What is a woman? The question has confounded sports authorities forever.

The current attempts to regulate this controversy are doomed to fail again.

What is a woman? Clearly it is not just XX chromosomes, since some women and men have mixtures of Xs and Ys. Some chromosomes are silent yet present, andothers express less of one characteristic than another.

Some men are testosterone (androgen) insensitive.

This means that no matter how much testosterone they produce, they do not express the male attributes usually attributed to the hormone. Other women, like South African track and field athlete Caster Semenya, present more traditional male-like appearances, with a large and well-defined musculature on a powerful frame.

But it is not just about physical appearance. Big breasts, little breasts, don’t define a woman. Genitalia inspections have also failed to solve the debate, as some testes are present in some people yet undescended, and other people have large clitorises that are not penises.

Testosterone levels are now being used as gender cutoffs. The “normal” female range is 0.12 to 1.79 nanomoles, and the normal male range is 7.7 to 29.4 nanomoles per liter.

The International Association of Athletics Federations has ruled that no female athlete may have natural testosterone levels at 5.0 nanomoles per liter or higher.

This IAAF ruling imposes a limit on how much testosterone a female competitor can have and still compete in an all-“female” event.

The athlete is now required to either take drugs to reduce testosterone, compete in all “male” events, or compete in transsexual events— which do not yet exist.

But these “solutions” are problems, not solutions.

Here are a few reasons why. The drugs to reduce testosterone have global effects on the body, not all of them healthy.

Females cannot in general compete in many sports with men and expect to win. Segregating people based on one physical attribute brings up all kinds of discrimination issues.

Should Michael Phelps be banned because he has an unusually long torso with extra long arms? Which characteristics qualify?

The fact is that, in every generation, people come along with physical advantages that help them in one activity and hinder them in others.

If these people are lucky enough to find their calling, many other things must fall into place. They must have the drive to train hard, the skill to take advantage of their attributes and the coaching to get them to the events. If they have this, along with all the good luck it takes to reach athletic pinnacles, then that genetic trait giving them an advantage may come into play — or it may not, on that particular day.

The lucky gene club is only a small piece of any athletic superstar.

So while we have the broad categories of male and female, into which most people appear to fit neatly, the margins have become so blurred that self-definition may be the only fair way to sort people.

So suck it up, athletes. You are entering competition with others who have dedicated their lives to excel at their sport. If you have to, your day may be at hand. But trying to eliminate the competition by determining who is a female and who is not is not going to level the playing field, any more than discrimination by race, sexual orientation, or religious affiliation once did.

Let everyone play, and may the best person win.

Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.

Dr. Kevin R. Stone
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Dr. Kevin R. Stone

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