Lindy Kato (Writer)

I don’t like to rant too often because it makes me sound like an angry person and I’m not. The ugly business of gender raised its head again at the Paris Olympics. Wasn’t the coverage great though? Shame about the world clock being against us!

I had thought that as a world we had moved on from bogus tests to determine gender.

But since the International Olympic Committee (IOC) decided it is up to the individual sports federations to determine the criteria for each sport, boxing, it seems has resorted to tests that the IOC say are ‘so flawed that it’s impossible to engage with’. The victims are boxers Imane Khelif and Taiwan’s Lin Yu-ting who have endured global abuse despite being female from birth.
The IOC aren’t saying what the tests were, but I do know that having a Y chromosome does not necessarily make you male. For instance, if the SRY gene (responsible for the initiation of male sex determination) is missing or damaged, or if you have testosterone insensitivity, then female is the default. The ancient Greeks (who initially would not allow women to even attend the Olympics apart from virgins and prostitutes) had men compete naked in order to prove their gender identity.

Current competition standards changed in 2021 because sex has become so complicated. Disorders of sex development (DSD), cover an increasingly wide variety of conditions (an overlarge clitoris, an undersized penis or features of both sexes), some can be whole sex chromosome differences but also ordinary XX girls and XY boys can have insensitivity to various sex hormones. Women with DSDs that result in high testosterone levels are over-represented among Olympians, but the hormone does not seem to directly impact their performance. We need to clarify here that there is a difference between naturally occurring higher levels of testosterone that the body has accommodated and testosterone doping which would be where a body not used to the extra boost would gain an advantage.

As far as I can find, the first woman disqualified from competition for failing a gender test – this is looking at the karyogram which is where the chromosomes are tightly coiled (chromatin), and counting X and Y chromosomes, was the Dutch athlete Foekje Dillema in 1950. She had XX/XXY genetic mosaicism, which is deemed to be rare. The first woman to be disqualified from participation in the Olympics due to gender identity was Polish sprinter Ewa Kłobukowska who had competed in the 1964 Olympics but in 1967 she was also found to be a genetic mosaic of XX/XXY. If she had been tested one year later at the Mexico Olympics she would have been eligible on the grounds that she was ‘Barr Body’ positive (the inactivated scrunched up X chromosome). Kłobukowska has a Barr Body in all of her cells. Athletes without this inactive X-chromosome were suspended from competition in 1968 in Mexico City. Ewa gave birth to her son in 1968, which seems reasonably conclusive.

Maria José Martinez-Patiño is a Spanish athlete who passed a gender test in 1983, failed a sex chromatin test in 1985 and was told to fake an injury and withdraw quietly which she did. The chromatin test was not supposed to be definitive just a first step and using her 1983 ‘femininity certificate’ she entered the Spanish 60 m hurdle event in 1986 and won but was disqualified. She lost her scholarship, her athletic residency and her fiancé. Her female status was restored three months later but she failed to qualify for the 1992 Olympics (Martínez-Patiño, 2005). Her chromosomes are XY with intact SRY but with testosterone insensitivity.

If you think about it for even a second you might realise that this ought to be a disadvantage because muscle strength requires sensitivity to testosterone including the lower levels that women naturally have. In fact in the five Olympic games up until 2008, the incidence of XY female competitors was 1:421 (Foddy and Savulescu, 2011). Clearly this is above the general population where it is declared ‘rare’. Exactly what rare means is a bit hard to fathom, because only those who are tested due to other problems (e.g., infertility) ever know. One estimate is one in 80,000 (NIH National Library of Medicine).

Caster Semenya was humiliated in front of the world as a teenager after winning gold medals in the 1500m-distance event in 2009. Just before the 800m final (which she won) it was leaked that the IAAF (International Association of Athletics Federation) had requested a ‘sex verification test’. She was suspended then cleared and the medals awarded but having her gender issues play out in front of the world showed great insensitivity. She was lied to about the nature of the tests and although the results were not made public at the time, her confidential medical records did not remain confidential. She was young and she was not protected by those charged with protecting her. In October 2016, the IAAF announced that Semenya was shortlisted for women’s 2016 World Athlete of the Year. In 2019 the then 28-year-old was banned from running in races from 400m to one mile unless she artificially suppress her testosterone levels.

In 2012 the IAAF determined that people with testosterone levels above 10 nanomoles per Litre of blood could not participate in women’s events, no matter how they identify. Exceptions were to be made only if the athletes could prove that they are resistant to the effects of testosterone (see above). However, in 2015 the court of arbitration for sport ruled that there is a lack of evidence that testosterone increases female athletic performance and notified the IAAF that it had two years to provide some evidence. None has been presented but the acceptable level is currently deemed to be 2.5 nanomoles per Litre of blood (down from an interim of 5 nanomoles per Litre) in order to be a qualified ‘female’. The International Olympic Committee (IOC), in their 2021 framework, has effectively said that it doesn’t make any difference, which is why it is up to the individual sports federations to determine the criteria for each sport. Note that despite the IOC framework, Caster Semenya still can’t run in her preferred distances because the IAAF is insisting on a testosterone level of less than 2.5 nanomoles per Litre. In a man a naturally higher level of testosterone is considered an advantage (case not proven because you should then predict male success on the basis of testosterone level, but you can’t) and in a woman it requires a ban. I can see chaos on the sports horizon.

This is a very different story to the systemic doping of the East German athletes who were unaware of the danger that this put them in and in most cases unaware that they were even being doped. It is suspected that as many as 10,000 athletes were given ‘vitamin’ pills, initially containing testosterone and later anabolic steroids, amphetamines, human growth hormone and EPO. Putting thousands at risk of masculinising effects in females, fertility problems, recurrent miscarriage, cardiovascular disease, liver problems, mood swings and is also linked with some forms of cancer. Many of these were children. Ugly times indeed.

Martínez-Patiño, M. J. (2005). Personal Account: A woman tried and tested. The Lancet, 366, S38. Available: DOI 10.1016/S0140-6736(05)67841-5 .

Foddy, B. & Savulescu, J. (2011). Time to re-evaluate gender segregation in athletics? British Journal of Sports Medicine, 45, 1184. Available: http://bjsm.bmj.com/content/45/15/1184.abstract