Differences in sex development are no one's business, but elevated hormone levels must be addressed
Olympics gender controversy: Should biological males compete against women?
Debate over the biological sex of a boxer who won a women's match at the Olympic Games is sweeping the globe. Here's what Americans have to say about the issue.
When it comes to high level competitive sports, it makes total sense that there should be no competitive advantage. That’s why doping is universally banned, and why there are frequent doping tests. It is also why so much consternation and international friction exists between the U.S. and China over suspected doping cases that China and global authorities supposedly covered up.
But a different – though related – question arose in the Olympics in Paris this week, namely what about a high testosterone level, not from anabolic steroids, but from a genetic variance or so-called Differences of Sex Development (DSDs)? This is not the same question as whether transgender women born as males have an advantage competing in women’s sports. That is a different debate. Today’s question is about Imane Khelif, of Algeria, who identifies as a woman but was disqualified from the 2023 world championships after failing some type of gender eligibility test.
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Yet now she was allowed to compete in an Olympic boxing bout which she won when her frightened opponent submitted after less than a minute. Is this fair? Yes it is. We are not right to question the International Olympic Committee defending her right to compete without specific information to the contrary. I also respect her opponent, Italian boxer Angela Carini, for apologizing for expressing her outrage following her loss. Both are high-road moves which I respect. But the real medical question still remains. What is a competitive advantage and how do we define it?
Algeria's Imane Khelif (in red) gestures to Italy's Angela Carini in the women's 66kg preliminaries round of 16 boxing match during the Paris 2024 Olympic Games at the North Paris Arena, in Villepinte on August 1, 2024. (MOHD RASFAN/AFP via Getty Images)
Almost everyone would agree that a high testosterone level over time gives a competitor a selective advantage, which is why supplements are banned.
When it comes to Khelif, or Taiwanese boxer Lin Yu-ting, who also was disqualified from her championship in 2023 by the International Boxing Association for reportedly failing gender eligibility testing, the IOC has ruled both decisions sudden and arbitrary and has allowed them to compete in the Olympics. I have no reason to doubt the IOC here, and I agree with their decision. But I do have a question: Is a person’s genetic makeup in terms of X and Y chromosomes relevant? I would think so, if only in terms of whether the hormones that are produced as a result of these genes deliver a competitive advantage similar to taking supplemental hormones.
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In other words, test the relevant hormones, not the genes that produce them.
Granted, there are variances in hormone levels within a gender, but the presence of a Y chromosome could lead to a production of excess testosterone well beyond what is ever found in a biological female.
It seems to me that without such a criteria (a strictly applied testosterone level for all), it would be impossible to determine where to draw the line. In the meantime, the IOC is right not to impose a ban based on hearsay or alleged differences in genetic makeup. Surely we can’t be testing athletes for their chromosomal makeup. That would seem to me to be an invasion of privacy and unnecessary. More relevant and practical would be the measurement of hormone levels, including testosterone and cortisol. Differences in sex development, as these two competitors allegedly have, is no one’s business. But a standard for hormones and their impact on athletic prowess is highly relevant.
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Marc Siegel, M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical analyst and author of "COVID: The Politics of Fear and the Power of Science." Follow him on Twitter @drmarcsiegel.
