StarTalk Radio - #ICYMI - Gender in Sports, with Joanna Harper

Episode Date: October 11, 2018

In case you missed this episode on the Playing with Science channel… Hosts Chuck Nice and Gary O’Reilly sit down with neuroscientist Heather Berlin and Joanna Harper, medical physicist and transgender endurance athlete, to investigate the complexities of gender and its role in sports.Photo Credit: © Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], from Wikimedia Commons. Subscribe to SiriusXM Podcasts+ on Apple Podcasts to listen to new episodes ad-free and a whole week early.

Today we attempt to tackle an enormous topic, the science and role of gender in sports. And joining us now is neuroscientist Heather Berlin. Heather, of course, welcome back to Playing With Science. Chuck, just in case there are listeners out there who aren't familiar. Oh, who couldn't be familiar with Heather? Heather is the assistant professor of psychiatry at Icahn School of Medicine at Mount Sinai and one of StarTalk All-Stars and our go-to expert for all things on brain science, better known as neuroscience.

I aim to please. Okay, so first of all, let's try and put this into some understanding for me. When we say gender and what we mean by sex and the difference. Usually what we mean by female is you have two X chromosomes and men have an X and a Y chromosome. And then they go on to express male genitalia on average. On average. I was going to say, because all fetuses start off the same, right? Yeah.

And then it's the, what's it called? The SRY, right? Right, yeah. It's the SRY that actually creates what you just said. But then there are variations within that that can express things differently inside of men and women. So it really isn't as cut and dry as one might think. Absolutely. And so then you have the development of the sex organs,

and that's one aspect of it, the biological. But then there's also the psychological aspect of what people identify themselves as. So some people might have male genitalia, but psychologically feel like they are female. And that's a different aspect. So there's the identity, the gender identity, and then there's actually just the biological physical differences between right so it depends on what you you know the definition can change depending on on you know your perspective gotcha say so it's real i was about to say so it really is gender

fluid but that's not the best way to but it really is kind of fluid in that, you know, through science, we have found that it isn't just as simple as, hey, you're a man, I'm a woman. Or, hey, you're a woman, I'm a man. It's really not as simple as we think it is. Yeah, but now, you know, you can look at, but on average. On average. On average, you know, you can look at, but on average, on average, you know, there are these biological differences.

Women, you know, have a uterus, have the capacity to have a baby, right? You know, and so there are

sexual differences on average. And then, of course, you have these things at the extremes where there becomes more fluidity

in terms of gender. Exactly. So if we were to take two brains and put them into an MRI, one male, one female, would you be able to go, ah, that's the guy, that's the girl? Is it as simple as that,

or have I just really oversimplified things? The answer is no. Okay. Absolutely not. I look at brain scans all the time. And often when I'm sort of trying to figure out what the problem is, because normally there are people who've either had a traumatic brain injury or there's some kind of problem there. I like to be, um, look at the brain completely as a clean slate without any information. So I can be blind to what the problem is before I then go and read

the report so I can get, yeah. That's fantastic. When you said that, I don't know why, but it just struck in me that all charts should be read just hand me a chart and say, this is patient 26547, then I'm reading all of these things blank slate. Yeah. Brilliant idea. Yeah. And this isn't standard. It's not like everybody does that, right? They usually are reading all the other people's reports. Of course.

But I like to first just have this clean look at it and not even know age, gender, anything. Nice. And then you kind of make your sort of diagnosis and then you start looking back and comparing to what other people said and integrate that. But you make your initial assessment sort of blind. Anyway, so when I look at these scans, I can maybe tell age, you know, based on, you know, the different differences in the brain structure, but gender, no. Never happens. No, never. So there's no male brain structure. But gender, no. Never happens, huh? No, never. So there's no male brain and no female brain,

just as a brain itself. If you're just looking at the raw anatomy, no. Now, there are some studies where you look across a whole group of male brains of scans and images, and you look at female brains, and then you try to see are there any differences on average. some studies do pick up differences but this is a different technique than just looking at any one individual brain and being able to understand now and and and i would suppose that when you talk about those studies the same thing would apply to if you were looking at a brain

lighting up in an mri uh as it is exposed to certain stimuli that you would be men and men and women would be different in that respect. So, yeah, yeah. I mean, they're OK. So as I said, so first, just looking not at function, but just that structure, there are some things like some studies have found that women have a slightly larger hippocampus, which is a part of the brain that has to do with memory. women have a slightly larger hippocampus, which is a part of the brain that has to do with memory.

And that might coincide with them maybe having a bit better memory, especially of emotional memories. So there's that structural difference. And some, again, these are on average, it's not everybody, linguistic differences. So for example, the language area of the brain tends to be more, what we call lateralized to the left, tends to be more to the left in men. Women, however, tend to also have some language areas on the right side as well. So it's less lateralized. It's still more to the left, but they also have, so there's more of the brain dedicated to language. And then when you look at it behaviorally, women actually tend on average to use more words throughout the day than men. And they never forget. And become verbal sooner than boys. Yeah, absolutely.

I mean, that's just a fact that anybody who has children knows that little girls become far more verbal than little boys much earlier. On a cellular level, is there any difference in the chemicals that present in a male or female brain when the processes are taking place? Yeah. I mean, so you have exposure to testosterone, to certain hormones, let's say, in utero that affect development and can affect brain development. There's some differences in connectivity. And that might be a result of higher exposure to testosterone in utero and then outside of utero, of course, but especially during these critical periods of development versus exposure to estrogen. And also oxytocin is another big one.

That females tend to release more oxytocin that's related to childbirth or bonding with their child when they're breastfeeding. All of those things do affect the brain in different ways. You know, they're subtle, but they do eventually have behavioral consequences. So speaking of testosterone, so let's relate this to sports. So testosterone in men as we go through puberty and we start to express this hormone and we get muscles and we have bigger bones and, um, skulls, thicker skulls.

Absolutely. You're thick skull, big crow magnets, thick skull, basket. So you're so used to bashing your head to develop thicker skulls. Yeah. So now what a lot of people don't realize is that testosterone is a vital part of females too. Like it gives them better bone

density. It gives some women are far more muscular, just naturally muscular, sex drive, all these things, right? So when you have a woman who is high testosterone, does that give her an advantage physically when it comes to physical sports? I'm talking about just the physical sports, physicality of sports. Does that give a woman an advantage to be a higher testosterone? It might. It might. There are certain studies that look at something as simple as actually I think it's the ratio between this finger to this finger.

I can't remember which finger it is. But there's one finger that if it's exposed to higher testosterone in utero, it will grow longer in proportion to the other finger. And you can actually see somebody's, like I think it's this finger to this finger. So I was actually exposed to some amount of testosterone in utero that's higher than average, let's say. Now, does that mean that I have thicker bones or I grow taller? Yes, perhaps. Whether it makes a hugely significant difference in the realm of sports is questionable because you have some of these genetic differences,

then you have the exposure to testosterone, and then you have the practice element or the environmental, right? And all of those things have to come into play. Right. So it's not just one thing. You know, one might give you a slight advantage, but if you have somebody who's lower testosterone,

but who works out- Works all the time. Yeah, yeah. They might do better at a certain sport than someone who's just higher in testosterone. So we go back to nature and nurture. Yeah. The other thing is, apart from the physicality of a lot of sport, it can be problem solving. And I say it can be. It is quite often solving a lot of problems during a game, whether it's tennis or soccer or basketball. Is a female brain more

predisposed than a male brain? Are there certain areas that you said, certain language areas and the hippocampus for memory? Are there other areas that would have an advantage in certain situations? So there are a lot of things I think that are happening during the play. So problem solving, now on average, they say, you know, men tend to be better at like spatial, visual spatial processing and women in language. But however, if you just take individuals, if you look at say me and my husband, I'm very good with math and visual spatial and language isn't my thing. And he's a writer and language is his thing. So we're totally the opposite of what you might expect on average. So again, these are all, um, there's a lot of exceptions to these rules, but on average men tend to be better at visual spatial processing,

um, of being able to really, so women are good at, you know, they say multitasking for a very, for a number of reasons. And men tend to be good at focusing on one particular thing and, and, um, being able to kind of tune out and anybody who's married knows this can tune out everything else. You know, I'm talking about, I tell him five times and he's just not, cause he's focused on something. Whereas I can hear five things at once and, you know, watch the kids and whatever. So in sense of, I mean, you know, problem solving involves a lot of different things, but I think one is, you know, if you're under a high amount of pressure, can you stay focused? Um, and that also has to do a lot with prefrontal cortex function which is which varies between

men and women so it depends on what you mean by problem solving I guess that's the answer to the question so if it okay sport will have a an element of spatial right I need to as if we stay with tennis if I need to place that ball there to set my opponent up to the third shot on to do certain things like that so so to think like also three steps ahead or that kind of which then which then may be uh possibly cliche and i'm falling into the trap of multitasking because you're already thinking about doing all of that while you're doing all of this yeah yeah and i that, again, there's going to be more importance in terms of individual variation than so much the male-female elements coming into play. I think in those sports, certainly the physicality of men will make a huge difference. If you're going to put a man up against a woman, I think that obviously the obvious physical differences, although you have some men who, you know, some women who can totally.

I mean, if you take Serena Williams, you know, she's going to beat the average male tennis player, I'm pretty sure. So, you know, but, but outside of the physicality, I think the problem solving and the thinking, you know, 10 steps ahead, you're not going to see huge differences between men and women, especially those who are prone to want to go into sports. And that's where they have an affinity, you know, for their, their, if they're going to get to the highest levels, they're all going to probably have equal ability to think ahead and solve problems. So I know there were some studies done back in the 90s about young children, how they perceive themselves and their abilities. Mm-hmm. Yeah.

Juxtaposed against children who were just a few years older. So we're talking about like five and six-year-olds. Juxtaposed against nine and ten-year-olds. The five and six-year-olds were like, I'm great. I'm good at this. I'm awesome. And then by the time they got to nine and 10, the boys were like, I'm great.

And the girls were like, not so much. Or they thought they were great at other things. So it's not like they it's not like they were suffering from self-esteem issues. It's just that they thought they were great at something else. And primarily the thing that that was glaringly different was sports competition. Right. Is this, I don't know what that study is saying, but I think it might be saying, because I don't think there's enough information to say this. But what it says to me is that a lot of this is just kind of like you're looking around, you're absorbing your surroundings and you're saying to yourself, Hey, this is not what I'm supposed to do. Well, I mean, there's studies, like if you even just look at, um, like math ability, for example, you know, girls and boys

start out, they equally, you know, thinking they can do math. They actually show, um, they tell girls before they're about to take a math test that girls tend to do better on average than boys on math. And they do really well on this math test. And then you tell another group of girls, actually, it shows that men do way better than women on math, and they actually do much worse on the math test. So those influences do affect your confidence and your ability, and then it becomes a snowball effect. That being said, you know, men, testosterone, tend to be more competitive, more aggressive, and they might gravitate more towards sports because they enjoy it. There's actually studies that show that in societies that have the most fluid gender roles where they don't have these oppressive laws and you are allowed to do whatever you want, that's where they actually see the biggest discrepancies in terms of what self-chosen, what men and women choose to do. So part of it could be a preference thing.

It could be that men just gravitate more towards the physical and aggressive kinds of sports. Women tend to want to be more cooperative and have group cohesion, and maybe kinds of sports that involve that, they'll gravitate more to. So again, it's hard to separate out all these factors. I mean, the influence of culture, of course, has an effect, but our natural inclinations and tendencies also have an effect. Well, how about gender segregation? Because we separate boys and girls all the time from the time they're very little. Yeah. Couldn't that actually exacerbate the fact that boys gravitate towards, like, I'm sure there are little girls, and maybe not on average, and maybe not as a whole, but just the little girl out of the eight boys, and then there's two girls who want to play baseball.

But the girls are like, they're told, no. to play baseball. But the girls are like, they're told no. So, I mean, wouldn't that also account for some of the discrepancy in, you know, the numbers, the interest and the performance? Yeah. Yeah. So that's, I mean, you know, it's a double-edged sword because at some level, you know, just as I talked about the physicality and men tend to be taller and bigger and larger and there can be some discrepancies there when, especially if you're talking about contact sports, right. But I remember when I was in graduate school, I wanted to play soccer. I mean, as a professional, but just, you know, I wanted to play intramural soccer and we are particular college only had a male team. So, and it was for fun. It wasn't, you know, like the,

the university team. And I said, you know, can I play? And so there was this huge debate in the team about, there was a whole group of them said, yeah, I want to play. And we were fighting for it, but then the other teams didn't want me there because they said they wouldn't play as aggressively if I was on the, so, you know, there's a lot of psychological preconceptions involved. So there could be problems. I think when they're young, of course, why not, you know, start out, have co-ed teams, whatever, as it gets more intense and aggressive and you're getting at the higher levels of like where little physical differences can make a big difference, then maybe it does make sense to separate it out at that level. Well, you know, and honestly, that's what happens with young boys too. I mean, I remember

playing football and going away for one summer from school and then coming back. And it seemed like over that summer, the team got five times the size. That was the end of my football. Actually. Because little skinny, I'm sorry, little skinny spindly Chuck could not play with these guys that somehow sprouted up and they were now like 190 220 you know and i'm still like i'll tell you this so could wear a brick it has less to do with actually gender differences than just the actual physicality so if you instead of making it the

line to get into a team um based on gender make it based on i don't know like size weight whatever whether you're a male or female, if you are, you know, X number of pounds and X tall, you can be on this team. Like wrestling. Right, right. And so it won't matter what the gender is. You've got weight categories in events like that.

For me, I quite simply, are you, one simple question, are you good enough? Right. And then, yes, no, you're in. And to the point where, are women as competitive as men I think that question seems the most redundant thing I could possibly say in this discussion because there's no doubt that every bit you've only got to watch the Olympics you've only got to watch any sporting event to see how competitive every female athlete is. So there's a whole load of things. We've talked about things already, and there's basically no difference.

You've said to me you could look at a brain, two brains, one male, one female, you wouldn't know. If you came to that blind and you looked at it and said, I couldn't tell you on a screen, which it is, there seems to be very little. The only thing that will change is the physicality. Physicality. And if you're mismatching on a physical,

I mean, if you go into a boxing ring and there's one guy 250 pounds and six foot five and you're five foot 10 and 130. That's no longer a boxing match. That's it. Yeah, it's called a slaughter. They don't do that. So perhaps you should match people up based on skill

and maybe weight categories and size categories, but not based on gender. Right. And I think that when you think about it, some of it has to be just cultural and societal bias because there's no reason a kicker, even in the NFL, couldn't be a female. Absolutely. There's no reason. I fully agree. I fully agree. And I think that that's why, you know, I think, but for instance, I don't want to play football.

You know, that's not something I would choose to do, right? But if I wanted to, and if I wanted to have a crack at it, there should be no reason why there should be, you know, rules against that, unless I'm going to get really seriously physically injured or whatever, but at least give me a chance to try out or, you know, see if I can reach the level of... The question that keeps popping up into my head in the last minute is, is society ready for that? That's another question.

That's a whole other show. That's a whole other... I mean, I think we all, everyone sat here is thinking pretty much the same thing. Well, I think you got to start with baby steps, right? Little by little, there's an integration and a change, just like everything else where, you know, women had to kind of fight their way to break through. And then it became the norm and like voting even. Right. So, you know, again, sports is different.

There's this physicality. in right so um you know again sports is different there's this physicality but if you match up teams based on the size aspect and you know i think that over time people will will adapt but it takes you got to go in baby steps if there was one thing from your point of view that could be done now that would would maybe speed up those baby steps what would it be? That's really, that's really, um, I would take a popular sport, just one of them, any one, and, and just start by opening that up and say, whether it's tennis, I mean, do they do that? And they have one match where it's going to be, you know, the best woman versus the best. I mean, they did the battle of the sexes, right? It was, they, they had this matchup, but let's just start by taking one sport and doing one like match or one type of competition where it's integrated and just

see how it goes and then we can start moving in that direction okay that is one thought there will be others and hopefully our audience will engage with it uh we're going to take a break but to dr heather berling thank you so much for your contribution to this particular show yeah you weren't bad for a woman i exactly took on two men took on two men and it's lead it when we come back the science of gender and sex and its role in athletics stick around we'll be right back And welcome back to Playing With Science and our gender show. I think we have a particularly interesting guest joining us now. Dr. Joanna Harper is a transgender and gender-varying athlete, an endurance runner, a medical physicist at Providence Portland Medical Center in Oregon,

and the only person in history, Chuck, to publish a peer-reviewed article on the performance of transgender athletes. Welcome to the show. Okay, Joanna, let's start with a few of the vocabulary and terminology so as I understand. so if we go through exactly what transgender intersex biological and anatomical sex and how this all unfolds if you could base that for my platform to work from please both sex the biology of the male female divide and gender the sociology of the male female divide are. And we can divide biological sex into different categories like external genitalia, internal genitalia, chromosome pattern, hormones, secondary sex characteristics. And these are not all necessarily concordant.

cordent. So, you know, some people might possibly have external genitalia of one sex and internal genitalia assorted with the opposite sex. Gender is also complex. Many people nowadays talk about gender fluidity that implies a one-dimensional continuum between male and female. But I actually like to think of gender as a two-dimensional graph in which we have male, female along a vertical axis, and then the number of gender aspects along the horizontal aspect. And in particular with sports, I like to think of gender assigned at birth, social gender, legal gender, and a concept that I like to call athletic gender. Others have used terms like sports sex. But we're talking about the same thing, gender for the purpose of sport. And so these things are complex, but I think we can narrow this down in terms of sports.

You did warn us it was complex. You have advised the IOC, the International Olympic Committee, on guidelines regarding sex reassignment and hyperandrogenism. The athlete that springs to mind is Semenya, but I think we're going to get a little bit more in depth with that later on when we talk. But all right, are athletes, here we go, simple question, are athletes being gender tested at the Olympics right now? In the 2016 and 2018 Olympics, there was no testing. Anyone who had been assigned female at birth was allowed to compete in 2016 and 2018. who had been assigned female at birth was allowed to compete in 2016 and 2018. Whether there will be some sort of test for 2020 remains to be decided.

Okay. Is there a blanket ruling as the IOC, the IAAF, the International Athletics Association, if I remember it, Federation, and the NCAA, all of these large governing bodies, Federation and the NCAA, all of these large governing bodies, do they have the same rules or are they all varied? They all vary. Certainly the IAAF and the IOC coordinate, but they haven't always had the same rules. And the NCAA is a completely different organization with its different set of rules. But in the last seven or eight years, all three of these organizations have come to center around the idea that hormones are the most important aspect for determining

who gets to compete in the male or female categories. for determining who gets to compete in the male or female categories. So they're looking at hormones and what are they proposing or is there any kind of universal proposition being put forward to create a standard and should there be? be? Well, I guess first question first, the NCAA since 2011 has used a testosterone-based standard for transgender athletes. Intersex athletes are not a big concern in the NCAA because the prevalence in North America is less and there are other complicating factors. But mostly the NCAA just has to consider themselves as transgender. The IAAF and the IOC both have to consider intersex and transgender. And they have separate policies for each of these.

As I say, the IOC has not had a policy on intersex athletes since the 2014 Olympic Games. The IOC has a transgender policy that has been in place since 2011. that govern intersex athletes that will start to take place in November 1st of 2018, so just a few weeks from now. So the second thing, should they all be the same? Well, not necessarily. I think we should look at elite athletes differently than we look at low-level athletes. But I think the NCAA is high enough level of sport that they should probably be fairly close. Okay. And can you do me a favor? Because as you were talking about intersex athletes,

I'm sure that there's a goodly portion of the listening audience that's not familiar with that. And in doing so, maybe visit the fact that this, everybody thinks that this is a very new, and even though it's very nuanced, it really isn't a new thing. I mean, this has a very long history going back to the Olympics in like, what, the 30s, right? Yes, and certainly intersex people before then, you know, in the 19th century, you had bearded ladies, you had these sorts of things. So intersex people who have either physical and or chromosomal characteristics that in some manner blur the line between male and female. Until the 21st century, these people were generally called hermaphrodites. Hermaphrodites, right.

So many people might be more familiar with that. And intersex people, their conditions are called DSDs or differences of sexual development. So I use the term intersex and DSD interchangeably, but many people might be more familiar with hermaphrodite. And so when we're talking about, let's kind of transition because to transgender, and you wrote an article, let me get the title right, because I read it, and it was in the Washington Post, and it said, do transgender athletes have an edge? And then you said in the title, I sure don't. Now, I read that article, and I have to say that the title is somewhat misleading, because people, I'm sure, will kind of maybe cruise through it or read in a cursory fashion or just read the headline and think that you feel there is no advantage whatsoever

for being transgender and competing. But I read the article. That's not what you're saying at all. You're not saying that. So please, for those people who might not understand what you're really saying, can you clear it up for them? Absolutely. First of all, organizations like The Washington Post have people who write titles for them. Yes. Yes. all, organizations like the Washington Post have people who write titles for them. Yes. Yes. And I'm sure you know that. So I wrote the article, somebody else wrote the headline. And anybody who reads the article, this is why I'm bringing this up. If you read the article, you realize that somebody slapped a headline on there to make you read the article. But the headline and the article are really not in

sync. So can you just tell us when it comes to advantages, what you really feel? I don't want to put words in your mouth. I read the article, but I don't want to put words in your mouth and just let people know what you're really saying. Okay. So most people are concerned about transgender women, people who start life as biologically male and then transition to female competing in women's sports. And many people say that trans women have advantages over normal women or cisgender women. And that's actually true. Even after hormone therapy, which makes enormous differences, but even after hormone therapy, transgender women are on average taller, bigger, and stronger than cisgender women. And in many sports, those are advantageous. However,

transgender women also have a large frame that they're now trying to power with reduced muscle mass and reduced aerobic capacity. So that's a disadvantage. So trans women have advantages, but disadvantages too. And then the most important question is, can transgender women and cisgender women compete against one another in an equitable and meaningful fashion? If they can, they belong in the same category. If they can't, they don't belong in the same category. It's interesting when we look at your personal journey, because you're an endurance runner and it's all about, I don't need the weight. I don't need this extra thing to drag this long distance. Are you saying that when you went through your process that it became particularly

disadvantaged to you? And if so, can you explain the processes that you went through and the disadvantages that came with it? Muscle mass still helps transgender athletes. And as a trans woman, I carry more muscle mass than cisgender women. And so that helps. But certainly the fact that, you know, I mean, I'm not a huge person, but by female distance runner standards, I'm, you know, bigger than average. And so, you know, that is a disadvantage. And so what I found in my particular case is that after nine months of hormone therapy, I was running 12% slower. And that's the difference between male distance runners and female distance runners. So I had lost that advantage over 12 months, or over nine months, rather. And then

I started finding other transgender distance runners, and the same thing had happened to them. And that made the basis of my study. But in particular, if you want to look really closely at it, when I was running in men's competition, my best event was the marathon. So the longer the race, the better I did. But that's actually no longer true. My best race distances as a woman are 5k to 10k. And that speaks of my advantage of a little more muscle mass, but my disadvantage of having a little more frame. And so I'm still pretty good at longer distances, but I'm now best at 5K, 10K. So there's been a little shift. It's interesting.

So now you talk and discuss this. and discuss this, is there a sort of specific events that would benefit some that don't, some that do, the advantage, disadvantage scenario within sports and different sports? Absolutely. One would expect basketball, volleyball, weightlifting, those sorts of sports you might think would be sports where transgender women would have advantages. In gymnastics, transgender women are going to be hugely disadvantaged, so disadvantaged, in fact, that I predict that I will never live to see an elite trans woman gymnast. Never. Wow. So now when you talk about, and I would say, maybe you can speak to this or not, and maybe you've come across this in your studies or not, but I will say that when it comes to games that require both hand-eye coordination skill sets and strength, that you really can't say that there's an advantage to being transgender or not, because you still have to have the skill set. You still have to have the hand. These are things that are developed through causing neurons to fire

together and wire together in such a way that you become super proficient at a particular action. Am I right in thinking that there's no real advantage you say basketball I believe that a female just you know a biological anatomical female could compete the same way as a male could in certain positions on a basketball court or am I crazy for thinking this way well you know you're not likely to see a biological female in the NBA. You know, so there is certainly something to the male-female divide. But if you're looking at transgender women, on average, they're four or five inches taller, which is certainly an advantage. That's an advantage. I would say that transgender women, and it's really hard to quantify this, but I am certain that transgender women are quickness disadvantaged with respect to other women.

And so does this balance out? Well, you know, there are no transgender women in the WNBA, so it's hard to say for sure. But I don't think even in basketball that trans women are so advantaged as to make competition unreasonable. And that's my point is that, you know, there are so many other variables involved that you can't flatly say, oh, hey, you have this great advantage because you're transgender. You know, that's all. I think a lot of this is political and a lot of it has to do with social bias more so than an actual empirical representation of true advantage. But I'm going on record as saying that is an opinion. So I can't, you know, that's my opinion.

Okay. And, you know, you're right. There are a lot of people who still think of transgender people being really the sex they were assigned at birth or the gender they were assigned at birth. And so a lot of people think trans women are really men who are pretending to be women. And that's where they have a problem. And so they think of men invading women's sports. But trans women, certainly in terms of gender identity, I mean, trans women are not faking who they are. Nobody would go through all the things that

transgender people have to go through just to succeed in sports. Yeah. And you know, that's a wonderful thing you just said there. Exactly. Nobody's going through all of this to truly acknowledge their real identity just so that I can win a medal or a trophy. I'm sorry, but I'm with you on that one. I'm just listening to Joanna there. And you spoke in your article in the Washington Post about fear, the fear of other athletes. And you said, oh, we don't mind you competing as long as you don't beat us. Is that just born out of pure ignorance? I don't want to label people to, but, you know, I think if people have a chance to compete closely with and against transgender athletes, you know, this sort of fear will go away. And, you know, as a runner, I have good years and bad years and good years and good races and bad races. And people have raced against me a lot. They understand that, that some days they'll beat

me and some days they won't. And so, you know, we're athletes like anyone else. So is there anything that can be done by any of these organizations, sanctioning bodies or governing bodies that can make inclusion easier? And are they looking to make inclusion easier, or is this really just a political football that must be handled? You know, the primary job of sports governing bodies is to govern sports. And, you know, inclusion is not their primary goal. But, you know, yes, they do have a certain responsibility to, you know, to try to be inclusive as long as they can maintain equitable and meaningful competition within whatever categories they have determined are appropriate for their sport. And so are there things they can do? Yes. And, you know, the NCAA has certainly made an effort.

The international governing bodies, the IAAF and the IOC, they're working on it. They, you know, they've got a ways to go, but they have both an intersex athlete and a transgender athlete among 12 worldwide experts that help advise them on this. And that's pretty good representation right there. And we're working on things. That's good. That's good to know. And you have such a very, I will say, measured and level-headed approach to this whole thing. You know, I quite admire the way you approached and broached the subject matter because for some reason this incites a very passionate and emotional response from so many people. You know, one that I don't get maybe is because I've never been a real athlete. You know what I mean?

one that I don't get maybe it's because I've never been a real athlete you know what I mean aside from playing some intramural sports in school I you know I don't know what it's like to have like you know to feel like everything's on the line or whatever so I'm not sure but it's it just really incites not only from players but also from the public this incredibly like passionate fiery response and you know I'm just a little I'm a I'm not as good at understanding that. It's interesting, Joanna, when we talk about where the answers might come from and what things are beginning to take place to find the right path forward. We have currently Keista Semenya, who I believe, and correct me if I'm wrong, is considered to be hyperandrogenist. Can you explain that to me so as I don't tread all over it and make the mistake of thinking of one way or the other?

It's a handball of a word, first of all. Is it? For me, it is. Yes, it means someone with naturally high levels of androgynous hormones, and testosterone is the most common androgen that we know of. So the thing, and if you look at the new IOC or the IAAF rules, they actually have gone away from calling them hyperandrogenism rules. They're now called

DSD regulations. And I think that's a better term because there are, um, there are things like, uh, polycystic ovary syndrome that can cause a hyperandrogenism in females, not, not as high level as, as having testes. But, um, uh, so, so talking about the various DSDs that they do in the new IAAF regulations, I think is a step forward. But hyperandrogenism is a natural level of high testosterone. And in the restricted athletes, that comes from having internal testes. There are some of these DSDs or intersex conditions where a person can be born with external female genitalia but internal testes. And some, but not all of these people, when they go through puberty, go through very much a male-type puberty where they get pretty much full male advantage. Now, not all of these intersex people do, but some do. And this is the problem for sports. You know, this person has been born,

was declared female at birth, raised female, and then goes through male puberty. What do you do with that person? Here's what I want to know about that though. When you talk about, I'm not going to, the DSD, why is it that that's never an issue when it's male and male? Like there are some men who are just naturally superior physical specimens and no one says anything about it. I point without any compunction to LeBron James. You look at LeBron James on the court and LeBron James is physically superior to everyone on the court. You can visibly see it. You can see it. No one says, well, the only reason he's good is because he's naturally, he's got a natural advantage. Nobody says that because they know what kind of work goes into getting there. So why is it that we focus only on females with this? I mean, I don't, I'm trying to figure that out, you know, and why is it okay for men to have a natural advantage, but for females not to have a natural advantage? Okay. So we divide athletes into male and female categories. And we do so because men are hugely advantaged in almost every sport.

So we want women to win things like Olympic gold medals. But there is no Superman category. If there was, LeBron James would belong in that Superman category. But we don't have one of those categories. We have a male category, we have a female category. And we have to find some way of dividing human beings into male and female athletes. So that's why there's no upper category for LeBron James, Usain Bolt, etc cetera, et cetera.

But we do have a female category and a male category. And so we need to pick some way to differentiate. And I would suggest that using the appearance of external genitalia at birth is not the ideal way to do it, but for the purpose of external genitalia at birth is not the ideal way to do it, but for the purpose of sport. But that's how we divide human beings at birth. You know, we divide them by that, the appearance of external genitalia. But in terms of sport, it's not optimal.

So speaking of that, because we're almost out of time and this is fascinating and you're so great at talking about it and educating people. So that being said, what would be a prescription? I'm not asking you to solve this problem right now, but are there any ideas? Are there any efforts? What would be the prescription that you feel might help this problem along? What I would suggest is that we use an evidence-based method that relies on a biomarker that is an important differentiator of male versus female athleticism and is mostly dimorphic. Testosterone fills all those boxes, but we'd like to come up with something better

than testosterone. We are starting to do some pretty exciting studies. We are currently studying two transgender athletes, one in the Denver area, one in the Phoenix area, as they transition. And we are learning a lot. And we very much hope to have these studies going around the world in the next few years. And I think we can learn a lot. And I think we can come up with better biomarkers in the next few years. And I think we can learn a lot. And I think we can come up with better biomarkers in the future. So Joanna, as we sit here in sort of like beginning

mid-October 2018, next month, the IAAF will introduce new testosterone ruling, which, correct me if I'm wrong again, will see athletes with higher levels of testosterone being put into a medication program that lowers that. And they focus, strangely enough, on the 400 metres, the 800 metres and the 1500 metres, which happens, surprisingly enough, to be Keister Semenya's particular chosen field of track events. How has the world reacted to that?

Well, many people have reacted very negatively. Those events were chosen not because they're castor simenius events but because those are uh a events which a a 2017 study undertaken by a couple of scientists showed advantage uh for higher testosterone levels and b these are the events that over the last 25 years have shown that intersex women have a huge advantage. I have a paper that's just been accepted for publication, and there's like 15 co-authors. But one of the things we looked at was how do intersex women do in those events over the last 25 years? And we found that they had a 1700 fold over representation in those restricted events at global track and field championships over the last 25 years. So it's not just Caster's Dominion.

Thank you for pointing that out. Is the IWF action the best way forward or is there a glaringly obvious other path that can be taken? I'm not certain it's the right way forward. I'm not certain it isn't. Castor Semenya, it appears, is going to challenge those rules in the court of arbitration for sport. And we will see what we will see. Absolutely, we will. Oh, my God, this is fascinating stuff. But we are out of time, unfortunately. And hopefully, maybe we can just revisit this as a kind of like a epilogue. So we can after after the trial and all the hearings and other that, maybe we'll be able to get you back on and just kind of revisit this if you don't mind. No, no, I would be happy to do so after the trial.

That's very generous of you because this is a moving thing. This thing is going to move forward, and I think we need to keep ourselves acutely aware of it. So, Dr. Joanna Harper, thank you so much for your insight and your patience with Chuck and I and explaining some very simple things to us. Thank you very much indeed. You're welcome. They're not simple at all. You're very generous, as I said. Thank you. All right, Chuck. Every day is a school day, my friend. Yes, it is. And I'm glad today I actually paid attention in class. I think we all are. And we'll look forward to your company on the other side.