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Take Note: Katrina Karkazis on her book "Testosterone" and how perceptions of the hormone shape policy and sport

WPSU Take Note Katrina Karkazis
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On this week's Take Note, we talked with Katrina Karkazis about her book, co-authored with Rebecca Jordan-Young, "Testosterone: An Unauthorized Biography."

Karkazis is a professor of Sexuality, Women's and Gender Studies at Amherst College and Senior Research Fellow with the Global Health Justice Partnership at Yale University.

In the book, Karkazis and her co-author outline many of the misnomers associated with testosterone. We also discuss how perceptions of the hormone continue to influence politics and sports regulations, like in the case of University of Pennsylvania swimmer Lia Thomas.

Here's the conversation:

Katrina Karkazis  
Thank you for having me. It's nice to be here.

John Weber 
For the listeners out there, we'll be using the term "T" interchangeably with "Testosterone" today. So Katrina, what is testosterone, or "T," and what does it do?

Katrina Karkazis  
It actually seems like it should be a really straightforward answer. And I think most people would expect that I give a scientific answer. But part of the argument in the book is that it's impossible to know both what testosterone is and what it does without also thinking about it as a cultural entity. So it's both a material substance in the body, it's a hormone. It's involved in many processes in the body, and a lot of the organs in the body and tissues in the body have testosterone receptors on which it acts. But the thing that is also really interesting about testosterone is it comes now with about 100 year even prior to its isolation, 100-year story about what it does. And so it's really difficult, but also necessary to disentangle in a way, what it does from what we want it to do. And there are a lot of notions about what we want it to do, what we think it does, that aren't always borne out by the evidence.

John Weber 
Thinking about the evidence and kind of the story of testosterone, I know one of the motivations to co-write your recent book was kind of to clear up some of the claims aired on the episode of This American Life that's featured on many NPR stations, as we are one as well, about testosterone. Is that right? And what do you think they got wrong in that episode?

Katrina Karkazis  
So we write quite a bit about that episode in the beginning of the book. It's sort of a wonderful episode for our purposes, because so many of the commonsense ideas about testosterone get aired in that particular episode. And we were interested in it because off the bat right now, I don't remember when it aired initially. But the reason we went back to it is that they aired it roughly 10 to 15 years later, with no addendum or update as though there was nothing else to add of importance at that time. There are quite a few myths, I think that circulate within that episode. For example, that testosterone is a sex hormone alone. That testosterone is a male sex hormone. That what it does in women is somehow substantially different than what it does in men. The assumption that people who are perceived as more manly would necessarily have higher levels. So one of the more comical moments is when they test the testosterone levels of maybe five or so people associated with the show. And it's actually the gay man who has the highest levels, and they have sort of, you know, a good laugh about this. But there's also a lot of anxiety about the levels. Will the women have high levels? And what will that mean about who they are? What is it mean about the masculinity or manliness of the men if they have lower levels? And I think it plays into a lot of ideas, not only about what kinds of levels people perceive others to have, or that they should have, but what those levels mean around masculinity or femininity, secondary sex traits, and also behaviors. For example, libido, right, or muscular development. So in that way, I think it was a handy heuristic for a lot of what we wanted to talk about in the book and start to pull apart in later chapters.

John Weber 
When we think about, you know, that story back to it of testosterone itself. In the book, it also mentions in the 1920s, testosterone was already kind of being viewed beyond being just a male sex hormone in some research, right? What are the other types of testosterone are the other multiples of testosterone, if you will?

Katrina Karkazis  
Yeah. So there are a couple of ways that we use this notion of multiplicity in the book. And I think one of the ways that you're talking about it, we have a chapter that's just called "Multiple T's" because when we use the word testosterone, it sounds singular, right? As though there's just sort of one molecule in one version, and when you look at it in the body, it's the same. And that's not true. There are multiple versions of testosterone like dihydrotestosterone. But the other thing is that estrogen actually converts into testosterone, which may be surprising to people. One is multiple versions in and of itself. The other thing is that testosterone shows up in different fluids in the body. So for example, you can measure testosterone via saliva, via blood, via urine. And when you do that, you actually can't translate the level that you understand from any one of those media to the other very easily. And different researchers will use different media for different reasons. So sport overwhelmingly relies on urine except in a couple of special instances where they rely on blood. But other kinds of studies in behavioral endocrinology will rely on saliva. Saliva's cheap, it's easy to do. It's plentiful. It doesn't involve the genitals, right? There's sort of a lot of reasons. But the other way it's multiple are the narratives or the stories that we tell about it. And then people tend to very often just think about testosterone level in the body. But then the question becomes, which testosterone are you measuring? What do you think it's relevant to? Like, are you interested in sport performance for some reason? Or are you interested in some other kind of behavior like violence? And does it matter what you measure, when you measure, how you measure? And the quick answer to that is, yes, it all matters. So it's incredibly dynamic, it changes time of day, time of year time of life. And so even if you're trying to correlate testosterone with something, let's say criminality, you can't take a testosterone measurement now and associate it with anything that will happen in the future, or anything that's happened in the past, because it's so dynamic, that even a couple of hours from now the level could be significantly different enough that it's actually not meaningful. Because it's not proximate enough to the outcome variable, or the event that you're interested in, both in the scientific work, but also when we talk about testosterone in more popular conversations. All of that complexity very often is lost or papered over. And so we tend to get very broad statements either about what testosterone is, or more problematically what it does, when the kinds of studies that are done can't speak to the kind of breadth of what people are claiming that it does, for example, higher levels of testosterone, produce a better athletic performance. And the answer is actually not straightforward about that relationship.

John Weber 
And on that subject of kind of misnomers, or murky science around testosterone, there's a lot of established feelings and beliefs, people are really quick to defend how like their beliefs on what testosterone is or what it does. And those sorts of things kind of create a lot of folklore or these sorts of "zombie facts", as you call them. In the book, you talk a little bit more about that "T-talk" and some of the misinformation that's kind of surrounding testosterone in general?

Katrina Karkazis  
Yeah. So this notion of "T-talk" or "Testosterone Talk" is something that we came up with because we found that when we actually started to talk about concrete evidence in media interviews like this, it was really hard very often for the interviewer to absorb counterintuitive facts. And what we realized is that you couldn't just talk about testosterone on its own without thinking about all of the stories, the myths and beliefs that get wrapped up in that that aren't just in popular talk about testosterone, but that are actually woven into science. And that there's this kind of circular relationship or circularity between how testosterone is spoken about in, you know, discourse out in the world, how that gets picked up in science, how that then gets translated back into the public conversations. I think what's hard about testosterone is that so many people feel without ever looking at the evidence that they know what it does. And I think we're so invested in those stories, and they're long stories that go back prior to even the isolation of the hormone. And yet, when you look at the evidence, for example, at athleticism, or violence, there is no straightforward direct relationship between testosterone level and violence. I think this is unbelievable to large groups of people. And yet, not only are we saying this in the book after looking at that body of work, but you have testosterone researchers themselves saying this decades ago, and yet still pursuing the same line of work with the idea, well, maybe we don't have the right measures. Maybe we need to measure testosterone differently. Maybe our outcome variable isn't right, maybe we didn't sample the right population. And so there are two terms that we came up with in the book to sort of describe this. One is the 'Mulder Effect", which has to do with the X-Files. And for people who don't know The X-Files. It's kind of these two detectives, Scully and Mulder. And their task in the world is to Look for signs of intelligent life in the universe. Always behind Mulder in his office is this sort of UFO poster that says, "I want to believe." And that's always what's happening very often with these researchers is even when they have a negative finding, it doesn't seem to unseat the idea or the hypothesis that drove the work, which is it must still be there. But we need another study to actually locate it. And the "zombie fact" is precisely that, which are facts that persist sort of, you know, even though there is plenty of counter evidence to show that it shouldn't persist, like with violence, and yet it goes on, right, it has a life of its own. That's not only threaded through science, but through society more broadly. The notion that the hormones were sex exclusive, meaning only men had testosterone, only women had estrogen. And that they only produce so called sex specific effects. So that T, for example, was only responsible for those things understood to be masculine. And so one of the chapters that we have in the book that's actually quite fun, we wanted to also explore surprising things about testosterone that hadn't been looked at because of this framework. And testosterone turns out to have an incredibly important role in ovulation and female reproduction. But if you understand it to be a male sex hormone that only does things in men, or only does things understood to be masculine or manly, then why would you ever look for any kind of role it would have in female reproduction. And so there's a lot that we don't know about testosterone because of the limitations in how it's been understood and therefore studied.

John Weber 
If you're just joining us, this is Take Note on WPSU. I'm John Webber and today we are talking with Katrina Karkazis, co-author of the book, Testosterone: An Unauthorized Biography and professor of Sexuality, Women's and Gender Studies at Amherst College. Katrina, there's a point in the book where you and your co-author write about athlete’s skills and abilities. There's an example that Usain Bolt, you know, one of the greatest sprinters of all time he kind of is asked about, can he dominate in the 800-meter sprint. For those out there, he's a short-term sprinter right, short distance. Really short, I guess, 100, 200 meters generally. How do assumptions of what makes the best athlete fuel testosterone arguments and opinions?

Katrina Karkazis  
This book, in many ways came out of work that Becca and I did for quite a while before, directly and indirectly. But the reason we wrote this book versus something else had to do with arguments that were being made in the field of sport around the role of testosterone. Specifically around women's athletic performance. And the notion that women who had naturally higher levels, so not doping, right. We call this in medical scientific terms endogenous, right, what you're born with. That women who had naturally higher levels had an unfair advantage over women with lower levels. And this became the focus of policies in track and field, but also in the Olympics, that sought to either exclude women completely from sport, or require them to lower their testosterone via medically unnecessary procedures, with the notion that this would level the playing field, so to speak. And this had come under a lot of criticism from a lot of different arenas, but very few people had actually looked at the testosterone research. And one of the things that was interesting is we felt like in that chapter, the way you're talking about Usain Bolt, that we had to step back for a second, and not only just look at what the literature on "T" in athleticism says, but to actually say what is athleticism? And what contributes to it? Because very often athleticism gets reduced to biology in the body alone, right? It might be genes, it might be hormones, and yet there's a whole realm that is important to athletic performance, that are not only physiological traits that we don't consider or talk about, like height differentials, for example, or weight. But also things that are socio-economic factors, right, that might include sort of what is the environment in which you're becoming an athlete? Is, for example, sport, something that's encouraged for women are discouraged? Do you get the same kinds of resources and training facilities and nutrition and other kinds of things that would impact one's ability to excel? And why is it that we're not only not taking into account all of these other physiological factors that are important, but don't take into account at all psychic factors, right. Like, you know, the mind if you will, which I think is incredibly important as well for athletes. And so we were looking at that because it does not help to have the body of a power lifter and try to be a rock climber, it's not going to work to one's advantage. So with Usain Bolt, part of what we were talking about as well, is the incredible height differential very often between he and his competitors, which is not perceived as unfair. Because height is not understood to be important in that context regarding unfairness. That's not because it's not important. It's because we zero in on certain things based on beliefs and values as being important. I think testosterone becomes the item of focus, if you will, in women's eligibility for two reasons, by me, maybe even more. But one is, it's continued understanding as a male sex hormone leaves the notion that it's problematic or doesn't belong in women, and that that's unnatural. And so lowering it is seen as a corrective, right, a return to nature about what should be. The other thing is that there's already an association existing between testosterone and athleticism, and also between athleticism and masculinity. And when you bring those together, I think they work synergistically to give the idea that women who have higher than typical levels necessarily will always do better than their competitors. And that in and of itself is unfair. But it doesn't take into account that in fact, the women who this regulation primarily affects, and harms are actually women of color from the Global South. Who, having interviewed many of these women with Human Rights Watch, we went around the world and interviewed quite a few, the largest sample to date. These women are coming from extremely impoverished backgrounds. Very often, though, not exclusively, they cannot have adequate nutrition not have adequate training shoes, not have access to at times electricity, other kinds of economic resources. And so that's not considered unfair, right. And so women who are coming from better resource backgrounds are not considered to have an unfair advantage over these women. And it's because of the values of I think the policy makers who make these policies that tend to understand and therefore favor the circumstances of women of the Global North.

John Weber 
When we think of that Global North and kind of right here in Pennsylvania, transgender swimmer, Lia Thomas at the University of Pennsylvania has won Ivy League Championships and NCAA division I Championships this year in swimming, and continues to face a lot of media attention for that testosterone as a policy, you know, these NCAA is testing and kind of requires three years of this kind of procedure to prove that you hit that level below their threshold. Are there better ways to measure that kind of athletic performance potential beyond these thresholds that are kind of being instated by the NCAA governing bodies?

Katrina Karkazis  
People might assume that there's a large body of scientific evidence on trans athletes. There's very little research. And I would say about a year ago, I looked at quite a few of those studies and what was being cited, for example, in court cases in legislation, and also in news media. And there are very, very few studies. Those studies look at different populations, they look at different outcome variables, they use different statistical methods. And it is pretty much impossible to say anything conclusive from those studies, because they are so diverse. And yet people assume that this is kind of a settled question. And I think one of the harms, I think that happens to athletes like Lia Thomas, is that I don't actually really think this is a debate about Lia Thomas. I think if we look over the last two to three years, what we're seeing is an instrumentalization and a politicization of the participation of trans athletes that's coming in the wake of other kinds of issues, that conservative groups or Alt-right wing groups have lost on. For example, gay marriage or bathroom bills, which are the precursors, right. These are sort of when we think about the kind of moral panics or sex panics if you will, that have come prior. Those battles have not been won by these groups. And so in the run up to midterm elections, what we're seeing is a tremendous amount of proposing of bills that not only banned trans athletes, but that actually also alternatively criminalize or recategorize as child abuse, gender affirming care for trans youth across different states. Now these are happening simultaneously by the same Governors and legislators that are also proposing bans on abortion. So for example, Oklahoma Governor Stitt recently signed into effect a bill banning trans athletes and now just this past week signed into effect probably the most near total ban on abortion that exists in this country right now. And so I think we miss something really important when we narrow the conversation to one particular athlete who's done well ignoring all of the other trans athletes, swimmers who are not excelling in this way. And so they point to a sample of one as being a kind of solid evidentiary base from which to conclude that, what testosterone is fueling this athlete? Well, what we know from what Lia Thomas has revealed, she actually transitioned three years ago, she's well within the testosterone limit range that has been proposed, there's not a single way in which she hasn't complied with the current regulations. But when an athlete excels, they come under scrutiny. The NCAA overnight, changed its policy after 10 years. And after many years of thinking that it would change the policy, we now know that that happened without any reexamination of any scientific evidence. So we know that that was a political decision that would have kept Lia Thomas out of the NCAA championships. Because at that point, she was I believe, 34 months post-transition, and they made the rule 36 months, which would have extended right through the NCAA championships and excluded her. Now they walked that back. But I think what's important and what I try to stress when I talk about this, yes, the science is important, we should consider it, we should think about it, we should take the evidence seriously, but not literally. But the science doesn't tell us what to do. That's a social question. And it can inform these decisions. But we can't understand these kind of really heated international debates without also looking at the politics that surround them, who's involved in the debates and what their investments are outside of this issue. You know, there are now all of these bills called, you know, save women's sports act is, you know, what was proposed in Idaho from legislators that up until this moment, have never put any attention towards women athletes, and women's sport and all of the inequity that exists. And so this idea that they're seeking to protect cisgender women in sport or trans youth in terms of medical interventions, not only doesn't take into account sort of where the real risks and harms are, but all of the ways in which they don't protect children and women more broadly, in the broad range of policies that they propose, like the abortion bans.

John Weber 
Kind of on the subject of Lia Thomas and just general men to women transitions in sports, when we think about a lot of the critiques of Lia Thomas, in particular are her size, you know what you mentioned about Usain Bolt as well being very tall, very skilled. That regardless of testosterone, critics of Lia Thomas and other trans athletes often feel they have an unfair advantage, and they shouldn't be competing with women generally. Can you talk about your thoughts on kind of possible solutions to this wedge issue that is clearly much beyond the NCAA or the Olympic governing bodies?

Katrina Karkazis  
it's convenient, yet problematic to point to her height. There are plenty of cisgender women out in the world that are her height as well. And so one of the things that people sometimes do when they're arguing in this domain is to point to averages, but averages flatten the full range. And so when we look at averages we ignore, for example, that women's height can range from I'm guessing I haven't studied this, but I know it's a wide range, say 4'11" to 6'4". Yes, they would be talking about Lia Thomas, if she were still winning, but it would be a lot harder to talk about her. I think if she weren't tall, you know, that if there wasn't something else that they could point to. They very often, you know, proponents of bans or exclusion, will point to the most obvious kind of phenotypical or physiological difference and underscore that because it's something that anybody any person out in the world could note and might have already noted on their own. But certainly that trait alone isn't what makes the person excel beyond you know, any other competitor. And then of course, nobody looks at the spread for example, and finds it problematic between say Katy Ledecky, who's another extraordinary swimmer. And her competitors instead, that gets celebrated. And so that kind of advantage that she has that allows her to excel is understood as a positive whereas for Lia Thomas, it's construed frankly as cheating. I think it is very often if even if it's not directly called that it's indirectly. The only thing that I would say, Ta-Nehisi Coates said something once and I've taken on and he said, "I'm not the policymaker, my job is not to come up with the policy. My job is to tell you what's wrong with what you've suggested." So I do think that's true, I do find it important to point out some of the inconsistencies or ill logics about what's been proposed. But I do think it's important to think about the history and rationale early on for sex segregation in sport, which was had multiple reasons for it. One was the notion of women's inferiority and inherent vulnerability and weakness next to men. And that coexisted as well with a particular idea that women might detract from the attention given to men in sport. And for that reason, for example, in the Olympics, women wouldn’t be allowed. In fact, Jaime Schultz is a good person, she's on this campus and is a good scholar to consult about this because it's more in her wheelhouse than in my own. So I would suggest looking at her work. But that kind of protectionism, which is really a Trojan horse for discrimination, or the paternalism that comes with the idea of women's inherent weakness. We know that over the years that the more women have gained access to sport, the better they've gotten, the faster they've gotten, the more that gaps have been closed. And that in many ways, there are differences in sport around for example, length and figure skating that there's no reason for that difference other than notions of women's lack of endurance, for example. And so I don't think the world is ready for getting rid of sex segregation. And it may not make sense for every sport. But there's also a way in which these categories have for a very long-time sort of encompassed and included a broad range of people, trans people, women with intersex variations, and others. And there's no reason that these categories cannot continue to accommodate that kind of physiological diversity. So I think there is a way in which these categories can continue to be expansive in the way that they have been historically. But also a way in which very careful thinkers could come together and think about in particular sports where sex segregation may make sense and where it may not because not all sports are sex segregated, and not all sports are sex segregated at all levels. So there is already precedent for rethinking that. And I think it's probably long overdue that we rethink even more.

John Weber 
Katrina Karkazis thank you so much for talking with us today.

Katrina Karkazis  
Thank you for having me. It's been fun.

John Weber 
Dr. Katrina Karkazis is a professor of Sexuality, Women's and Gender Studies at Amherst College and a Senior Research Fellow with the Global Health Justice Partnership at Yale University. Katrina's latest book, Testosterone: An Unauthorized Biography, written with Rebecca Jordan-Young explores the murky science behind testosterone. Karkazis recently presented the Penn State Rock Ethics Institute's Richard B. Lippin Lecture in Ethics titled "Sex Itself: The Science, Politics and Ethics of Categorization. For more information on Katrina Karkazis' work, visit wpsu.org/takenote. I'm John Weber, WPSU.

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