Steroids, ‘Gender,’ and Fair Play

Anabolic Steroids, Gender, and Fair Play

It seems that we’re still struggling with the issue of how best to accommodate, include, and be fair to all athletes whether male, female, or transgender. The issue is especially fraught in the case of trans female athletes competing against natal women. While some see this debate as centering around gender identity and inclusion, others believe it’s strictly about fair play. However, I don’t see these positions as mutually exclusive.

One reason that the controversy remains ongoing (and seemingly insoluble) is that the two key issues —  gender identity and fair play — have not been convincingly untangled. Separating the two would allow for a more reasoned discussion of both. Doing so, however, requires an understanding of some basic facts about biology and the history of athletics (which is often omitted from the conversation). The biology part has to do with the effects of anabolic steroid hormones on the human body. The history part has to do with the introduction of synthetic anabolic steroids into competitive athletics, especially women’s athletics.

Anabolic steroids are naturally occurring, androgenic hormones such as the male sex hormone, testosterone and its more potent metabolic derivative, dihydrotestosterone (DHT). These hormones are produced naturally by both sexes but at much higher quantities in males. Hence, the obvious (average) physical differences between mature males and females. However, what’s often ignored is the fact that the effects of anabolic steroids actually begin months before birth.

Prior to the seventh week of embryonic development, the human fetus has what are called “bi-potential” tissues. That means there are both internal and external embryonic structures that can develop into the typical female (if it has only X chromosomes), or the typical male body type (if it has a Y chromosome). Without a Y chromosome and its protein-coding SRY gene, the embryo will develop as a female. However, under the influence of a hormone cascade elicited by the SRY gene, the embryo undergoes “defeminization” and “masculinization.” In embryology, these terms refer (among other things) to the regression of anatomical structures that would have developed into the ovaries, fallopian tubes, and uterus, and the development of structures that will become the internal and external male reproductive glands (the epididymis, vas deferens, seminal vesicles, prostate, and bulbourethral glands, and testes). In turn, testosterone produced by the testes and its derivative, DHT play an essential role in the development of both primary and secondary male sexual characteristics, and embryonic and postnatal brain development.

There are two important points here: First, masculinization (in the biological sense) begins prior to birth by changing the structural characteristics of the fetus. The second is that anabolic steroids have the same masculinizing effects whether they occur naturally (if you have a Y chromosome), or are administered (by pill or injection), irrespective of what chromosomes you have. The implication is that every natal male has been under the strong developmental influence of anabolic steroids prior to birth, and will be again when testosterone levels begin to rise at approximately 10 years old. These effects cannot be reversed.

Anabolic steroids were synthesized in the 1930s, and are now used therapeutically to treat a variety of medical conditions including chronic wasting diseases such as cancer and AIDS. However, because anabolics increase muscle mass, shorten recovery time from exercise, and augment exercise-induced gains in strength, and because they have similar effects irrespective of your natal sex or self-identified gender, they can be used to enhance athletic performance.

The key historical event pertinent to this discussion is the doping scandal surrounding the 1976 Montréal Summer Olympics. Tragically, East German women athletes (most notably, swimmers) had been the unwitting victims of a systematic government-sponsored regime of anabolic steroid administration by their coaches and trainers. Girls as young as 11 years old were started on the steroid regimen without parental knowledge.

The steroids masculinized the women athletes just as they would have young men. This included dramatically enhancing their athletic ability. The women were stronger, faster, bigger, and much more muscular than the other women athletes, and they easily dominated their competitors. This was devastating for their competitors, and universally condemned as both unethical and grossly unfair.

There are two critical lessons to be learned from this unfortunate series of events. First, the Olympic athletes victimized by the surreptitious steroid program were women. The more serious ethical issues aside, it is clear that we can both recognize an athlete as a “woman” and recognize the fact that her body is sufficiently different from other women’s bodies that competition between them is unfair. This has nothing to do with gender identity, and it has nothing to do with denying or affirming someone’s womanhood (however one defines it). It has to do with the effects of anabolic steroids on human bodies. The second lesson is that the anabolic steroids, per se, did not change any athlete’s gender identity. In later interviews, the East German swimmers still identified as female athletes.

Conversely, men who undergo anabolic steroid suppression as a therapy for prostate cancer do not come to identify as women despite the fact that their testosterone is suppressed to one fifth the level allowed for trans-women athletes. Again, changing the amount of anabolic steroids someone has in their body does not determine their gender identity.

So, it seems well established that anabolic steroids can confer an unfair competitive advantage under several circumstances. The first is when an athlete who has been shaped by naturally occurring anabolics competes against someone who has never had that advantage, such as MMA transgender fighter Alana McLaughlin fighting natal women. Interestingly, an analogous situation could occur between two genetically male athletes if one had the rare condition, androgen insensitivity syndrome. In this syndrome, a person is genetically male (has a Y chromosome), but is insensitive to the masculinizing effects of hormones such as testosterone due to impaired steroid receptors on their cells. The affected athlete would not have the typical male physical characteristics of their opponent despite them both having a Y chromosome. Competition between the two athletes would also be unfair. The third unfair circumstance is when an athlete of either sex artificially increases their steroid levels above that of their peer competitors, for instance, Lance Armstrong (male), or Marion Jones (female).

Under all three of these circumstances, the gender identity of the athletes and the route of steroid administration make absolutely no difference. If the athlete has been enhanced by anabolic steroids, he or she has an unfair advantage over athletes whose bodies have not been so enhanced.

Further, as evidenced by the 1976 East German women swimmers, men who have undergone therapeutic testosterone suppression, athletes who cycle anabolic steroid use to avoid detection, and the enhanced performance of trans women athletes, the effects of anabolic steroids do not completely disappear even when hormone levels are reduced.

As a Biology Professor and former competitive weightlifter, three things seem clear to me. First, anabolic steroids matter irrespective of the time or origin of occurrence. They irrevocably change body structure and physiology whether they‘re produced naturally or administered, and, in the former case, those changes begin before birth. Second, athletes who have steroid-induced structural and physiological advantages over natal women athletes (whether naturally occurring or through drug administration) should compete in a separate division, not directly against women who are not steroid enhanced. This is simply a matter of fair play: Both a 220-pound woman and a 105-pound woman weightlifter are women, but they compete in different weight classes. That’s just fair. Likewise, a woman who is competing in the women’s division of a drug-tested weightlifting competition is explicitly choosing to compete against other women who have not been enhanced by anabolic steroids (either naturally or by administration). If she chooses to compete in the men’s division, or in an open women’s competition that does not drug test, she knows that she will be competing against athletes who have been enhanced by steroids. The important point is that — unlike the women in the 1976 Olympics — she is free to make the choice about whom she competes against.

Athletic divisions based on physical structure or physiology are not new, and they have nothing to do with gender identification, per se. These are two completely separate issues. Athletics can — and should — respect and include all varieties of people while still expecting them to compete fairly. For instance, any sport could easily designate a “Female Division” (natal females), and an “Open Women’s Division” (anyone identifying as a woman). Under these circumstances, everyone would still compete together, but winners would be designated within divisions. This is analogous to the “Novice,” “Open,” and “Masters” divisions used in weightlifting. Within a particular weight class, there could be several first-place winners (a novice, a veteran, and an older athlete). Everyone is included but competition is fair. Tennis has long solved this problem for teams by designating double versus mixed double categories.

The stubborn truth is that we’ve had a solution to this ongoing debate for decades, at least. It really has nothing to do with an athlete’s unique identity, gender or otherwise. It only has to do with the athlete’s physical attributes. Everyone should be valued, respected, and included. However, an essential tenet of athletics is fair competition. If we lose sight of that, we’ve lost the meaning of athletics.

This essay originally appeared as a guest post in Colin Wright’s Substack, Reality’s Last Stand on 18 June 2022. It was updated here on 20 May 2023.