Not So Fast

 

 

 

By Danny Shapiro, M.D.

 

Corey Whelan’s blog (http://theafa.typepad.com/theafablog/2009/08/hot-stuff-that-mama.html) on Caster Semanya raises some very interesting medical questions. Corey asserts that as a ‘proud owner of a vagina, she has always considered herself to be a woman’. Alas, it isn’t that simple!  As the proud owner of a penis however, I and all of my dangling brothers can assert that we are men.  Why is this so? Seems unfair I admit, but appearing female doesn’t necessarily mean one is female while appearing male ‘down there’ almost always mean one is actually male.

            There are many components of gender. The first and most important is genetic. The second is based on the type of gonad one possesses; ovary, testis or indifferent.

The third component is based on one’s psychological make-up. This is the least well understood since penis-owing individuals who feel like girls stuck in a boy’s body usually feel this way right from the start. Same for the other way around too.

            Let us assume for a moment that Caster Semanya actually has a vagina. She is then probably a genetic female, possessing two X chromosomes and no Y. If that is the case she is a woman. Period (pun intended). Her masculine appearance could be the result of any one of many medical conditions or she could be taking male hormones. In the later case, her testosterone to epi-testosterone ratio would be out of whack, which was NOT the case according to the London newspaper, The Daily Mail.

            Conditions that could cause her appearance are common. Most common would be the PCOS or ‘poly-cystic ovary syndrome’ which has absolutely nothing to do with ovarian cysts but can be associated with high-normal or high testosterone levels in women. Far less common but far more concerning would be conditions such as congenital adrenal hyperplasia or a hormone secreting tumor from the ovary or adrenal.

Since these conditions cause rapid masculinization and Carmen has been kinda boyish for a while, my best guess is that she has PCOS.

            Let us assume now that Caster has a vagina but she also has a Y chromosome. There are several medical scenarios where this is possible but only a few where masculinization actually occurs. The Y forces a system destined to look female into being male, unless the Y itself is faulty or the programming from the Y fails.

In the most common scenario where a woman has a Y, androgen-insensitivity syndrome, the patient looks like a girl and has a vagina BUT NO UTERUS. Her gonads are usually found in her groins and when biopsied, the pathology report says ‘testis’. In this condition, the patient cannot respond to the effects of testosterone and therefore cannot make a penis or scrotum. The hormone that causes the regression of female organs other than the vagina (anti-Mullerian Hormone) is still functional, so the uterus doesn’t form.  There are several famous Hollywood celebs with this condition, which is no surprise since these women are usually tall, buxom and have silky-smooth skin.

There is also a condition where a woman has a Y chromosome but has neither a true testis or ovary. This is called XY gonadal dysgenesis and these girls don’t masculinize either because the have no functional gonads at all.

The other conditions that DO androgenize are 1) true hermaphroditism and a little rare chestnut called 2) 5-alpha reductase deficiency. In the first case, patients have both functional testicular tissue and ovarian tissue. They frequently look female or have indeterminate external genitals.  In the 5-alpha reductase deficiency problem, the enzyme that converts Testosterone to its active form, DHT, is absent or lacking. All the tissues dependent on DHT to form (penis and scrotum) don’t. These patients look like girls until puberty when the testosterone levels skyrocket and the androgen-dependent tissues start to masculinize.  This condition is usually found in Guatemalan Indians so Caster is off the hook for that one too.

As for her sexual orientation…that has nothing to do with any of this. If she thinks she is a man caught in a woman’s body, the Track and Field Association will still have to call her a girl. If she is a lesbian, she’s still a girl.

Best as I can tell, she just has PCOS and the competition she trounced should just get over it.

Comments

[Michelle]

Has anyone heard else had breakouts and acne because of PCOS? I have had acne all over my chest and back for years, and didn’t know it was related to my PCOS. I just found this great article about it. http://www.wellnesswithrose.com/articles/PCOSandAcne.asp Just thought I would pass this along!

[Amy]

I just found out that PCOS causes acne and breakouts, and not just on your face, body acne too! Has anyone else heard of this? My friend passed this article along to me. She cleared her breakouts that she had from PCOS that were covering her whole chest following what it says in this article: http://www.wellnesswithrose.com/articles/PCOSandAcne.asp

[Amy]

I just found out that my PCOS is what has been causing my acne! Has anyone else heard of this? There is a great article on it here: http://www.wellnesswithrose.com/articles/PCOSandAcne.asp