By Jane Sullivan
After the Rio 2016 Olympics the issue of athletes with a Disorder of Sexual Development (sometimes called a Difference of Sexual Development) or DSD came to the fore. In the women’s 800m three male athletes with DSDs won Gold, Silver and Bronze. The three women who were placed fourth, fifth and sixth in the event were cheated out of their rightful medals by sports’ governing bodies and the International Olympic Committee that had failed to protect the fairness and integrity of female categories.
Melissa Bishop (Canada), Joanna Jozwik (Poland) and Lynsey Sharp (Great Britain) are the women who are the true winners of those medals. At the time, there was a media blackout on discussing what was pretty obvious – three men had won medals in a women’s event. Melissa Bishop’s coach Peter Eriksson, was threatened with a life-time coaching ban after he called the results into question. Lynsey Sharp who set a personal best to come sixth, suffered appalling online abuse after her tearful interview indicated the true nature of the winners.
In truth, World Athletics has been awash with males competing in the women’s categories for at least two decades (and probably more). Since sex-testing of Olympians stopped in the late 1990s the door to women’s sport has been open to men who have a genetic condition that may have led to them being incorrectly assigned female at birth.
At Rio 2016, the women’s 800m Gold went to South African Caster Semenya, a male who has a DSD. The Silver medallist, Francine Niyonsabi from Burundi, and the Bronze medallist, Kenyan Margaret Wambui, are also both male and both have a DSD.
Rio Olympics 2016, the women’s 800m gold, silver and bronze winners
There are at least eight more runners who have competed in international women’s events – all sanctioned by World Athletics.
At Tokyo 2020, Christine Mbomba of Namibia won a silver medal in the women’s 200m – Christine is male. Also at Tokyo, Nigerian Aminatou Seyni competed in the women’s 200m, as did Beatrice Masilingi of Namibia – both males.
Fiordazila Cofil from the Dominican Republic is a male athlete who in 2022 won gold in the World Championships women’s 4x400m relay. Then there’s Kenyan 400m women’s record holder Maximilla Imali. Annet Negesa of Uganda who won the 800m at the All-African Games in 2011. In 2023, fellow Kenyan athlete Evangeline Makena won the women’s 10k in the Kenyan Athletics Track and Field Championship. The Indian runner, Dutee Chand, competed in the women’s 100m at Rio 2016.
All of these runners are male. They have XY chromosomes. We name them here, not out of personal malice to the individuals (all the information about their condition is in the public domain) but to demonstrate the scale of the problem and to highlight how their inclusion in women’s sport has been to the detriment of female athletes. For every male runner listed in the women’s events, there is a woman who has been excluded from the race. For every male runner who wins there is a woman who has been denied a prize, and the recognition, sponsorship and career opportunities that a medal could bring.
Aside from Caster Semenya of South Africa you are unlikely to have heard of many of the runners. And if you look them up in the mainstream media who will see them described as ‘she’ or ‘her’. You will read that Semenya has ‘unnaturally high levels of testosterone’. A common description is that they are ‘XY DSD athletes with naturally high testosterone levels’. You may feel compassion for these ‘women’ who look like men and appear to have been ‘banned’ from their sport.
This BBC sports story about Caster Semenya is a good example of how reporting of male athletes with DSDs has set out to confuse.
Throughout the article Semenya is referred to as ‘she’ which naturally inclines the reader to assume that Semenya is female. The article states that Semenya was ‘born with differences of sexual development (DSD) which mean she has an elevated level of testosterone - a hormone that can increase muscle mass and strength.’ This indicates that Semenya is a female who has higher than normal levels of testosterone for a female. In fact, Semenya is male and has normal levels of testosterone for a male – but much higher than those seen in women.
World Athletics has moved to tighten up its rules. For Paris 2024 there are stricter eligibility criteria for male athletes with a DSD who wish to compete in the female category. Many of the male athletes who competed at Tokyo and were aiming for women’s events in Paris have failed the new eligibility criteria. Will there be males with DSDs at Paris? Time will tell. We have focused in this article on athletics as that is the only sports governing body that had written a policy. There could be males in other sports – basketball is one sport where there are suspicions about the sex of several players. But without sex-testing of all ‘female’ competitors we may never know if teams are all female or not.
DSD Fact Check – a guide for journalists and spectators
Male or female?
Sex is determined by the sex chromosomes. In females the sex chromosomes are XX. In males the sex chromosomes are XY. The Y chromosome contains a section of genes that code for ‘maleness’. Occasionally, something goes wrong with this bit of genetic code and results in a Disorder of Sexual Development.
What is a DSD?
A DSD is a Disorder of Sexual Development (sometimes called a Difference of Sexual Development). In the past the term ‘Intersex’ was sometimes used – this term is not used as it implies that people affected are part-male / part-female. This is not the case.
In sport the most common DSDs are
· 5α-reductase type 2 deficiency;
· partial androgen insensitivity syndrome (aka PAIS)
Other, very rare, DSDs are: 17β-hydroxysteroid dehydrogenase type 3 (17β-HSD3) deficiency and ovotesticular DSD.
5α-reductase type 2 deficiency
This is the most common DSD seen in male athletes competing in women’s event. Individuals with this DSD have XY sex chromosomes and are male. A fault in the genetic code means that they cannot convert testosterone hormone to the more potent di-hydro-testosterone (or DHT).
They have a genetic disorder that blocks the development of normal-looking penis and testicles before birth. The male foetus needs DHT to masculinise the sex organs – that’s form a penis and testicles. At birth, these babies often have a micro-penis and their testes may be inside the body, instead of descended into the scrotum.
A baby boy who has 5-ARD may look ‘female’ (although midwives often report that the baby doesn’t look ‘right’) and in the absence of a chromosome sex test the boys may be recorded female at birth. These individuals do not have any female organs (uterus, ovaries) and do not develop breasts at puberty.
While these individuals may have female written on their birth certificate, this is incorrect. They are male, they have normal male levels of testosterone and their development from birth onwards follows a normal male trajectory. That’s because boys do not need DHT to develop into men – they need, and have, testosterone. When they hit puberty they develop, as boys should, into men, with increased height and muscle mass compared to girls, facial hair, deepening voice, penis and testes growth (in most, but not all, the testes descend outside the body cavity).
The incidence of 5α-reductase type 2 deficiency is extremely rare. A 2020 study found only 434 cases across 44 countries. In the Dominican Republic where the incidence of DSDs is higher than average, the word Güevedoce, which translates as testes at 12, describes children who are ‘assigned’ female at birth but who ‘become boys’ at puberty. These children have 5α-reductase type 2 deficiency.
Partial androgen insensitivity syndrome (PAIS)
This is a DSD in which the cells of the body are resistant to the effects of testosterone. These individuals usually have normal male levels of testosterone in their blood but the tissues that need to use it cannot do so because of a genetic anomaly.
PAIS only occurs in males. Babies are born with genitalia that may ‘look female’ as for 5α-reductase type 2 deficiency. It is not within the scope of this fact sheet to expand on medical aspects of this condition but suffice to say these individuals are male, not female.
If these athletes are regarded as female with higher-than-normal testosterone what’s the harm in letting them compete?
These athletes are not female – they may have been ‘assigned female at birth’ but after birth they generally follow the developmental pathway of a normal boy to man. They have normal testosterone levels for males because they are male. Their testosterone levels are way above the norm for females and this gives them a huge sporting advantage over women, such as bigger heart and lungs, they are taller and stronger, with more muscle mass. They do not have female organs and therefore do not experience menstrual issues and bleeding that female athletes have to factor into their training and competition.
What are normal testosterone levels?
Males and females both produce the hormone testosterone.
In females aged 18-49 the normal blood level of testosterone ranges from 0.06 to 1.68 nmol/L.
In males aged 18-49 the normal blood level of testosterone ranges from 7.7 to 29.4 nmol/L.
When a news outlet describes a DSD athlete as having higher than normal testosterone levels, they are stating that a male has higher testosterone than a female. This is an immutable biological fact.
Male athletes with DSDs have normal levels of testosterone for males.
How come there are so many athletes with DSDs in sport?
It’s easy to see how a child wrongly assigned female at birth and who excels in girls’ sport could end up being fast-tracked to national and international stardom. No questions asked. In the absence of sex-testing of female athletes there has been no verification of the sex of athletes. In the past all female athletes had a sex test (a simple one-time-only cheek swab that removes all ambiguity) but these were phased out during the 1990s.
In its place, World Athletics have introduced ELIGIBILITY REGULATIONS which require athletes to reduce their testosterone levels to <2.5nmol/l for a minimum of 24 months before competition. While 2.5nmol is well below normal male testosterone levels it is still significantly higher than the normal range for females. This also raises ethical questions about a requirement for athletes to take powerful medication to reduce normal male levels of a hormone to abnormally low levels for a male.
Will there be DSD athletes at Paris 2024?
We don’t know. World Athletics has (belatedly) worked to protect fairness in the female category and a number of male athletes with DSDs who had their sights set on competing at Paris have not been cleared to compete as they have not fulfilled the testosterone requirements.
Other sports do not have the rigorous procedures that World Athletics has introduced and it is rumoured that males are competing in women’s basketball, football and hockey. Without sex testing we will never know and the gossip mill will continue to work overtime.
