When a whole lot of “unnatural” technology is permissible, what justifies the rules that say that a baseball slugger cannot use synthetic testosterone to improve his swing?

Sex, drugs and prosthetic legs. Who would have thought they could have so much in common? Yet all three are posing ever more challenges to sports officials, and all have at their root the same conundrum: What is sport really about?

Restrictions on testosterone, on prosthetic limbs and on men competing in women’s sports are meant to protect athletes from unfair advantages.

Some may say they protect against unnatural advantage. The idea is that, at its essence, sport is about one human competing against another to see who is naturally the strongest, the fastest, the most skilled.

But athletes left the realm of the natural a long time ago. Running barefoot may be a growing fad, but no one expects all athletes to go without high-tech footwear. No one even expects them to all use the same type. And forget about telling teams they can’t use NASA-quality machinery and dietetics during training. FINA, which oversees international swimming competitions, recently banned swimsuits that aid “speed, buoyancy or endurance.” This shows that some technologies are seen as going too far. But why ban innovative swimsuits and not innovative goggles?

Put another way, when a whole lot of “unnatural” technology is permissible, what justifies the rules that say that a baseball slugger cannot use synthetic testosterone to improve his swing? If the logic is that the technology must at least stop where it meets the athlete’s skin, why is Tiger Woods allowed to use Lasik eye surgery? What makes vitamins, vaccines and protein shakes fair game? In the case of testosterone injections, some have argued that the issue is safety. Fair enough; steroid use can be dangerous. But surely sport is not fundamentally about the safety of athletes. If it were, we’d probably have to ban professional football, right after boxing.

The safety argument against steroids may be a good one, but let’s be honest. It isn’t the one that motivates most officials and fans to frown on steroids. Steroid use does not just seem risky or unnatural, it seems to disrupt the level playing field.

So let’s consider the possibility that the level playing field is at the heart of sport. That is why some people think the South African sprinter Oscar Pistorius should not be allowed to compete on his prosthetic legs in the Olympics. They argue that the prosthetics’ springiness confers on Pistorius an unfair advantage.

Caster Semenya, the South African 800-metre world champion whose sex is in question, faces similar opposition. Perhaps her biology is just too male to entitle her to compete on the women’s playing field. Specifically, maybe she makes too many androgens, those “masculinising” hormones.

But the medical commission of the IAAF, the world governing body for track and field, knows that women naturally vary substantially in their androgen levels. In fact, IAAF policy allows a woman with adrenal tumours — who may make more androgens than the average man — to compete as a woman. When asked to explain its reasoning, the IAAF did not respond.

The IAAF even allows a woman with testicles to compete, as long as she doesn’t have too many cellular receptors for the testosterone she makes. Her androgen insensitivity means she will receive the benefits of only some of her testosterone. How many receptors are too many? Again, the IAAF won’t say.

Meanwhile, the World Anti-Doping Agency confirmed that it allowed waivers, known as therapeutic-use exemptions, for men who successfully argued that they did not make enough testosterone naturally to stay healthy. Exemptions have been granted to men born with XXY chromosomes, a disorder called Klinefelter syndrome, in which the testes make lower-than-average levels of testosterone. Any male athlete who successfully argues that he doesn’t make “enough” testosterone can take more, even though the medical benefits of raising testosterone to average levels from “low” are questionable. (Being low on testosterone does not pose anywhere near the danger of serious asthma, for which athletes can obtain waivers to take performance-boosting medicines.)

In the end, the fundamental problem isn’t with any individual policies on sex, drugs and prosthetics — although the policies do sometimes seem capricious. The fundamental problem is that the science of sport has outpaced the philosophy of sport.

Science now makes it possible to know far more about who really has what inside, and so we’re faced with ever more questions about what’s fair. The athlete with Klinefelter syndrome can now prove a chromosomal disadvantage and get his exemption for testosterone injections. The woman who feels cheated can urge officials to scrutinise her competitors’ cellular makeup for signs of maleness.

On top of that, science has made it possible for us to change our bodies in radical ways. Apollo is no longer a god, he’s every third guy at the gym. Pistorius, born without fibulas, is no longer just disabled, he’s a super runner, too. And yet our philosophy of sport has remained largely static, based on vague principles like “level playing fields” and “natural” advantages. How can such old-fashioned, romantic ideals stand up to today’s realities? Sports officials certainly need to tap expert scientists to come up with a clear rulebook for sex verification and a more rational policy on waivers for testosterone. But what we will need first is for sports leaders to come to some consensus on this question: What is sport really about? — © 2009 The New York Times News Service

( Alice Dreger is a professor of clinical medical humanities and bioethics at Northwestern. She is writing a book on science and identity politics.)

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