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(Photo: Nickola_Che/Shutterstock)

Why Are Synthetic Hormones Off-Limits in Sports?

• March 03, 2014 • 9:00 AM

(Photo: Nickola_Che/Shutterstock)

Our bodies naturally create hundreds of hormones that are key to determining our athletic abilities. But the introduction of unnatural hormones raises important questions about how we define sex and gender.

Whether it is gays in the Olympics, or anabolic steroids and A-Rod, our assessment of athletics is dramatically colored by our beliefs about sex, gender identity, and the role steroid hormones play in that mix. In fact, steroids are the epicenter of two distinct controversies shaking the world of elite sports:

  • Should intersex women who have naturally elevated levels of steroids called androgens be eligible to compete as women?
  • Should athletes, male or female, be able to administer chemically modified androgens (anabolic steroids) to improve athletic performance?

Naturally or by needle, some argue that people with elevated levels of anabolic steroids, should not compete. If we agree one’s God-given hormone environment should not disqualify a female from participating in women’s sports, why don’t we sanction the use of performance-enhancing steroids?

We make hundreds of hormones naturally in our bodies or synthetically in a lab. For example, growth hormones regulate size, and hormones like insulin regulate energy use. These hormones are key players in athletic performance, and these two, as well as many others, could be manipulated to gain a competitive advantage. Despite the large number of hormones that play critical roles in athletic performance, we would yawn if we found out an athlete used a peptide hormone like melatonin, but get downright aroused when they use steroid hormones.

Most of us were brought up to think in in simple dichotomies: male female, straight gay. But evolution rides on the back of diversity, and nature is always more complex than simple binary choices.

A Google search for cortisol (a glucocorticoid) and sports performance scores a paltry 164,000 hits, while testosterone (an androgen) tops out at more than 4.8 million. It is not just anabolic steroids that are taken illicitly through a pill or a syringe that cause conniptions; we have a hard time dealing with individuals where nature, through genetic mutations, has given them a similar hormonal boost. Our concerns about such innate mutations, however, are strangely limited to cases that impact not only performance but also traits that give rise to our sense of sex and gender.

Few questioned that Yao Ming, despite his extraordinary height, should have been allowed to play basketball in the NBA or that Usain Bolt, despite his otherworldly speed, should be allowed to run track. Does Ming have mutations in the gene for growth hormone that confers exceptional height? Does Bolt possess insulin receptors that allow his muscles to make better use of energy? We don’t know, nor should we: They are people blessed with exceptional physical traits that allow them to excel at their chosen sports. However, the sports world was up in arms over the International Olympic Committee’s (IOC’s) deliberations over whether South African runner Caster Semenya should have been allowed to compete in track and field as a woman in 2012. Unlike Ming or Bolt, Semenya’s biology (she has a mutation in the receptor for androgens) raises thorny questions because her particular genetics are also at the heart of how we define sex and gender.

Most of us were brought up to think in in simple dichotomies: male female, straight gay. But evolution rides on the back of diversity, and nature is always more complex than simple binary choices. Sex, a biological term, is confusing enough (just ask any 16-year-old), but gender is a social construct comprising not only our genetic sex (the complement of x and y chromosomes), gonadal sex (whether we have testes or ovaries), and phenotypic or body sex (our secondary sex characteristics such as breasts and facial hair), but also our brain or behavioral sex, which includes both gender identity (whether one thinks of oneself as male/female) and sexual orientation (attraction). The component parts don’t always neatly fit.

Intersex individuals like Semenya are born with a y chromosome, but a change in the genetic code for their androgen receptors means their bodies do not respond well to these steroids and they do not fully develop the external appearance we typically associate with men. As important, steroids organize brain development, especially in the period right around birth and again at adolescence, in ways that may shape our gender identity. Thus, individuals with this Androgen Insensitivity Syndrome (AIS), despite having a y chromosome and levels of androgens often higher than in women with two x chromosomes, have feminized brains. They therefore not only look like women but also behave like women and think of themselves as women. Moreover, as they grow up, society treats them like women, thereby reinforcing this female gender identity. AIS is not all that rare (estimates are one in 20,000), but the syndrome doesn’t often surface as a societal problem. Not so at the Olympics, where, unlike genetic differences that give rise to other exceptional physiological traits, the performance advantage conferred by androgens in AIS women also crosses that binary boundary we conventionally have used to separate men (xy chromosome/high androgens) versus women (xx chromosomes/lower levels of androgens).

Well, we have come a long way, baby, since the 20th century, and the IOC in recognizing the complexities of gender and sexual identities has permitted women like Semenya to compete in the Olympics as women. But if we say it is acceptable in sports for individuals to have outside of normal levels of androgens if they occur by nature, why do we ban the use of androgens when they are made by labs like BALCO and delivered by a syringe? After all, we allow athletes to consume all sorts of supplements that build strength and design sophisticated skis and suits that allow them to carve a few hundredths of a second off a run to give a winning time. Why are the advantages conferred by steroids off-limits?

Perhaps one of the most compelling reasons is once every two years, our kids find themselves glued to their TVs and iPhones to watch Olympic athletes compete. Current estimates are that three to five percent of adolescent boys and about one percent of girls take anabolic steroids. Illicit steroids are taken at concentrations hugely in excess of normal levels of steroids and have significant effects not only on the body, but also on the brain; effects that may be long-lasting or even permanent. Given that these drugs are not all that difficult to get, and the Web is replete with all sorts of advice on how to take them, the last thing kids need is doping Olympians as their role models. For these young competitors, let’s agree any advantage given to Caster Semenya by her natural androgens is OK but the edge given to Marion Jones by her unnatural androgens is not.

Leslie Henderson
Leslie Henderson, Ph.D. is senior associate dean for faculty affairs and professor of Physiology 
and Neurobiology at The Geisel School of Medicine at Dartmouth College.

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