost the same (thus the word “almost”) as total AIS, but she would have a close to normal for a female reaction to androgens.

  23. #23 Alessandra
    September 12, 2009

    I have one question and a few related remarks. First the question. You wrote: By the same token, this testosterone is not doing anything androgen-like in an AIS person. If Semenya is a typical complete AIS person, there is no help from the testosterone. This runner is not getting any kind of natural steroid treatment from these testes.

    What impact/effect does testosterone have in Semenya’s body, if she has AIS? (or any other person with this condition)

    Why wouldn’t large doses of testosterone increase muscle and resistance/performance in such people?

    As far as visual evidence with clothes on, Semenya appears to have several androgenic aspects of a steroid “user” (deep male voice, facial buff, male muscle line). What is quite weird is the shape of her body, which is very masculine (skeleton + muscle).

    This is the contextual historical background for Ekkart Arbeit (the current SA Athletics’ head coach).

    East Germany’s monstrous doping program

    For a fascinating read on the subject:
    http://www.clinchem.org/cgi/content/full/43/7/1262

    Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic government

  24. #24 Dawn
    September 12, 2009

    Santhi Soundarajan (from India) had AIS and she had to give her medal back. The author is coming to the conclusion she is female, but having an XY makes you a male.

  25. #25 chezjake
    September 12, 2009

    An excellent post, Greg. I think you’ve hit the nail on the head.

    However, I have a major gripe about everyone and her brother in the media and the blogosphere referring to Caster’s “gender” as being the problem. Gender is a grammatical/linguistic term referring only to the perceived sex of an individual. There is no doubt at all that Caster’s gender is feminine. The questions all pertain to her actual biological sex.

  26. #26 Alessandra
    September 12, 2009

    The following accusatory article, although, up until now, in alleged status, has been followed by the British paper claim of higher testosterone, and the Australian newspaper claim that Semenya is a hermaphrodite (or intersex):

    http://www.bild.de/BILD/news/bild-english/sport-news/more-sport/2009/08/21/caster-semenya-sex-test/ex-coach-says-world-800m-champion-is-a-hermaphrodite.html

    Caster Semenya’s ex-coach has claimed the sex test controversy athlete is actually a hermaphrodite. The unnamed coach told Swiss tabloid ‘Blick that tests to determine her gender had already been taken. South Africa carried them out in March. The result is clear. Semenya should not have been allowed to start with the women at the World Championships in Berlin.

    The unnamed source also claimed that South Africas head coach Ekkart Arbeit, who used to hold the same position with East Germany, knew exactly what had to be done to get Semenya past authorities in previous competitions.

    Her testosterone level can be altered using medication so that she was not found out in previous doping tests.

    =======================
    If I had to bet money, I would have bet it on the above article, which came out way back in Aug 24.

    Even though most people don’t like the fact that sports have become inundated by doping, nobody boycotts anything because of it. The money in sports only gets bigger, the politicians are always on the lookout to exploit their next little hero/shmero, and the drugs just keep getting stealthier. And, of course, the public must have their circus. All sports have come a long way about doping controls, but the problem is certainly very, very far from being solved; too far, in my opinion.

    I have thought for some time that it was time to divide sports competitions between clean and drugged. It is not a matter of ideals, but of pragmatism. Since we cannot stop the doping because of all the factors briefly outlined above, not excluding yet others, let us bring it out into the open. I only saw one commentary on the Internet along these lines, related to the current African hermaphrodite train wreck. the basic idea is that everything concerning drugs in sports would be allowed. The only rule is that each athlete would need to inform the list of drugs they had been taking. Therefore we would have that Athlete A had beat the world record by 10 seconds while taking X, then Athlete B by taking Y, etc etc. And then we would have the “lame” ones, who would never beat a world record again, but who would race clean. At the end of the games, we would have the clean records, the drug X records, the drug Y records, etc.

    Of course, it would only a matter of time before we discovered that Athlete A beat the drug Y record while really taking drug Z, but I would still prefer this more transparent sports scheme to what we have now.

  27. #27 Dawn
    September 12, 2009

    chezjake-This whole story started because everyone and her brother doubted she was female and saw no feminine qualities.

  28. #28 platipus
    September 12, 2009

    “XY makes you male” is 1950′s science — we know now there are XY female people who have gotten pregnant & given birth. It seems nutty to call a person who’s given birth “male.”

    Journal cite:

    Kan, A.K.S., et. al. (1997) Two successful pregnancies in a 46, XY patient. Hum. Reprod.,12(7):1434-1435.

  29. #29 Dawn
    September 12, 2009

    You may call it 1950s science but it’s what they still teach; it was also one of the determining factors for Santhi Soundarajan. That was not in the 1950s either.

  30. #30 Dawn
    September 12, 2009

    Although these females have ovarian tissue which degenerates prematurely(11),when they are provided with donor eggs, their giving birth to single pregnancies(5,8), twin pregnancies(6), and even more than one successive pregnancy(7)

    Above is from:

    Kan, A.K.S., et. al. (1997) Two successful pregnancies in a 46, XY patient. Hum. Reprod.,12(7):1434-1435.

    Obviously they needed female donors, so it’s debatable.

  31. #31 platipus
    September 12, 2009

    Yes, it’s what they teach and it’s wrong information. Those teachers, and the people who judged Soundarajan on that basis are f****** idiots.

    Why is 1950′s debunked science still taught & regarded as true — I have no idea.

  32. #32 Azkyroth
    September 12, 2009

    What impact/effect does testosterone have in Semenya’s body, if she has AIS? (or any other person with this condition)

    Why wouldn’t large doses of testosterone increase muscle and resistance/performance in such people?

    …because testosterone is an androgen and AIS MEANS (slightly simplified) their bodies don’t respond to androgens. Including cues to increase muscle mass and thus resistance/performance. Did you read the damn article?

  33. #33 Rick MacPherson
    September 12, 2009

    troy (16): “Her “gender identification” is also irrelevant… Saying that she considers herself a woman and so everything is fair is about on level as saying that a boxers weight class should be determined by how big he feels.”

    but troy, semenya is not a male boxer, a male gymnast, or a female skater… she’s an intersex woman runner… as such, not a conventional binary in sex or gender… gender identification is hardly irrelevant, imho… she didn’t “feel” fast… she was a physiologically (and competitively) fast intersex woman…

    that the sports world has not responded to recognizing the existence of a continuum of sexual or gender realities is the real controversy here…

  34. #34 Amanda
    September 12, 2009

    Love this article. It’s very informative. The one question I have is – if you say that XY women who have complete/near complete AIS have no competitive advantage, and possibly a competitive disadvantage because of not being able to use testosterone, then why is there a disproportionate amount of AIS women in competitive sports? I’m not sure if it’s true because there’s so much disinformation going around, but a few articles said that one year when they still did the xx/xy test, there were 7 women who ‘failed’ the chromosome test. 6/7 were allowed to compete as women because AIS does not give competitive advantage. If there’s no competitive advantage, wouldn’t the proportion of XY women in the olympics be similar to the proportion of XY women in the general public? you might even expect fewer AIS women in the olympics than in the general population if CAIS was actually a disadvantage since XX women respond to testosterone. The prevalence of XY women in elite sports makes me wonder if something other than testosterone gives women with AIS an advantage– possibly some other hormone? Regardless, Caster is beautiful and has a kick as* body! I’m rooting for her.

  35. #35 nails
    September 12, 2009

    The tendency of people to neatly push people into either male or female category is pretty annoying to see in the comments here. Seems a lot more like a spectrum to me. Other cultures have a third option available for genders.

    Feministe had a good post awhile back about Semenya, and brought up previous cases of women being called to undergo gender testing. They really aren’t masculine looking at all by todays standards. Doing really well at a sport seems to be what prompts this kind of crap though.

  36. #36 acı cehre
    September 12, 2009

    I only saw one commentary on the Internet along these lines, related to the current African hermaphrodite train wreck.

  37. #37 nyb
    September 12, 2009

    Those interested in this topic might also like:

    http://www.isna.org/faq/y_chromosome

  38. #38 Alessandra
    September 12, 2009

    Oh look, a baboon has answered my question. I was hoping for an intelligent human. Here’s the contradiction — if Semenya has CAIS, where does (what appears to be) several of her secondary male sex characteristics come from? Is this normal in a CAIS individual? And if she doesn’t have CAIS, but some lesser form of AIS, would some of this elevated testosterone production have an effect on “her” body or not? (Stupid readers to this thread, please abstain from answering).

    On wikipedia, it says of CAIS individuals at puberty:
    “Some of the testosterone is converted into estradiol, which begins to induce normal breast development. Normal reshaping of the pelvis and redistribution of body fat occurs as in other girls.”

    However, reportedly, none of this happened with Semenya.

  39. #39 davem
    September 12, 2009

    I don’t understand this: If she’s producing excess testosterone (whatever that may or may not do to her body), how come she passed the doping tests that, one has to assume, were given to her?

    Was she not tested?

  40. #40 Rob
    September 12, 2009

    Ahh, chimera, yes, that was the term I was trying to think of for Stella Walsh. Bit rusty on the biology. Not so much about track time improvements, which were jaw dropping when I first read about her, although I don’t have that information in front of me now.

    Happy to see the information about 7 grades of AIS rather than being labeled “misinformation”. Semenya’s physique is very well muscled with a quite visible advantage over other female competitors. It laughable that anyone can argue that Semenya isn’t deriving anabolic benefits from the reported elevated testosterone levels. In fact, Semenya’s rapid virtual overnight massive improvement in her 800 meter times is a very strong argument for the testosterone influence. While testosterone may not be the only hormone for muscle development, it’s a major one.

    Rather than being simply labelled as misinformation again, I can be enlightened with other body processes that enabled Semenya to lower her 800 so quickly to world class level that there wasn’t enough time to administer a gender test. This academic discussion is completely oblivious to the improvement in Semenya 800 meter times.

  41. #41 Ian Tindale
    September 12, 2009

    If this has indeed come as a surprise to her, then I wonder how this is being handled psychologically? It’s a fairly sudden and highly external set of changes in perception, which must be at least a bit on the depressing side due to unexpected lack of control of violations of world model. In a way, it must be a bit like when, historically, a hitherto accepted member of a community is suddenly deemed to be a witch. There’s not only pretty much no way out – all control is removed and the circumstances are very externally driven – but it can’t be the kind of change that makes you overly happy, which may end up governing responses in a self-fulfilling manner. I’m not sure we’ve evolved anywhere near mature protocols and trajectories for handling this kind of situation without psychological damage. On the contrary – we have newspapers instead, which are the modern evolution of the witch-hunter general. If, as I say, this is an unplanned turn of events for her, then she must quite rightly have not been expecting the Spanish Inquisition.

  42. #42 jeremy
    September 12, 2009
  43. #43 Kerrie
    September 12, 2009

    Caster is far more likely to have 5 alpha reducatase deficiency – they can appear female or somewhere in between the sexes when they are young, but become more masculine in puberty. She is too responsive to testosterone for her to have complete or almost complete AIS.

  44. #44 Mikey Moe
    September 12, 2009

    If she has AIS, then she’s not really a female but a failed male. Are failed males women? The question is philosophical.

  45. #45 Greg Laden
    September 12, 2009

    [22] What effects? Again, we don’t know, and again, I”m guessing complete AIS. The andwer is in an adult, probably nothing at all.

    Why wouldn’t large doses of testosterone increase muscle and resistance/performance in such people?

    Testosterone is a molecule that acts a certain way, in interaction with other molecules. Those other molecules are called receptors. If the receptors don’t work, the testosterone won’t work.

    You physical description of her could apply to a lot of female athlete runners (i don’t know what a facial buff is).

    Thanks for the reference. For me it is not so historical! Well, sort of. It is widely believed in the west that the Russians/East Germans simply dressed a bunch of men up a women and sent them in. I’m sure that’s not quite true….

    dawn[23]: XY complete AIS people generally self identify as females. Given that there are 1 in 20,000 people (minimum estimate, probably) who are like this, you probably know the names of one or two such individuals (who would be female to you) and you probably don’t know it. If someone told you that the Queen of Britian was actually and AIS individual (who had secretly adopted) would you require that she be called a king?

  46. #46 Greg Laden
    September 12, 2009

    chezjake[24]: But someone’s gender is not independant of their sex, and it is hypothetically possible for someone to have a perectyl ambiguous physiological gender (though this is extraordinarily rare) that gender may be the “tipping point” in such cases.

    IN any event, I don’t personally like the strict distinction because I view it as an attempt to de-biologize gender and de-contextualize (culturally) sex. There are sex determinig factors (among metazoans) that are behavioral and not genetic. If sex = genes and gender = behavior then there are no reptiles with “sex” … they only have gender.

    In other words, I problemtize your problemitization!

    (getting ready for vilification tennis later today)

  47. #47 Greg Laden
    September 12, 2009

    Dawn, I have not checked your reference, but those individuals are not complete AIS individuals. AIS individuals can not carry a fetus any more easily than a man can.

    I hope there are two lessons slowly developing here, which was the point of writing this blog post:

    1) The actual, scietific details matter. Time after time people are making the “yeah, but…” statement that if there are piles of hormones there is an enhancement. How can one make such as statement after learning* that in complete AIS there are no receptors, unless one believes that hormones are magic juices that have an effect no matter what?

    and

    2) There is not a single easy to point to sex determination/gender making essence that is a chromosome or a gene. You know, genes move around. It is possible for a person who karyotypes as XX to be a male because the key genes on the Y chromosome are there anyway!!! The note of XX/XY chimerism has been an example as well of this misunderstaning: There are so many ways that XX/XY can manefest that it’s very instructive. Each cell is EITHER xx or xy, and there is a thing called X inactivationthat may or may not be working in each cell (but certainly not in the XY cells… I think….). So, exactly which stem cells are xx vs. xy maters enormously. You proably know an XX/XY chimera, and there is a good chance that most XX/XY chimeric persons are unaware of this.

    *for the specific case of complete AIS which, again, we do not know, but rather, guess for now, applies here.

  48. #48 Greg Laden
    September 12, 2009

    Rick [32]… I don’t know. I think you have to “feel fast” to be a sucessfull runner…

    But anyway, I want to introduce a new term, and I need help with this. I want to call it either “sports-sex” or “sports-gender.”

    Amanda[33]: I’d love to know if there really are more Complete AIS women in sports.

    I would also wonder if something else is going on. Also, let me ask you this: Are males more oriented towards sports than females? Yes, probably, on average. If so, is this part of an early developmental neural pathway? That would be speculation. But if so, remember that AIS women have an early masculinization of part of the brain, maybe. That could cause either a) some kind of physical effect or b) a psychological orientation that simply brings them into the sports world.

    Having athletic physical traits is ALWAYS a characteristic of elite athletes, so of course, that does not mean much.

    Please keep in mind that if there is a masculine feature created early in cAIS women, a) that could vary and b) it may be that this same feature can exist to one degree or another in any women, so let’s not throw the baby out with the bathwater.

    We don’t want to make the mistake (or allow it to be made) that an official “woman” requires a narrower set of “qualifications” than an official “man.”

  49. #49 Greg Laden
    September 12, 2009

    nails[34]The tendency of people to neatly push people into either male or female category is pretty annoying to see in the comments here. Seems a lot more like a spectrum to me. Other cultures have a third option available for genders.

    My own analysis suggests that if there are categories, there are dozens of them, and there are no culture that has enough. The cultures with three or four “gender categories” are overstating how cool they are. It’s like saying “I own nine stamps! I’m a great stamp collector!!!”

  50. #50 Greg Laden
    September 12, 2009

    davem: I could not answer your question without knowing what the doping tests were, but I do know there are tests that detect synthetic steroids, and her testes (if reports are accurate and being accurately reported) are not those. Guessing here.

    Rob and others: Again, please keep in mind that all the elite women runners in any race Semenya had run in are also rather buff and exhibit other impressive physical attributes, such as strength and speed. I tink it is very important to refrain from using standard physical features that we see as observers of the sport in this discussion. Even her total lack of visible body and facial hair is meaningless (though I admit I did look for pics of her with her arms up in a victory salute or whatever…).

    And, again, we may well be able to identify specific “body processes” for Semenya, but all of the runners have “body processes!”

  51. #51 Greg Laden
    September 12, 2009

    Ian [39] If this is a surprise it is a shock. The first indications of cAIS is usually no menses. It is common for elite runners to no ovulate, so that could have been passed. Oh, and South Africa is ‘blessed’ with both news papers and Witch Hunters, so this will be difficult.

  52. #52 D
    September 12, 2009

    “there are XY female people who have gotten pregnant & given birth.”

    How?

  53. #53 D
    September 12, 2009

    “there are XY female people who have gotten pregnant & given birth.”

    I’ve not heard of this before. How does it work?

  54. #54 daedalus2u
    September 12, 2009

    Greg #47, the patient mentioned in that case did seem to be CAIS. She had bilateral ovotestes which were remove at age 17 and she was given hormone replacement therapy which caused her to go through puberty. She did have a uterus where she carried 2 pregnancies (from donor ova) to term.

    Not having a menstrual cycle might give a woman an advantage in sports and not going through a female puberty might give her an advantage too.

  55. #55 marktime
    September 12, 2009

    Thanks once again for a cogent and sensitive analysis. I think it’s true to say that you stand head and shoulders amongst your peers on Science Blogs in the quality amd range of your posts,

    I am surprised though that you did not touch on some of the psychological issues facing this young woman and in addition, from your knowledge of South Africa, some of the very real dangers she now faces. At this very moment I would wager that there are a bunch of guys sitting around talking about how they are going to prove to the world that Caster can “take dick” by raping her.

    “Corrective rape” in South Africa is applied to lesbians and one of the most recent cases involved the captain of the South African female soccer team which had just won the All Africa Cup.

    It’s difficult to see how this situation will resolve itself but one can hope that Caster will have the strength and resolution to overcome the witch hunt that is now in place and emerge a stronger person from it.

  56. #56 LAJ
    September 12, 2009

    Many years ago at the Cytogenetics lab where I work, a woman referred for infertility turned out to be 46,XY. I remember there was an issue regarding disclosure because she spoke very little English and was bringing along her sister-in-law to translate. In fact, there was some fear for her safety, because she was in an arranged marriage and was expected to have children. (I actually never did hear how this was resolved. I hope she got good counseling and that her husband was a kind and understanding man.)

    In that case there were so many ethical issues regarding disclosure, and that was just within the woman’s family. In Caster Semenya’s case, the whole world is learning all about her gender/sexuality/medical condition/genetic makeup/whatever you want to call it, presumably at the same time she is. I can’t imagine how distressing it must be for a young woman to go through this amid so much commentary and speculation, not to mention the bad jokes that I am starting to hear.

  57. #57 sports realist
    September 12, 2009

    The notion that Caster has CAIS is ludicrous. She has no female secondary sex characteristics and is showing obvious evidence of potent biological androgen action. For an illustration, look at the difference in body types between steroid-using and “natural” female body builders (and yes, they have separate competitions). My guesss would be 5-alpha reductase deficiecy in which there is an XY karyotype and male testes (which remain undescended) but an absence of the 5-alpha-reductase enzyme that converts testosterone to dihydrotestosterone (DHT). In the fetus DHT is responsible for the development of normal male external genitalia so that lacking DHT the infant is born with female (or ambiguous) external genitalia and usually identified and raised as a girl. However at puberty the testes produce the normal adult male amount of testosterone (which is 10 times higher than in women) and virilization takes place. From a sports competitive basis there is no question that androgenic steroids enhance performance. For examples we need look no further than Ben Johnson and our own Flo Jo – both journeymen track atheletes who became overnight world beaters with radically transformed bodies. It might not be fair to Caster because she is not intentionally increasing her androgens levels, they are occurring as a result of her endocrinopathy (whatever it precisely turns out to be), but she is an XY individual with testosterone-producing gonads who is at a clear competitive advantage compared to XX individuals with much lower levels of testosterone production.

  58. #58 Alessandra
    September 12, 2009

    “Thanks for the reference. For me it is not so historical! Well, sort of. It is widely believed in the west that the Russians/East Germans simply dressed a bunch of men up a women and sent them in. I’m sure that’s not quite true….”

    I’m sorry, but I don’t understand what you were referring to above. What relationship does this myth have with the article on East Germany’s athlete doping program?

  59. #59 Gotchaye
    September 12, 2009

    Greg [48]: “We don’t want to make the mistake (or allow it to be made) that an official “woman” requires a narrower set of “qualifications” than an official “man.””

    In terms of sports, is this true? My feeling is that people would be much less upset with someone not obviously male competing in men’s events, as long as they’re obviously human. I don’t imagine that there’d be much of a fan outcry if an extremely capable and unambiguously female woman wanted to compete against men, even if she could beat them all.

    We don’t have men’s and women’s events just because we want men and women to compete separately on principle – we segregate because otherwise there would be very few competitive female athletes. Women’s events serve a handicapping function, and it’s not obvious to me that it’s wrong to have stricter requirements for entry for women’s events than for men’s events. Personally, I’d have no problem with having no sex requirements at all for “men’s” events, but obviously the sex requirements are the whole point of the women’s division.

    That said, to the extent that you’re talking about the “man” and “woman” labels in general and not just in sports, I’d agree that there’s a problem with making one category broader than another or deciding that one category is just the negation of the other. But I’ve no problem defining “sports-female” rather narrowly and then defining “sports-male” as “not-sports-female”, to use your sports-sex idea.

  60. #60 Stella
    September 12, 2009

    Greg, mind if I give somebody this link? It’s just on a private blog.

  61. #61 Will TS
    September 12, 2009

    Dawn [29] said in reference to XX/XY sex determination “You may call it 1950s science but it’s what they still teach;” It may be what ‘they’ still teach, but it’s not what we teach. Sex hormones and their role in sexual development is taught in most state high school curricula in the US as well as in AP biology and college level genetics, A&P and introductory biology. In the genetics text that I am using this fall the case of Maria Patino, a Spanish hurdler with CAIS who was disqualified from the 1983 Helsinki track and field world championships, is featured in Chapter 1. Maybe you just weren’t paying attention.

  62. #62 Brian
    September 12, 2009

    @Realist,

    I have sincere doubts that this is 5-a reductase deficiency. That would be consistent with the so-called “Penis at 12″ phenomenon, where an inability to convert T to DHT results in female phenotype, but elevated androgens at puberty cause development of secondary male sex characteristics.

    But then, what do I know?

  63. #63 Greg Laden
    September 13, 2009

    daedalus2u [52] An XY CAIS person can not have a uterus. Hormone replacement will not affect that. An XY CAIS person would would still produce Mullerian Inhibiting Factor and that causes the degeneration of the tissues that would differentiate into a uterus.

    Marktime [53] I think it’s true to say that you stand head and shoulders amongst your peers on Science Blogs in the quality amd range of your posts

    So true, so true.

    I am surprised though that you did not touch on some of the psychological issues facing this young woman and in addition, from your knowledge of South Africa, some of the very real dangers she now faces.

    I have thought quite a bit about this, but I’ve not commented specifically because I don’t know enough about her specific situation. In the above post I take only the hypothetical that she has (hypothetically!) complete AIS, and explore that from a mostly physical perspective. The premise might be wrong. Going deeper into the psychological issues actually does require knowing more exactly and certainly what the situation is because that matters. But yes, the S.A. environment has certain difficulties, but also certain advantages. South Africa is the only country I know of, for instance, that has a 100% across the board human rights foundation at the constitutional level. So there might be (is) a lot of screwy stuff that happens, but there is also a will to do better than average!

  64. #64 Dawn
    September 13, 2009

    Greg Laden[47] The research I posted was to platipus [28] who cited the study, read all the posts.

    Greg Laden[45] Are you forgetting that this is sports? It’s competition and money/jobs. Just because she self identifies means nothing. Now she could have the testes removed and whatever else would be required, hormones, waiting period, etc, ad she can legally compete as a women. Right now according to what’s in the press all she has that is female is a vagina, that’s very little of what physically makes a women a women.

    Also my original statement made reference to a similar case in India (if it is AIS)and they took her medals.
    Santhi Soundarajan looks much more feminine. It seems unlikely Caster Semenya has AIS, it just doesn’t fit. Also did you read Semenya’s training? Semenya took 3-4 months off before winning the race and said this was normal for his/her training to rest that long. Plus if you watched the race from last year, times were up dramatically (2:11 and 2:04 in 2008, then without much training 1:56 last month.

  65. #65 Greg Laden
    September 13, 2009

    [55] Sports Realist: No, it is not ludicrous at all. It is the most likely conclusion given what has been intmiated. 5-alpha-reductase deficiency is a distinct possibility and I have thought about that, but the clues don’t match it as well.

    I just want readers of your comment to understand that there are two flaws in what you say. First, your reasoning backwards from phenotype to genotype is entirely facetious. She is an athlete. See my comments above. Second, your insistance that “there is no question that androgenic steroids enhance performance” simply would not apply to a CAIS person, and thus that assertion of yours is based entirely on the validity of your first assertion.

    You could be right about 5-alpha, as I say it is a possibility. I reiterate that my post above is based on the assumption, which could be flawed, of CAIS.

    Gotchaye[57] In terms of sports, is this true? My feeling is that people would be much less upset with someone not obviously male competing in men’s events, as long as they’re obviously human. I don’t imagine that there’d be much of a fan outcry if an extremely capable and unambiguously female woman wanted to compete against men, even if she could beat them all.

    What I mean specifically is that if we see a) androgens, b) androgens having an effect, c) a link between androgens and inappropriate advantage for women the we will next have to eliminate almost all women athletes from sports!

    Stella: Yes, give everyone the link, no problem.

  66. #66 Greg Laden
    September 13, 2009

    Dawn. Again. Listen carefully.

    Internal testes in a person this age is almost always CAIS. High level of production of T in such testes is almost always CAIS. Internal testes producing presumably (and it is a presumption) unregulated output of CAIS is not PAIS. It is not XY/XX, it is not 5-alpha reductase. In PAIS or other non CAIS conditions there woudl be regulation. In 4-alpha reductase the production of T cascades to masculiniztion of the genetalia to be virtually unambiguous (with one minor glitch) and the T production is regulated.

    Now, the fact that Santhi Soundarajan, assuming she was CAIS, was stripped of her status and medals is astonishing and wrong. It is not relevant. And, again, working backwards from phenotype to genotype is absurd.

    And, again, I’ll state that I’m guessing that she is CAIS, I still think it’s a good guess, and everything I say in the original post is based on that presumption, but it is only a presumption.

  67. #67 gwen
    September 13, 2009

    As for sexual reassignment and competition, there was a male tennis player in the 70s(?) who underwent sexual reassignment as a female and petitioned to compete as a woman in tennis tournaments. I believe she won the petition. I think her name was Christine either Richardson or Jorgenson. To take away Semenya’s medals would be cruel. I also hope she will get the counseling she will need to cope with this new and very unexpected information, as well as protection from superstitious idiots in her country who may believe that in death, her body will give them some unusual powers (like albinos). She lives in a part of the world is rife with superstitions that begin with the death of another human being……

  68. #68 Sean
    September 13, 2009

    Regarding risks from testosterone:
    My understanding is that there is less risk from retaining the testes than removal. The aromatised testosterone (estrogen) will help prevent osteoporosis and other conditions in later life. If she has her testes removed, then she would require supplemental estrogen.

  69. #69 a lurker
    September 13, 2009

    I can’t see why naturally having more testosterone is anymore of an “unfair” advantage than for any one of a hundred anatomical reasons that can give a person more innate ability to run faster than other people.

  70. #70 speedwell
    September 13, 2009

    Excuse me for being a little slow, but how can the fact that she has testosterone-producing organs possibly help her in any way if her body is insensitive to testosterone in the first place?

  71. #71 speedwell
    September 13, 2009

    OK. I re-read the original post. Obviously the extra testosterone is really not “extra” with respect to her biochemistry. So the individuals complaining that she’s getting something from the “extra” hormones are morons. Got it.

  72. #72 Greg Laden
    September 13, 2009

    Gwen: Renee Richards?

    Sean: That’s a tough call. The rate of testicular cancer is about 1 in 20 in this sort of situation. What happens is the testes are left in place for a certain amount of time allowing the androgen to mimic estrogen, then the desision is made to remove or not, but I think removal is still more often than not done. Maybe that’s changed, though.

    lurker [69] I can’t see why naturally having more testosterone is anymore of an “unfair” advantage than for any one of a hundred anatomical reasons that can give a person more innate ability to run faster than other people.

    I just want to point out that the premise of this post is CAIS, in which case there is not advantage confered by “more testosterone” beause that testosterone does not have receptor sites to work with. Without receptor sites, the testosterone may as well not exist. Having said that, the “CAIS” is at this point only a guess.

    Speedwell[70]:Excuse me for being a little slow, but how can the fact that she has testosterone-producing organs possibly help her in any way if her body is insensitive to testosterone in the first place?

    Speedwell read the whole post and got it!!! DING DING DING DING …..

    Thanks.

    [71]So the individuals complaining that she’s getting something from the “extra” hormones are morons. Got it.

    I prefer to think of people who are not getting this as being excellent exemplars of intelligent members of a society in which very very basic and critically important concepts in science are not widely known of or understood. One of those concepts is of course, the Humor Theory of Heath and Disease. (Not being valid, that is.)

  73. #73 james K McIntyre
    September 13, 2009

    Caster Semenya has a unique condition of possessing remnants of both male and female genitalia. Intersexuality, as it is known scientifically, is indeed a rarity in ‘higher’ animals. With this condition, if an individual can not function as both a male and a female reproductively, it is more correctly termed pseudohermaphrodite. The rarest of this pseudohermaphrodite condition is a male pseudohermaphrodite in which an individual appears, phenotypically, female but whose internal genitalia are those representing “maleness.” Caster Semenya appears to be this type. A colleague and I have been studying a unique form of intersexuality on remote islands of the archipelago of Vanuatu in the Southwest Pacific since 1993.( See http://www.swpacificresearchfoundation.com)
    On certain isolated islands intersexual pigs are found possessing this condition. On Vanuatu, pigs are woven into the very fabric of traditional life. Male pseudohermaphroditic pigs can be found here in relative abundance and nowhere else in the world. Occasionally intersexes are identified in pig and cow slaughter houses throughout the world. Because these unique pigs are revered by the villagers in Vanuatu that still practice “Kastom”, this condition is purposely bred for, thus perpetuating the condition. A man’s value in a Vanuatu village is proportional to how many pigs he owns. These intersexual pigs are worth one hundred “normal” pigs and are, indeed, a valuable commodity.
    Because of our research, another mammal species with this condition has been identified which will enable us to learn more about this condition in humans.
    For more information contact;
    James K. McIntyre
    Director
    Southwest Pacific Research Foundation
    1009 White Street
    Fernandina Beach, Fl. 32034 USA
    jmcint6317@aol.com
    904-261-5630

  74. #74 Daniel Hollis
    September 15, 2009

    Questions: I seem to recall hearing that a woman’s pelvic girth is disadvantageous in running. Is there evidence of this? Provided that Caster Semenya has AIS, her testosterone levels may or may not give her an advantage over XX women. But, could her male pelvis give an advantage?

  75. #75 Anonymous (for my sisters' sake)
    September 16, 2009

    Thanks for the clear and shock-free explanation! I have some AIS sisters and I’ll defend their right to identify as female to all comers (Dawn, that means you).

    One of my sisters had always wanted children before she found out; she’ll probably adopt but if she wants a surrogate I’d consider doing it for her. Another is really sporty. Her childhood dream was to be a professional soccer player, which is pretty unlikely if you’re female in any case, but the question of gender in sports was always an uncomfortable cloud over that, too. I’m grateful to anyone who explains this issue with clarity and without prejudice. You’re helping to create a world where my sisters can be ‘out’ to their closest friends and/or boyfriends without as much hassle as they would otherwise get.

  76. #76 Timothy (TRiG)
    September 17, 2009

    Some related information on various intergender categories are discussed in the article What Is a Man? What Is a Woman?

    TRiG.

  77. #77 Jeannie
    October 1, 2009

    To tell you the truth, she doesn’t fit any of well-known categories of intersex to my knowledge.(I am not a gender/endocrinology specialist)To be a complete AIS, she’s just too masculine. Could her muscles be not testosterone-reponsive? She might be partial AIS ?

  78. #78 Greg Laden
    October 1, 2009

    People with total AIS do grow muscle (with growth hormone).

    When I was first thinking about this I used Google to look for “AIS athlete.” Turns out that this condition is prevalent in Australia.

  79. #79 Calli Arcale
    October 7, 2009

    Greg @ 49:
    My own analysis suggests that if there are categories, there are dozens of them, and there are no culture that has enough. The cultures with three or four “gender categories” are overstating how cool they are. It’s like saying “I own nine stamps! I’m a great stamp collector!!!”

    Like you, I don’t think it’s really worthwhile to have additional genders; it’s more productive to recognize that gender is a continuum, and that there will forever be “edge cases” like Ms Semenya.

    But for those who think it’s somehow noble or enlightened for a culture to provide a third (or even fourth) gender, consider carefully what most of those third genders are, and how their society treats them. There should be a place for such people, but I would hope that place was not consistently at the margins. Consider the hijras in India. They are a third sex. And they only got the vote in 1994. (Indian women, by contrast, got the vote in 1947.)

  80. #80 greg laden
    October 7, 2009

    Calli: That is a very, very good point.