Simply having the regulations state that SRY
is used as a proxy to determine if you have a
Y chromosome or not. And that's their kind of
their bottom line. If you have SRY, then you're
going to have a Y chromosome and vice versa.
But that's the part that's just not 100 % true
because you can have or not have SRY. And that's
irregardless of having a Y chromosome or not.
Hi Shani, it's my pleasure to have you on Evidence
Strong Show. for the second time. And please
briefly introduce yourself. Yes, Alex. Thanks
for having me. It's nice to talk to you again.
So last time we talked about sex differences
in exercise physiology. And so I introduced myself
then, but I guess I'll say again that I'm a researcher
in genetics and molecular biology and how it
relates to sex differences, both in health and
disease. And also in the past, I had a stronger
focus in exercise physiology. And I'm an 800
meter runner myself. I guess even more related
to this topic. And yeah, I'm in Melbourne at
the Hudson Institute doing a postdoc and finished
my PhD in epigenetics about four years ago. Amazing.
So today we talk about DSD athletes and transgender
athletes and the policies and how they relate
to research. So let's start with some kind of
definitions, what DSD athlete is and transgender
athlete and how they differ. talking about dsd
and transgender i'll define sex and i'll define
gender and i think that those are commonly used
interchangeably in society but in biology there
are two separate words with separate definitions
so sex we call the biological sex and the two
main categories are male and female and i'm keeping
it simple for the sake of the definition and
we'll go into more details after and this is
determined by our sex chromosomes so Female typically
will be XX and having XX chromosomes means you
have a certain set of genes and those genes lead
to development of ovaries. On the other hand,
you have... XY individuals, that means they have
an X and a Y chromosome, and having the genes
on those set of chromosomes lead to the development
of testes in typical males. And so I guess to
simplify it, the way we define biological sex
in biology is based on the phenotype or the gonads.
So if you have testes or ovaries, so basically
your reproductive organs, and that's how we kind
of refer to it. at least in the field that I'm
in and the way that we're approaching that biology.
Gender, on the other hand, is a social construct.
So it's the genders, what one identifies with
or perceives themselves as. And that more broadly,
the two categories is man or woman. So to kind
of use the terminology correctly, which it's
often not, and even in a lot of peer reviewed
papers and a lot of really high impact papers,
people will still interchange them. But if you're
talking about what is actually. happening from
a biology perspective sex is male and female
and gender is man and woman and that means that
comes up a lot in research is that mice don't
have a gender they have a sex because we don't
know mice can't tell us what they identify as
right so they can be male or female they can't
be you know that they don't have a gender and
that's again to keep it simple i won't go into
all the different variations of trend of um gender
identity so i gave you just the two man and woman
but yeah i won't go into the details of of all
the in between because study biology. So we're
interested in what's in between male and female.
But we're here to talk to you about biology,
not about the social constructs. So I'll stick
to that. And then how that relates to DSD and
transgender. So DSD stands for differences in
sex development. It used to stand for disorders
and sex development, but that was changed. It
used to be termed as intersex, but that's also
less commonly the medical term. So now we go
with DSD, which is a difference in sex development.
So a lot of what What my lab at the Hudson does
is study those exact pathways of sex development.
So how does an XX embryo lead to the eventual
sexual characteristics? And what that means is
about 1 % of the population, which is a lot more
than what people tend to think, and that is kind
of commonly thought, is born with a DSD. So that
means they present with sexual characteristics
that are not 100 % typical to male or 100 % typical
to female, but are somewhere in between. And
that's a really big range and a really big spectrum.
So you can have anything from a partial sex reversal
to a full sex reversal. So what we mean by partial
is you are XX, you're presenting as a female,
but you have some characteristics that are male
-like. And that's why we use the word typical
because 99 % of the population... that's how
a male develops. 99 % of the population, that's
how a female develops. So this is the typical
pathway. If everything is coordinated. in a specific
way. And variations to that pathway will lead
to a difference in sex development. And that
can be at several stages along the pathway, therefore
leading to this spectrum. So that was partial
sex reversal, meaning you still have the sex
chromosomes that your phenotype or your gonads
are presenting as, but maybe you have some variation.
And then you have full sex reversal, where you
can have an XX chromosome makeup, but you're
actually presenting entirely as a male. male
characteristics. So there's a range and everything
in between. And so what my lab does is try to
identify the genes that are or the variants in
the genes that are causing those differences
in sex development. So the main gene that was
discovered several decades ago was SRY, the sex
determining region on the Y chromosome is what
SRY stands for. And it's a gene that lies on
the Y chromosome. And generally, typically, if
it's present, it leads to the development of
testes. So... It's kind of like as a simplistic
statement, if you have SRY, you'll develop testes.
If you don't have SRY, you won't. But that's
a very simple statement because the pathway is
very complex. There's a lot of parts of the pathway
that are already known. So which targets there
are upstream or downstream of SRY. And there
are also inhibitory pathways to then inhibit
the development of ovaries at the same time.
So it's a coordinated pathway. It's almost like
you start with what's called the biopotential
gonad. And it kind of has a, you know, an unknown
fate at that point. And it depends on the presence
of a multitude of different genes in the pathway.
And if the right genes are present at the right
time, so they're expressed at the right time,
that bipotential gonad will differentiate into
a testes. And if the right genes are present
or not present at the right time, that bipotential
gonad will differentiate into the ovaries. So
it kind of has these two pathways that it can
go down. That said... because it includes a number
of genes that need to be coordinated and turned
on at the right time in the right place, right,
and you go and add. Then variations, whether
it's at this point in the pathway or at this
point, then all of a sudden you could find yourself
coming towards the other pathway. So that can
happen at multiple different stages, and that's
where the complexity comes in. So there's about
50 % of cases, and I'm giving a rough estimate
because it depends on which type of DSD. If we're
talking about an individual that's XY or an individual
that's XX, but at least 50%. both categories
have variations in genes that we haven't yet
discovered or variants that we haven't yet discovered.
So about 50 % of the cases that present will,
you know, if a baby is born and presents with
ambiguous genitalia or ambiguous sex characteristics,
so kind of a mix or a mixture of both, then they
usually undergo a DSD gene panel, which has 138,
so approximately 140 genes that have been confirmed
and identified to lead to DSDs. If they test
positive, for any of those specific variations
of those specific genes, then they have a diagnosis
and they can be advised with their treatment
options or kind of the way that that DSD tends
to develop in people. And then the other kind
of 50 plus percent don't fall on any of the genes
on the gene panel. And that's the patients that
we often get. So we'll get patients that. are
called panel negative. So none of the genes that
cause DSDs that we know of don't explain their
DSD. And then we perform a mixture of whole exome
sequencing or whole genome sequencing with a
combination of other methods to identify the
potentially causing variant or that DSD. Is it
possible that it's not obvious at birth and the
person gets to know later? And if yes, what circumstances
would bring this topic about? Yeah. So because
it's such a spectrum, there's a lot of answers
to that question because depending on the type
of DSD. But as an example, so the three kind
of main types of DSDs that we categorize into
are one is sex chromosome aneuploidies, which
means you basically have a different number of
sex chromosomes than what is typically found.
So instead of having XY or XX, you have either
XO, which is Turner syndrome. So females that
have just one X chromosome and you have X. XXY,
which is Klinefelter syndrome, so males that
have two X chromosomes and a Y. And you have
Jacobs syndrome, which is XYY, which is more
rare. And that also leads to male development,
but with two Y chromosomes. So a good example
of individuals finding out later on is with these
sex chromosome aneuploidies, because they have
some mild phenotypes. And again, it ranges depending
on the individual and what we call the mosaicism.
So some cells can have just one X, some cells
potentially have a combination. So depending
on that individual's present genetic condition
or kind of genetic makeup, they will present
with different symptoms and potentially at different
stages of life. So often what will happen either
with Turner syndrome or Klinefelter syndrome
is these people have problems with conceiving
or problems with fertility. And upon fertility
investigation, we'll find out that they have
one X chromosome in a female or potentially two
X chromosomes in Klinefelter men. So that's one
example of how. that can be found later on. And
then back to the other two types of DSDs that
we talked about, sex chromosome aneuploidy types,
then there's what we call 46XY and then 46XX.
And what that means is that the individual has
the two sets of sex chromosomes that are typical,
right? Either XX or XY, but they have a partial
or a full sex reversal. So a variation to their
development, meaning someone that's XX isn't
presenting phenotypically completely as an individual
who is XX. X and vice versa with X, Y. Wow, super
complicated to say the least. That's good. I
really wanted to show it. Why do we care in sports
whether the person developed typically or atypically?
In the context of sports, and this is where,
yeah, it just, it's complicated in biology. It's
complicated in what we study. And so that obviously
translates also to... to the sporting regulations
and to the definitions in sport. So I'll go through
kind of just a rough history of what's kind of
happened. So update on the DSD participation.
And I guess I'll keep my wording a bit vague
because I'm not here to point fingers at anybody
or at any body or organization. I'm a biologist
or interested in the biology. And I'm here to
discuss the facts of what we know and what we
don't know and not to give my opinion on what
I think the regulations should and shouldn't
be. So the saga with DSD. participation is not
new it's something that's come up in history
but it really blew up around 2009 after the 800
meters in the world championships and since then
it went through a number of different regulations
so first it was decided that females that wanted
to compete in events from 400 meters to the mile
in athletics had to have a testosterone concentration
below 10 animals per liter that concentration
i'll talk a little bit about the testosterone
aspect That concentration recommendation or restriction
then moved down to five nanomoles per liter,
and then it moved down to two and a half in 2019.
And that's where it sits right now. And there
is a lot of debate around that. But what that
meant is that females that had a DSD that caused
them to have high testosterone levels were required,
if they wanted to participate, to take medication
to lower their testosterone levels below that
allowed threshold. Could you just, my audience
may not be... quite familiar with the normal,
maybe typical ranges should be for females and
for males. Why 10, 5, 2 .5? How it relates to
male levels? So males have several folds higher
levels of testosterone. A normal, you know, a
typical male and a typical female. And there
are conditions in females and that's what I was
going to get to on the complexities in it because
there are conditions in females such as PCOS,
so polycystic ovary syndrome, which can lead
to those higher levels, but it's a trait that
we call sexually dimorphic, which means it totally
doesn't overlap. So there are traits that have
sex differences, for instance, height. If you
look at a graph, you know, it's kind of like
this, like, yes, on average, males are taller
and females are shorter, but there's going to
be an overlap. It's not like there's not males
that have the same height as a female and vice
versa. But when it comes to testosterone levels,
it's like this, you know, like you can take someone's
testosterone and you want to know if they're
you know, if they're a male or a female, we're
talking about to keep using the word typical
to keep that in mind. So yeah, it's many, many
folds higher in males. Okay. So if that's the
case, why 10, 5, and 2 .5? Yeah. And that's what
a lot of the debate and criticism has been around
because those numbers, at least in science, whenever
there are thresholds, we always see that as a
little bit arbitrary. You know, we choose a p
-value of 0 .05, but some people choose a p -value
of, and a p -value is just how significant something
is in science, right? Of 0 .05 or 0 .05 or 0
.01 or 0 .01. So, you know, choosing a threshold
that's going to decide, you know, if you're above
or below that always is going to have a sense
of subjectivity to it and I guess arbitrariness
to it. And I think that's why the numbers were
adjusted every few years is because there really
wasn't evidence to support that threshold. So
there were studies done trying to measure performance.
females and their levels of testosterone and
correlate levels of testosterone to performance
but we know that performance is so multifaceted
so how can you you know single that one thing
and say oh this person has high testosterone
therefore they have better performance when there
was maybe another person that had that same level
and they had lower performance so it's it's not
a black and white the levels that were decided
were debated on and that's why they kept coming
down and the data that was out there to support
that threshold was very weak yeah and in addition
to that There's different reasons for having
high testosterone and there's different ranges.
So if you have PCOS and it's also all about the
receptors as well, you can have high testosterone,
but is it bioavailable? Is your body actually
able to have the sensitivity in the receptors
to respond to those higher levels? So it's a
combination of a lot of different things that
are going to present differently. an individual,
depending on the reason that they have that high
testosterone and the background of everything
else that they have. So it's, there's kind of
not been any single study that's been able to,
you know, really answer that question fully because
most studies and most of what we know about testosterone
historically was done in studies in males. And
now there are more studies coming out in females
and we'll get to transgender, gender -firming
hormone therapy, looking at the effect of when
you take exogenous, so out. of your body testosterone
and what that does. But when it comes to having
high endogenous testosterone levels that have
high variability and a multitude of different
functions, it's really hard to answer that question
of exactly at what threshold do you get a performance
benefit with testosterone in females. It's just
not really well known and the data is not there
to support that. Okay, so if we think DSDs, we
understand now that it's a spectrum and the things
may diverge from the typical pathway. on many,
many levels. So now in terms of sport, the different
DSDs will have different presentations in terms
of potential performance improvement. Exactly.
And because it's 1 % of the population and in
that 1 % that splits to a certain percent being
males and a certain percent presenting as females,
that's going to be even less. And then you have
the number of those people that actually ended
up in sports or having skills in a specific sport.
So that's... reduces it even more. And then you
have the ones that... you know, they have variable
presentations of what are the genetic causes
and then it splits it up even more. So you have
a really small number of people to represent,
you know, each one of those different categories
or however many there even are. But the point
is to say that when it comes, so I didn't mention,
so the latest ruling is what I was going to add.
The latest ruling that was just now before the
Tokyo World Championship, so just in September,
was that the testosterone for... in the female
category needed to be below 2 .5 animals per
liter. So that stayed. And individuals who wish
to compete as a female needed to undergo a test
to see if they have the SRY gene or not. So we
talked before that the SRY gene is one of the
key members in the pathway to determine if you
develop testes or if you develop ovaries. But,
and this is where the big buck comes in and where
the DSD researchers are kind of trying to, I
guess, make it clear that it's a lot more complex
than that. And it's not just one gene that decides
if you have testes development or ovaries development.
So there are what we call SRY negative cases
and SRY positive cases. And that means that,
for example, an individual that is XY could not
have the sry gene and could have crazy things
happen in genetics genes can get moved on to
different chromosomes and chromosomes can rearrange
and split up in meiosis and separate strangely
like a lot of strange things happen and simply
having sry or not having sry doesn't doesn't
determine the sex development 100 it explains
a lot of the cases but not all of the cases so
that means that you can have a female so an xx
chromosome complement but there can be a mutation
in another gene such as SOX9, and that can lead
to some male sex determination pathways. So that's
just an example of why this SRY simple gene test
to decide if a female can compete or not doesn't
actually cover the range or the spectrum of conditions
because there can be mutations. Well, there can
be. There are mutations in other genes, ones
that are known. but also ones that are not known.
That will lead to male sex determination in a
female and vice versa. So a simple test is just,
well, the biology is complicated. And, you know,
where do you draw the line for female enough?
We don't even know that in biology. So I don't
know how you would draw that line for sport.
It's just too complicated. So I guess the other
detail to add to the ruling that was made back
in September is that females with, so women that
were XY, but are presenting as females that have
what's called androgen insensitivity syndrome
are allowed to compete in the female category
as long as their testosterone is at a low level.
And this is because they don't have the receptors
to actually respond to that. So that was things
that are based off data and rulings that are
based off of science. So it's nice to see when
the policies and guidelines do have some science
rationale. to them because that was argued. Well,
they have higher testosterone, but they can't
actually use it. So it's not actually helping
them. But the thing that still stands, that is
not. completely aligning with the science of
DSDs is the fact that now the SRY gene is deemed
the, you know, be -all, know -all to if you have
a male or female sex development. And we simply
know that that's not that simple. And there's
other genes involved. Okay. Should we move to
transgender athletes? Yes. So I have much less
to say about this because we do study a little
bit in my current lab and my past lab, but it's
not currently... that, how do I say it? No, but
I think we need just to complement the topic
of the athletes and to make it maybe not full
picture, but maybe a little bit more rich picture.
So we have these athletes who wear the jeans
and the development are varying from the typical.
And now we have transgender athletes who at some
point decided that they present or want to present
as the other gender. So that has consequences.
in terms of fairness and participation in sports.
So from that perspective, who are transgender
athletes and how they differ from DSD athletes?
Yes, well said. So I think what's important to
understand with transgender athletes and the
decisions that they make around their process
for if they want to perform gender from hormone
therapy or not is understanding what... administering
hormones does to the body and to performance.
So two kind of main things in that to understand
is what we call organizational and activational
hormone effects. And what that means is organizational
is the lifelong exposure to a specific hormone
level, so having high testosterone in males or
higher estrogen in females, means that there
are things that will happen in the body and the
structure in your physiology that are irreversible.
So a good example, a well -known studied example,
is that there's a very specific time window in
embryonic development that having high testosterone
at that time leads to development of a specific
region of the brain to be bigger and that region
of the brain is again in typical males and females
is always larger in males and smaller in females
because there's that critical window of testosterone
exposure. And if you treat developing female
embryos with testosterone during that critical
period, they will develop the male type size
for that brain region. But if you give the testosterone
later on outside of that critical period, then
they won't. That brain region will develop as
it does in females. So it's to show that there
are critical periods in development that rely
on specific hormone levels and either having
or not having them at the right time is going
to... to confer sex differences that remain for
life and aren't reversible. So growing up with
a certain hormone level and having that exposure
throughout your in utero and throughout your
life is going to set up some differences that
are not going to be reversed. That's what we
call organizational. The activational hormone
differences means that those are kind of the
acute effects of hormones and those can be reversed.
So you can have taking testosterone can have
some immediate effects on your self -signal.
on your cell pathways that respond to that. And
if you then remove that, then that pathway then
stops that signaling or, you know, goes back
to what it was before. So there are effects that
are long term and irreversible and that happen
from long term exposure and effects that are
that are reversible. So I think understanding
that and the field is still in its infancy and
understanding exactly what the long term effects
are of gender affirming hormone therapy in transgender
individuals. So I think it's something think
that's quite a hot topic right now. And I think
that we're going to see a lot more studies coming
out on it in the coming years. So that's something
to keep your eyes open for. But a lot is looking
at, you know, what risks or what immune differences
or what are the effects on the physiology and
non -performance that are going to come about.
So it's trickling in and we are seeing a little
bit of, you know, the effects of strength performance
if you take testosterone, if you take estrogen,
and you do see an increase in strength in specific
tests with testosterone. and a decrease with
reducing testosterone and increasing estrogen.
But I think that there's just a lot still left
to understand there. And yeah, there's also important
to take into consideration how it affects the
rest of your health. So there is an increase
in risk with having thrombotic events as well
as a few other cardiovascular events and having
specific genetic predispositions to those events
might exacerbate that. So it's very much still
in the process and young and understanding the
exact. effects of taking exogenous hormones for
a long period and what that does so i think when
it comes to transgender athletes and the decisions
that that they can make for themselves is that
just having the knowledge of what we already
know and what the effects can be for that person
will allow them to make the decision of you know
what they want to do because there are the regulations
set out which is having the testosterone levels
at a certain level and if they want to in the
female category, then that is something to consider
because that's something that they have control
over as opposed to the DSD athletes, which is
different because that's made endogenously. It's
made from within. it would be taking something
external to reduce those levels, while in transgender
athletes, they can choose to change those levels
to be higher as opposed to lower. So yeah, I
think when it comes to transgender athlete participation,
it's less complex and there's more power in the
individual's decisions that they can make in
order to confer or kind of confer to the guidelines
and then be able to compete in the category,
in the female category. Okay, so what I'm hearing
is... From the embryo, there are differences
between female embryos and male embryos and how
they develop. And these differences grow with
the long -term exposure to the typical hormonal
profile the female or male will have. So transgender
athletes are different fundamentally. And there
are differences that cannot be changed or controlled
for using the gender -affirming hormonal therapy.
So that's... obvious on the basis of the science.
Now, how much it influences performance, that's
where the gray area is and where the investigations
are. Am I understanding correctly? Yes, I would
say so. I would say gray, it's not as gray as
DSDs, let's put it that way. So we know what
taking exogenous hormones can do to your performance
immediately, but I think we don't fully know.
So exactly what those hormones influence. Lewin's.
But I think... It's, you know, even intuitively
and understanding and looking at a male and a
female athlete and the size difference and all
the other sex differences that we talked about
in the previous recording is there are going
to be established sex differences that are not
going to be able to be reversed. So, yes, taking
exogenous hormones or gender affirming hormone
therapy will will shift those numbers a bit strength
wise, performance wise. But the difference between
male and female performance is so large that,
you know, that's kind of how. I see it. So there's
more left to understand. I'll put it, I'll agree
with that, but we know enough to know that, that
the lifelong exposure to, to hormones and even,
even not lifelong, even if people undergo, you
know, hormone replacement therapy earlier on,
there's still E and utero differences and, and
going through puberty that are going to be, yeah,
irreversible in a sense. Do we know anything
about the, for the transgender individuals, maybe
not necessarily artists, because I don't think
we have enough research. to draw on that. But
how the gender affirming hormonal therapy influences
risks of developing health conditions or diseases
that are typically correlated or are more common
in one or the other sex in typical lifelong exposure?
I love that question. It's a great question.
I think it's fascinating. When we are able to
hopefully one day answer that, that is very much
kind of connects to a lot of the research. that
we're doing, which is understanding the basis
or the reason for sex differences in conditions.
And we talked about last time, I think, that
there are diseases that are more prevalent in
males where the symptoms are more severe in males
and vice versa in females. And a lot is still
understanding what are the drivers of that, if
it is more sex chromosome genes or if it is more
hormones. And the more that we've been able to
do, we've been able to answer some of those questions
around some of those diseases. And I think that
that will tie in. really interestingly with your
exact question, which is which diseases are we
potentially protecting or becoming or exacerbating
the risk to in males or females who are undergoing
hormone replacement therapy? From what I know,
there's not enough out there to answer that question,
but I think that's going to come out as a really
interesting question to answer. But for transgender
individuals, but also for the rest of the population
as well. I think as it does relate to the nice
intersection between you know, that we're talking
about performance and sports, but also about
health. Because, of course, at the end of the
day, we want to be healthy so that we can compete
in our sport, right? So knowing the broader implications
of hormones at the different stages and what
it means to be taking them at different stages
for your health is, yeah, a growing body of evidence,
I would say. So there's a bit known as what I
just mentioned, but there's still a lot left
to understand with that. I don't think there's
going to be one fair solution that is inclusive
of all and fair to all. Yeah, there's just so
much complexity in it. So I think the more we
can study this, these conditions and how they
relate to performance, the more we can design
experiments that really help us to understand
what testosterone is doing in females and in
female muscle and in female performance. The
best that we can design those experiments and
answer that question and have a threshold that
maybe is really based off of strong scientific
evidence. You know, you would say you would have
a gene. panel and you could look at all the DSD
genes and then you can make decisions. But yeah,
there will be individuals that fall in that in
-between spectrum. And that's a lot of the issues
that we also, that also individuals with DSDs
will experience with making medical decisions
with their conditions is, you know, if you're
somewhere in the middle, how do you choose which,
you know, it's hard to draw a line in biology
in that sense. So I think it's hard to draw a
line in sport as well, which I think I kind of
repeated. this before, but I think, yeah, my
simple answer is that it's too complex. And there's,
in my opinion, there's just not going to be one
solution that fits for all. And the more that
we can base it on scientific evidence and strong
scientific evidence that's robust and not biased,
just the most, it'll be the most fair that we
can have for the most people. But yeah, I think
that's the best that we can do. All right. Is
there anything I didn't ask about, but you think
it's important to bring while we're on this topic
today? Yeah. As long as you think that I explained
the sex development pathways and how it doesn't
solely rely on SRY, because that was the main
takeaway that I wanted to get across here, because
I know from friends who competed in the last
world championships that, you know, they did
their SRY test and all was good and well, but
the athletes don't actually understand the meaning
of it, I think, at a deeper level. And not that
I expect people to, because it is complex and,
you know, the average person isn't studying sex
development pathways in their free time. But
I think that when you're subjected to take a
test, that's going to tell you something about
yourself. And when all of your peers that are
competing are subjected to take that test, I
think that there should be more information out
there to understanding the complexity of it and
what it really means to have an SRY test. Because
I don't know if I touched upon this, but simply
having the regulations state that SRY is used
as a proxy to determine if you have a Y chromosome
or not. And that's their kind of their bottom
line. If you have SRY, then you're going to have
a Y chromosome. Y chromosome and vice versa.
But that's the part that's just not 100 % true
because you can have or not have S or Y, and
that's irregardless of having a Y chromosome
or not. So I think, yeah, as long as my main
point came across, which is that, you know, the
test that's currently the regulation is trying
to make something gray, black, or white is what
I'd say at the end of the day. And I think that
the general population or the population that's
interested in sports will gain from understanding
what that really means. And also in their attitude
towards dsd and their attitude towards towards
sports and fairness because yeah it's just at
the end of the day those are people with conditions
that they didn't choose to have and not that
and it's not necessarily a bad thing so yeah
and i think and my other main thing that i want
to make sure got across is that dsd and transgender
those are two entirely different situations and
i think that commonly they're grouped together
and that's not fair to either of them right with
with differing reasons for their circumstances.
And yeah, I just think that the more knowledge
that anyone has, the more they can make an informed
decision that is the best for them and suits
them the best. So people that are involved in
athletics or involved in sports are very interested
in a lot of coaches and stuff that they just
want to understand. Like the recent regulations,
what do they mean? Is it fair? Is it not fair?
How much of it is evidence -driven? How much
of it is political? So I think that I've come
across a number of people that are just really
interested in understanding what the regulations
even mean. Where did it come from? So, yeah.
Right. And if it affects the athletes, it's good
to understand how. Because when you see cases
in media, you make up your mind on the small
part that you understand. And then you say, oh,
they should do this. black and white solution
but what you're showing here is that's actually
pretty complicated and to do it right you need
to spend time and do some research and and so
on so it's even with the organizations that are
trying to sort it out and are basing their regulations
on The science we have at the moment, even these
organizations are not perfect because it is so
complicated and hard to do. Exactly. Yeah, well
said. All right. Two short questions to finish.
If you could make one. change in sports on the
base of your research, previous or the research
you do now, what would it be? I don't think that
I have any specific change today or tomorrow
that I would implement based off of what we know.
But I do think that understanding that putting
two thresholds, an SRY threshold and a testosterone
threshold on performance is just a simplistic
view. And I think it'd be good to appreciate
the complexities. of sex development and how
There's more to it than just those two things.
So I think mainly it'd be to have the data supporting
it. And so to have, I think I mentioned before,
to have, again, there's nothing I would change
today or tomorrow because we just don't have
the data yet. But to be able to have the data
and the evidence to choose a threshold for testosterone,
to choose maybe a receptive level or sensitivity
to the testosterone, and maybe to just have the
information to support that threshold that whatever
one gets ends up. getting chosen and you know
if there are individuals that fall in between
because of the sry test to have an avenue for
them and for it not to be black and white for
those individuals that don't fit into that black
and white category so that they at least have
some clarity but i think at the end of the day
i feel like i'm very repetitive but at the end
of the day like i don't have any specific changes
i'd make i would just like to see things be supported
by robust science and for that to be the driver
and not for a political agenda or anything else.
And not that I'm saying that that is what's happening,
but just that it's hard for a scientist to see
when... Decisions beforehand were made around
the different thresholds and people studying
endocrinology and knowing what we know, we're
like, where are these thresholds coming from?
The evidence to support it, especially the testosterone
threshold, are pretty weak. So lower evidence
-based decisions, guidelines, let's put it that
way. All right, and the last. question to finish
is where people can find you if they want to
look at your research, get in touch, look what
you're up to. I'm not very active, but I do have
a LinkedIn account. That's my first and last
name. And our research, I mean, anywhere that
if you search Google Scholar or PubMed, then
any peer reviewed publication. comes out there.
So thank you so much, Shani. Huge pleasure to
talk to you and thank you for agreeing to talk
about the topic that is hot and very debated
at the moment. Thank you. Thanks, Alex. It's
been great again speaking with you.