To Solve a Problem you Must Understand it: The Doping Issue

This article is going to discuss some of the other themes involving doping. Doping is a hot topic at the minute with 17 positive tests coming out of the World Weightlifting Championships and NFL players using HGH (Human Growth Hormone) to enhance their performance. Look at the Sport of MMA it is rife with drug use but has been clamping down on it due to pressure from sponsors and other external parties. Now we are seeing less dramatic weight cuts from the athletes. Some questions are being asked if it is so prominent in most sports then why don't we stop the testing for PED's (Performance Enhancement Drugs) and test for their health?

TEST FOR HEALTH, NOT DRUGS (Taken from the Journal of BiSportMed, "Why we Should allow Performance Enhancing Drugs in sport").

"The welfare of the athlete must be our primary concern. If a drug does not expose an athlete to excessive risk, we should allow it even if it enhances performance. We have two choices: to vainly try to turn the clock back, or to rethink who we are and what sport is, and to make a new 21st century Olympics. Not a super-Olympics but a more human Olympics. Our crusade against drugs in sport has failed. Rather than fearing drugs in sport, we should embrace them. In 1998, the president of the International Olympic Committee, Juan Antonio Samaranch, suggested that athletes be allowed to use non-harmful performance enhancing drugs. This view makes sense only if, by not using drugs, we are assured that athletes are not being harmed.

Performance enhancement is not against the spirit of sport; it is the spirit of sport. To choose to be better is to be human. Athletes should be the given this choice. Their welfare should be paramount. But taking drugs is not necessarily cheating. The legalisation of drugs in sport may be fairer and safer".

Full journal linked in references section.

Quite the curve ball and gives a different train of thought on this sensitive topic. Myself as a keen sports scientist at university I enjoy these sort of debates as it shows many sides to a discussion. We have one camp that is pro use PED's, another totally against PED's and finally, a group who want to use PED's but have it regulated.

For those who need some more background on the areas of PED's please articles I have done below.

Physiological effects of using PED's: http://strengthtrainingforyou.blogspot.co.uk/2015/06/the-physiological-effect-of-using-peds.html

Psychological effects of using PED's: http://strengthtrainingforyou.blogspot.co.uk/2015/04/psychological-effects-of-peds-anabolic.html

Now I am not pro nor against PED's from a science standpoint. I find it an interesting subject to discuss. However in terms of me competing I would be against the use of them as it is seen as an unfair advantage (statistically those on PED's would be 5% better than me). I am a member of the UKAD (United Kingdom Anti Doping) as an accredited coach where I help to promote anti-doping and their 100% me campaign in competitive sports.

Here is some basic info on the area. All AAS (Anabolic Steroids) are derivatives of Testosterone and are divided into 3 categories;

Anabolic: muscle growth, bone, red blood cell production.

Androgenic: masculariszation, libido and fertility

Estrogenic: anabolic, metabolic effects

Some of the known side effects of using AAS;

Cardiovascular
- Cholesterol (reduced HDL/LDL ratio)
- Ventricular Hypertrophy
- Increased blood pressure
- Increased prothombion time

Reproductive
- Infertility
- Sexual Dysfunction
- Testicular Atrophy/Hypogonadism (men)
- Menstrual Irregularities (women)

Liver Toxicity
- Liver dysfunction
- Liver Cancer

Cosmetic
- Acne
- Hair Loss
- Gynecomastia
- Water or fat retention

Psychological
- Depression
- Aggression

Virilization (women)
- Body hair (facial hair) growth
- Clitoral enlargement
- Vocal Change

Not supported side effects of AAS
- "Roid Rage"
- Suicide
- other cancers

Then came the "word on the street" that AAS helped increase muscle size and strength which then filtered into all sports. This led to hospitals being flooded with toxicity cases, sporting events being banned, AAS becoming a prohibited substance. Then came what we all know, doping scandals, the media fixation on this issue and public speculation who is on what etc.

As many of you have watched "Bigger Stronger Faster" there is a section in it how many departments opposed the banning of all steroids as criminal acts.

See film: https://www.youtube.com/watch?v=O77cVVOFqbE

Drug Enforcement Agency
American Medical Association
Department of Health and Human Services
Various Experts

All opposed the criminalization of steroids, for the reason there is a huge medical benefit to having them;

AAS are acutely safe drugs

- no overdose
- no physical addiction
- non-toxic primarily
- Exceedingly rare to have a life threatening reaction
- Most short term side effects are short term or cosmetic

Health risks associated with long term AAS Abuse;
- Increased risk of CVD (cardiovascular disease)/ heart attack/stroke
- Hypogonadism

To date there has been 24 documented cases involving AAS from 1992-2012

This was taken from the Department of Forensic Medicine (DOFM)
All men, mean age was early 30's

- Accidental Drug Toxicity 54.2% (13)
- Combined accidental drug toxicity/CVD 8.3% (2)
- Suicide 16.7% (4)
- Homicide 12.5% (3)
- Accident 4.2% (1)
- Undetermined 4.2% (1)

This was from the Journal of Forensic Science (2014)

Looking at the Australian AAS Death Report

Only one case of death solely has had AAS on it own.

- Opioid's 37.5% (9)
- Psycho-stimulants 66.7% (16)
- Benzodiazepines 45.8% (11)

Steroid deaths = Other Drugs are involved

Cardiac pathology was detected in 47.8% of all cases

Reason for some of these deaths can be put too poor AAS quality or contamination issues;

One study (Hartfourd Courant "Poison in a Package" November 2005) looked at 12 samples of AAS off 3 internet dealers. None of the samples matched the label, overdosed, under-dosed, substituted ingredients. Containments included;

- Tin
- Arsenic
- Lead
- Prednisone (corticosteroid)
- Betamethasone (corticosteroid)
- Furfural (industrial processing)
- Benzyl Chloride (alkylating agent, precursor chemical)
- Diethylstilbestrol (synthetic estrogen)

Another study (Underground Anabolic's 2005), 24 samples sent in to be tested;

- 6 samples (25%) contained bacteria
- Food preservatives
- Paraffin
- Fatty Acids
- Amines & Carboline

Again in Australia one case looked at a 35 year old body-builder carrying assortment of supplements, steroids, other drugs, two unlabelled vials admitted to the hospital.

- symptoms of liver dysfunction
- Progressed to signs of heavy metal poisoning
- he was over 33x the safe limit of arsenic. Patient died soon after

Analysis of vials found in unlabelled bottle with very high levels of arsenic with no presence of AAS (This was from the Journal of Clinical Endocrinol Metab. 2013)

To prevent unnecessary deaths and correct regulation of AAS/clean competition the following needs to be done;

Making things Safer by William Llewellyn (video in link)

1/ Quantify the risk of AAS

- Researchers and clinicians need to work together to collect and analyse the data
- Short term risks
- Long term risks
- Athletes V Recreational use

2/ Quantify Black Market Risk

- Heavy Metals
- Other substance contamination
- Bacterial/microbial contamination
- Dosage/Drug mislabelling

3/ Evaluate New Equipment

- Better and more reliable testing measures
- Syringe Filters
- Sterile Vials

4/ Address Abuse V Self Medication

- Many men 35+ suffer from hypogonadism (low testosterone)
- Clinical Symptoms: loss of libido, reduced energy, loss of muscle mass, increased adiposivity, osteoporosis and depression
- HRT shows consistent improvements in CVD, diabetes, metabolic syndrome and cancer risk
- Some needle exchange users should be referred for medical treatment

5/ Allocation of Resources

- AAS user should not take away resources from narcotic interventions
- AAS = seperate issue = new resources

6/ Staffing: Hire former athletes whom have used to educate those not to/advise on the side effects if they decide to do

- Connect with current users; better acceptance of drug-related advice

7/ Re-think Policies

- Ease restriction on imports
- Recovery Agenda
- Allow for personal use. Never criminalise the use of it (in terms of recreational use)
- Allow Dr's to recommend and monitor patients

Reason for using AAS (pre sport use) was the following; 

- Osteoporosis
- Anaemia
- Tissue Healing/Injuries and Burns
- Anti-Wasting
- Breast Cancer

Types of AAS pre 1960's;

Injection Methods
- Testosterone Esters
- Nandrolone Esters
- Methenolone
- Boldenone
- Trenbolone

Oral Methods;
- Methandrostestosterone
- Oxymetholone
- Oxandrolone
- Stanozolol
- Mesterolone

Regardless what they are on as an effect of "x%" improvement they will probably get more out of it from thinking it will work as a placebo effect. If you want to read more about placebo effects see the article I have written here: http://strengthtrainingforyou.blogspot.co.uk/2015/08/lying-to-make-athletes-stronger-placebo.html

Many athletes have dodged tests in recent years thanks to the cheater's being ahead of the testers. One famous example was Victor Conte. 



He was the main target of the Balco labs case, Sent to prison for it (short sentence less than 6 months) for giving athletes PED's. Famous athletes Marion Jones (athletics), Garry Sheffiled (Baseball), Barry Bonds (Baseball), Chris Cooper (NFL), Barrett Robins (NFL), Jason Jarnby (NFL). He was famous for marketing the "clear" steroid now known as Narbolothone (developed in 1960's). It wasnt brought to market due to liver issues. Victor bought a stock off the creator Patrick Arnold. He then studied it and made safer to take and less likely to be caught in testing procedures. 2 versions of the clear (1st the Narbolothone, the 2nd being a modified version of Narbolothone which was ahead of the testers). 

Victor describes the Olympics is a fraud. He says the "Anti-Doping rules are so easy to beat, its like taking candy from a baby". All his athletes he saw them on a level playing field as everyone they are against was using some form a PED. Looking at the Marion Jones case she never failed a single drug test (84 of them) between 1997-2001. Victor gave her a doping plan which had her taking 4 different PED's on different days of the week in a calendar. Each day would have either one of the following letters or a combo of them;


E = EPO
G = Growth Hormone
I = Insulin
C = Clear Steroid 

A major reason for doing all the doping was Victor knew first hand through a friend the IOC covered up a number of shot putters whom had tested positive. The IOC didn't do anything so figured they wont do anything about his work. 

Back to Marion, when she was caught she denied she had ever taken anything. Her husband Tim Montgomery, was using Balco labs to improve his performance. Him and Victor worked on "Project World Record" which the goal was to have the fastest 100m time in history. They achieved this breaking the world record to sub 9.78 seconds. Tim was known (jokingly) as "Tiny Tim" before working with Victor

After 8 weeks on the doping protocol using a calendar like Marion he put on 28 pounds of lean muscle mass. Victor saw the record as legitimate as he knew everyone else on the line-up was on drugs as well. As he said the Olympics is a fraud. 



Victor Conte on his guest appearance with Joe Rogan (video link at bottom of article) looked at different testosterone testing methods. 

One method used by the majority of nations assumes all testosterone is the same so when it tests people the number it is given must be below a certain value. To ensure you get the test lower is be tested in the evening, That's when test production is at it's lowest. Test production is highest in the morning (hence guys wake up with morning wood). This combined with a taper off with the drugs meant no one got caught.

Alot of athletes got away doing this until WADA (World Anti-Doping Agency) used another. This was using a carbon 2 isotope which could detect which sorts of testosterone was in athletes blood. To make it simpleit could detect synthetic from natural. Those athletes which had synthetic testosterone (without a TUE form) got suspended. Justin Gatlin being one of them.




He discussed how the IOC has a flawed testing system. If you miss your first test its one strike. Doesn't matter as long as you do the next test. If you repeatedly miss the first test every year you will be watched like a hawk. People make themselves unavailable for the first tests (as they are on PED's) so when it comes to the second required test they can do it as all the PED's have been flushed out.

A famous example of an athlete missing her first test was Serena Williams (story goes she rang the police from her panic room as the testers arrived unannounced hahaha) she got away with not having to do the test came back after a period of time and guess what was clean.

Now in today's era, with NFL players coming out using HGH as the testers have caught up.

2010 HGH made
2014 Test for HGH made available
2015 people being caught using HGH

In time people will always be caught but its those with the money and the knowledge that always stay ahead.

Baseball has been a sport known to masses to of used many PED's the reason for this was its poor Anti-Doping polices.

Before the Maguire and Bonds cases this was Baseball's Anti-Doping policy.

- 1 random drug per year Per team
- 5 strike rule if caught using something (so could do it 5 times before being punished)

Madness!!

Moving onto the history of drugs and AAS (Anabolic Steroids) development.

Timeline on Testosterone production;

1931- testosterone is synthesised 
1934- first steroid produced for hypogonadism

1935/1936 - Testosterone esters and Methyltestosterone
1940's - AAS common use in medicine
1950's - Research Decade

Here are some studies which have looked at Doping in competitive sports;

The information was obtained from IPF Magazine pages 48-54 Issue 10(2015) and NADA Germany, Prof. Dr. Dirk Clasing (Doping and list agents 2003), Wikipedia, WADA, Peter Konopka (Sports Nutrition, 2002).

1970’s: Study from the UDSSR

-          A secret document from the Soviet Union publicised in 2000, proves the existence of government-sponsored studies from the early 1970’s on the effects of anabolic steroids Dianabol and Retaboil/Decaburabolin) on various morphological, biomechanical and physiological variables of athletes and athletic performance in various sports. The athletic performance increased, regeneration was accelerated and appetite increased. A positive mood led to the desire to exercise more. There were also detailed recommendations for steroid use in various sports.

1984: Study from America

-          1984 NCAA (National Collegiate Athletic Association) together with the Human Medicine at the Michigan State University published a survey called “The Substance Use and Abuse Habits of College Student-Athletes”. 2039 sports people took part in the evaluation. Here are some of the results:

Use of in the past 12 months;

Amphetamines                                  8%     of respondents

                                                             61% took if for private or social reasons

                                                             37% took it to improve athletic performance

Anabolic Steroids                              9% American Football Players

                                                             4% Athletes, Tennis players, Basketball Players

Marijuana or Hashish                       36%

Cocaine                                               17%

Barbiturates or Tranquilizers          2%

                                                             28% took it due to injuries

                                                             8% took it to improve athletic performance

Greater consumption of Alcohol   37% (more than 3-5 drinks, 2-5 times a week.

1987: Study from America

-          The first study in the USA was conducted on the use of anabolic steroids. 6.6% of male high school visitors had experience with one or more of these agents. 38% had started taking it before the age of 16. Numerous other studies found that 4-12% of male high school visitors had an experience with anabolic steroids during their lifetime.

1988: Study from Italy

-          Survey done in 1988 on Italian athletes by the Italian Olympic Committee and the National Health Council regarding their doping knowledge and doping habits. 1015 athletes (690 male, 325 female) and 216 caregivers, doctors and managers were interviewed. 30% of athletes, coaches and managers and 21% of physicians said that performance could be improved by prohibited substances or practices. 27% of the athletes reported occasional use of amphetamines. 26% took anabolic steroids and 25% of autologous blood transfusions. The reasons for the abuse that was mentioned; 63% win in competition, 9% improve performance, 6% pain reduction and 6% prompted by trainer. The vast majority of athletes demanded strict doping controls not only in comp but also in training. 

1993/94: Study from Germany

-          In Hanover, Germany 1993/1994 a total of 97 students (53 girls, 44 Boys) between the ages of 15-19 and 19 teachers were asked about strategies to improve performance. On the subject of doping 57% knew of the prohibited substance groups. However, none of them had their own experience with drugs. Almost all students rejected the manipulation of physical performance by doping from a substance. Half of the young people had known such agents could be obtained if the need for such arose.

1994: Study from Switzerland

-          The doping laboratory in Lausanne conducted a student survey in 1994. As part of a health survey 5 500 students between the ages of 11-16 were surveyed regarding their opinion on the efficacy of drugs, their knowledge and the procedure to use of drugs, their knowledge and the procedure to use drugs. The most important message from this study was that they believed the efficacy of doping substances increases strongly from 13-14 years of age. Accurate knowledge about doping remained low however.

1998: Study from Germany

-          Recreational athletes from 24 North German fitness centres were asked drug abuse in 1998. 255 in total took part: 204 male, 51 female, 49 men and 4 women were classified as users. The male users (these were further evaluated) took one or more active ingredients such as methandrolstenolone, nandrolone, testosterone, oxandralon, stanozolol, methenolone, HCG, STH, cleanbuterol and others, and also cannabis, coacaine, ecstacy and amphetamines. The intake periods lasted about 7.5 weeks. The procurement was carried out on the black market. In the 15% of cases the anabolic steroids were prescribed by a doctor. The authors suggested that entry into drug abuse was likely after about 2 years of training if no more power progress was observed by the athlete.

1999: Study from Germany

-          In 1999 the Emnid Institute Bielefeld Germany, questioned 3085 sporty students. They were aged between, 14-18 on issues regarding doping. 91% were of the opinion that doping ruins sport. 74% felt that the penalties should be harder. 88% thought that professional athletes taking drugs under medical supervision should not be allowed 83% wanted trainers and doctors punished. The regular use of sedatives and sleeping pills was specified by 8% of 12 year olds and 12% of 17 year-olds, while the regular use of excitation and stimulants of 6% of 12 year old and 11% of 17 year olds. Girls were accessing medicines more often than boys. The drug consumption was related to the “stress of school”.

2001: Study from Switzerland

-          In 2 population surveys (1998 and 2001) 800 and 1 535 people were interviewed from all linguistic regions of Switzerland. The surveys found that 90% of the respondents felt that doping in sport is a very big or fairly big problem. 57% (1998) and 75% (2001) are for a general ban a doping. 34% (1998) and 19% (2001) are for delivery under medical supervision. 6% (1998) and 4% (2001) are for a release of doping. In general, the majority responded that control measures should be amplified especially prevention and that fair play among young people is encouraged, that there are more checks and that sportsmen testing positive should be punished.

Obviously doping occurred before the 1970’s but there isn’t any studies that go into depth on the use and effects of them.

I will end this article with a conversation one of my close friends gave on PED's:

"My debate would be kind of what I have always said really, which is that ...if you take away the testing you kind of open up the floodgates. The balance of health and performance is greatly distorted. People will become lab rats, so yes you will test for health but all that will do is highlight how medically messed everyone is now and that there is no CAP on PED's. But I totally get the argument too...like everyone takes drugs and its not really cheating if everyone takes them
but then that creates quadruple the pressure on natural people to endanger their health
and there's also a whole other level because then it becomes a case of 'some people may have unfair supply advantages''.

Having a good source will become the new cheating lol "that guy can get HGH in his country, I  cant...its not fair...'' blabla ''oh the top end athletes have more money for better drugs and higher dosages'' also could be deemed unfair and on a par with cheating so you still have all those moral conundrums so unfortunately although it seems somewhat futile...... you need those steroid sanctions and regulations in place.....to maintain the *balance in the force*

So yes people will cheat but it will be in moderation and everyone's kind of restricted to the same kinds of cycles and the same kinds of drugs in order to clear their systems for testing dates etc etc
We need to accept that at a top level drugs are often required to keep an athlete on the rails due to recovery and expectations etc but weirdly condemn it at the same time. The one thing I will say about PED's tho if you did open up the floodgates and allow it all it would eliminate or at least minimize what I deam a huge ''cheating'' factor which most people would scream at me for is, genetics.

Look, ok someone with good genetics, they didn't actively ask god for super powers over other people, but at the same time how is it any worse than someone enhancing themselves. They were gifted with abilities that they didn't have to work any harder than anyone else for (that's not to say they haven't worked for it of course). But its undeniable that you have people out there who diet and train the same, and have the same kinds of pain thresholds and more than often 1 guy will be miles ahead of another due to his genetics

My point being, life has always been unfair, cheating is the definition of unfair in many cases so yea open use of drugs puts people on a much more level playing field. As the margins between our super-physiological potentials are much smaller than our natural ones you have years of body-builders with different genetics who got to top level stuff to prove that. To have people like Tom Prince who were pretty ectomorph who were able to hold their own against naturally mesomorph guys like Ronnie Coleman and Jay Cutler due to drugs.

If you took them all off drugs you could bet your ass Jay and Ronnie would be bigger than him so what has PED's done...simply narrowed the gap. So its very hard to really come out with a moral answer we can prohibit them and keep people healthy or we can uncap them, create a fairer playing field but unwittingly create a race of mutants that our kids look up to and then that's a whole other debate in itself.

This issue will not stop it will go on forever. Next cheating method is gene doping (for gene doping see reference at the bottom) and myostatin inhibitors to take the athletes to the next levels.

Testing is getting better but so is the drug companies and the athletes are getting smarter. Unfortunately no one wants to see world records beaten by a few cm or 0.01 of a second. They want to see records smashed by freaks, majority of the public don't care. In fact they are more swayed to seeing drug cheats than clean athletes as it will be better entertainment to the viewer, the tv company and the sponsors. Everyone wins, more views, more money, more products sold and linked back to the freaks whom we call heroes and villains. Thank you PED's for making things morally complicated hahaha 

I hope you found the all the information above helpful in understanding the issue of Doping in sports. It is a very complex issue which requires a broad understanding to be able to give an opinion on it.

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Some good videos looking at the science of Doping (from a doctors perspective)


- William Llewellyn Anabolic Steroids (William Llewellyn presented at the Public Health and Enhancement Drugs Conference at Liverpool John Moores University Centre for Public Health)


- Balco Interviews https://www.youtube.com/watch?v=lKqAUm1Tjek 

Some good podcasts looking at the Doping side (from the athletes and coaches perspective)

- Joe Rogan # 737 Lance Armstrong https://www.youtube.com/watch?v=rEfSdPz1WtA
- Joe Rogan # 277 Victor Conte (in charge of the Balco Labs) https://www.youtube.com/watch?v=azzhD2QJ8B0
- Joe Rogan # 682 Bell's Brothers (Powerlifters) https://www.youtube.com/watch?v=rMSGMuumwu0

Some good podcasts which look at the Anti-Doping side (the people whom are trying to stop them)

- Joe Rogan #685 with Jeff Novitzky (one of the main guys to take down Lance Armstrong)
https://www.youtube.com/watch?v=rR7IqzwgGeU



References

1. http://m.bjsm.bmj.com/content/38/6/666.full.pdf Journal of BiSportMed, "Why we Should allow Performance Enhancing Drugs in sport"
2. Gaffney, G.R. and Parisotto, R., 2007. Gene doping: a review of performance-enhancing genetics. Pediatric Clinics of North America, 54(4), pp.807-822. 

Andrew Richardson, Founder of Strength is Never a Weakness Blog

I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University. 

Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019. 

I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.  

My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.

My most recent publications: 

https://www.sciencedirect.com/science/article/pii/S1752928X19300216

https://www.sciencedirect.com/science/article/abs/pii/S1752928X19301076 

My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning. 

Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering. 

I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness. 

I had my own business for providing training plans for teams and athletes. 

I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships, 

in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge. 

Contact details below; 

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Discussion on Hyperandrogenism and the IAAF New Regulations affecting Caster Semenya

Introduction and Aim 

This is currently one of my favorite things to talk about right now. I am referring to the issue of hyperandrogenism in female athletes. The article will be discussing the ins and outs of hyperandrogenism, touching upon testosterone, estrogen, doping, World Anti Doping Agency (WADA) and anti - doping laws. Finally looking at the International Olympic Committee (IOC) stance. The International Association of Athletic Federations (IAAF) position and notable athletes, coaches and sport scientist positions on the matter of hyperandrogenism at hand. 

The aim of this article would give a non biased stance on the current issue and help you (the reader) make a informed decision. 

I have gathered as much information as I could find on this topic to ensure both sides of the topic are covered. All information is up to date

This will be one of the longest if not the longest article I have ever written. This is due to;

Mainstream media writing for sensation not for facts

- The lack of scientific knowledge and evidence
- No unbiased reports or reviews on the topic thus far

If you want to learn more about Caster Semenya and her athletic journey to this point in time. Then follow the video link here;

Too Fast to Be a Woman The Story of Caster Semenya

This video is 45 minutes long so you want to watch it after you read the article.

Set aside 20 minutes to read the article properly (not including the videos attached. Please watch some of them after reading this to further expand your knowledge)

Lets dive right in!!

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**Copyright Disclaimer Under Section 107 of the Copyright Act 1976, allowance is made for 'fair use' for purposes such as criticism, comment, news reporting, teaching, scholarship, and research. Fair use is a use permitted by copyright statute that might otherwise be infringing. Non-profit, educational or personal use tips the balance in favor of fair use**

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Pre Caster Semenya and Screening Genders in Sport 

(This first section until the start of Hyperandrogenism, is written in reference to the book Bioethics, Genetics and Sport Chapter 8, (8.1 - 8.2) by Silvia Camporesi and Mike McNamee (2018)) 

Right now in the sporting world, in particular the sport of athletics. There has been a lot of focus on one athlete and her natural physiology. This is referring to Caster Semenya of South Africa, the middle and long distance runner who has got Hyperandrogenism. Caster has been in the spotlight before for her notable success in the 800m and 1500m (Appendix 1.0) across national, World,  Commonwealth and Olympic Championships over the last few years. Semenya's case triggered the initial drafting of the IAAF regulations and policy on the eligibility of female athletes with hyperandrogenism to compete in the female category (hence Hyperandrogenism Regulations).

Yet despite passing drug tests, never cheating and never doping, some have said she has been unfairly targeted by the media for many things. These include, her muscular figure, deep voice and accusations to if she was even a female at all but a man. She was even screened to see if she was actually a man which is embarrassing for Caster but from a organisation point of view (IAAF) it may be considered questionable that they would even need to do such tests.

Such tests included a sex verification tests which is described as "Sex verification in sports (also known as gender verification, or loosely as gender determination or a sex test) is the issue of verifying the eligibility of an athlete to compete in a sporting event that is limited to a single sex" (Wiki, 2018). The earliest known case is that of Stanisława Walasiewicz (aka Stella Walsh), a Polish athlete who won a gold medal in the women's 100 m at the 1932 Summer Olympics in Los Angeles, but who after her death in 1980 was discovered to have had partially developed male genitalia (Wiki, 2018). These tests come in the form of; physical examinations, chromosome testing and hormone testing.

Caster is at the end of a long line of women athletes who have faced disgraceful individuals and sporting bodies in the past. Some examples include;

• 1936, President of the IOC stated that "all women athletes entered into the Olympics be subjected to a thorough physical examination to make sure they were really 100% female" (Ibid., 106). 

• 1972, Mary Peters competed for Great Britain and Northern Ireland wining gold in the women's pentathlon. Despite this amazing feat she has extensively written about a manual internal gynecological examination that was tantamount to groping (Ibid). 

Chromosome testing was introduced by the IAAF in 1967 to prevent incidents like the aforementioned never happening again. This didn't stop members of sporting organisations from making future mistakes. To help prove the gender of an athlete, one is required to bring their birth certificate to events at the request of the organizers of the event. Spanish athlete Martinez - Patino forget her birth certificate at the 1985 World University Games in Jobe (Japan). Only to be tested anew with a further test and be disqualified from the competition (Martinez - Patino, 2005). 

As time went on there became an increasing need for some form of discriminatory process among participants who happen to blue the line of male/female stereotypes. This process became known as "gender verification" (Skirstad, 2000). This may seem ironic as some will argue gender doesn't exist (especially as this is 2018 and many people are identifying as trans gender or non binary). Daniels (1992) states "gender is a social construct and biological test can verify that". Schultz (2012) states "gender verification has focused on the Three G's; Genitals, Gonads and Genetic Material). 

Gender testing was removed by the IAAF in 1991 and 1999 by the IOC (Elsas et al, 2000). Hence when Caster came about in 2009, the IAAF had no guidelines regulating "gender" testing. Heggie (2010, 7) reported that the IAAF argued that "gender testing was no longer needed in their sport due to the modern sportswear was so revealing that it seemed unfeasible that a man could masquerade as a women". Caster's case triggered the IAAF in coordination with the IOC to revisit the guidelines for "when a woman should be allowed to compete as a women". Although neither the IAAF nor the IOC mention a relation between Caster and the regulations, this is quite apparent as you will see when you continue reading this article from the extensive literature written on the subject (Cookey et al. 2013,; Montanola and Olivesi, 2016; Schultz 2012; Teetzel 2014). .

----------------------------------------------------------------------------------------------------------------------

*Disclaimer*

I am not going to argue my personal opinion on gender nor dictate what it is for you to read. However, from my scientific background and education I have learned and worked with the understanding of Male is XY and Female is XX pair of chromosomes (Yang et al, 2010). This is how the significant majority of papers, biology textbooks and scientific literature has been dispensed. For the context of this article we will be sticking with this.

----------------------------------------------------------------------------------------------------------------------

Now we will explore what Hyperandrogenism is

Figure 1.0 IAAF Logo 

Credit: https://www.iaaf.org/home 

Hyperandrogenism 

This second section is written in reference to the book Bioethics, Genetics and Sport Chapter 8, (8.3 - 8.4) by Silvia Camporesi and Mike McNamee (2018))

Definition from Wikipedia states, "Hyperandrogenism, also known as androgen excess, is a medical condition characterized by excessive levels of androgens (male sex hormones such as testosterone) in the female body and the associated effects of the elevated androgen levels. It is an endocrinological disorder similar to hyperestrogenism". Hyperestrogenism can be defined as "Hyperestrogenism, hyperestrogenic state, or estrogen excess, is a medical condition characterized by an excessive amount of estrogenic activity in the body" (Lavin,  2009).

Less common causes of hyperandorgenism can be ovarian tumors or tumors of adrenal glands (Sirmans and Pate 2014; Housman and Reynolds 2014). it is important to note that hyperandrogenism does not pose an immediate threat to the health of the person affected. It's is generally not medicated except in very severe cases, to prevent the insurance of co-morbidities.

Hyperandrogenism can be caused by external factors and or natural causes. These include the following;


Polycystic ovary syndrome


Probably the most common cause of hyperandrogenism which is an endocrine condition affecting up to 15-20% of women of reproductive age, where ovaries contain multiple follicles which lead to irregular menstrual periods and can lead to excess acne, excess hair and in more severe cases to a number of co-morbidities including metabolic syndrome, hypertension, dyslipidemia, glucose intolerance and diabetes.

• (Franks, 1995)
• (Polycystic Ovary Syndrome (PCOS), 2016)
• (Defining PCOS, 2016)
• (Hammond and Bocchinfuso, 1996)
• (Irina, Zieve and Ogilvie, 2016)

Hyperthecosis and hyperinsulinemia

• (Pasquali, Renato, 2011)
• (Atmaca, 2014)
• (Barbieri, Hornstein. "Hyperinsulinemia and Ovarian Hyperandrogenism. Cause and Effect". Endocrinology and Metabolism Clinics of North America. 17.4: 685–703. No date given)
• (William, Berger, and Dirk, 2005)
• (Somani, Harrison, Bergfeld, 2008)

Cushing’s syndrome

• (Cushing's Syndrome, 2012)
• (Atmaca, 2014)

Congenital adrenal hyperplasia

• (Wilson, 2016).

Menopause

• (Fogle,  Stanczyk, Zhang, and Paulson, 2007)

Drug-induced hyperandrogenism

• (Neraud, Barbara; Dewailly, Didier. Contemporary Endocrinology: Androgen Excess Disorders in Women: Polycystic Ovary Syndrome and Other Disorders, Second Edition. Edited by: R. Azziz et al. © Humana Press Inc., Totowa, NJ. No date given)

Heredity

• (Puttabyatappa, Cardoso and Padmanabhan, 2016)

There are also a number of tumors that can lead to Hyperandrogenism. These include;

• (Adrenocortical Carcinoma, 2016)

Adenoma of the adrenal gland

• (Adenoma of the Adrenal Gland, 2016)

Arrhenoblastoma

• (Martin, 2016a)

Hilar cell tumor

• (Martin 2016b)

Krukenberg tumor

• (Uyeturk, Serife, Oznur, Ulku, and Omur, 2016)

Below in Figure 2.0 what has been mentioned above is displayed in picture format to make understanding it easier. 

Figure 2.0 What may cause Hyperandrogenism 

Credit: https://shieldate.wordpress.com/2015/08/06/hirsutism/

I have came across some very good PowerPoint Slides on Hyperandrogenism if those who are more from a scientific background would like to know more;

• https://www.slideshare.net/shashwatissen/hyperandrogenism 

• https://www.slideshare.net/hanifmin1/hyperandrogenism-ppt-2512011?next_slideshow=1 

• https://www.slideshare.net/LifecareCentre/understanding-hyperandrogenism-diagnosis-managementthrough-case-discussion-dr-sharda-jain-dr-deepti-nabh-dr-jyoti-agarwal-dr-jyoti-bhaskar?next_slideshow=2 

You cannot Police Natural Selection and Ability in Sport 

In this part of the article we will discuss how the IAAF's ruling is simply silly and a huge mistake waiting to happen. Before continuing on we will define a few terms to make the reading flow better;

1. Doping can be defined as the use of a banned chemical compounds e.g. andorgenic anobloic steorids (AAS) or techniques (e.g. blood doping) to improve sports performance. The substances and practices are called doping agents or just dope (Hackney, 2018). Anavar (Oxandrolone) is an  androgen and anabolic steroid (AAS) medication which is used to help promote weight gain in various situations. It helps to offset protein catabolism caused by long-term corticosteroid therapy
(Llewellyn 2011).

2. In the foreword of "Doping, Performance - Enhancing Drugs, and Hormones in Sport" by Anthony Hackney (2018) he sums up the current situation with doping very well; "Doping in sport is nothing new - it has gone on since ancient times - and some athletes and always will stoop t any means to win. Regrettably, in modern times, it seems the prevalence of athletes doping is on the rise; but the financial rewards with winning are astronomical and provide the motivation and temptation for many athletes to dope. The rewards may be great but the payback can be deadly as the use of many contemporary performance - enhancing drugs can result in serious morbidities and premature morality" (Hackney , 2018). 

In 2011 Hyperandrogenism Regulations require female athletes who do not fall within the limits of 100ng/dL2 (Nanograms per Decilitre) of testosterone to undergo androgen-suppression as females. In simple words; "If a female expresses a higher than "normal" testosterone value" through natural means and without the instance of doping through administration of oral or injectable androgenic anabolic steroids or testosterone variations. Then this is classed an excess of testosterone". This to me in my most professional opinion is; 

Figure 3.0 Ludacris 

Credit: http://www.photosgood.com/ludacris/ludacris-picture-13993.html 

If you can't work it out the gentleman is Ludacris the rapper from America. My shocked expression is reflecting the "Ludicrous" nature of the IAAF. 

My jokes are bad

Continuing on, 

I can only see this decsion made by the IAAF creating alot of issues and since 2011 it has. Paragaph 6.5 of the IAAF policies on eligibility of women with hyperandrogenism to compete in women's competition states; 

"The Expert Medical Panel shall recommend that the athlete is eligible to compete in women's competition if; 

1. she has androgen levels below the normal range; or 

2. she has androgen levels within the normal male range but has an androgen resistance such that she derives no competitive advantage from having androgen levels in the normal male range"

This is ruling that caused South African representative (Law Professor Steve Cornelius), to leave the IAAF Disciplinary Tribunal in 2018. Below is the image of his letter to Lord Seb Coe regarding his departure

Figure 4.0 Law Professor Steve Cornelius written letter to IAAF




Link for his comments on for leaving the IAAF;

https://www.iol.co.za/mercury/sa-official-quits-iaaf-over-caster-saga-14739435 

He also called the policy a "warped ideology". Since then (to this date), the IAAF has quite possibly the worlds most sophisticated guidelines to date (Montanola and Olivesi, 2016).


Link to these documents;

1st document covers the following (taken from IAAF website): Eligibility Regulations for Female Classification (Athlete with Differences of Sexual Development) for events from 400m to the mile, including 400m, hurdles races, 800m, 1500m, one mile races and combined events over the same distances (Restricted Events)

• https://www.iaaf.org/download/download?filename=0c7ef23c-10e1-4025-bd0c-e9f3b8f9b158.pdf&urlslug=IAAF%20Eligibility%20Regulations%20for%20the%20Female%20Classification%20%5BAthletes%20with%20Differences%20of%20Sex%20Development%5D%20in%20force%20as%20from%201st%20November%202018 

2nd document covers the Explanatory Notes by the IAAF Council

• https://www.iaaf.org/download/download?filename=c402eb5b-5e40-4075-8970-d66fccb10d41.pdf&urlslug=Explanatory%20Notes%3A%20IAAF%20Eligibility%20Regulations%20for%20the%20Female%20Classification 

From Athletics Weekly (AW) the IAAF made a statement saying that these rules "are in no way intended as any kind pf judgement on or questioning of the sex or the gender identity of any athlete". The IAAF insists this is in the interest of fairness: "These regulations exist solely to ensure fair and meaningful competition within the female classification, for the benefit of the board class of female athletes. In no way are they intended as any kind of judgement on or questioning of the sex or the gender identity of any athlete. To the contrary, the IAAF regards it as an essential to respect and preserve the dignity and privacy of athletes with different sex development (DSD), and therefore it will continue to handle all cases arising under these regulations in strict confidence". 

Anti - Doping Policy? Or being Forced to be Weaker 

From my point of view is it not quite hypocritical of the IAAF to force athletes to take drugs so they can be slower/weaker than their natural best. Then lecture everyone that they can't dope but you can't be as good as you are naturally. Seems very strange and from a medical point of view would it not be advised to suppress an athletes natural hormonal balance to suit a narrow minded/weak argument. I am sure their would be medical complications for these athletes being forced to take hormone suppressing drugs to allow them to compete still if this came into affect.

Figure 5.0 Effects of Estrogen on Performance 

Image Credit: http://www.sportsintegrityinitiative.com/questions-remain-iaaf-differences-sex-development-regulations/

If these rules are set in place then the likes of fellow athlete Lyndsey Sharp (British Runner) will be jumping with joy as in her own words "she hadn't a chance at victory" when competing against Caster due to her "apparent" biological superior advantage over everyone else. Even tho she only beats the competition by a few seconds. It's not as if it is 15/20 seconds more than her next opponent.

Paula Radcliffee added her comments to say "However hard she (Sharp) goes away and trains, she is never going to be able to compete with that level of strength and recovery that those levels of elevated testosterone bring. Lord Coe also added his comments in to say "the organisation (IAAF) would continue to fight for a ruling to force athletes with hyperandrogenism to take drugs or have surgery - and is confident of this succeeding".

It's funny when these athletes feel that their fellow countrymen and women can't win that they play the victim card but fail to realise that they compete for GB. One of the worlds best for athletics and athlete supports through coaching and sport science. Yet someone with natural talent and hard work from South Africa isn't allowed to win due to her more masculine appearances and slightly faster times.

This of course is just one way of looking at it.

World renowed Sport Scientist Ross Tucker reckons the effect of taking these estrogen drugs on Caster will slow her times down by and up to seven seconds. He told the Gurdian Newspaper "history suggests Semenya will lose about 4 seconds to 5 seconds. Because in 2013 and 2014, when the IAAF were diligent about ensuring her compliance with the upper limit at that time (10nM), she was running 2:00. I don't think she even qualified for the Commonwealth Games then. Now, at 5nM, the effect will be even larger, I suspect. She will go from a 1:54 to a 2:01 - 2:03 is my estimate". 

From the website scientificamerican.com, they had an article looking at this topic and they had a great paragraph discussing testosterone; The official Olympic testosterone cutoff for females athletes is 10 nanomoles per litre, but some go beyond it, into the male range, and some men fall into the female range, thanks to normal hormonal fluctuations that differ from individuals to individual. Moreover, high T is not always synonymous with good performance. Some top level male athletes have testosterone levels that dip into the female range, e.g. : one recent study of 693 elite athletes in Clinical Endocrinology found that 16.5% of makes had testosterone levels that were below the male range and almost 2% fell in the female range. Also, almost 14% of women were above the permissible maximum for female athletes. 

The idea that a female competitor shouldn't compete as a female due to having naturally higher level of testosterone not through external or artificial means is wrong. Sport is for the best, the gifted, the talent, the biologically superior human beings. Athletes are the outliers in society and it is a form of artificial selection to pick athletes with better traits for certain sports. See David Epsteins work on the Sports Gene and the video attached below;

Are athletes really getting faster, better, stronger? | David Epstein

Spectators pay to see talent and those that have the predisposed characteristics which may make them better should be encouraged to compete. Even learning that if someone has a high level of testosterone it won't necessarily make them a better athlete adds more weight to let those with hyperandrogenism compete as their defined gender.

At the very core of the IAAF's argument is the notion that women's sport is "protected" (which after reading the above seems comical by now) and they state clearly that "the IAAF divides competition into male and female categories because male athletes have clear performance advantages in terms of size, strength and power. These advantages are mainly due to the fact that, starting from puberty, men produce 10-30 times more testosterone than women".

Then why has the IAAF just settled on the testosterone values of male and females as their "measure of performance ability"? Well one can hypothesise that with chromosome testing is so flawed and outdated and that the IAAF may be able to prove that by simply having more testosterone this some how makes an athlete better. If that was the case then why aren't all mid teenager boys Olympic champions with their high testosterone levels........

Exactly hahahahah

Caster against the Dopers

When looking at Caster and other athletes in a similar situation, they and her have never doped or conducted doping to better their performance. Focusing on Caster for the moment in her event the types of doping that may occur ranges from blood doping, injections of EPO and possible use of testosterone for recovery purposes between sessions to reduce recovery time. Take the women's 800m event for example. In 2012 at the London Olympic Games a Russian Athlete who beat Caster to a silver medal was caught doping using Oxandrolone (also known as Anavar) (Figure 3.0).

Figure 6.0 Chemical Formula of Oxandrolone

Credit: https://en.wikipedia.org/wiki/Oxandrolone

The athlete in question doped and is called Maria Savinova (Figure 4.0). Her teammate (Ekaterina Poistogova) who got third in the same race is under investigation as well from doping too. Caster was then upgraded to gold medal position after confirming Maria had indeed doped.

Figure 7.0 Maria Savinova beating Caster Semenya to Gold at the London 2012 Games

Credit: https://www.telegraph.co.uk/sport/othersports/athletics/11272052/Russias-London-2012-800m-champion-caught-in-doping-storm.html

So here we can see in the midst of Caster's scrutiny, in the 2012 Olympics just over a year after the IAAF ended their 11 month investigation into the sex/gender of Caster. This investigation started posit 2009 Berlin World IAAF Championships (August). Yet being beaten by someone who uses performance enhancing drugs (PEDs) she still is scrutinized over her appearance and athletic abilities. Which to me seems unfair and child like.

Figure 8.0 Caster's times since 2008 

Below shows the tracking and progress of Caster's times since her debut at the Youth Commonwealth  Games in 2008. 

Image Credit: https://www.theguardian.com/sport/2016/jul/29/the-return-of-caster-semenya-olympic-favourite-and-ticking-timebomb 

Research Papers

This section of the article has highlighted 6 relevant papers to for the reader to look in their own time. However, the main one under scrutiny is paper number 1. This one has attracted the most criticism and flak by fellow researchers, politicians and athletes. It is also worth noting that one of the authors (Dr Bermon) of this paper sits on the IOC Consensus meeting back in 2015 and on the medical board' board as well. How convenient that this happens to fit into their research and current position.

1. Serum Androgen Levels and their relation to performance in track and field: mass spectrometry results from 2127 observations in male and female elite athletes. By Stephane Bermon and Pierre-Yves Garnier 2017

As many of you already know, I love a good paper critique but too many people have beaten me to it. This is in no order but here are the top comments of the critique of Garnier and Bermon 2017 paper;

• Andrew Gelman (Higgins Professor of Statistics at Colombia University" described the analysis as "such a mess that I can't really figure out what data they are working with, what exactly they are doing, or the connection between some of their analyses and their scientific goals". 

• Jamie Schultz whom is the Associate Professor of Kinesiology at Pennsylvania State University created the article titled "A Sexist Policy may end the career of one of the Commonwealths greatest female runners" on the website: "The Conversation" on April 8th 2018. She said, "Yet without explanation, the new guidelines omit both the pole vault and hammer throw, where high T women ostensibly enjoy the greatest advantage, and add the women's 1500m race, even tho it was not one of the events in which testosterone seemed to matter. The hormone, the study concluded, does not affect men "in any of the male athletic events"..... 

• Franklin S, Ospina Betancurt J, Camporesi S. What Statistical data of observational performance can tell us and what they cannot: the case of Dutee Chand v AFI and IAAF. Br J Sports Med Published Online: First 23 February 2018. doi: 10.1136/bisports-2017-098513. This paper heavily criticises the original paper which concludes by saying; "we believe that it is scientifically incorrect to draw the conclusions in the Bermon and Garnier paper from the statistical results presented. Their paper claims that certain athletes have an advantage in precisely the five events where a significant effect was found: we calculate that a high share of those five significant effects are likey to be false positives". 

• Simon Franklin (a Post Doctoral at LSE) said "There are more than a few problems with the paper, not least the fact that it makes casual claims from correlations in a highly selective sample, and the bizarre choice of comparing averages within the highest and lowest tertiles of T levels using a student t-test (without any other statistical tests presented). But most problematic is the multiple hypothesis testing. The authors test for a correlation between ft- Levels and performance across a total of over 40 events (men and women) and find a significant correlation in 5 events, at the 5% level. They then conclude; These are 5 events for which they found significant correlations. And we are lead to believe that there is no such advantage for any of the other events. Female athletes with a high fT levels have a significant competitive advantage over those with low fT in 400m, 800m, 400m Hurdles, hammer throw and pole vault. 

• Professor Peter Sonksen of Endocrinology at the St. Thomas Hospiatal and King's College London and lead author in the same British Medical Journal denouncing the French IAAF study. Sonksen said the paper "be taken out of the hands of the IAAF and given to someone more honest like the International Olympic Committee". He also says "it's simple really, anyone born and reared as a girl/woman should be treated as a woman", he wrote to a WIRED in an email. 

Professor Roger Pielke, Jr of the University of Colorado at Boulder. He made has made numerous posts and comments about this topic and has a paper which critically analysed the work of Garnier and Bermon. They are as follows; 

• Pielke Jr, R.(2017). Sugar, spice and everything nice: how to end "sex testing" in international athletics. International Journal of Sport Policy and Politics, 9:649-665. (PDF, free to read). 

• The paper has some significant methodological issues, most notably the inclusion of female athletes who doped with those with naturally high levels of T. There is some double counting of athletes in 2011 and 2013. There is also speculation that the male findings are contaminated by doping. Methodological issues notwithstanding, the paper nonetheless strongly reinforces the 2015 CAS Chand decision. 

• The IAAF data of Bermon and Garnier 2017 don't support the proposed regulations of testosterone in women at distances of 400m to one mile as shown from the graph below; 

Image Credit: http://leastthing.blogspot.com/2018/04/some-resources-on-testosterone.html

•  Professor Pielke, Jr continues; "These IAAF data (pink bar) indicates that over distances of 400m, 800m and 1500m high testosterone women are on average 1.1% faster than their low testosterone counterparts. Then looking at the data that IAAF collected for men at 400m and 1500m (blue bar). These data indicates that high T men are on average 1.1% faster than their low T counterparts. Surely if high T in women in selected events were performance differs is to be regulated, then high T in men in selected events where performance differs is also to be regulated as well?"

*academic mic drop* 

• As Professor Pielke Jr so rightly says "This is the very hallmark of sex discrimination and only scratches the surface of flawed T regulation". 

On Tuesday the 5th of June Professor showcases the IAAF discussing and defending their justification for their new proposed rulings on his blog linked here: http://leastthing.blogspot.com/2018/06/iaaf-opens-up-on-testosterone-some.html. Here are some of the main highlights from that post; 

There are two logical fallacies here that are worth discarding up front, one typically advanced by opponents to T regulations and one advanced by IAAF in support of T regulations. They are:

• Fallacy #1: Governing bodies do not (generally) regulate other "natural advantages" so IAAF cannot regulate T. 

• Fallacy #2: Governing bodies do (sometimes) regulate other "natural advantages" so IAAF should regulate T.

The issue here is not going to be settled by invocation of general principles, but rather, the specific question of whether it is appropriate for IAAF to regulate women's athletics based on endogenous levels of T across four events. What a big picture view can tell us however is that biological regulation of athletes in the disciplines of athletics is incredibly unique, and T would be the only biological characteristic that is regulated in all of the Olympic sport of Athletics. This fact does not determine an outcome, but it should set a high bar for approving any such regulatory action. 

• The resulting research (much discussed on this blog) is Bermon and Garnier (2017). Not surprisingly, IAAF claims that its results support further regulation of testosterone. A close look doesn't really support this claim. The most striking conclusion of this paper -- taking it at face value -- is that the resulting statistics come no where close to the 10% difference in athletic performance cited by CAS as an appropriate basis for regulation. In fact, the paper found no performance difference worth regulating in 19 of 23 athletic events in which women compete. Think about that. After all of the talk of the overwhelming importance of testosterone to athletic performance, an internal IAAF study designed to look for such differences could not justify testosterone regulations for almost all women's events. Clearly, testosterone is not the magical athletic elixir claimed by some.

In Professors Pielke Jrs post, he is getting the answers from the IAAFs lawyer (or one of many I imagine) from a gentleman called Johnathan Taylor of Bird and Bird. This isn't to be confused with Teesside Universities own Johnathan Taylor and GB Endurance runner, Two very different Taylor's hahahha (as shown below). Mr Taylor sat on the IOC Consenus Meeting on Sex Reassignment and Hyperandrogenism in November 2015. 

At this meeting it was agreed "To avoid discrimination, if not eligible for female competition the athlete should be eligible to compete in male competition". 

Which to me means okay, a more "masculine" female by the IAAF definition of what a female is and isn't is allowed to compete against the men but isn't expected to win but she is allowed to compete so that is okay....... 

Pathetic.

This isn't over yet more to follow. Just recently on the 12th of July this occurred. 

Erik Boye (of Oslo University Hospital) made a statement about 

A set of data normally follows publications like Bermon and Garnier (BG) 2017 paper. The conclusions are linked to the data and their interpretation and the data must be made available to the general public. That is basic in science. If now the authors have received some help to understand that their data are fraught with errors they should call for a retraction and resubmit a new paper with new data if they so wish. We have pointed out this to the IAAF and to the publisher. None of them appear to handle this well. It is unacceptable that the paper stands and that a few people are informed that there were serious errors attached to the data and that unseen changes have been made to the data set. Furthermore, there is no sign that the new set of data has been subjected to any more of a critical review or that it will be released for external scrutiny.For this reasons we should insist that scientific standards and rules are followed. In my practice at editorial boards (the EMBO and FEBS publications) I am certain that such a faulty data set would have released a demand for a retraction, with the possibility of a resubmittal.

Regarding the IAAF date for the 2017 paper, it has been requested by a number of fellow researchers. This is a normal and common thing in peer reviewed research to uphold standards of the field and ensure credibility. So far (to my knowledge) that it has been asked by Ross Tucker, Professor Pielke Jr and Erik Boye. Yet no one has received anything which means the IAAF are withholding the data which is very worrying (from an academic standpoint). 

Ross Tucker has commented on this by saying that "the concept of defending between men's and women's sports", the crux of the matter is transparency. "If research is done, and if that research is foundation to actions (in this case, a policy), hen the data must be made available on request, so that anyone can arrive at the same position and understand why something is being enforced. It is right to be transparent". 

 2.  Natural Selection for Genetic Variants in Sport: The Role of Y Chromosome Genes in Elite Female Athletes with 46, XY DSD. By Malcom Ferguson-Smith and Dawn Bavington (2014).







3. Serum Androgen profile and physical performance in women Olympic Athletes. By Emma Eklund, Bo Berglund, Fernand Labrie, Kjell Carrlstrom, Lena Ekstrom and Angelica Linden Hirschberg (2017).








4. Review: Androgen's and Athletic Performance of Elite Female Athletes. By Stephane Bermon (2017).








5. Hyperandrogenic Athletes: performance differences in elite standard 200m and 800m finals. By Jonathan Betancurt, Maria Zakynthinaki, Maria Jose Martinez-Patino and Carlos Martienez (2018).

Intersex Sport 

Dr Bermon (one of the co-authors of the research paper we so heavily criticized) has talked about intersex categories in sport becoming a real thing. He says "he is in favor of a third category for intersex athletes and that it could happen within 5 fives - although he admitted public opinion will have to shift first". However Mr Bermon said "my feeling is also public is not ready for this. We don't want to stigmatize athletes. We also have to take into account religious and cultural sensitivities. So basically I am in favor but there needs to be some changes in public opinion".

He goes on to say "We have a lot of athletes with hyperandorgenism. it is not just the one or two people you hear about in the media. In elite female athletics the number of intersex athletes is 140 times more than what you might find in the normal female population.

Brian Cookson, UCI President about Astana doping case and mix gender events for Tokyo2020

Athletes who have Hyperandrogenism

There are two notable examples of female athletes who express this. They are, Caster Semenya (South Africa) one whom we have already been discussing and Dutee Chand (India). Which we are now going to explore a bit more about.

Image Credit: http://www.sportsintegrityinitiative.com/iaaf-study-shows-chand-case-far/ (sportsintegrityinitiative, 2017)

Dutee who won her case against the IAAF regarding her Hyperandrogenism. This is outlined below in the Court of Arbitration for Sport (CAS) media document;

The full report and legal document regarding this case for Dutee Chand can be found here;

http://www.tas-cas.org/fileadmin/user_upload/AWARD_3759__FINAL___REDACTED_FOR_PUBLICATION_.pdf

It is 161 pages long, outlining the whole case/court proceedings. The summary of the case outlined the following for Dutee;

From Yahoo News on the 27th of April 2017 Dutee Chand said that the new Track and Field rules for women's testosterone rulings were "wrong" and she has kindly offered legal aid to help the current Olympic Champion Caster Semenya. Chand has said she "was relieved to have avoided falling under the regulations, which only cover distances between 400m and one mile". She has publicly criticised the current news surrounding the IAAF ruling against Caster via telephone to AFP stating "I am happy and relieved after four years of uncertainty but I feel for athletes like Semenya. I strongly believe the current rules are also wrong". 

Dutee took her case in 2014 to the Court of Arbitration for Sport (CAS) to battle her right to compete in women's sport with expressing symptoms of Hyperandrogenism. She comments on this; "I lost crucial years of my career when I could not focus on my training and initially (in 2014) lost 6 months which is a significant time in a sportsperson's life". She missed three big competitions due to the rulings and dealings in court. These included; Asian Games, Commonwealth Games and the World Junior Athletics Championships. Now she is targeting the 2022 Commonwealth Games in Birmingham. 

CAS reasons for disagreeing the IAAF motion against Dutee Chand was as follows; 

The CAS ruled against IAAF in the Chand case because the evidence available did not support the claim that high testosterone levels in certain female athletes were associated with a difference in performance between these women and other women that was similar to the difference between male and female.

CAS explained (527):

The Panel considers the lack of evidence regarding the quantitative relationship between enhanced levels of endogenous testosterone and enhanced athletic performance to be an important issue. While a 10% difference in athletic performance certainly justifies having separate male and female categories, a 1% difference may not justify a separation between athletes in the female category, given the many other relevant variables that also legitimately affect athletic performance. The numbers therefore matter. Because the performance numbers matter, levels of testosterone (or, unmentioned in the regulations, the presence of testes) are by themselves irrelevant. CAS judged that it is only if high levels of testosterone can be associated with a performance advantage of the order enjoyed by men over women that regulation might make sense.

CAS further explained (528):

However, in order to justify excluding an individual from competing in a particular category on the basis of a naturally occurring characteristic such as endogenous testosterone, it is not enough simply to establish that the characteristic has some performance enhancing effect. Instead, the IAAF needs to establish that the characteristic in question confers such a significant performance advantage over other members of the category that allowing individuals with that  characteristic to compete would subvert the very basis for having the separate category and thereby prevent a level playing field. The degree or magnitude of the advantage is therefore critical. 

This ruling got knocked back in July 2015 with Lord Coe commented on by saying "We were surprised by the CAS decision, and I think the IOC was too. We are looking again at this issue and will be talking to CAS at some time over the next year". This is referring to bringing the new evidence to the court.

The Court of Arbitration for Sport (CAS) 

This section has been made in reference to Paul David's Book "A Guide to the World Anti Doping Code: The Fight for the Spirit of Sport 3rd Edition" and the CAS website. 

CAS is an independent body from any sporting committees or parties which provides services to facilitate sports-related disputes through arbitration or mediation by means of procedural rules adapted to the sports world. CAS was established in 1984 and is a sub body of the International Council of Arbitration for Sport (ICAS). CAS head office is in Lausanne, Switzerland.

CAS has nearly 300 arbitrators from 87 countries  whom are selected based upon their specialist knowledge of arbitration and sports law. Each year there are around 300 cases registered and processed by CAS. The main function and role of CAS is to resolve legal disputes within sport through arbitration. It achieves this by pronouncing arbitrarl awards that have the same weight/impact and enforceability as judgments of ordinary courts. It can also help resolve issues between parties through mediation when the procedure is deemed appropriate.

Arbitration can be defined as "Arbitration is a non-judicial process for the settlement of disputes where an independent third party - an arbitrator - makes a decision that is binding" (CIARB, 2018).

Mediation can be defined as "A settlement of a dispute or controversy by setting up an independent person between two contending parties in order to aid them in the settlement of their disagreement" (Legal - Dictionary, 2018).

Logo referenced from: http://www.tas-cas.org/fileadmin/user_upload/LOGO_TAS.jpg 

CAS occupies a central position in it's interpretation and application. CAS panels have empathized the need for consistency in their awards. These positions can be set up during events with high importance such as Olympic Games and or Commonwealth Games (or other similar events). To take into account each event, a set of specific rules are developed rating to the events in question and its setting.

What kinds of dispute can be submitted to the CAS ?

The disputes can be submitted by anyone and they can be directly or indirectly linking sport. These disputes can range from a company and client issue (sponsorship contract breach) or a sports organisation behavioral issue (cheating or doping in an event).

If you wish to find out other cases CAS has dealt with then follow their database link:

• http://www.tas-cas.org/en/jurisprudence/archive.html 

To resolve sports-related issues through arbitration and mediation. Two bodies are were created:

• The International Council of Arbitration for Sport (ICAS)
• The Court of Arbitration for Sport (CAS).

"The purpose of ICAS is to facilitate the resolution of sports-related disputes through arbitration or mediation and to safeguard the independence of CAS and the rights of the parties. It is also is responsible for the administration and financing of CAS".

http://www.tas-cas.org/en/icas/code-statutes-of-icas-and-cas.html 

Here are some other notable links for CAS; 

• Website for CAS: http://www.tas-cas.org/en/index.html 

• Results and Information on CAS Trials: http://www.swissarbitrationdecisions.com/ 

• CAS Statistics: http://www.tas-cas.org/fileadmin/user_upload/CAS_statistics_2016_.pdf 

In recent news, Anti-Doping Norway are reportedly seeking for a Supreme Court to rule on anti-doping matters, rather than the Court of Arbitration for Sport (CAS). Not all appears as it seems when it comes to doping/anti - doping in sport. However, on the 19th of June 2018; IAAF STATEMENT ON CAS ARBITRATION OF NEW FEMALE CLASSIFICATION REGULATIONS was announced (see link below).

https://www.iaaf.org/news/iaaf-news/iaaf-statement-cas-arbitration-of-new-female

Social Media Opinion on Caster, IAAF and Hyperandrogenism

As you can imagine the social media backlash for this against Caster has gained the support from many fellow athletes with hyperandrogenism, newspapers, celebrities, governments and women's rights groups.

There have been some interesting comments off news sites, forums, boards and social media discussing the matter. Here are some of the highlights that I have seen; 

• Username of "Ingrid Luyt" publicly commented; 

IAAF: Women competing in women's races must.....er, well, be women.

ANC/EFF: Unfair! Sexists! Racists! 

Sports Doctor: What's difficult? Kick her in the nuts, if she goes down, she's out. 

• #HandsOffCaster Hastag trend on Social media has gathered alot of support

• Funny Tweets 

@Lebo_thagane wrote; 

"If performance enhancing drugs are prohibited shouldn't the same apply for performance inhibiting drugs? I though the aim was not to alter an athlete's biology artificially? Once this begins where are we going to draw the line? #CasterSemenya #IAAF

• Newspaper Comments 

Username "Monty" off the Irish Times post about Caster said this; 

IAAF: To the best of our knowledge, there is no other genetic or biological trait encountered in female athletics that confers such a huge performance advantage."

Monty: "Probably missed the high jump final then........................" 

Username "PhilipDavis" off the Irish Times post about Caster said this; 

"I find this outrageous! I understood Seb Coe to have huge lung capacity which gave him the edge over rivals. That's just the way it is, should he have had surgery to bring it inline with others?" 

• Some are claiming this is an act of Racism 

• Even Caster has made some posts about it

She has been posting stuff like this for past few weeks which I can't blame her really. She is being publicly attacked for her looks, gender and her achievements put into question by those who don't understand what she has grown up with.

Wider Issue and Future Possibilities for Caster and athletes with Hyperandrogenism

One can not help to align themselves with feminists and women's rights even more over this matter. Even tho in the Western World which promotes equality and diversity for all this topics is a low point for women's rights and sport. South African minister of Sport described these rulings the "Caster Semenya Regulations" and I am very much inclined to agree with her as they seem to be targeting her (especially when it is her events they are only signposting to which is both factually and morally incorrect based off their claimed data and research statements). 

More needs to be done to support athletes with hyperandrogenism not bully or segregate to be pointed at. More needs to be done to champion women in sport not define them as masculine if they appear to not fit the ideal "image norm". Finally, more academics need to come out against the IAAF and their attempts to alter the future of sport forever. If I had the time I would make a Systemmatic Review on hyperandrogenism in athletes across all sports and or the same review but showing having high testosterone levels does not mean a better sporting performance. 

We should thank the likes of CAS, Dutee Chand, Professor Pielke Jnr and other academics for their quest to get the honest truth out to protect Caster and others like her. I would love to sit in a room with all the professors and academics such as; Professor Pielke, Professor Gelman, Associate Professor Schultz and Professor Sonksen to hear their discussions on the topic. No limits, free thinking say it as it is and I am sure we would get an agreed consensus supporting Caster and perhaps other interesting comments being developed from that academic melting pot.

Conclusion 

It is a very interesting time in sport with  sides being drawn across this topic. I just hope that with the media coverage on it and up incoming court hearing with Caster/IAAF/IOC/CAS that the correct decision is made. I am sure supporting Caster and correct research to protect and promote women's rights in sport.

Thank you very much for reading. I sure enjoyed working on this the last few months. Let me know what you think in the comments section below.

Thanks again and I leave you all with a quote by William Shakespeare 

"No Legacy is so rich as Honesty"

Take care

Andrew

References 

1. "Adrenocortical Carcinoma." National Cancer Institute. N.p., n.d. Web. 10 November 2016. "Adenoma of the Adrenal Gland | Genetic and Rare Diseases Information Center(GARD) – an NCATS Program." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 10 November 2016.

2. "Cushing's Syndrome". National Institute of Diabetes and Digestive and Kidney Diseases. April 2012. Retrieved 14 November 2016.

3. "Polycystic Ovary Syndrome (PCOS)." Causes. Mayo Clinic, n.d. Web. 9 November 2016. "Defining PCOS." - The University of Chicago Medicine. The University of Chicago Medical Center, n.d. Web. 10 November 2016.

4. "Puttabyatappa Muraly, Cardoso Rodolfo C., Padmanabhan Vasantha. In Special issue: Impact of maternal metabolism on newborn health". Molecular and Cellular Endocrinology. 435: 29–39. 5 November 2016. doi:10.1016/j.mce.2015.11.030.

5. "R. H. Fogle, F. Z. Stanczyk, X. Zhang, and R. J. Paulson, "Ovarian androgen production in postmenopausal women"". Journal of Clinical Endocrinology and Metabolism. 92 (8, pp. 3040– 3043, 2007.).

6. Neraud, Barbara; Dewailly, Didier. Contemporary Endocrinology: Androgen Excess Disorders in Women: Polycystic Ovary Syndrome and Other Disorders, Second Edition. Edited by: R. Azziz et al. © Humana Press Inc., Totowa, NJ.

7. Uyeturk, Ummugul, Serife Hulya Arslan, Oznur Bal, Ulku Yalcintas Arslan, and Omur Berna Cakmak Oksuzoglu. "Isolated Ovarian Metastasis of Gastric Cancer: Krukenberg Tumor." Contemporary Oncology. Termedia Publishing House, 19 December 2013. Web. 10 November 2016.

8. Apter D (1998). "How Possible Is The Prevention Of Polycystic Ovary Syndrome Development In Adolescent Patients With Early Onset Of Hyperandrogenism". Journal of Endocrinological Investigation. 21 (9): 613–617. doi:10.1007/bf03350786.

9. Atmaca, Murat (16 December 2014). "An Interesting Cause of Hyperandrogenemic Hirsutism". Case Reports in Endocrinology. 2014: 987272. doi:10.1155/2014/987272. PMC 4280803 Freely accessible. PMID 25580312.

10. Barbieri; Hornstein MD. ""Hyperinsulinemia and Ovarian Hyperandrogenism. Cause and Effect."". Endocrinology and Metabolism Clinics of North America. 17.4: 685–703.

11. Burd, Irina, David Zieve, and Isla Ogilvie. "Polycystic Ovary Syndrome: MedlinePlus Medical Encyclopedia." Polycystic Ovary Syndrome: MedlinePlus Medical Encyclopedia. A.D.A.M Inc., n.d. Web. 9 November 2016.

12. Cookey, C and S.L. Dworkin. 2013. Policing the boundaries of sex: a critical examination of gender verification and the Caster Semenya Controversy. Journal of Sex Research, 50(2): 103-11.

13. Daniels, D.B. 1992. Gender (body) verification (building). Play & Culture, 5(4): 370-376.

14. Elas, L.J., A. Ljungqvist, M.A. Ferguson-Smith, J.L. Simpson, m. Genel, A.S. Carolson and A.A. Ehrhardt. 2000. Gender verification of female athletes. Genetics in medicine, 2(4): 249-254.

15. Franks, Stephen. "Polycystic Ovary Syndrome — NEJM." New England Journal of Medicine. N Engl J Med, 28 September 1995. Web. 14 November 2016.

16. Hammond GL, Bocchinfuso WP (1996). "Sex hormone-binding globulin: gene organization and structure/function analyses". Hormone Research. 45 (3–5): 197–201. doi:10.1159/000184787. PMID 8964583.

17. Heggie, V.2010. Testing sex and gender in sports: reinventing, reimagining and reconstructing histories. Endeavour, 34(4): 157-163.

18. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders.

19. Martin, Elizabeth. "hilar cell tumour." Concise Medical Dictionary. : Oxford University Press, 2015. Oxford Reference. 2015. Date Accessed 10 November 2016

20. Martin, Elizabeth. Arrhenoblastoma N. Arrhenoblastoma. n.p.: Oxford University Press, 2015. Oxford Reference. Web. 10 November 2016

21. Martinez-Patino, M.J. 2005. Personal account: a women tried and tested. te Lancet, 366:S38.

22. Montanola, S. and A. Olivesi, eds. 2016. Gender Testing in Sport: Ethics, Cases and Controversies. London: Routledge.

23. Norman Lavin (1 April 2009). Manual of Endocrinology and Metabolism. Lippincott Williams & Wilkins. p. 274

24. Pasquali, Renato (April 2011). "Research in Polycystic Ovary Syndrome Today and Tomorrow". Medscape. Blackwell Publishing. Retrieved 14 November 2016.

25. Schultz, J. 2012. New standards, same refrain: the IAAF's regualtions on hyperandrogenism. The american journal of Bioethics, 12(7): 32 - 33.

26. Skirstad, B. 2000. Gender verification in competitive sport. In vales in sport: Elitism, Nationalism, Gender Equality and the Scientific Manufacture of Winners, eds C. Tamburrini and T. Tannsjo. London: Routledge, pp. 116-122.

27. Somani N, Harrison S, Bergfeld WF (2008). "The clinical evaluation of hirsutism". Dermatol Ther. 21 (5): 376–91. doi:10.1111/j.1529-8019.2008.00219.x.

28. Teetzel, S. 2014. The onus of inclusivity: sport policies and the enforcement of the women’s category in sport. Journal of the philosophy of sport, 41(1): 113-127.

29. William Llewellyn (2011). Anabolics. Molecular Nutrition Llc. pp. 342–352. ISBN 978-0-9828280-1-4.

30. Wilson, Thomas (23 June 2016). "Congenital Adrenal Hyperplasia". Medscape. Retrieved 14 November 2016.

Bibliography 

• http://indianexpress.com/article/sports/sport-others/cas-suspends-hyperandrogenism-policy-for-another-6-months-5031787/ (read)
• http://news.bbc.co.uk/sport1/hi/athletics/8937467.stm
• http://www.asser.nl/SportsLaw/Blog/post/regulating-the-human-body-in-sports-lessons-learned-from-the-dutee-chand-case-by-dr-marjolaine-viret-and-emily-wisnosky (read)
• http://www.asser.nl/SportsLaw/Blog/post/why-the-cas-let-dutee-run-the-proportionality-of-the-regulation-of-hyperandrogenism-in-athletics-by-piotr-drabik
• http://www.ciarb.org/dispute-appointment-service/arbitration/what-is-arbitration 
• http://www.dailymail.co.uk/news/article-3752136/Gender-row-runner-hard-beat.html
• http://www.sportsintegrityinitiative.com/caaws-cces-jointly-oppose-iaafs-new-eligibility-regulations-female-classification/ 
• http://www.sportsintegrityinitiative.com/sexist-policy-may-end-career-one-commonwealths-greatest-female-runners/ 
• http://www.sportsintegrityinitiative.com/subterfuge-continues-iaaf-differences-sex-development-regulations/ (read)
• https://legal-dictionary.thefreedictionary.com/mediation 
• https://www.express.co.uk/sport/othersport/839922/Lynsey-Sharp-slammed-fans-Twitter-Caster-Semenya-comments 
• https://www.independent.co.uk/voices/caster-semenya-rio-2016-gold-800m-intersex-gender-femininity-doesnt-look-the-way-we-want-a7203506.html 
• https://www.news24.com/SouthAfrica/News/hopkins-insists-on-caster-semenya-facts-in-tweet-storm-20170812
• https://www.telesurtv.net/english/news/Olympic-Champion-Semenya-I-am-who-I-am-20180502-0007.html
• https://www.theguardian.com/commentisfree/2016/aug/23/caster-semenya-olympic-spirit-iaaf-athletes-women
• https://www.theguardian.com/commentisfree/2016/aug/23/caster-semenya-olympic-spirit-iaaf-athletes-women
• https://www.theguardian.com/commentisfree/2018/apr/26/testosterone-ruling-women-athletes-caster-semanya-global-south
• https://www.theguardian.com/commentisfree/2018/apr/29/caster-semenya-atheltics-iaaf-ban-testosterone 
• https://www.theguardian.com/sport/2016/aug/19/lynsey-sharp-caster-semenya-800m-olympic-final
• https://www.theguardian.com/sport/2016/aug/21/caster-semenya-wins-gold-but-faces-scrutiny
• https://www.theguardian.com/sport/2016/aug/21/lynsey-sharp-caster-semenya-rio-2016-olympics
• https://www.theguardian.com/sport/2016/jul/29/the-return-of-caster-semenya-olympic-favourite-and-ticking-timebomb
• https://www.theguardian.com/sport/2016/jul/29/the-return-of-caster-semenya-olympic-favourite-and-ticking-timebomb
• https://www.theguardian.com/sport/2016/jul/29/what-is-an-intersex-athlete-explaining-the-case-of-caster-semenya
• https://www.theguardian.com/sport/2017/aug/07/laura-muir-caster-semenya-world-championships
• https://www.theguardian.com/sport/2018/apr/27/iaaf-accused-blatant-racism-over-new-testosterone-regulations-caster-semenya 
• https://www.theguardian.com/sport/2018/jul/11/billie-jean-king-and-other-top-athletes-call-for-end-to-discriminatory-testosterone-policy
• https://www.theguardian.com/sport/blog/2018/may/01/caster-semenya-iaaf-science-athletics-testosterone 
• http://leastthing.blogspot.com/2018/07/a-call-for-bermon-and-garnier-2017-to.html
• http://leastthing.blogspot.com/2018/06/iaaf-opens-up-on-testosterone-some.html
• http://leastthing.blogspot.com/2018/04/some-resources-on-testosterone.html

Appendices 

1.0 Caster Semenya Career Results 

Looking at the career Caster Semenya has had. She is arguably one of the worlds greatest female runners we have seen. The best from the Commonwealth countries and undisputed greatest female runner from South Africa.

Her achievements and accolades include;

• Olympic Games

Gold medal – first place 2012 London                 800 m

Gold medal – first place 2016 Rio de Janeiro 800 m

• World Championships

Gold medal – first place 2009 Berlin                 800 m

Gold medal – first place 2011 Daegu                 800 m

Gold medal – first place 2017 London                 800 m

Bronze medal – third place 2017 London       1500 m

• Commonwealth Games

Gold medal – first place 2018 Gold Coast        800 m

Gold medal – first place 2018 Gold Coast      1500 m

• African Games

Gold medal – first place 2015 Brazzaville       800 m

• African Championships

Gold medal – first place 2016 Durban              800 m

Gold medal – first place 2016 Durban            1500 m

Gold medal – first place 2016 Durban          4x400 m relay

• World Junior Championships

Gold medal – first place 2008 Bydgoszcz    800 m

2.0  Sports Gender Controversy - Bonus Scene | Gender Revolution           

3.0 Gender-verification in women's competitive sports 

Andrew Richardson, Founder of Strength is Never a Weakness Blog

I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University. 

Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019. 

I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.  

My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.

My most recent publications: 

https://www.sciencedirect.com/science/article/pii/S1752928X19300216

https://www.sciencedirect.com/science/article/abs/pii/S1752928X19301076 

My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning. 

Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering. 

I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness. 

I had my own business for providing training plans for teams and athletes. 

I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships, 

in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge. 

Contact details below; 

Facebook: Andrew Richardson (search for)

Facebook Page: @StrengthisNeveraWeakness

Twitter: @arichie17 

Instagram: @arichiepowerlifting

Snapchat: @andypowerlifter 

Email: a.s.richardson@tees.ac.uk

Linkedin: https://www.linkedin.com/in/andrew-richardson-b0039278 

Research Gate: https://www.researchgate.net/profile/Andrew_Richardson7