LA Olympics 2028| XX-XY divide: Eligibility vs Identity

Bengaluru: Once again, the female body and its functioning have made headlines. This time, the very definition of ‘a woman’ is being laid bare in the context of sport. 

Before getting to the core of it all, it would be preferable to keep aside emotions and personal choices as we focus here on understanding the latest policy announced by the International Olympic Committee (IOC) on the ‘Protection of Female (Women’s) Category in Olympic Sport’ and then weighing in some concerns by experts. 

The new IOC president, Kirsty Coventry, and Dr Jane Thornton, medical and scientific director of IOC, through a press conference released a 10-page document on March 26 that cites ‘for all disciplines on the sports programme of an IOC event, including individual and team sports, eligibility for any female category is limited to biological females.’

This effectively closes the door on individuals with certain types of Differences in Sex Development (DSD), apart from trans women, from competing in the female category on the grounds of a perceived male advantage.

A few key points: the IOC policy will be applied for the first time at the Los Angeles 2028 Olympic Games and is not retroactive. It will also require elite female athletes to undergo a one-time sex-determination test focusing on the SRY (Sex-determining Region Y) gene. The IOC considers this marker to be fixed throughout life and to provide highly accurate evidence that an athlete has experienced, or will experience, male sex development.

The basics: Female: XX chromosome; Male: XY chromosome. 

The process: All female athletes will have to undergo an unintrusive SRY Gene screening by submitting their saliva, cheek swab or blood samples. If the result is negative then the individual is cleared to compete in the female category. However, the scenario gets complicated in case of a positive result which points to the presence of a male Y chromosome in a female-assigned body contradicting the defined XX combination. 

This isn’t the end of the road just yet. The screening result, if positive, then leads to further evaluation, subjected to the individual’s approval, to determine the complications. If the athlete is then diagnosed of Androgen Insensitivity Syndrome (AIS) - a condition that affects sexual development before birth and during puberty where affected individuals may have external sex characteristics that are typical for females or have features of both male and female sexual development - what type of AIS then becomes critical.

AIS has three forms: CAIS - complete androgen insensitivity syndrome; PAIS - partial androgen insensitivity syndrome and MAIS - mild androgen insensitivity syndrome.

The IOC policy states: ‘Those athletes with a diagnosis of CAIS or other rare DSDs that do not benefit from the anabolic and/or performance-enhancing effects of testosterone will be allowed to compete in the female category.’

But those with PAIS or MAIS, where the body’s tissues are partially/ mildly sensitive to the effects of androgens, are barred. 

The third condition under DSD mentioned by the IOC is the 5-alpha reductase deficiency (5-ARD) - a rare genetic disorder where the body of XY chromosome individuals cannot efficiently convert testosterone to dihydrotestosterone (DHT) resulting in ambiguous or predominantly female appearing external genitalia at birth leading to female gender assignment despite having male testes. South African athlete Caster Semenya is said to have this condition. Such persons will also not be able to participate in the female section. 

Finally, the transgender women -- persons registered male at birth but live and identify as a woman -- are also banned with IOC president Coventry stressing: “It would not be fair for biological males to compete in the female category.”

Considering multiple scientific studies, IOC argues that despite suppressing testosterone levels, nuances such as a larger heart, higher lung capacity, more red blood cells and stronger ligaments for being born a male gives an upper hand when such individuals grow up to identify themselves as trans women. 

Is the process fool proof? Given the complexities of a human body, especially that of a female, the medical experts, though credit the detailing, remain cautious. 

“The good thing is that they are specifying it to be screening that will later lead to testing,” says Dr Priya Ranganath, consultant clinical geneticist at the Apollo Hospital in Bengaluru. 

“But biology doesn’t work in such simple binaries. Sex development isn’t controlled by a single gene. It’s a complex interplay of multiple genes, hormones and how the body responds to those hormones. So while SRY might start the process, it doesn’t determine the final outcome,” adds Dr Priya. 

Dr Nivedita Jha, obstetrician and gynecologist at Sparsh Hospital in Bengaluru, echoes similar concerns saying: “The entire embryology of internal and external genitalia and their advantages, disadvantages in sporting performance is a very complex process.

“I’m more interested if those responsible for testing will be counselling the athletes beforehand. Because before we do karyotyping, we do genetic counselling. For example, if somebody comes to the clinic expressing that they have never had periods (which is the case with AIS & 5-ARD) and we are suspecting that it may be a situation where they are XY but we know typically they are female, you should have a proper mental health team.” 

The IOC’s 10-page policy document has listed ways to go about the sensitive issue under athlete-centred approach, right to privacy and confidentiality and implementation workshops and knowledge sharing. 

The proper procedure to be followed by International Federations, National Olympic Committees, National Federations and Continental Associations is all on paper. The trickiest bit, however, is the interpretation of the ‘doing it the right way’ during implementation. At least in India, with a few examples of DSD-related athletes from sprinter Dutee Chand to middle-distance runners Santhi Soundarajan and Pinki Pramanik, the handling of their cases have shown laxity. 

“I had no idea about hyperandrogenism until I was directed to undergo testing in 2014. After the test, I was told I have a higher testosterone level than a female and that makes me a DSD athlete,” Dutee tells DHOS. 

“While I had no control over this development, I was called a man, a cheat, and barred from competing. I subsequently lost my job and respect in society too. I had to fight for my place in an international court (CAS) to earn my rights to compete again only to see that it was all for nothing, as we are again regarded as different when I know I was born a female.”

In 2014, Dutee was tested by the Athletics Federation of India and Sports Authority of India after an anonymous complaint, and was found to have naturally high testosterone due to hyperandrogenism. She was barred from the Commonwealth and Asian Games as her testosterone levels exceeded the then limit of 10 nmol/L.

Dutee refused medical intervention and challenged the rule at the Court of Arbitration for Sport (CAS) in 2015. CAS suspended the regulations, allowing her to compete again. She went on to set national records, competed at the Rio Olympics.

On the other hand, a biological female Indian sportsperson, who once filed a complaint against an alleged DSD athlete, tells DHOS on condition of anonymity: “It does feel unfair. Unlike doping, where you often cannot figure out if the athlete is cheating or not, it’s too apparent to us that a rival has an unfair advantage. 

For all those advocating for the female category to be exclusive to biological females, the new IOC policy feels like a victory. For females with DSD condition and trans women it is a fight for inclusion in the female category.

“And I can tell you that most of us, if not all of us, feel hard done. And when you try to complain, you are discouraged by the officials and such athletes are protected. It is further discouraging when you see them break records and they are holding it to this day even after going off the circuit. To be honest, we don’t see any difference in doping and such an advantage held by DSD athletes.”

Imane Khelif

The majority of experts on the subject agree that defining biological sex entirely by chromosomes is overly simplistic. The consensus is that more research is needed to conclusively arrive at a conclusion that athletes’ complex biological conditions enjoyed an unfair advantage.

Caster Semenya

IOC, on the other hand, feels precaution under uncertainty is the best option available to it.

Laurel Hubbard

Fair? Unfair? Exclusive? Inclusive? Where and how does one draw the line? The debate will continue...