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Hyperandrogenism: A curse or blessing?

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Caster Semenya (Photo by Fabrice COFFRINI / AFP)

Caster Semenya is a multiple award winning South African runner who is mostly popular not only for her skills, but also for her looks. At first look, she appears to be female but on further assessment, one may notice that she has some masculine characteristics or features. Caster Semenya is a highly celebrated athlete, who has won so many gold medals as a track athlete; she is also a highly controversial athlete due to ‘how she was created’ as she puts it. Following her victory at the world championships in 2009, issues were raised about her sex and she was asked to take a gender verification test to ascertain whether she is male or female.

There were claims that she had an intersex trait and results claimed that she had hyperandrogenism, a medical abnormality which resulted in excess testosterone levels which allegedly made her perform better than her female counterparts. In 2018, it was announced that hyperandrogenous female athletes would have to take medication to lower their testosterone levels, a decision which Caster Semenya announced that she would challenge legally. At the beginning of 2019, legal proceedings began on her counter challenge regarding her sex, and just last week the Court of Arbitration for Sports rejected her challenge. Caster Semenya has said that she has never taken any enhancing drugs, and so she should not be made to take any testosterone lowering drugs to reduce her performance.

Disorders of sex development are medical conditions involving the reproductive system. At conception, long before we are born, we all start out the same way and usually follow a pathway of sex development up until the time we are born as either a boy or a girl. Sometimes, some people don’t follow this typical pathway and this result in certain differences where the chromosomal, gonadal or anatomical sex is atypical. For example, a person might be born appearing to be female on the outside, but having mostly male anatomy on the inside. Or a person may be born with genitals that seem to be in-between the usual male and female types—for example, a girl may be born with a noticeably large clitoris, or lacking a vaginal opening, or a boy may be born with a notably small penis, or with a scrotum that is divided so that it has formed more like labia. It could also be that a person may be born with mosaic genetics, so that some of her cells have XX chromosomes and some of them have XY. These differences however are not always noticed at birth. Sometimes a person isn’t found to have intersex anatomy until she or he reaches the age of puberty, or finds himself or herself as an infertile adult, and some people may never even realize it.

Hyperandrogenism is a medical condition that is characterized by high levels of androgens, for example testosterone. Hyperandrogenism can occur in both males and females but it is more noticeable in females due to the fact that men already have testosterone so the signs of excess testosterone such as aggression are often negligible. Signs and symptoms of hyperandrogenism in females include masculine appearance, menstrual abnormalities, deep voice, male pattern hair growth, balding, acne etc. There are several causes of this hyperandrogenism and they include medications such as corticosteroid drugs, immunosuppressant drugs, chemotherapeutic agents, antipsychotics, and even some dermatological agents. Hyperandrogenism can also be caused by certain adrenal tumors, pituitary tumors and ovarian tumors, it could be caused by Polycystic Ovarian Syndrome. It can also be due to natural, congenital causes as is thought to be the case with Caster Semenya.

Congenital Adrenal Hyperplasia (CAH) is the most prevalent cause of sex differentiation disorder among people with XX chromosomes. CAH happens when an anomaly of the adrenal gland causes the synthesis and excretion of an androgen precursor, initiating virilization or masculinization of a XX person even before birth. Though it may not be able to prevent it or cure it, it can be managed with medication.

Whatever the arguments surrounding hyperandrogenism and its enhancing effects on female athletes, different people with this condition exhibit different signs and symptoms, it is important for a proper diagnosis to be made to determine the cause of excess testosterone. By so doing, we would know how to treat associated symptoms. Some people, like Semenya may decide not to get treated; in her words “I just want to run naturally, the way God created me.” However, it is important to note that high levels of androgens in females, if left untreated can result in serious health consequences such as insulin resistance, diabetes, infertility, recurrent miscarriages, obesity, Hypercholesterolemia, high blood pressure and heart disease. It can also cause severe depression due to the societal stigma associated with being ‘intersex’. If you or someone you know is exhibiting signs of hyperandrogenism, it is advisable to visit a heath care professional for appropriate diagnosis and available treatment options.


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