UNDER THE MICROSCOPE

Sorry to disappoint those who think this is going to be a salacious discussion. But it does discuss sex—genetic sex, gonadal sex, and anatomic sex.
The 2024 Paris Olympics is over but the issue of sex or gender lingers, as a result of which boxing, a sport in which Filipinos have been successful, may not be included in the 2028 Los Angeles Olympics.

Two Olympic gold medalists in boxing, Imane Khelif (Algeria) and Lin Yu-ting (Taipei), are in the center of the controversy. Both have been previously disqualified from the 2023 World Championships for failing a gender eligibility test done by the International Boxing Association (IBA).

Based on the IBA press conference, both boxers had XY sex chromosomes (genetic sex), which is the biological definition of maleness. Women have XX sex chromosomes. Moreover, the IBA contends it conducted testosterone level determinations which showed both to have “a high level of testosterone like a man”.

However, the International Olympic Committee (IOC), which has parted ways with the IBA in 2023, claims the two athletes were “victims of a sudden and arbitrary decision by the IBA” and were suddenly disqualified without any due process.”  It further said that “the Algerian boxer was born female, was registered female, lived her life as a female, boxed as a female, has a female passport.” Essentially, the IOC states that it is not a transgender case. 
It may not be transgender, but is there science to the IOC stand?

There is a group of conditions known as Differences/Disorders of Sex Development (DSD) that occur in one in 4,500 persons. That may not seem to be common but  in sports, its occurrence in athletes has led to controversy such as this one. It is not known whether Imane Khelif or Lin Yu-ting is one of these individuals but if we take the IBA statement on face value, their having XY chromosomes and male levels of testosterone are indicative of   male sexual development, no matter if they were externally considered female, raised as a female, given female sex assignment on their birth certificates or their passports. 

If they are indeed cases of DSD, then their testosterone levels indicate that they have functioning internal testes (gonadal sex). However, there is an entity known as Androgen Insensitivity Syndrome  (AIS), which may be complete (CAIS) or partial (PAIS), that may make a person with XY chromosomes appear to be female, in the case of CAIS, or have some male characteristics, as in PAIS. So, genetically, the person is male (with XY chromosomes), but have external female sexual characteristics (anatomic sex) due to lack of response of the body to testosterone.

One thing is certain though. If both have XY chromosomes and high levels of testosterone, they are not  cases of Swyer syndrome, a genetic defect in the Y chromosome which is missing the SRY gene (Sex-determining region of the Y chromosome). The SRY gene (also known as “make male” gene) codes for the production of testosterone and is the master switch of sex development.

There definitely needs to be more extensive testing of these athletes to determine what category they belong to. In sports, men definitely have physical superiority over women due to larger muscle mass, bigger and longer bones and larger hearts and lungs. In addition, men have higher levels of blood hemoglobin that can lead to improved oxygen delivery to the muscles. 

A person with Swyer syndrome will not have an advantage over normal females, but one with  PAIS will do. Normal women (XX) with hyperandrogenism (male level of testosterone) will also have an advantage, which is another big issue in sports where testosterone testing is routinely done.
Some experts have argued for a comprehensive sex test that includes, 1. Genetics (including testing for Y chromosome and the SRY gene, 2. Hormones including testosterone, and 3. The body’s responsiveness to testosterone.

But that’s easier said than done, considering the resources needed for such testing. However, considering the stakes in international competition, international sports federations should get together to fund a reputable laboratory for such testing.

Where does that leave athletes who have DSD? They can’t compete with normal males, though that’s allowed, or normal females, who they have innate advantages over. Would it be possible to put up a parallel Olympics for DSD athletes where they can compete among themselves, like what they did for PWDs with the Paralympics?

If we consider the original Olympic motto: “Citius, Altius, Fortius,” Latin for Faster, Higher, Stronger, athletes should compete on an equal basis.  The International Olympic Committee added  “-Communiter” (Together) which recognizes the unifying power of sports  and the importance of solidarity.  With a separate Olympics for DSD athletes, we will have a  community of differently-abled athletes sharing the spirit of fair competition and the love of sports.