#ICYMI - Gender in Sports, with Joanna Harper

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.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:09Gary O'Reilly?

  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...

• 0:25Chuck Nice?

  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.

• 0:41Heather Berlin?

  I aim to please.

• 0:42Gary O'Reilly?

  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.

• 0:52Heather Berlin?

  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.

• 1:05Gary O'Reilly?

  Right, on average.

• 1:06Heather Berlin?

  You know, there are some variations.

• 1:08Chuck Nice?

  I was gonna say, because all fetuses start off the same, right?

• 1:11Heather Berlin?

  Yeah.

• 1:11Chuck Nice?

  And then it's the, what's it called, the S R Y, right?

• 1:14Heather Berlin?

  Right, yeah.

• 1:15Chuck Nice?

  It's the S R Y 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.

• 1:26Heather Berlin?

  Absolutely. And then, 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.

• 1:50Chuck Nice?

  Right.

• 1:50Heather Berlin?

  So it depends on what you, you know, the definition can change depending on, on, you know, your perspective.

• 1:56Chuck Nice?

  Gotcha. 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.

• 2:20Heather Berlin?

  Yeah, but now, but 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, and so there are sexual differences on average. And then, of course, you have these things at the extremes where there becomes more fluidity.

• 2:41Chuck Nice?

  Right.

• 2:42Heather Berlin?

  In terms of gender.

• 2:43Chuck Nice?

  Exactly.

• 2:43Gary O'Reilly?

  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 is that, have I just really oversimplified things?

• 2:56Heather Berlin?

  Yeah, the answer is no.

• 2:58Chuck Nice?

  Okay.

• 2:58Heather Berlin?

  Absolutely not. I, I, I look at brain scans all the time. And when I, and often when I'm sort of trying to figure out what the problem is with it, 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.

• 3:17Chuck Nice?

  That's fantastic. When you said that, I don't know why, but it just struck in me that all charts should be read blindly, no matter what the condition is, because everyone has bias, including doctors. And so if I look at your chart and I know that you're a black female from Chicago, I'm going to actually have something in my head attached to that as opposed to if you just hand me a chart and say, this is patient two, six, five, four, seven, then I'm reading all of these things.

• 3:53Heather Berlin?

  Blank slate.

• 3:53Chuck Nice?

  Blank slate.

• 3:54Heather Berlin?

  Yeah.

• 3:54Chuck Nice?

  Brilliant idea.

• 3:55Heather Berlin?

  Yeah, and it's, and so, and this isn't standard. It's not like everybody does that, right? They usually are reading all the other people's reports. But I like to first just have this clean look at it and not even know age, gender, anything. And then you kind of make your sort of diagnosis. And then you start looking back and comparing to what other people said and, and integrate that. But you make your initial assessment sort of blind. Anyway, so, but 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.

• 4:25Chuck Nice?

  Never happens, huh?

• 4:26Heather Berlin?

  No, never. Now, there are-

• 4:27Chuck Nice?

  So there's no male brain and no female brain, just as a brain itself?

• 4:30Heather Berlin?

  If you're just looking at the raw anatomy, no. Now, there are some studies where you look across, you know, 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. And 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.

• 4:52Chuck Nice?

  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 diff- men and women would be different in that respect.

• 5:11Heather Berlin?

  So, yeah, yeah, I mean, there, okay, so as I said, so first, just looking not at function, but just the 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. 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, um, 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, there's, there's more of the brain dedicated to language.

• 5:56Heather Berlin?

  Um, and, and then when you look at it behaviorally, women actually tend, on average, to use more words throughout the day than men.

• 6:03Chuck Nice?

  And, and actually-

• 6:04Heather Berlin?

  And they never forget.

• 6:05Chuck Nice?

  And, and become, and become verbal sooner than boys.

• 6:08Heather Berlin?

  Yeah, absolutely.

• 6:08Chuck Nice?

  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.

• 6:16Heather Berlin?

  Yeah.

• 6:17Gary O'Reilly?

  On a cellular level, is there any difference in- The chemicals that present in a male or female brain.

• 6:24Heather Berlin?

  Well, there's.

• 6:25Gary O'Reilly?

  When the processes are taking place.

• 6:27Heather Berlin?

  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 more, higher exposure to testosterone in utero and then outside of utero, of course, but especially during these critical periods of development. Um, 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.

• 7:08Chuck Nice?

  So speaking of testosterone, so let's, when we're, when, let's relate this to sports. So testosterone, um, in men, as we go through puberty and we start to express this hormone and we get muscles.

• 7:23Heather Berlin?

  Yeah.

• 7:23Chuck Nice?

  And we have bigger bones.

• 7:26Heather Berlin?

  Mm hmm.

• 7:27Chuck Nice?

  And, um.

• 7:29Heather Berlin?

  Thicker skulls.

• 7:30Chuck Nice?

  Thicker skulls, absolutely, a thick skull, a big crow magnet, thick skull bastard.

• 7:35Heather Berlin?

  You guys are so used to bashing your head around. They had to develop thicker skulls, yeah.

• 7:39Chuck Nice?

  So now what a lot of people don't realize is that testosterone is a vital part of females too. Like it, it gives them big, uh, better bone density. It gives, some women are far more muscular, just naturally muscular, uh, it, it, it, sex drive, all these things, right?

• 7:54Heather Berlin?

  Yeah.

• 7:54Chuck Nice?

  So when you have a woman who is high testosterone.

• 7:58Heather Berlin?

  Right.

• 7:59Chuck Nice?

  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?

• 8:11Heather Berlin?

  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 my, it's this finger to this finger. So I have, 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 or, you know? 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.

• 8:56Heather Berlin?

  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. Works out. All the time. Yeah, they might do better at a certain sport than someone who's just higher in testosterone.

• 9:09Gary O'Reilly?

  So we go back to nature and nurture.

• 9:10Heather Berlin?

  Yeah.

• 9:11Gary O'Reilly?

  The other thing is, apart from the physicality of a lot of sport, it can be problem solving. And let's say it can be, it is quite often solving a lot of problems during a game, whether it's tennis or soccer or basketball.

• 9:25Gary O'Reilly?

  Is a female brain more predisposed than a male brain? Are there certain areas that, you said, certain language areas in the hippocampus for memory? Are there other areas that would have an advantage in certain situations?

• 9:37Heather Berlin?

  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 are 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, there's a lot of exceptions to these rules. But on average, men tend to be better at visual spatial processing 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 being able to kind of tune out.

• 10:21Heather Berlin?

  And anybody who's married knows this. Yeah. Can tune out everything else. You know, I'm talking about, I tell him five times and he's just not, because 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? And that also has to do a lot with prefrontal cortex. Function, um, which is, which varies between men and women. Um, so it, it depends on what you mean by problem solving. I guess that's the answer to the question.

• 10:53Gary O'Reilly?

  So if it, okay, sport will have a, an element of spatial.

• 10:56Heather Berlin?

  Right.

• 10:57Gary O'Reilly?

  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 that certain things like that. So.

• 11:07Heather Berlin?

  So to think like also three steps ahead or that kind of.

• 11:10Gary O'Reilly?

  Which then, which then maybe, uh, possibly cliche and I'm falling into the trap of multitasking. Cause you're already thinking about doing all of that while you're doing all of this.

• 11:19Heather Berlin?

  Yeah.

• 11:20Gary O'Reilly?

  Yeah.

• 11:20Heather Berlin?

  And I think that again, more, there's going to be more, um, 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, you know, 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.

• 11:49Gary O'Reilly?

  Right.

• 11:49Heather Berlin?

  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 um, 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.

• 12:11Chuck Nice?

  So I know there were some studies done back in the nineties.

• 12:14Heather Berlin?

  Mm hmm.

• 12:15Chuck Nice?

  About, um,

• 12:19Chuck Nice?

  young children, how they perceive themselves and their abilities.

• 12:23Heather Berlin?

  Mm hmm. Yeah.

• 12:25Chuck Nice?

  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 10 year olds. The five and six year olds were like, I'm great. I'm good at this.

• 12:41Heather Berlin?

  Right.

• 12:42Chuck Nice?

  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, or. They thought they were great at other things. So it's 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 the thing that that that was glaringly different was sports competition.

• 13:07Heather Berlin?

  Right.

• 13:08Chuck Nice?

  Is is this, I 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 I 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.

• 13:28Heather Berlin?

  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 in your ability, and then it becomes a snowfall, the 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.

• 14:11Heather Berlin?

  There's actually studies that show that in societies that have um the most fluid gender roles, where they don't sort of, you know, 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. You know, 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 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.

• 14:51Chuck Nice?

  Well, how about gender segregation? We separate boys and girls. All the time from the time they're very little.

• 14:59Heather Berlin?

  Yeah.

• 14:59Chuck Nice?

  Um, 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.

• 15:19Heather Berlin?

  Right.

• 15:19Chuck Nice?

  Wanna 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?

• 15:35Heather Berlin?

  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, and there can be some discrepancies there, when especially if you're talking about contact sports, right? Um, but I remember when I was in graduate school, I wanted to play soccer. I mean, I was 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 wanna 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.

• 16:20Heather Berlin?

  So there could be problems. I think when they're young, of course, why not, you know, start out, have coed 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.

• 16:34Chuck Nice?

  Well, you know, and honestly, that's what happens with young boys too. I mean, I remember playing football and going uh, away for one summer from school. And then coming back and it seemed like over that summer. The team got five times the size.

• 16:52Heather Berlin?

  Right.

• 16:53Chuck Nice?

  And that was the end of my football.

• 16:55Heather Berlin?

  Actually.

• 16:56Chuck Nice?

  Because little skinny eh, I'm sorry, little skinny spindly Chuck could not play with these guys that somehow sprouted up. And they were now like a hundred and ninety, two twenty, you know, and I'm still like.

• 17:10Heather Berlin?

  I'll tell you this, you know what it is.

• 17:11Chuck Nice?

  Carrying a brick.

• 17:12Heather Berlin?

  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 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.

• 17:29Chuck Nice?

  Like wrestling.

• 17:30Heather Berlin?

  Right, right. And so it won't matter what the gender is.

• 17:33Gary O'Reilly?

  You've got weight categories in events like that. For me, I quite simply, are you, one simple question, are you good enough?

• 17:40Heather Berlin?

  Right.

• 17:41Gary O'Reilly?

  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 just see how competitive every female athlete is. So you, there's, there's a whole load of things, this, we've talked about things already and there's basically no difference. You've said to me, you could look at a brain, two, two brains, one male, one female, you wouldn't know. If you came to that blind and you looked at it, I couldn't tell you on a screen, which it is, there seems to be very little.

• 18:24Gary O'Reilly?

  The only thing that will change is the physicality.

• 18:27Heather Berlin?

  Physicality.

• 18:27Gary O'Reilly?

  And if you're mismatching on a physi, I mean, if you go into a boxing ring and there's one guy two hundred and fifty pounds and six foot five and you're five foot ten and a hundred and thirty.

• 18:37Chuck Nice?

  That's no longer a boxing match.

• 18:39Gary O'Reilly?

  That's it. So they don't, they don't, they don't do that.

• 18:42Heather Berlin?

  So perhaps you should match people up based on skill and maybe weight categories and size categories, but not based on gender.

• 18:49Chuck Nice?

  Right. And I think that some of, when you think about it, some of it has to be just cultural and societal bias. Because there's no reason I.

• 19:02Chuck Nice?

  A kicker, even in the NFL,

• 19:04Heather Berlin?

  Mm-hmm.

• 19:05Chuck Nice?

  Couldn't be a female.

• 19:06Heather Berlin?

  Absolutely.

• 19:06Chuck Nice?

  There's no reason.

• 19:07Heather Berlin?

  I, I fully agree. I fully agree. And I think that that's why, you know, I think, but look, for instance, I don't want to play football, you know, that's not something I would choose to do, right? Um, 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...

• 19:30Gary O'Reilly?

  The question that keeps popping up into my head in the last minute is, is society ready for that?

• 19:38Heather Berlin?

  That's another question.

• 19:39Chuck Nice?

  That's a whole nother show.

• 19:41Heather Berlin?

  That's another, yeah.

• 19:43Gary O'Reilly?

  But that's, I mean, I think we all, everyone sat here is thinking pretty much the same thing.

• 19:48Heather Berlin?

  Mm-hmm. 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, 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.

• 20:13Gary O'Reilly?

  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?

• 20:21Heather Berlin?

  Ah, 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.

• 20:53Gary O'Reilly?

  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 Dr. Heather Belling, thank you so much for your contribution to this particular show.

• 21:05Chuck Nice?

  Yeah, you weren't bad for a woman.

• 21:06Heather Berlin?

  I exactly was going to say, I took on two men, took on two men and it's lead it.

• 21:12Gary O'Reilly?

  When we come back, the science of gender and sex and its role in athletics. Stick around, we'll be right back.

• 21:24Gary O'Reilly?

  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 variant 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,

• 22:09Gary O'Reilly?

  and how this all unfolds, if you could base that for my platform to work from, please.

• 22:15Speaker 03

  Both sex, the biology of the male female divide, and gender, the sociology of the male female divide are complex. 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. So, you know, some people might possibly have external genitalia of one sex and internal genitalia assorted with the

• 22:53Speaker 03

  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.

• 23:20Speaker 03

  In particular with sports, I I like to think of gender assigned at birth, social gender, legal gender, and and a concept that I like to call athletic gender. Others have used terms like sports sex, but but we're talking about the same thing, gender for the purpose of sport. And and so so these things are complex, but I think we can narrow this down in terms of sports.

• 23:45Gary O'Reilly?

  You did warn us it was complex. You you have advised the IOC, the International Olympic Committee, on guidelines regarding sex reassignment and hyperandrogynism. 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?

• 24:14Speaker 03

  In the 2016 and 2018 Olympics, there there was no testing. Anyone 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.

• 24:30Gary O'Reilly?

  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, do they have the same rules, or are they all varied?

• 24:50Speaker 03

  They all vary. The certainly, the IAAF and and the IOC coordinate, but 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 have come to center around the idea that hormones are are the most important aspect for determining who gets to compete in in the male or female categories.

• 25:25Chuck Nice?

  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?

• 25:41Speaker 03

  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 concern themselves with transgender. The IAAF and the IOC both have to consider intersex and transgender, and they have separate policies for each of these.

• 26:20Speaker 03

  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. They have a new DSD regulations 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.

• 27:05Speaker 03

  But I think the NCAA is high enough, a level of sport, that they should probably be fairly close.

• 27:13Chuck Nice?

  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?

• 27:39Speaker 03

  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.

• 28:04Chuck Nice?

  Hermaphrodites, right.

• 28:05Speaker 03

  Um, so, so many people might be more familiar with that. And, and intersex people, their conditions are called DSDs or Differences of Sexual Development. Uh, so I use the term intersex and DSD, uh, in- interchangeably, uh, but, um, but many people might be more familiar with hermaphrodite.

• 28:27Chuck Nice?

  And so when, when we're talking about, let's kind of transition because, uh, to transgender. And you wrote an article, uh, let me get the, the title right, cause 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, the, uh, 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, I read the article, that's not what you're saying at all.

• 29:12Chuck Nice?

  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?

• 29:20Speaker 03

  Absolutely. First of all, organizations like the Washington Post have people who write titles for them.

• 29:26Chuck Nice?

  Yes, yes.

• 29:27Speaker 03

  And you, I'm sure you know that. So I wrote the article, somebody else wrote the headline.

• 29:32Chuck Nice?

  And, 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.

• 29:57Speaker 03

  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, and many people say that trans women have advantages over normal women or cisgender women. And, and that's actually true. Um, 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. Um, however, transgender women also have a large frame that they're now trying to power with reduced muscle mass and reduced aerobic capacity.

• 30:42Speaker 03

  So, 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.

• 31:04Gary O'Reilly?

  It's interesting. Well put, well put. 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?

• 31:30Speaker 03

  Muscle mass still helps transgender athletes. And as a trans woman, I carry more muscle mass than cisgender women. And, and so that helps, but, but certainly the fact that, um, you know, I mean, I'm not a huge person, but by female distance runner standards, I'm, I'm, you know, bigger, bigger than average. And so, you know, that is a disadvantage. And, 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, um, male distance runners and female distance runners. So I had lost that advantage, uh, over 12 months, or over nine months, rather.

• 32:12Speaker 03

  And, and then I started finding other transgender distance runners, and the same thing had happened to them. And, and that made the basis of my study. But, 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 bespeaks 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. So there's been a little shift.

• 32:57Gary O'Reilly?

  It's interesting. So now you talk 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?

• 33:13Speaker 03

  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.

• 33:39Chuck Nice?

  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 then that require both hand-eye coordination, skill sets, and strength, that you really, I mean, 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-eye. 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

• 34:19Chuck Nice?

  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?

• 34:40Speaker 03

  Well, you know, you're not likely to see a biological female in the NBA.

• 34:46Speaker 03

  You know, so, so, so there is, is certainly something to the male, female divide. But, but if you're looking at, at transgender women, on, on average, they're four or five inches taller, which, which is certainly an advantage.

• 34:59Chuck Nice?

  That's an advantage.

• 35:00Speaker 03

  But I would say that, uh, that transgender women, and it's really hard to quantify this, but I, I am certain that transgender women are quickness disadvantaged with respect to other women. And, and, and so, does, does this balance out? Well, you know, there are no transgender women in the WNBA, so it's hard to say for sure. But, but I, I don't think, even in basketball, that, that trans women are so advantaged as, as to make, uh, competition unreasonable.

• 35:31Chuck Nice?

  And, and that's, 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, 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, uh, empirical representation of true advantage. But I, I'm going on record as saying, "That is an opinion." So, so, I can't, you know, that's my opinion, okay.

• 36:03Speaker 03

  And, and you, you know, you're right, there are a lot of people who, who still think of transgender people being really the, the sex they were assigned at birth, or the gender they were assigned at birth. And, 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, and so, they, 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.

• 36:43Chuck Nice?

  Yeah, and you know, that's a wonderful thing you just said there, exactly. Nobody's going through all of this to, uh, truly, uh, acknowledge their real identity just so that I can win a medal, or a trophy.

• 36:59Chuck Nice?

  I'm sorry, but I'm with you on that one.

• 37:01Gary O'Reilly?

  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?

• 37:17Speaker 03

  Um, you know, I, I don't want to label people to, but, um, you know, I, I think if, if people have a chance to compete closely with and against transgender athletes, you know, this sort of fear will go away. And, 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, and, and so, um, you know, we're, we're athletes like anyone else.

• 37:56Chuck Nice?

  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?

• 38:14Speaker 03

  You know, the, the primary job of sports governing bodies is to govern sports.

• 38:20Chuck Nice?

  Okay.

• 38:20Speaker 03

  And, and, you know, inclusion is, is not their primary goal, but,

• 38:26Chuck Nice?

  Okay.

• 38:26Speaker 03

  but, you know, yes, they, 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, and so are there things they can do? Yes. And, um, you know, the, the NCAA has, has certainly made an effort. Um, the international governing bodies, the IWA, and the IOC. They're working on it. They, they, you know, they've got a ways to go, but um they have both an intersex athlete and a transgender athlete among 12 worldwide experts that help

• 39:11Speaker 03

  advise them on this. And that's pretty good representation right there. And, and we're working on things.

• 39:18Chuck Nice?

  That's good. That's good to know. And, and you know, you, you have such a very, I will say, measured and level-headed approach to this whole thing. You know, I'm, 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 it's because I've never been a real athlete, you know what I mean? Aside from playing some intermural sports in school, I, I, you know, I, 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

• 39:59Chuck Nice?

  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.

• 40:08Gary O'Reilly?

  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, the right path forward. We have currently, Kaisa Semenya, who I believe, and correct me if I'm wrong, is considered to be hyperandrogynist. Can you explain that to me so as I don't tread all over it and make the mistake of thinking?

• 40:32Speaker 03

  It's a handful of a word, first of all, but.

• 40:36Gary O'Reilly?

  So for me, it is.

• 40:37Speaker 03

  Yes, it, it means someone with naturally high levels of androgynous hormones and testosterone is, is the most common androgen that we know of. So um, the thing, and if you look at the new IOC or the IAF 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, there are things like polycystic ovary syndrome that can cause a hyperandrogenism in females, not, not as high level as, as having testes. But um.

• 41:24Speaker 03

  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.

• 42:09Speaker 03

  And, and, and this is, is the, 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?

• 42:21Chuck Nice?

  Here's what I want to know about that, though. When you talk about, I'm not with 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. With, I, I point with, without any compunction to LeBron James. You look at LeBron James on a 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."

• 43:05Chuck Nice?

  Nobody says that, because they know what, how, what kind of work goes in to get in there. So why is it that we focus only on females with this? I mean, I don't, I'm, 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?

• 43:23Speaker 03

  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, 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, et cetera, et cetera.

• 44:06Speaker 03

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

• 44:39Chuck Nice?

  So let's, 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 is, are there any ideas? Are there any, um, um, efforts? What would be the prescription that you feel might help this problem along?

• 45:00Speaker 03

  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. Um, 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. Um, uh, 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.

• 45:43Speaker 03

  And I think we can learn a lot, and I think we can come up with better biomarkers in the future.

• 45:48Gary O'Reilly?

  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 meters, the 800 meters and the 1500 meters, which happens surprisingly enough to be Castor Semenya's particular chosen field of track events. How has the world reacted to that?

• 46:30Speaker 03

  Well, many people have been reacted very negatively. Um, you know, um, those events were chosen not because they're Castor Semenya's events, but because those are, uh, A, events which 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, uh, have shown, uh, that intersex women have a huge advantage. Um, I have a paper that's just been accepted for publication and there's like 15 co-authors.

• 47:14Speaker 03

  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 Castor Semenya.

• 47:34Gary O'Reilly?

  No, thank you for pointing that out. Very good. Is the IAAF action? The best way forward or is there a glaringly obvious other path that can be taken?

• 47:48Speaker 03

  Um, I'm not certain it's the right way forward. I'm not certain it isn't. Castor Semenya is, it appears is going to challenge those rules in the Court of Arbitration for Sport and we will see what we will see.

• 48:06Chuck Nice?

  Absolutely, we will. Oh my God, this is fascinating stuff, but we are out of, out of time unfortunately and hopefully maybe we can just revisit this as a kind of like a, a, a, a epilogue so we can, after, after the trial and all the hearings and other, maybe we'll be able to get you back on and just kind of revisit this if you don't mind.

• 48:27Speaker 03

  No, no, I would be happy to do so after the trial.

• 48:30Gary O'Reilly?

  That's very generous of, because this is a, 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.

• 48:50Speaker 03

  You're welcome. They're not simple at all.

• 48:52Gary O'Reilly?

  You're very generous, as I said. Thank you. All right, Chuck. Every day's a school day, my friend.

• 49:00Chuck Nice?

  Yes, it is. And I'm glad today I actually paid attention in class.

• 49:04Gary O'Reilly?

  I think we all are and we'll look forward to your company on the other side.