NPR champions a nonbinary marathoner's fight to make it easier to dope

A highly irresponsible example of how now-captured media push the anti-science, anti-truth, anti-sport narrative of gender ideology

About a month ago, Ariana Lee, a producer at NPR contacted me to ask some questions for a story she was working on about transmasculine nonbinary runner Cal Calamia getting a Therapeutic Use Exemption to use testosterone, a prohibited substance. Lee had come across the July post entitled USADA pretends there are sexless runners, and was mostly interested in why I wrote the article.

Her story, entitled A nonbinary marathoner’s fight to change anti-doping policy, was published on Nov 5, the same day as the New York City Marathon. For an outlet that bills itself as a “free and independent” news source, I’ve rarely seen such a single-mindedly captured, blatantly false piece of propaganda. And that bar is very high. It’s painful to think that Lee used her respected platform to perpetuate anti-science, anti-sport, anti-reality lies. And as is the case with nearly all of these gender ideology sales brochures, comments were disabled.

Below, I’ve pasted the article, pointing out just a few of the most egregious falsehoods.

Roughly 50,000 runners are jamming the streets of New York this Sunday morning for the annual New York City Marathon. This year, for only the third time, the marathon includes a nonbinary category and 96 people registered for it. Cal Calamia, 27—a trans and nonbinary runner who uses both he and they pronouns – is one of them.

Two things here. First, Lee immediately tells readers what pronouns to use for Calamia but fails to mention that Calamia is female, and that she’s chosen to use testosterone, a prohibited substance, not for medical need, but for the sake of appearing male. This fact would make anyone who plays by the rules in sports far less sympathetic to Calamia’s “fight” to dope.

Secondly, maybe because Lee knows nothing of running, she failed to mention that Calamia ran the Chicago Marathon a month ago, setting a PR, and is now running New York City. Lee later follows Calamia’s lead in downplaying testosterone’s performance enhancing abilities, but of course running a PR, and turning around to run another marathon a month later is a red flag for testosterone abuse. The ability to recover very quickly from a hard effort is one of testosterone’s performance enhancing benefits.

Racing in the nonbinary category, Calamia won the 2022 San Francisco marathon and went on to claim second in the Chicago marathon and the 2023 Boston marathon. In the latter, the New York Times noted that Calamia's advocacy played a role in driving Boston to include a nonbinary category for the first time.

"I was just on cloud nine," said Calamia, referring to these first experiences racing in the nonbinary category. "The possibility to participate in nonbinary divisions and then rally community support to make them better," he added, "I just was like, this is living."

But this past summer, the U.S. Anti-Doping Agency (USADA) reached out to Calamia. The agency had been notified that he was using a prohibited substance: testosterone. Calamia, who takes testosterone as gender affirming hormone therapy, learned that in order to continue racing he had to attain a therapeutic use exemption (or TUE) from USADA. The exemption grants athletes who need prohibited substances as medication permission to compete.

Anyone who had run on a college team, or lived through the Lance Armstrong years would know that testosterone is a prohibited substance. Calamia was undoubtedly aware she was flaunting the rules; Lee set out to write a sympathetic story and asked zero questions.

The requirements, however, are extensive. The exemption application calls for trans athletes to send in numerous documents, including a full medical history with psychological records pertaining to a diagnosis of gender dysphoria. Documentation of sex reassignment surgery—which is unrelated to hormone levels—is also mandatory.

The requirements for a TUE are no more extensive for Calamia than for any other athlete. Gender dysphoria being a psychological condition, having psychological records to establish a diagnosis of gender dysphoria makes perfect sense. As far as I know, neither World Athletics nor USADA demands documentation of sex reassignment surgery. Sex reassignment surgery has not been a requirement for trans-identified males to participate in women’s sports since 2015, and it’s never been a requirement for females who wish to compete as males. It’s possible USADA was asking for documentation about Calamia’s double mastectomy as a way to establish gender dysphoria, but the inference here is that USADA was prying into whether Calamia had had phalloplasty. Lee does not say where she got this information, maybe from Calamia.

"The whole thing hinges upon this diagnosis, the idea that being trans is a disorder," said Calamia.

Calamia is fighting for “gender affirming care.” That “care,” testosterone, is the fix for something, a disorder. If you need the care, you need it for some medical reason. If it’s not a disorder, why does Calamia need medication? Which is it?

Calamia decided to submit his TUE application, but withhold his full psychiatric and medical records, instead substituting alternative provider notes and supplemental materials. It was a risky decision—one that potentially jeopardized Calamia's ability to compete in future marathons. But from his perspective, withholding the full materials was about protecting the privacy of future trans and nonbinary competitors seeking exemptions.

Calamia did lots of “risky” things during this period that Lee does not mention, including continuing to race and win money while taking testosterone without a TUE, again disregarding USADA’s rules. Lee did not ask Calamia why she continued to race while her TUE application was still under review. Why? Throughout her experiences, Calamia has shown blatant disregard for anti-doping rules that every other runner must adhere to--why is she different? It was almost as if she knew she’d get the TUE anyway, no matter how outrageous her behavior, since she had some hulking backing from Winston & Strawn, an international law firm that specializes in social justice cases. Hardly a cowering victim, Calamia took every opportunity possible to give USADA a giant f%*#k you. And she still got the TUE, not because it was right but thanks to legal strong-arming. Lee does not mention this.

"I don't want to set a precedent that this is a normal amount of information to submit to this agency to even show up to a race," he said. "There's no way."

Again, this is in fact normal for every other athlete on the planet. Calamia wanted to set a precedent that trans and nonbinary people did not have to abide by the rules like anyone else.

USADA could not comment on Calamia's case. But the agency's chief science officer Matthew Fedoruk said that the ban on testosterone is based on peer reviewed studies that conclude that high doses of synthetic testosterone can function as performance enhancing drugs. It's important to note that people doing hormone replacement therapy for gender-affirming care typically use much lower doses than those cited in these studies.

Dead wrong. Exactly opposite. Lee has apparently never heard of microdosing, which is now the most common way of achieving performance enhancing benefits that elude anti-doping detection. Ross Tucker said, “In this study: https://pubmed.ncbi.nlm.nih.gov/31615775/, women were given quite small amounts of testosterone, well below any masculinising levels [that Calamia exhibits], sufficient only to raise T levels to 4.3nmol/liter. Calamia has admitted to being in the lower male range, between 10 and 15nmol/liter.  The women in the study improved their performances in sprints significantly.  The famous ’study,’ https://pubmed.ncbi.nlm.nih.gov/9216474/, was actually the ’theft’ of documents from the East German system by Werner Franke and his wife. It documented enormous improvements, and we know that some of those women developed masculinising features.” Which is to say that Calamia is taking massive doses of testosterone, far more than most athletes who dope, and she is definitely getting performance enhancement from it.

Fedoruk acknowledged the exemption process can be "onerous" for athletes and stressed that the agency tries to collaborate with athletes and support them through the process.

However, for weeks after submitting his application, Calamia waited for communication from USADA and heard nothing.

The idea that testosterone is "performance enhancing" is itself controversial. While there are scientists who believe higher levels of testosterone—naturally occurring or synthetic—improve athletic ability, there are other researchers who challenge this claim. Anthropologist Katrina Karkazis, a coauthor with Rebecca Jordan-Young of the book Testosterone: an Unauthorized Biography, said the current studies on testosterone's effects on athletes show wide ranging effects.

"Sometimes people with higher levels do better," Karkazis says. "Sometimes people with higher levels do the same. And sometimes people with higher levels do worse."

As mentioned, Karkazis is a cultural anthropologist. Her work has been discredited by virtually every reputable. sport scientist, physiologist, or biologist. Her “study” examined the effects of testosterone within the male category or within the female category, and yes, higher or lower T within those categories does not effect performance. So women with higher T did not perform better than other women. But the level of T between males and females varies enormously, it does not overlap at all, and the difference those vastly different levels of testosterone make between males and females is huge. The fact that Calamia has a male level of testosterone means she is receiving enormous performance enhancing benefit. Karkazis’ frankly idiotic claim that exogenous testosterone does not have performance enhancing benefit is just unconscionable from anyone who calls herself a scientist.

Currently, Karkazis says, there is very little research on the impact of testosterone on transmasculine athletes. And more broadly, while it's clear that testosterone can impact athletic ability, it remains unclear how much, in what context, and under what circumstances.

Huh? Does she mean testosterone doesn’t provide performance enhancement if you claim to be nonbinary? Let’s remember that exogenous T is also a prohibited substance for males. So, under what circumstances is it not performance enhancing? It’s uncontroversially been on USADA’s prohibited list for males and females since the organization was formed.

There are also plenty of lingering questions about the role physical, social and psychological factors play in athletics, Karkazis says. In some cases, these factors could play a more significant role than testosterone on performance.

The role physical factors play in athletics is why we have male and female categories. Males have structural and physiological differences triggered by a lifetime of testosterone and a body that is ordered to produce sperm by XY chromosomes that lead to sports advantage over females. Karkazis is onto something there. Neither Karkazis nor Lee mention what the social and psychological factors are, nor what those have to do with Calamia’s choice to use massive amounts of performance enhancing testosterone.

In early October, Calamia finally heard back from USADA. After exceeding its own deadline of 21 days, USADA emailed Calamia and granted him a 10-year exemption which allows him to run in both the men's and nonbinary categories.

"I just want to cry with how relieved I feel that I can run my race and not feel like I'm doing something wrong for just being there," Calamia told NPR the day he received the exemption.

Calamia ran the 2019 Chicago Marathon in the women’s category while using testosterone without a TUE. This is a clear doping violation. She continued to race while USADA was reviewing her application for a TUE. She raced at Boston and San Francisco without a TUE. In all these instances, Calamia knew she was doing something wrong. She just thought, being trans and nonbinary, she would have more rights than anyone else. Lee asked no questions about Calamia’s doping violations.

It's unclear whether this decision is a sign the anti-doping agency is permanently reducing its requirements for testosterone exemptions among trans and nonbinary athletes. Some advocates told NPR that going forward, they hope that the application process will be less invasive and more turnkey for trans athletes. NPR has learned that the World Anti-Doping Agency, of which USADA is the U.S. branch, is currently re-evaluating its processes for trans and nonbinary athletes and actively gathering feedback on its therapeutic use exemption process.

More turnkey? For doping? I really can’t believe I’m reading that. It needs to be easier for trans and nonbinary people to dope?

Lee did not ask Calamia any questions at all. For example, why does Calamia have to take testosterone? Many females who identify as nonbinary don't. If she chooses to take testosterone for the sake of appearing more male, that's her choice. But choices come with consequences. Such as not being able to race.

But for now, one thing is certain—Calamia can compete. "I feel optimistic again that change is possible and that change is going to happen," he said.

It’s abominable that Lee used her significant platform to perpetuate dangerous lies. Given that some people will cheat, which is why anti-doping was established in the first place, what is to stop anyone from signing up in the nonbinary category, and gaining performance benefits from taking testosterone? For that matter, can any male or female runner claim they need T (for low energy, for recovery, as antidepressant) in any category? What happens to fairness for all athletes? Fair competition is what sport is about, not affirming one's gender identity. Lee has not thought about any of those questions in her determination to push the narrative that Calamia is somehow a victim.