03 February, 2018

A brief history of sex verification

Before embarking upon this brief history of sex verification it is necessary to deal with some terminology and make clear the difference between being transgender (or transsexual) and having an intersex condition. 

People who identify as transgender or transsexual are usually people who are born with typical male or female anatomies but feel as though they’ve been born into the “wrong body.” For example, a person who identifies as transgender or transsexual may have typical female anatomy but feel like a male and seek to become male by taking hormones or electing to have sex reassignment surgeries (and vice versa).
People who have intersex conditions have anatomy that is not considered typically male or female. Most people with intersex conditions come to medical attention because doctors or parents notice something unusual about their bodies. In contrast, people who are transgender have an internal experience of gender identity that is different from most people.

In spite of these similarities, these two groups should not be thought of as one. While "gender" is a social construct, "sex" refers to biological differences. Thus in this post we will be talking about sex, rather than gender, verification. 

In an article, "Comparing the best athletic performances of the two sexes", published in New Studies in Athletics (New Stud. Athl. 29:4, 2014, p. 37) Y. Charon and myself estimated the ratio of women top performances to those of men. We found that for running events women were performing at 90 % of men, while for jumps the ratio was close to 85 %. (The situation of throws is more complicated due to the different weights of the implements but, based on results of powerlifting, one expects women's upper-body force to be around 60 % of that of men's). So it is essential that men, who have an appreciable biological advantage over women not be allowed to participate in women's competitions. 

A well-known case of a man masquerading as a woman is that of Herman (Dora) Ratjen who participated  for Germany in the high jump competition at the 1936, Berlin, Olympics. Although Dora managed only a 4th place at the Olympics `she' went on to establish a world record two years later. 

A mugshot of Herman/Dora Ratjen when arrested for transvestism

But the best story from the '36 Olympics is that of Helen Stephens and Stella Walsh. The latter was the 1932 Olympic champion over 100 m but in the Berlin final Stephens beat her roundly. A Polish journalist (Walsh, although residing in the US, was running for Poland under the name of Walasiewicz) suggested that Stephens was of questionable femininity. 

H. Stephens and S. Walasiewicz at the berlin Olympics

Stephens had to undergo a crude examination which confirmed her female sex. The juicy detail is that when Walsh was accidentally killed in 1980 it was discovered during the autopsy that she had ambiguous genitalia and abnormal sex chromosomes and should not have been allowed to participate in women's competitions. (Curiously her medals have not been re-allocated). 

H. Stephens and A. Hitler

However not everybody considered that Stephens was lacking femininity. Apparently when Hitler met her in order to congratulate her, he told her that she was an Aryan and should run for Germany and, for emphasis, he pinched her fanny. He went on to invite her to spend the weekend in Berchtesgaden, something that Stephens refused. Looking at the photos and given the way she dominated the 100 m (her best time was 11.5 s while the second best, excluding those of S. Walsh, was only 11.9 s) I cannot help thinking that she was a hyperandrogenic one. 

In the post-war period rumours started circulating concerning essentially eastern bloc female athletes. The best known case is that of the Press sisters, Tamara and Irina, multiple world record holders with 6 olympic gold medals between them, who were also known as the "Press brothers".

The Press sisters/brothers

The persisting rumour was that they were hermaphrodites and the fact that they suddenly retired in 1966 when sex verification became mandatory just added fuel to the fire.

Under the pressure of the media the IAAF introduced a sex verification in 1960 which became compulsory, in the form of a gynaecological examination, just before the 1966 European Championships. Women reacted vehemently to that degrading `nude parade' and a more acceptable process was sought. Thus in the 1968 Olympics the criterion of Barr body detection was introduced, deemed simpler, more dignified and objective. While the first descriptives are spot-on, the third one turned out to be debatable. The Barr body is a dark staining body only found in the nucleus of cells with XX sex chromosomes. Its detection was thus proclaimed to be the solution to gender misrepresentation. Unfortunately that proved a too naïve an approach, which neglected the complications of the disorders of sex development. The first victim of this new criterion was the polish sprinter Ewa Klobukowska.

E. Klobukowska winning  the 4x100 m relay at the Tokyo Olympics

She had passed a gynaecological test in the 1966 Europeans but, in 1967, she failed the Barr body test. She was subsequently excluded from women's competitions and her world records were annulled (but at least she got to keep her olympic medals). It is believed today that she had what is known as XX/XXY mosaicism. However this genetic abnormality did not make her a man and in fact Klobukowska became pregnant in 1968 and successfully bore a son.

It soon appeared that the Barr body/chromatin test created more problems than it solved. Women with complete androgen insensitivity syndrome would have been barred from competing due to the presence of XY sex chromosomes despite an entirely female phenotype. The best known case is that of the spanish hurdler Maria José Martínez-Patiño. 

Maria José Martínez-Patiño

While she passed a sex text in the 1983, she failed the chromatin test in 1985, during the Kobe World University Games and was ruled ineligible to participate in women's athletics. She was reinstated in 1988 but, alas, too late for the Seoul Olympics.

In 1991 two things happened. First, the IAAF decided to stop compulsory sex verification, reserving themselves the right to proceed to tests on a per case basis. Second, the IOC decided to replace the Barr body analysis by a polymerase chain reaction (PCR) analysis for the sex-determining region Y (SRY). The PCR analysis for the SRY locus was performed on DNA extracted from buccal smears (just like the Barr body test). The test was applied to the participants at the 1992 and 1996 Olympics. In the latter case 8 positive (out of a total of 3000) test were reported but 7 out of those eight had androgen insensitivity syndrome (which was most probably the case for Martinez-Patiño) and the last one a deficiency in the testosterone conversion which allowed her to compete as a woman (but notice that the presence of elevated levels of testosterone might have conferred some performance advantage).

However the test for the SRY has also its limitations. It is known today that other genes are also required for testes development and, what is more troublesome, individuals with XX sex chromosomes (and thus no SRY gene) can have testes. Finally, the IOC decided to abandon mandatory sex verification in 1999, while still keeping the authority to request sex verification on an individual basis.

So, where do we stand now? Since 2005 out of 7 tested athletes four have been driven away from athletics while the remaining three were allowed to pursue their careers. Among the latter we find the famous C. Semenya. In fact this article was initially conceived as a warm-up to the Semenya article I am going to write in a near future. While researching for it I came to realise that sex verification in athletics and sports in general is a particularly complex issue. It was initially welcomed by female athletes as a method of preventing cheaters but its proponents soon became disillusioned realising that discrimination against persons with disorders of sex development was unfair and perhaps detrimental to the sport.

I beleive that it is Semeya's presence that is detrimental to the sport

The IAAF Medical and Anti-Doping Commission published, in 2006, the Policy on Gender Verification. It makes clear that no mandatory sex verification will be in place and that problematic cases will be resolved albeit not solely through a laboratory-based sex determination but rather through an evaluation by a multidisciplinary panel of experts.

I have already written on the question of hyperandrogenism (and will write again in the future). Since the matter has yet to be resolved at the Court of Arbitration for Sport I guess that we'll have to wait a little bit more before drawing final conclusions of the situation. But as I was titling my article from last year: hyperandrogenism is a plague for athletics.

Bruce and Caitlyn Jenner

The whole article was, till now, focusing on intersex athletes. However the question of transgender athletes must also be addressed. These cases are rather rare to date but it is to be expected that more and more male to female transsexual athletes will seek to compete in their acquired sex. The one name that springs to mind is of course Bruce Jenner, who recently switched gender and became Caitlyn. Had he decided to pursue his career after Montreal as a woman he could have been world record holder of both men's decathlon and women's pentathlon.(Warning: the previous sentence was written tongue in cheek). In order to be allowed to compete the athlete must submit to an endocrine assessment and his/her case is then reviewed by a Expert Medical Panel. If the athlete is declared eligible his/her eligibility for competition will be subject to ongoing monitoring. It will be interesting to see how things evolve in the future. In the meantime, if you are interested in the question of transgender athltes you can read the excellent interview of Joanna Harper (who describes herself as a “scientist first, an athlete second, and a transgender person third”) to Ross Tucker at the web site on The Science of Sport.

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