Carole Hooven, the author of "Testosterone: The Story of the Hormone that Dominates and Divides Us", has taken to social media to call media out for falling shy of the explanations required for proper and deep understanding of the themes resurrected by the latest European Court of Human Rights (ECHR) ruling in the challenge brought by former South African runner, now coach, Caster Semenya.

Her book is a must-read for those who want to understand differences in human development and why artificial enhancement with 'T' is a banned method/substance in sport. And for those who need a reminder of where the Semenya story was at last time round, here's a BBC backgrounder from 2023:

Caster Semenya Q&A: Who is she and why is her case important?

With Caster Semenya back in the news, BBC Sport looks at why her case is important.

BBC SportBBC Sport

As that report notes, Semenya has a DSD (difference in sexual development) which means that the biological fact of the matter - the athlete competed with male levels of testosterone well beyond the female range - is highly pertinent to the argument between the athlete and World Athletics in the challenge brought at the ECHR.

The article Dr. Hooven links to in calling for 'more/better' can be read here at ABC News. It's written by two excellence sports reporters from the Associated Press, Graham Dunbar and Gerald Imray - and important to point out that Dr. Hooven's frustration was not with the published content of the report per se, nor with an ECHR ruling that does not force World Athletics to change policies designed to keep male biological advantages out of female competition.

Rather, it about the limitations of reporting on a story at the heart of a wider debate - on whether trans women should have access to women's sport despite male advantage - and characterised by misinformation, inaccuracy (some of it sheer ignorance, some of it part of a wilful campaign of lies, some of it part of a political divide in which you can look left and right and find you disagree where leaders lean on opinion not facts.

NB: World Athletics (largely) ruled male biology out of female sport in 2023, a year after World Aquatics' decision to protect the female category for women.

Here's the AP report outlining the ECHR ruling and picked up by several media outlets, this the ABC News version:

Human rights court rules Olympic champion runner Semenya did not get fair hearing

Two-time Olympic champion runner Caster Semenya has won a partial victory at the European Court of Human Rights in her seven-year legal fight against track and field’s sex eligibility rules

ABC NewsABC News

Let's turn to Dr. Hooven - an evolutionary biologist, a nonresident fellow at the American Enterprise Institute and an associate in the lab of Dr. Steven Pinker, the Johnstone Family Professor of Psychology at Harvard University, where until recently Dr. Hooven was co-director of undergraduate studies in the Department of Human Evolutionary Biology.

Dr. Hooven's words speak for themselves and here is the detailed explanation she believes is essential to understanding the story of Caster Semenya and what that means for sport, women's sport and Fair Play. Her thread on the Semenya case follows a social media post penned by British marathon ace Mara Yamauchi, in which she challenges a reporter and report at The Guardian and calls for accuracy when biological males are described as 'women' in the context of sport. Dr. Hooven's comment on that specific point follows Mara's note:

Part 1 - why its unfair to women

In Full:

"World Athletics drew up its rules in 2018 forcing Semenya and other female athletes with Differences in Sex Development to suppress their testosterone to be eligible for international women’s events." ABC News, today, reporting on a new ruling from the European Court of Human Rights. I'm less concerned with the ruling (you can read about it below) and more concerned with the reporting.

Semenya deserves to be treated with respect and dignity. But Semenya is fighting to compete as a female, against females, at the highest levels of sport. Given this, although it may be uncomfortable, the details of Semenya's condition deserve to be understood and accurately represented in the press and elsewhere. The narrative—that Semenya is a female who has been discriminated against because she happens to be blessed with naturally high testosterone levels—is false.

Semenya reaps the benefits of naturally produced male-typical testosterone because Semenya is male. Semenya has confirmed (see the next post) having XY sex chromosomes, undescended testicles, typical male testosterone levels, and what appears to be a vagina (albeit one that does not connect to a cervix, and without a uterus or fallopian tubes). This is all consistent with the condition called 5ARD (5-alpha reductase deficiency).

5ARD is caused by the lack of an enzyme (5-alpha reductase) that normally catalyzes the conversion of testosterone into to a more potent androgen, dihydrotestosterone, or DHT. DHT is what promotes the development of a penis and scrotum and the descent of the testes into the scrotum in fetal development, and in puberty, causes the growth of thick, dark and dense facial hair, acne, male-pattern baldness, and more. Without DHT, some aspects of physical appearance are feminized, like the skin, and certainly external genitalia.

Affected individuals have a body that responds to male levels of testosterone in all the ways that give males large physical advantages over females in sports: size, strength, power, hemoglobin, etc. (see last post in the thread). The female category exists specifically to protect the ability of females to have a shot at winning.

Accurate reporting on sex matters, especially when it comes to policies designed to protect women, whether in sports, prisons, or on the street.

Part 2 - the deeper science

In Full:

Confirmation that a lack of DHT (the missing androgen in 5ARD) does not reduce strength (from a previous post):

TLDR: "Our data are consistent with studies that have reported no effects of 5α-reductase inhibitors on muscle or bone mass."

I've been asked if men with the DSD 5-ARD (in which ppl cannot convert testosterone into the more potent androgen DHT) experience the typical benefits of male puberty, that would give them an advantage in strength and speed relative to women. This is relevant to questions about whether male athletes with 5-ARD should be allowed to compete in the female category.

This is an excellent question, because it could be the case that DHT is necessary for the development and maintenance of male-typical muscle, lean body mass and strength. If that were the case, then people with 5-ARD might not have a typical male advantage, because the lack of DHT would perhaps lead to a more feminine pattern of fat, lean body mass and strength. I've wondered about this myself and have looked into the evidence.

Perhaps the top researcher in this area, Shalendar Bhasin, who is scrupulous in his methods, has examined this very question. The answer appears to be: no, testosterone does not need to be converted to DHT to exert its typical anabolic effects. These findings are reported in his 2012 study, "Effect of Testosterone Supplementation With and Without a Dual 5α-Reductase Inhibitor on Fat-Free Mass in Men With Suppressed Testosterone Production, A Randomized Controlled Trial." (Hooven note: It is linked to below—and since it's paywalled, I've included the graphs that show comparisons between the placebo and DHT— inhibited conditions, with no difference on the various outcomes.)

The investigators wanted to examine the effects of suppressing DHT on muscle mass, strength, and sexual function. This important because one of the treatments for benign prostatic hyperplasia and male-pattern baldness is to suppress DHT, but clinicians have been concerned about effects on other outcomes that affect health and quality of life. Participants (healthy men, 18 to 50, with normal T levels) had their T blocked, and were given graded doses of T, along with either placebo or a drug that blocked the conversion of T to DHT. So both groups had T, but only one, the placebo group, also had DHT.

After 20 weeks of treatment, changes in lean body mass, muscle, and strength were assessed. There were no significant difference between the placebo and DHT-blocked groups in these outcomes.

For LOTS more detail, [see] the relevant text from the results. Please don't ask me questions about the study. Just look at the abstract and results which you can find by Googling. The main point is that while there are predicted effects of the different doses of T received, there were no differences in the outcomes according to whether they had DHT blocked (with dutasteride) or not (placebo).

"Fat-Free Mass Fat-free mass and lean body mass increased in a dose-dependent manner in the placebo and dutasteride [THIS IS THE DRUG THAT BLOCKS CONVERSION OF T TO DHT] groups (Figure 2). The changes in fat-free mass were related to testosterone dose and changes in testosterone concentrations in the placebo and dutasteride groups but did not differ between groups; the dose-adjusted mean difference (placebo minus dutasteride) in fat-free mass was 0.50 kg (95% CI, −0.22 to 1.22 kg; P = .18).

There was no significant interaction between testosterone dose and randomization to dutasteride or placebo, indicating a lack of evidence that the relationship of testosterone dose to change in fat-free mass differed between the dutasteride and placebo groups.

The model-based smoothed regression lines, obtained by generalized additive models, describing the relationship between changes in testosterone concentrations and changes in fat-free mass and lean body mass were similar in the placebo and dutasteride groups. Changes in fat mass were negatively related to testosterone dose and concentrations, but the relationship between change in fat mass and dose did not differ significantly between the placebo and dutasteride groups (P = .41; Figure 2)."

"Muscle strength Leg-press and chest-press strength increased dependently by dose in the placebo and dutasteride groups. Increases in leg-press and chest-press strength were greater with larger doses and higher concentrations of testosterone. These relationships did not differ between the placebo and dutasteride groups (Figure 2)."

Really interesting commentary from the authors on the role of DHT in adult men: "Why then did the steroid 5α-reductase system evolve for androgens?

Forty-six XY males with steroid 5α-reductase deficiency exhibited ambiguous or female external genitalia at birth and poor prostate development, but underwent normal muscle and bone development during pubertal transition. The phenotype of these patients suggests that steroid 5α-reductase plays an essential role in the development of prostate and phallus by providing local amplification of an androgenic signal without systemic hyperandrogenemia during critical periods of sexual differentiation, illustrating nature's extraordinary ingenuity in creating mechanisms for tissue-selective amplification during development.

We speculate that in adult men, in whom this tissue-specific amplification is not essential because the circulating testosterone concentrations are substantially higher than those in the fetus, testosterone and DHT can interchangeably subserve many androgenic functions. When circulating testosterone concentrations are low, intraprostatic DHT formation may become important in maintaining prostate growth, thus buffering the effects of decreasing testosterone levels, which has been suggested by Marks et al.

Our data are consistent with studies that have reported no effects of 5α-reductase inhibitors on muscle or bone mass. Inferences from these trials are limited by the fact that administration of 5α-reductase inhibitors increases testosterone levels, rendering it difficult to ascribe the outcomes to differences in DHT levels alone. In our trial, inhibition of endogenous testosterone by administration of a gonadotropin-releasing hormone agonist eliminated this problem. Additionally, the high-dose dutasteride regimen effectively inhibited both steroid 5α-reductase isoenzymes."

Of course, the mainstream media cannot run that depth of material and understanding on a basic news story such as that from the AP.

And that's why we place Dr. Hooven's explainer here, as a reference point for SOS readers to refer to and share with others, including those who have a strong opinion that is simply not based on the facts of the matter and does not take into account the rights of access of women athletes to fair and safe sport in recognition of male advantage and the discrimination it delivers to female sport.

One of several reminders out there of the reasons why Dr Hooven's insistence on truth and facts in the gender-in-spoerts debate has been so important:

And here's her position on transwomen in sports, in her opening statements for New England University President’s Forum in March 2023:

More about Dr. Hooven:

Carole Hooven: about

Carole Hooven background

CAROLE HOOVEN

Here's Dr. Hooven's 'T' book if you've never read it and are minded to

And the compelling story from swimming by Sharron Davies, with me, that transcends the sport and highlights the experience of generations of women robbed of their rightful rewards and recognition as a result of what Dr. Hooven describes so well as 'the Hormone that Dominates and Divides Us':

Unfair Play | Swift Press

A TIMES AND DAILY TELEGRAPH BOOK OF THE YEAR SHORTLISTED FOR THE SPORTS BOOK AWARDS 2024 Sharron Davies is no stranger to battling the routine sexism of the sporting world. She missed out on Olympic Gold because of doping among East German athletes in the 1980s; now, biological males are being allowed to compete directly […]

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