Sex verification in sports
Sex verification in sports consists of tests conducted to determine an athlete's eligibility for sporting events that are restricted to women or for mixed-sex competitions with specific gender requirements. Practice has varied tremendously over time, across borders and by competitive level. Issues have arisen multiple times in the Olympic games and other high-profile sporting competitions, for example allegations that certain male athletes attempted to compete as women or that certain female athletes had intersex conditions perceived to give unfair advantage. The topic of sex verification is related to the more recent question of how to treat transgender people in sports. Sex verification is not typically conducted on athletes competing in the male category because there is generally no perceived competitive advantage for a female or intersex athlete to compete in male categories.
Sex verification in sports began in the 1940s with "femininity certificates" provided by a physician. It subsequently evolved into visual inspections, physical examinations, chromosome testing, and later testosterone level testing. These tests were all designed to ensure that athletes were only allowed to compete as their sex, but mostly resulted in the exclusion of intersex athletes from female sports. Mandatory sex verification testing was fueled by anxieties surrounding the "unfemininity" of some female athletes, as more participated in historically "masculine" events.
Sex verification can be substantially more complicated than checking whether a person's sex chromosome pair is XX vs. XY, or comparing their levels of key sex hormones to distinct reference ranges, to determine an athlete's sex. This is due to variations in human biology where some people are not unambiguously female or male, not all cells in a person's body have the same genotype or the presence of other atypical genetic condition. These reasons, among others, led sporting bodies to abandon chromosome testing towards the end of the 20th century and use hormone testing instead. The downside of hormone testing, however, is that policies on hyperandrogenism were required, which have sparked both public debate and legal battles.
History
From 1946 to 1966, national sporting associations conducted sex verification testing. The first mandatory sex test issued by the International Association of Athletics Federations, the world's track and field governing body, for woman athletes was in July 1950 in the month before the European Championships in Belgium. All athletes were tested in their own countries. The IAAF instituted sex testing at the actual games, starting at the 1966 European Athletics Championships in response to suspicion that several female athletes from the Soviet Union and Eastern Europe were actually men. At the Olympics, testing was introduced in 1968. Subsequent reports have shown that the tests could cause psychological harm. Sex verification—identifying athletes whose hormone levels are abnormal compared to others of their purported sex—can cause sex identity crises, elicit demeaning reactions, isolate athletes socially, and lead to depression and sometimes suicide.Physical examinations
Future IOC president Avery Brundage requested, during or shortly after the 1936 Summer Olympics in Berlin, that a system be established to examine female athletes. According to a Time magazine article about intersex people, Brundage felt the need to clarify "sex ambiguities" after observing the performance of Czechoslovak runner and jumper Zdeňka Koubková and English shotputter and javelin thrower Mary Edith Louise Weston. Both individuals later had gender reassignment surgery and legally changed their names, to Zdeněk Koubek and Mark Weston, respectively.Sex verification tests began in 1950 with the IAAF, using physical examinations. "Sex segregation and verification are mutually interdependent because, if there were no claims or basis for having separate male and female sporting events, there would be no need for sex verification testing." Initially, women athletes "were asked to parade nude before a panel of doctors". For a period of time these tests were mandatory for female athletes, due to fears that male athletes would pose as female athletes and have an unfair advantage over their competitors. Additionally, fears increased in the mid-20th Century about female athletes not being "true" women as it became more acceptable for women to compete in sporting events.
At the 1966 British Empire and Commonwealth Games, the IAAF required that all female athletes undergo a gynaecological examination to confirm they possessed female genitalia. Two weeks later, at the 1966 European Athletics Championships, they conducted visual examinations. This process was deemed the "nude parade" and many athletes reported feeling humiliated by these procedures. The International Olympic Committee never adopted these methods.
Chromosome testing
From 1958 to 1992, all female athletes underwent mandatory sex verification tests before taking part in any IAAF or IOC event. Barr body tests were conducted by taking samples from inside the cheek to find evidence of XX chromosomes, indicating the athlete was female. This test was first conducted by the IAAF in 1967 at the European Cup Track and Field event in Kiev, Soviet Union. Those who passed the tests and verified as females were provided femininity certificates which they could use at all future international competitions. Compulsory sex verification tests were commonplace and not many female athletes questioned the practice until the late 1980s.Chromosome testing was criticized by scientists, such as de la Chapelle, Ferguson-Smith, Ferris, Ljungqvist, and Simpson. They, among others, argued the Barr body test did not take into account gonadal, morphological, and psychological sex attributes. Ultimately, a central contention was whether a Y chromosome yields a competitive advantage because it is not always accompanied by "manly" attributes that provide greater strength, power, or flexibility.
In 1985, runner Maria José Martínez-Patiño failed her sex verification at the World University Games in Kobe, Japan, after passing the test at the 1983 World Championships in Athletics. Martínez-Patiño was told to retire discreetly due to her results, which was commonplace among athletes who failed gender verification tests. However, she refused to retire, leading to immense public scrutiny.
Finnish geneticist Albert de la Chapelle worked alongside Martínez-Patiño to appeal the decision to the IAAF. De la Chapelle protested sex testing in sports for years, arguing that the Barr body test incorrectly identified intersex women. Furthermore, he pointed out that the finding of the abnormal sex chromatin and exclusion of these athletes from women's sporting events violated their rights and caused psychological damage. With de la Chapelle's support, the IAAF reinstated Martínez-Patiño in 1988. Martínez-Patiño's case, and later advocacy, led to the elimination of chromosomal sex verification tests.
This method of testing was later abolished, as it was shown to be inconclusive in identifying maleness. The International Association of Athletics Federations ceased sex screening for all athletes in 1992, but retained the option of assessing the sex of a participant should suspicions arise. As well, in 1992, the IOC continued compulsory sex verification, but switched from the Barr body test to a Polymerase Chain Reaction test to look for "male-related genetic material" through DNA samples collected from a buccal swab. This test was still subject to criticism and several medical associations opposed gender verification by the late 1990s. A resolution was passed at the 1996 International Olympic Committee World Conference on Women and Health "to discontinue the current process of gender verification during the Olympic Games". The International Olympic Committee's board voted to discontinue the practice in June 1999. Chromosome testing was last performed at the Atlanta Olympic Games in 1996.
In the twenty-first century, increasing regulation of genetic testing—which is typically restricted to cases where there is medical benefit to the person concerned—makes it difficult or impossible to legally test athletes for non-medical purposes, such as sports eligibility, in many jurisdictions. Disqualification of athletes on genetic grounds can also violate various anti-discrimination laws. The World Medical Association has also called on medical professionals to avoid participating in genetic testing for sports eligibility purposes, calling it "not based on medical need" and "flagrant discrimination based on the genetic variation of female athletes".
Hormone testing
In 2006, the IAAF published a new Policy on Gender Verification. This allowed the organization to subject athletes to medical examinations by gynaecologists, endocrinologists, psychologists, internal medicine specialists, and experts on gender/transgender issues if suspicions arose of the athlete's gender. The IAAF clarified the sex determinations would not be made on the sole basis of laboratory-based results. Athletes were provided with the option to undergo medical and surgical procedures to compete if they had failed the gender verification testing. Furthermore, the 2006 Policy listed conditions that would not provide advantages over other females, thus allowing the athlete to compete. These included: androgen insensitivity syndrome, gonadal dysgenesis, Turner syndrome, congenital adrenal hyperplasia, androgen producing tumours, and polycystic ovary syndrome.In August 2009, South African athlete Caster Semenya was subjected to mandatory sex verification testing at the request of the IAAF. In the wake of the Semenya case, testosterone testing was introduced to identify cases where testosterone levels were elevated above a particular level, termed hyperandrogenism, with national Olympics committees tasked by the IOC to "actively investigate any perceived deviation in sex characteristics".
In 2011, the IAAF released new protocols related to testosterone and hormone testing. The protocols rejected the terms "sex testing" and "gender verification" and placed emphasized importance on testosterone levels, as certain athletes would not be eligible to compete in the female category due to hormonal characteristics. The protocols claimed that hormone levels indicated the differences in athletic performance between men and women. Investigations under the protocol were prompted by suspicion and carried out through endocrinological blood tests. These tests determined whether androgen levels were below the male range of 10 nmol/L. If the athlete was over that level, more tests would be carried out to determine if she had androgen resistance, which means she would not have a competitive advantage. If the athlete was found to have a competitive advantage, under this protocol, she was ineligible to compete until undergoing IAAF-recommended treatment.
In association football, FIFA's current gender verification policy dates to 30 May 2011. In June 2012, in advance of the 2012 Summer Olympics, the IOC released IOC Regulations on Female Hyperandrogenism to address these cases. It includes the statement:
"Nothing in these Regulations is intended to make any determination of sex. Instead, these Regulations are designed to identify circumstances in which a particular athlete will not be eligible to participate in 2012 Olympic Games Competitions in the female category. In the event that the athlete has been declared ineligible to compete in the female category, the athlete may be eligible to compete as a male athlete, if the athlete qualifies for the male event of the sport."Policies on hyperandrogenism were suspended following the case of Dutee Chand v. Athletics Federation of India & The International Association of Athletics Federations, in the Court of Arbitration for Sport, decided in July 2015. Chand had been dropped from the 2014 Commonwealth Games at the last minute after the Athletic Federation of India stated that hyperandrogenism made her ineligible to compete as a female athlete. The ruling found that there was insufficient evidence that testosterone increased female athletic performance. In doing so the court immediately suspended the practice of hyperandrogenism regulation used by the IAAF and declared it void unless the organization could present better evidence by July 2017.
A study published in 2017 by Stéphane Bermon and Pierre-Yves Garnier analyzed 2,127 performances and hormone concentrations in male and female elite track and field athletes during the 2011 and 2013 Track and Field World Championships. When compared with women with lower levels of the hormone free testosterone, women with the highest fT levels performed significantly better in the 400 m, 400 m hurdles, 800 m, hammer throw, and pole vault with margins of 2.73%, 2.78%, 1.78%, 4.53%, and 2.94%, respectively. Such a pattern was not found in any of the male athletic events. The study concluded that female athletes with high testosterone levels have a significant competitive advantage over those with low fT in 400 m, 400 m hurdles, 800 m, hammer throw, and pole vault.