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Of course, there should be no competitive advantage in high-level competitive sports. That is why doping is banned worldwide, why doping tests are so frequent, and why there is so much unrest and international friction between the United States and China over doping allegations that China and international organizations allegedly covered up.
But this week’s Paris Olympics raised a different, albeit related, question: what about high testosterone levels due not to anabolic steroids but to genetic mutations, so-called disorders of sex development (DSDs)? This is not the same as the question of whether transgender women born male have an advantage in women’s sports; that’s a separate discussion. Today’s question is about Algerian athlete Imane Kherif, who identifies as female but failed certain gender eligibility tests and was disqualified from the 2023 world championships.
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Yet she was allowed to compete in an Olympic boxing match and won when her frightened opponent surrendered after less than a minute. Is this fair? It is fair. It is not right to question the International Olympic Committee’s defense of her right to compete without concrete evidence to the contrary. I also respect that her opponent, Italian boxer Angela Carini, apologized for expressing her anger after her loss. Both were noble actions and I respect them. But the real medical question still remains: What is competitive advantage and how do we define it?
Imane Kherif (red) of Algeria gestures to Angela Carini of Italy during the women’s 66 kg boxing qualifying round of 16 for the Paris 2024 Olympic Games at the Paris Nord Arena in Villepinte on August 1, 2024. (MOHD RASFAN/AFP via Getty Images)
Nearly everyone would agree that high testosterone levels over a long period of time give athletes a selective advantage, which is why supplements are banned.
Although Kerif, or Taiwanese boxer Lin Yu-ting, was disqualified from the 2023 championships by the International Boxing Association for failing gender eligibility tests, the IOC found both decisions sudden and arbitrary and allowed both to compete in the Olympics. I have no reason to doubt the IOC here and agree with its decisions. But one question remains: does a person’s genetic makeup in terms of X and Y chromosomes matter? If only in terms of whether the hormones produced as a result of these genes provide a competitive advantage similar to taking hormones in supplements, I would say yes.
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In other words, we test for the relevant hormones, not the genes that produce them.
While hormone levels certainly vary between the sexes, the presence of a Y chromosome can result in the production of excess testosterone, far beyond the amounts found in biological females.
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In the absence of such a standard (strictly universal testosterone levels), it seems to me impossible to know where to draw the line. On the other hand, the IOC is right not to impose bans based on hearsay or allegations of differences in genetic makeup. Of course, you can’t test an athlete’s chromosomal makeup. That would be an invasion of privacy and seems unnecessary. What would be more appropriate and practical would be to measure hormone levels such as testosterone and cortisol. The difference in sex differentiation between the two athletes is of no concern to anyone. But the hormone standard and its impact on athletic performance is very significant.
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