Reunión Miami especialistas y COI

Gender Testing Hangs Before the Games as a Muddled and Vexing Mess

Published: January 15, 2010
At closed meetings in Miami on Sunday and Monday, medical specialists and representatives of the International Olympic Committee will tackle one of the most vexing questions in sports: What test should be used to determine whether an athlete competes as a man or a woman? Or should there be any official testing at all?

The issue exploded in August when a South African runner, Caster Semenya, won a gold medal in the 800 meters at the world championships in Berlin.

Other athletes had complained that Semenya looked extremely masculine, and track and field’s world governing body ordered sex testing. The results were not released. Semenya was allowed to keep her medal. It is not yet clear if she will be allowed to compete in future races as a woman.

What, though, if she had been in the Olympics? Since 1999, the Olympics have had no official sex verification policy.

The issue has ramifications beyond the Games because Olympic standards tend to be adopted by groups like the International Association of Athletics Federations, track’s governing body, as well as national and local athletic organizations.

“The Caster Semenya issue just demonstrated the chaos that can occur if there is not a prescriptive way of addressing this,” said Dr. Joe Leigh Simpson of Florida International University. He is an expert on gender disorders and an invited participant at the Olympic committee meetings in Miami.

Although it may seem straightforward to decide who is a man and who is a woman, it can be a scientific and medical mess, experts said. Some with the male-determining Y chromosome, for example, do not respond to testosterone. They develop as females. Others, genetically female with two X chromosomes, have overdeveloped adrenal glands whose hormones are converted to testosterone. They have high testosterone levels, like men, and ambiguous genitalia. Are they to compete with men or women?

Athletes whose sex is ambiguous say testing can be invasive and traumatic.

One who has spoken up, writing an essay in the medical journal The Lancet, is María José Martínez-Patiño, a Spanish hurdler. She had sex testing at age 22 at the 1983 world championships in Helsinki. She received a “certificate of femininity.”

In 1985, she was tested again at the World University Games in Kobe, Japan. The night before her race, she was told, in front of her teammates, that there was a problem. It turned out that she has a Y chromosome and a genetic defect preventing her from responding to testosterone.

“I was expelled from our athletes’ residence, my sports scholarship was revoked, and my running times were erased from my country’s athletic records,” Martínez-Patiño wrote. “I felt ashamed and embarrassed. I lost friends, my fiancé, hope and energy.”

Nevertheless, she added, “I knew that I was a woman.”

“I have breasts and a vagina,” she wrote. “I never cheated.”

Since the early 1930s, athletic federations have struggled with the issue, concerned by the possibility that some men might pose as women in competitions.

The Olympics long required physical exams for female athletes. Then it settled on a policy that seemed to make scientific sense. A male would have a Y chromosome. The problem was that the chromosome test allowed for too many muddied exceptions — athletes like Martínez-Patiño, for example.

Finally, in 1999, the Olympic committee and other federations dropped the chromosome testing, reserving the right to test an athlete’s sex if it was questioned.

Chromosome problems were rare among athletes anyway. Dr. Arne Ljungqvist, chairman of the International Olympic Committee’s medical committee, and Dr. Myron Genel, an emeritus pediatric professor at Yale, reported that in 1996 — the last time chromosome testing was done — 3,387 female athletes were tested and 8 were found to have gender disorders. Seven had Y chromosomes but did not respond to testosterone. One had two X chromosomes but an overactive adrenal gland. All were allowed to compete as women.

When the Olympic committee dropped chromosome testing, its members thought they had a better way. Drug tests instituted in the late 1990s required athletes to urinate in front of an observer. Any man posing as a woman would be spotted immediately.

That left the question, though, of what, if anything, should be done when a woman has ambiguous external genitalia — a very large clitoris, for example.

“We can’t say, ‘Too bad, good luck,’ ” said Simpson, the gender expert at Florida International University. Often women with ambiguous genitalia have testicles in their abdomens, placing them at risk for cancer. Or they may have dangerously high hormone levels.

“She’s now a patient who needs medical advice,” Simpson said.

The Olympic committee must decide whether doctors should order a series of tests in order for an athlete to compete. She would not be in medical danger from competing. Should she be prevented from entering events as a woman?

The Endocrine Society, the organization whose members treat people with such disorders, says sports federations should not even try to use medical tests to rule on who is a woman. Instead, it says, the criterion should be: Was the athlete raised as a male or a female? Someone who was raised as a female and considers herself female, the organization says, should be allowed to compete as a female.

Sports is inherently unfair, regardless of sex ambiguities, says Dr. Eric Vilain, an invited participant at the Olympic committee meeting and the director of the U.C.L.A. Center for Gender-Based Biology. Elite athletes have inborn advantages over the rest of the population. That is why they can train and be the best in the world.

“Nobody says there should be a level playing field,” Vilain said. “On the contrary. If you are gifted, you should do the sport.”

And while it might seem desirable to find some way of dealing with women whose sex is ambiguous, Dr. Vilain and other endocrinologists say it is best to abandon that quest.

“It’s just impossible,” Vilain said. “We are going to have to accept that at the fringes, there are no perfect categorizations.”



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