Katrina Karkazis
Drawing on my training in cultural anthropology, gender studies, science studies, and empirical bioethics, my work is deeply interdisciplinary, and addresses a range of topics challenging entrenched scientific and medical beliefs about gender, sexuality, and the body.
My current research, which has been supported by the National Science Foundation and the Brocher Foundation, examines the many identities of testosterone. I am currently working on a book, T: The Unauthorized Biography (under contract with Harvard University Press), with the wonderful Rebecca Jordan-Young. This book is supported by a Guggenheim Fellowship and an American Council of Learned Societies Collaborative Research Fellowship.
This book stems from my work on “sex testing” and sports policies that ban women athletes for having naturally high testosterone. This research has appeared in Science, The American Journal of Bioethics, and BMJ. I helped to mount Dutee Chand’s successful appeal against the IAAF’s hyperandrogenism regulation at the Court of Arbitration for Sport, and served as an expert witness in the hearing.
I began my career looking at controversies over treatment for people with intersex traits, which resulted in my book Fixing Sex: Intersex, Medical Authority, and Lived Experience (Duke 2008).
My research has been covered in the New York Times, Time, BuzzFeed, The Week, CNN, ESPN, The Daily Beast, The Los Angeles Times, Boston Globe, Jezebel, Slate, The Advocate, La Liberation, The Chronicle of Higher Education, San Jose Mercury News, and the Toronto Star. I’ve also appeared on The World, BBC, CBS News, NBC News, KCBS, CTV News, Q Radio, Al Jazeera, and the Australian Broadcasting Corporation, among others.
My current research, which has been supported by the National Science Foundation and the Brocher Foundation, examines the many identities of testosterone. I am currently working on a book, T: The Unauthorized Biography (under contract with Harvard University Press), with the wonderful Rebecca Jordan-Young. This book is supported by a Guggenheim Fellowship and an American Council of Learned Societies Collaborative Research Fellowship.
This book stems from my work on “sex testing” and sports policies that ban women athletes for having naturally high testosterone. This research has appeared in Science, The American Journal of Bioethics, and BMJ. I helped to mount Dutee Chand’s successful appeal against the IAAF’s hyperandrogenism regulation at the Court of Arbitration for Sport, and served as an expert witness in the hearing.
I began my career looking at controversies over treatment for people with intersex traits, which resulted in my book Fixing Sex: Intersex, Medical Authority, and Lived Experience (Duke 2008).
My research has been covered in the New York Times, Time, BuzzFeed, The Week, CNN, ESPN, The Daily Beast, The Los Angeles Times, Boston Globe, Jezebel, Slate, The Advocate, La Liberation, The Chronicle of Higher Education, San Jose Mercury News, and the Toronto Star. I’ve also appeared on The World, BBC, CBS News, NBC News, KCBS, CTV News, Q Radio, Al Jazeera, and the Australian Broadcasting Corporation, among others.
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Books by Katrina Karkazis
This book explores the social and scientific identities of testosterone (T). The sex hormone concept powerfully shaped early endocrine studies. This concept still underlies T research, but as scientific specialties and foci have proliferated, divergent versions of T are produced. We examine these divergences and ask which versions gain authority, and for what purposes? Employing methods from anthropology, philosophy of science, and gender studies of science, we will analyze scientific research and “T talk” related to five high-stakes domains (e.g. science achievement, violence). Ultimately, our book will present a dense picture that characterizes various sciences of T in relation to the social worlds in which these sciences are produced and used.
What happens when a baby is born with “ambiguous” genitalia or a combination of “male” and “female” body parts? Clinicians and parents in these situations are confronted with complicated questions such as whether a girl can have XY chromosomes, or whether some penises are “too small” for a male sex assignment. Since the 1950s, standard treatment has involved determining a sex for these infants and performing surgery to normalize the infant’s genitalia. Over the past decade intersex advocates have mounted unprecedented challenges to treatment, offering alternative perspectives about the meaning and appropriate medical response to intersexuality and driving the field of those who treat intersex conditions into a deep crisis. Katrina Karkazis offers a nuanced, compassionate picture of these charged issues in Fixing Sex, the first book to examine contemporary controversies over the medical management of intersexuality in the United States from the multiple perspectives of those most intimately involved.
Drawing extensively on interviews with adults with intersex conditions, parents, and physicians, Karkazis moves beyond the heated rhetoric to reveal the complex reality of how intersexuality is understood, treated, and experienced today. As she unravels the historical, technological, social, and political forces that have culminated in debates surrounding intersexuality, Karkazis exposes the contentious disagreements among theorists, physicians, intersex adults, activists, and parents—and all that those debates imply about gender and the changing landscape of intersex management. She argues that by viewing intersexuality exclusively through a narrow medical lens we avoid much more difficult questions. Do gender atypical bodies require treatment? Should physicians intervene to control the “sex” of the body? As this illuminating book reveals, debates over treatment for intersexuality force reassessment of the seemingly natural connections between gender, biology, and the body.
Papers by Katrina Karkazis
Athletics Federations (IAAF) released new regulations
placing a ceiling on women athletes’ natural testosterone
levels to Bensure fair and meaningful competition.^ The
regulations revise previous ones with the same intent.
They require women with higher natural levels of testosterone and androgen sensitivity who compete in a set of
Brestricted^ events to lower their testosterone levels to
below a designated threshold. If they do not lower their
testosterone, women may compete in the male category,
in an intersex category, at the national level, or in unrestricted events. Women may also challenge the regulation, whether or not they have lowered their testosterone,
or quit sport. Irrespective of IAAF’s stated aims, the
options forced by the new regulations are impossible
choices. They violate dignity, threaten privacy, and mete
out both suspicion and judgement on the sex and gender
identity of the athletes regulated.
examine the covert operation of race and region in a regulation restricting the natural levels of
testosterone in women athletes. Sport organizations claim the rule promotes fair competition and benefits
the health of women athletes. Intersectional and postcolonial analyses have shown that “gender
challenges” of specific women athletes engage racialized judgments about sex atypicality that emerged in
the context of Western colonialism and are at the heart of Western modernity. Here, we introduce the
concept of “T talk” to refer to the web of direct claims and indirect associations that circulate around
testosterone as a material substance and a multi-valent cultural symbol. In the case we discuss, T talk
naturalizes the idea of sport as a masculine domain while deflecting attention from the racial politics of
intra-sex competition. Using regulation documents, scientific publications, media coverage, in-depth
interviews, and sport officials’ public presentations we show how this supposedly neutral and scientific
regulation targets women of color from the Global South. Contrary to claims that the rule is beneficent,
both racialization and medically-authorized harms are inherent to the regulation.
players’ biodata. These technologies have the potential to prevent injuries, improve performance, and extend athletes’ careers;
they also risk compromising players’ privacy and autonomy, the confidentiality of their data, and their careers. The use of these
technologies in professional sport and the consumer sector remains largely unregulated and unexamined. We seek to provide
guidance for their adoption by examining five areas of concern: (1) validity and interpretation of data; (2) increased surveillance
and threats to privacy; (3) risks to confidentiality and concerns regarding data security; (4) conflicts of interest; and (5) coercion.
Our analysis uses professional sport as a case study; however, these concerns extend to other domains where their use is
expanding, including the consumer sector, collegiate and high school sport, the military, and commercial sectors where
monitoring employees is viewed as useful for safety or to maximize labor potential.
to Addressing Racism,” Danis, Wilson, and White
(2016) call for the field of bioethics to end its relative
silence on issues of race and racism and to engage issues
of police violence toward blacks with the urgency they
require. We applaud their call, including their suggested
interventions in the realms of scholarship, teaching,
ethics consultation, and more. Our enthusiastic support
of the article’s main themes also prompts our desire to
expand and shift the view of the “problem” to focus
more centrally on operations of power and the ways in
which bioethics as a field is implicated in this operation,
not only by its scant attention, but also by its institutionalization
and practices. Without such understandings,
any call to action regarding the injustices to which the
authors so skillfully draw our attention loses its urgency
and weight.
The International Olympic Committee (IOC) and international sports federations have recently introduced policies requiring medical investigation of women athletes known or suspected to have hyperandrogenism. Women who are found to have naturally high testosterone levels and tissue sensitivity are banned from competition unless they have surgical or pharmaceutical interventions to lower their testosterone levels.1 2
Sports authorities have argued that women with naturally high testosterone have an unfair advantage over women with lower levels, and thus the primary aim of the policies is to address this perceived advantage. However, sports bodies have also claimed that the investigations are for the medical benefit of athletes with hyperandrogenism.3 4 5 We consider this claim in the light of a new study of four young athletes (aged 18-21) from developing countries who had gonadectomy and “partial clitoridectomy” after being identified as hyperandrogenic under these policies.6 The report notes that these procedures were not required for health reasons. These interventions are invasive and irreversible, and given the potential number of female athletes affected the report prompts an important question: do the new policies undermine ethical care?
This book explores the social and scientific identities of testosterone (T). The sex hormone concept powerfully shaped early endocrine studies. This concept still underlies T research, but as scientific specialties and foci have proliferated, divergent versions of T are produced. We examine these divergences and ask which versions gain authority, and for what purposes? Employing methods from anthropology, philosophy of science, and gender studies of science, we will analyze scientific research and “T talk” related to five high-stakes domains (e.g. science achievement, violence). Ultimately, our book will present a dense picture that characterizes various sciences of T in relation to the social worlds in which these sciences are produced and used.
What happens when a baby is born with “ambiguous” genitalia or a combination of “male” and “female” body parts? Clinicians and parents in these situations are confronted with complicated questions such as whether a girl can have XY chromosomes, or whether some penises are “too small” for a male sex assignment. Since the 1950s, standard treatment has involved determining a sex for these infants and performing surgery to normalize the infant’s genitalia. Over the past decade intersex advocates have mounted unprecedented challenges to treatment, offering alternative perspectives about the meaning and appropriate medical response to intersexuality and driving the field of those who treat intersex conditions into a deep crisis. Katrina Karkazis offers a nuanced, compassionate picture of these charged issues in Fixing Sex, the first book to examine contemporary controversies over the medical management of intersexuality in the United States from the multiple perspectives of those most intimately involved.
Drawing extensively on interviews with adults with intersex conditions, parents, and physicians, Karkazis moves beyond the heated rhetoric to reveal the complex reality of how intersexuality is understood, treated, and experienced today. As she unravels the historical, technological, social, and political forces that have culminated in debates surrounding intersexuality, Karkazis exposes the contentious disagreements among theorists, physicians, intersex adults, activists, and parents—and all that those debates imply about gender and the changing landscape of intersex management. She argues that by viewing intersexuality exclusively through a narrow medical lens we avoid much more difficult questions. Do gender atypical bodies require treatment? Should physicians intervene to control the “sex” of the body? As this illuminating book reveals, debates over treatment for intersexuality force reassessment of the seemingly natural connections between gender, biology, and the body.
Athletics Federations (IAAF) released new regulations
placing a ceiling on women athletes’ natural testosterone
levels to Bensure fair and meaningful competition.^ The
regulations revise previous ones with the same intent.
They require women with higher natural levels of testosterone and androgen sensitivity who compete in a set of
Brestricted^ events to lower their testosterone levels to
below a designated threshold. If they do not lower their
testosterone, women may compete in the male category,
in an intersex category, at the national level, or in unrestricted events. Women may also challenge the regulation, whether or not they have lowered their testosterone,
or quit sport. Irrespective of IAAF’s stated aims, the
options forced by the new regulations are impossible
choices. They violate dignity, threaten privacy, and mete
out both suspicion and judgement on the sex and gender
identity of the athletes regulated.
examine the covert operation of race and region in a regulation restricting the natural levels of
testosterone in women athletes. Sport organizations claim the rule promotes fair competition and benefits
the health of women athletes. Intersectional and postcolonial analyses have shown that “gender
challenges” of specific women athletes engage racialized judgments about sex atypicality that emerged in
the context of Western colonialism and are at the heart of Western modernity. Here, we introduce the
concept of “T talk” to refer to the web of direct claims and indirect associations that circulate around
testosterone as a material substance and a multi-valent cultural symbol. In the case we discuss, T talk
naturalizes the idea of sport as a masculine domain while deflecting attention from the racial politics of
intra-sex competition. Using regulation documents, scientific publications, media coverage, in-depth
interviews, and sport officials’ public presentations we show how this supposedly neutral and scientific
regulation targets women of color from the Global South. Contrary to claims that the rule is beneficent,
both racialization and medically-authorized harms are inherent to the regulation.
players’ biodata. These technologies have the potential to prevent injuries, improve performance, and extend athletes’ careers;
they also risk compromising players’ privacy and autonomy, the confidentiality of their data, and their careers. The use of these
technologies in professional sport and the consumer sector remains largely unregulated and unexamined. We seek to provide
guidance for their adoption by examining five areas of concern: (1) validity and interpretation of data; (2) increased surveillance
and threats to privacy; (3) risks to confidentiality and concerns regarding data security; (4) conflicts of interest; and (5) coercion.
Our analysis uses professional sport as a case study; however, these concerns extend to other domains where their use is
expanding, including the consumer sector, collegiate and high school sport, the military, and commercial sectors where
monitoring employees is viewed as useful for safety or to maximize labor potential.
to Addressing Racism,” Danis, Wilson, and White
(2016) call for the field of bioethics to end its relative
silence on issues of race and racism and to engage issues
of police violence toward blacks with the urgency they
require. We applaud their call, including their suggested
interventions in the realms of scholarship, teaching,
ethics consultation, and more. Our enthusiastic support
of the article’s main themes also prompts our desire to
expand and shift the view of the “problem” to focus
more centrally on operations of power and the ways in
which bioethics as a field is implicated in this operation,
not only by its scant attention, but also by its institutionalization
and practices. Without such understandings,
any call to action regarding the injustices to which the
authors so skillfully draw our attention loses its urgency
and weight.
The International Olympic Committee (IOC) and international sports federations have recently introduced policies requiring medical investigation of women athletes known or suspected to have hyperandrogenism. Women who are found to have naturally high testosterone levels and tissue sensitivity are banned from competition unless they have surgical or pharmaceutical interventions to lower their testosterone levels.1 2
Sports authorities have argued that women with naturally high testosterone have an unfair advantage over women with lower levels, and thus the primary aim of the policies is to address this perceived advantage. However, sports bodies have also claimed that the investigations are for the medical benefit of athletes with hyperandrogenism.3 4 5 We consider this claim in the light of a new study of four young athletes (aged 18-21) from developing countries who had gonadectomy and “partial clitoridectomy” after being identified as hyperandrogenic under these policies.6 The report notes that these procedures were not required for health reasons. These interventions are invasive and irreversible, and given the potential number of female athletes affected the report prompts an important question: do the new policies undermine ethical care?
To untangle the political thicket of so-called sex testing, who better to turn to than Katrina Karkazis? Karkazis is a senior research scholar at the Center for Biomedical Ethics at Stanford University. Her research on “sex testing” policies, which has been funded by the National Science Foundation, has appeared in Science and The BMJ, and she’s written essays for outlets like the New York Times and the Guardian. She also served as an expert witness in Chand’s case. A 2016 Guggenheim Fellow, she is at work on a new book with Rebecca Jordan-Young, T: The Unauthorized Biography (Harvard University Press), that explores the many scientific and social identities of testosterone in high stakes domains like sport.
Ultimately, the cover reinforces the idea that we should be thinking about her biology and not the humiliation, injustice or violation she suffered that Padawer so forcefully describes in the article. Katrina Karkazis, San Francisco
Re “A Win for Athletes Whose Sex Was Questioned,” July 29: Dredging up the notion of questionable sex, not just in the headline but in the article itself, is a disturbing case of the newspaper inventing news instead of reporting it. John Branch’s article raised questions about Dutee Chand’s sex, even while it elsewhere indicated that her status as a woman was never in question. This amplifies the harm that has already been done to Ms. Chand.
Hand-wringing about sex determination misses the point of the case. The Court of Arbitration for Sport said that this regulation never served to draw the line between men and women. Instead, the policy divided the category of female athletes into those eligible to compete and those ineligible by virtue of their natural biology.
This is the crux of what CAS found impermissible: A rule that prevents some women from competing at all as a result of the natural and unmodified state of their body is antithetical to the fundamental principle of Olympism that “every individual must have the possibility of practicing sport, without discrimination of any kind.” So, too, is a rule that permits an athlete to compete on condition that they undergo a performance-inhibiting medical intervention that negates or reduces the effect of a particular naturally occurring genetic feature (Article 513).
REBECCA JORDAN-YOUNG and KATRINA KARKAZIS, San Francisco
Rebecca Jordan-Young is an associate professor of women’s, gender and sexuality studies at Barnard College. Katrina Karkazis is a senior research scholar at the Center for Biomedical Ethics at Stanford University and served as an expert witness in Chand’s appeal.
Mireya Navarro sensitively and accurately captures the difficult decisions parents face about whether to choose surgery for their infants born with atypical genitals. Everyone wants what is best for these children, but as the article makes clear, there are no straightforward answers.
My research shows that some parents were not informed about the potential risks and complications of genital surgeries and the diversity of clinical opinion about their necessity and success. Nor were they told that some adults who underwent surgeries as infants are speaking out against them. Moreover, some parents were pressured into choosing surgery after they initially decided against it, and in a few instances surgeries were performed without their consent.
KATRINA KARKAZIS
Palo Alto, Calif.
The writer is a research associate at the Stanford University Center for Biomedical Ethics.
Imagine if, having proved to be the best, with the eyes of the world on you, the atmosphere sours and you face rumours and allegations of an unfair advantage and the condemnation of your competitors and the watching public. Imagine that this has nothing to do with cheating or doping, but is simply because of the biology you were born with.
We're talking about sex testing for elite female athletes, a highly charged issue that has been officially resurrected for the first time in more than a decade.
The Contrary View: There is no scientific basis to claim women with naturally high testosterone have an unfair advantage.
The international Olympic Committee (IOC) released new eligibility restrictions for women’s competitions in June. Like the International Association of Athletics Federations last year, the IOC declared that women with naturally high testosterone levels—a condition known as hyperandrogenism—are too masculine to compete against other women, calling this an unfair advantage. Men’s usual performance advantage over women can be chalked up to having more testosterone, the argument goes, so if some women are more endowed than others, the contest is unfair. A number of athletes have been removed from competition because of these policies; to protect their privacy, their names have not been released.
Using strategies from critical race studies and feminist studies of science, medicine and the body, we examine the covert operation of race and region in a regulation restricting the natural levels of testosterone in women athletes. Sport organizations claim the rule promotes fair competition and benefits the health of women athletes. Intersectional and postcolonial analyses have shown that “gender challenges” of specific women athletes engage racialized judgments about sex atypicality that emerged in the context of Western colonialism and are at the heart of Western modernity. Here, we introduce the concept of “T talk” to refer to the web of direct claims and indirect associations that circulate around testosterone as a material substance and a multi-valent cultural symbol. In the case we discuss, T talk naturalizes the idea of sport as a masculine domain while deflecting attention from the racial politics of intra-sex competition. Using regulation documents, scientific publications, media coverage, in-depth interviews, and sport officials’ public presentations we show how this supposedly neutral and scientific regulation targets women of color from the Global South. Contrary to claims that the rule is beneficent, both racialization and medically-authorized harms are inherent to the regulation.
Keywords: health / hyperandrogenism / racialization / sex and gender / science / sport / T talk / violence