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Gender Verification in the Olympics

Gender Verification in the Olympics For nearly 15 years, we have advocated abolition of laboratory-based, on-site testing for gender verification in sports competition.1-11 The ostensible goal of gender verification is to ensure that female athletes do not unwittingly compete against men. Given that men presumably would have an unfair competitive advantage on the basis of speed or muscle mass, such a policy superficially seems endorsable on the grounds of fairness. In reality, gender verification tests are difficult, expensive, and potentially inaccurate.1,4,8,10 Furthermore, these tests fail to exclude all potential impostors (eg, some 46,XX males), are discriminatory against women with disorders of sexual development, and may have shattering consequences for athletes who "fail" a test.1,4,10 During the 1996 International Olympic Committee (IOC) World Conference on Women and Health, the IOC passed a resolution "to discontinue the current process of gender verification during the Olympic Games."12 In January 1999 the IOC Athletes' Commission recommended to the IOC Executive Board that gender verification testing be discontinued, and the decision was ratified in June 1999 by the 109th IOC session in Seoul, South Korea.13 The medical community should applaud the decision of the IOC to abolish on-site gender verification preceding athletic events, effective with the current Summer Olympics in Sydney, Australia. The issue of gender verification arose in the early 1960s when rumors circulated that men secretly posing as women were competing against female athletes. At the 1966 European Track and Field Championships in Budapest, Hungary, and at the 1967 Pan American games in Winnipeg, Manitoba, physical inspection was made of disrobed female athletes. At the 1966 Commonwealth Games in Kingston, Jamaica, gynecologic examinations were performed. Complaints and resentment about this embarrassing approach led the IOC to search for an alternative gender verification method at its competitions. The IOC decided to require all female athletes to undergo sex chromatin analysis (X chromatin or Barr body analysis). Laboratory-based gender verification became compulsory in 1968 at the Mexico City Summer Olympics,13,14 after it was introduced on a small scale at the European Cup in Track and Field Athletics in Kiev, Ukraine (1967) and the Grenoble Winter Olympics (1968) in France. Gender verification has long been criticized by geneticists, endocrinologists, and others in the medical community.2,3,15,16 One major problem was unfairly excluding women who had a birth defect involving gonads and external genitalia (ie, male pseudohermaphroditism). Male pseudohermaphroditism is defined as genetic males (Y chromosome) whose external genitalia fail to develop—the genitalia may be ambiguous or resemble female genitalia. Many different forms of male pseudohermaphroditism exist.17 A second problem is that only women, not men, were stigmatized by gender verification testing. Systematic follow-up was rarely available for female athletes "failing" the test, which often was performed under very public circumstances. Follow-up was crucial because the problem was not male impostors, but rather confusion caused by misunderstanding of male pseudohermaphroditism.17 Noteworthy was the courageous contribution of the Spanish hurdler Maria Martinez Patino in documenting abuse by sports authorities.5 Patino had complete androgen insensitivity, and like most male pseudohermaphrodites she was raised as female. If athletic, these individuals naturally compete as women. Few if any plausible athletic advantages exist, especially given that gonadal extirpation usually has occurred by adulthood; however, abnormalities in external genitalia and gonads understandably create confusion. The IOC began to reconsider the issue of gender verification in the 1980s. The IOC and the International Amateur Athletic Federation (IAAF) convened workshops in the late 1980s and early 1990s at which it was consistently stated that "the aim of gender verification tests is not to differentiate between sexes but to prevent male impostors from participating in female competitions."13 That is, detection of male pseudohermaphrodites was not the goal. Despite these recommendations, the persistent aim of the IOC Medical Commission remained to exclude athletes with intersexuality, especially if androgen production was perceived to confer competitive advantages; thus, the IOC chose to retain laboratory-based testing. However, X chromatin analysis for diagnostic purposes had been abandoned by virtually all cytogenetic laboratories during the 1970s and was replaced by standard metaphase analysis that would require venipuncture. The IOC response was to replace the obsolete method of X chromatin analysis with the technically preferable polymerase chain reaction for the Y-linked gene SRY (sex-determining region Y). This new protocol began in Albertville, France, at the 1992 Winter Olympics,18 and has continued at every Olympics since.9,11,18,19 A few male pseudohermaphrodites were detected with this new method. For instance, at the 1996 Summer Olympics in Atlanta, Ga, 8 of 3387 female athletes were found to be SRY positive (1 per 423). This frequency may be higher than expected in the general population; however, 7 of the 8 had complete or partial androgen insensitivity. The other SRY-positive female athlete was a gonadectomized woman who probably had 5α-reductase deficiency, a disorder in which testosterone cannot be converted to dihydrotestosterone.11 Overall, the prevalence of male pseudohermaphroditism has been estimated to be 27 in 11,373, or 1 in 421, through 5 Olympics.20 However, no men posing as women have been detected at either the Olympics or other international events at which X chromatin analysis or SRY testing has been performed.4,10,11 The IAAF considered the issue of laboratory-based gender verification and, in contrast to the IOC, reached an entirely different conclusion. In 1991 the IAAF abolished laboratory-based gender verification testing. Initially this testing was replaced by a medical examination for health,8 but when this approach proved unwieldy, in 1992 the IAAF did away entirely with screening for this purpose.10 The medical delegate at an IAAF event still retains the option of assessing the gender of a particular participant should suspicions arise; however, in the intervening 8 years this has not occurred at any IAAF competition. In particular, concurrent requirements (for participants in IAAF events and in the Olympics) to produce urine under direct visualization for drug testing would seem to render formal gender verification testing moot. Decisions concerning eligibility of postpubertal transsexuals (male to female) also were left to the medical delegate, who could seek consultation.8 Many physicians and professional organizations concurred with the IAAF in its abrogation of gender verification testing.21 All but 5 (Basketball, Judo, Skiing, Volleyball, and Weightlifting) of the 35 International Federations of Olympic Sports have abolished gender verification testing at their world championships. The IOC's revision of its stance on gender verification is long overdue. The new policy protects rights and privacy for athletes while safeguarding fairness of competition. This new policy of abolishing gender verification procedures for female athletes, for the millennium's first Olympic Games, should be applauded by the medical and scientific communities as well as athletes. References 1. de la Chapelle A. Why sex chromatin should be abandoned as a screening method for "gender verification" of female athletes. New Stud Athletics.1986;2:49-53.Google Scholar 2. de la Chapelle A. The use and misuse of sex chromatin screening for "gender identification" of female athletes. JAMA.1986;256:1920-1923.Google Scholar 3. Simpson JL. Gender testing in the Olympics. JAMA.1986;256:1938.Google Scholar 4. Ferguson-Smith MA, Ferris EA. Gender verification in sport: the need for change? Br J Sports Med.1991;25:17-20.Google Scholar 5. Carlson A. When is a woman not a woman? Women Sport Fitness.March 1991:24-29.Google Scholar 6. Ferris EAE. Gender verification testing in sport. Br Med Bull.1992;48:683-697.Google Scholar 7. Ferguson-Smith MA, Carlson A, de la Chapelle A. Olympic row over sex testing. Nature.1992;355:10.Google Scholar 8. Ljungqvist A, Simpson JL.for the IAAF Plan. Medical examination for health of all athletes replacing the need for gender verification in international sports. JAMA.1992;267:850-852.Google Scholar 9. Simpson JL, Ljungqvist A, de la Chapelle A. et al. Gender verification and the next Olympic Games [letter]. JAMA.1993;269:357-358.Google Scholar 10. Simpson JL, Ljungqvist A, de la Chapelle A. et al. Gender verification in competitive sports. Sports Med.1993;16:305-315.Google Scholar 11. Elsas LJ, Hayes RP, Muralidharan K. Gender verification at the centennial Olympic games. J Med Assoc Ga.1997;86:50-54.Google Scholar 12. Mascagni K. World conference on women and sport. Olympic Review XXVI.1996-1997;12:23-31.Google Scholar 13. Ljungqvist A. Women in sport. In: Drinkwater BL, ed. Olympic Encyclopedia. Vol 8. Oxford, England: Blackwell Science Ltd; 2000:183-193. 14. Hay E. Sex determination in putative female athletes. JAMA.1972;221:998-999.Google Scholar 15. de la Chapelle A. Sex chromosome abnormalities. In: Rimoin DL, Connor JM, Pyertiz RE, eds. Principles and Practice of Medical Genetics. New York, NY: Churchill-Livingstone; 1983:193-215. 16. de la Chapelle A, Genel M. Gender verification of female athletes. Lancet.1987;2:1265-1266.Google Scholar 17. Simpson JL. Genetics of sexual differentiation. In: Carpenter SEK, Rock JA, eds. Pediatric and Adolescent Gynecology. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000:1-41. 18. Serrat A, Garcia de Herreros A. Determination of genetic sex by PCR amplification of Y-chromosome-specific sequences. Lancet.1993;341:1593.Google Scholar 19. Dingeon B. Gender verification and the next Olympic Games [letter]. JAMA.1993;269:357.Google Scholar 20. Ferguson-Smith MA. Gender verification and the place of XY females in sport. In: Harries M, Williams C, Stanish WD, Micheli LJ, eds. Oxford Textbook of Sports Medicine. Oxford, England: Oxford University Press; 1998:355-365. 21. Stephenson J. Female Olympians' sex tests outmoded. JAMA.1996;276:177-178.Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 2000 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.284.12.1568
Publisher site
See Article on Publisher Site

Abstract

For nearly 15 years, we have advocated abolition of laboratory-based, on-site testing for gender verification in sports competition.1-11 The ostensible goal of gender verification is to ensure that female athletes do not unwittingly compete against men. Given that men presumably would have an unfair competitive advantage on the basis of speed or muscle mass, such a policy superficially seems endorsable on the grounds of fairness. In reality, gender verification tests are difficult, expensive, and potentially inaccurate.1,4,8,10 Furthermore, these tests fail to exclude all potential impostors (eg, some 46,XX males), are discriminatory against women with disorders of sexual development, and may have shattering consequences for athletes who "fail" a test.1,4,10 During the 1996 International Olympic Committee (IOC) World Conference on Women and Health, the IOC passed a resolution "to discontinue the current process of gender verification during the Olympic Games."12 In January 1999 the IOC Athletes' Commission recommended to the IOC Executive Board that gender verification testing be discontinued, and the decision was ratified in June 1999 by the 109th IOC session in Seoul, South Korea.13 The medical community should applaud the decision of the IOC to abolish on-site gender verification preceding athletic events, effective with the current Summer Olympics in Sydney, Australia. The issue of gender verification arose in the early 1960s when rumors circulated that men secretly posing as women were competing against female athletes. At the 1966 European Track and Field Championships in Budapest, Hungary, and at the 1967 Pan American games in Winnipeg, Manitoba, physical inspection was made of disrobed female athletes. At the 1966 Commonwealth Games in Kingston, Jamaica, gynecologic examinations were performed. Complaints and resentment about this embarrassing approach led the IOC to search for an alternative gender verification method at its competitions. The IOC decided to require all female athletes to undergo sex chromatin analysis (X chromatin or Barr body analysis). Laboratory-based gender verification became compulsory in 1968 at the Mexico City Summer Olympics,13,14 after it was introduced on a small scale at the European Cup in Track and Field Athletics in Kiev, Ukraine (1967) and the Grenoble Winter Olympics (1968) in France. Gender verification has long been criticized by geneticists, endocrinologists, and others in the medical community.2,3,15,16 One major problem was unfairly excluding women who had a birth defect involving gonads and external genitalia (ie, male pseudohermaphroditism). Male pseudohermaphroditism is defined as genetic males (Y chromosome) whose external genitalia fail to develop—the genitalia may be ambiguous or resemble female genitalia. Many different forms of male pseudohermaphroditism exist.17 A second problem is that only women, not men, were stigmatized by gender verification testing. Systematic follow-up was rarely available for female athletes "failing" the test, which often was performed under very public circumstances. Follow-up was crucial because the problem was not male impostors, but rather confusion caused by misunderstanding of male pseudohermaphroditism.17 Noteworthy was the courageous contribution of the Spanish hurdler Maria Martinez Patino in documenting abuse by sports authorities.5 Patino had complete androgen insensitivity, and like most male pseudohermaphrodites she was raised as female. If athletic, these individuals naturally compete as women. Few if any plausible athletic advantages exist, especially given that gonadal extirpation usually has occurred by adulthood; however, abnormalities in external genitalia and gonads understandably create confusion. The IOC began to reconsider the issue of gender verification in the 1980s. The IOC and the International Amateur Athletic Federation (IAAF) convened workshops in the late 1980s and early 1990s at which it was consistently stated that "the aim of gender verification tests is not to differentiate between sexes but to prevent male impostors from participating in female competitions."13 That is, detection of male pseudohermaphrodites was not the goal. Despite these recommendations, the persistent aim of the IOC Medical Commission remained to exclude athletes with intersexuality, especially if androgen production was perceived to confer competitive advantages; thus, the IOC chose to retain laboratory-based testing. However, X chromatin analysis for diagnostic purposes had been abandoned by virtually all cytogenetic laboratories during the 1970s and was replaced by standard metaphase analysis that would require venipuncture. The IOC response was to replace the obsolete method of X chromatin analysis with the technically preferable polymerase chain reaction for the Y-linked gene SRY (sex-determining region Y). This new protocol began in Albertville, France, at the 1992 Winter Olympics,18 and has continued at every Olympics since.9,11,18,19 A few male pseudohermaphrodites were detected with this new method. For instance, at the 1996 Summer Olympics in Atlanta, Ga, 8 of 3387 female athletes were found to be SRY positive (1 per 423). This frequency may be higher than expected in the general population; however, 7 of the 8 had complete or partial androgen insensitivity. The other SRY-positive female athlete was a gonadectomized woman who probably had 5α-reductase deficiency, a disorder in which testosterone cannot be converted to dihydrotestosterone.11 Overall, the prevalence of male pseudohermaphroditism has been estimated to be 27 in 11,373, or 1 in 421, through 5 Olympics.20 However, no men posing as women have been detected at either the Olympics or other international events at which X chromatin analysis or SRY testing has been performed.4,10,11 The IAAF considered the issue of laboratory-based gender verification and, in contrast to the IOC, reached an entirely different conclusion. In 1991 the IAAF abolished laboratory-based gender verification testing. Initially this testing was replaced by a medical examination for health,8 but when this approach proved unwieldy, in 1992 the IAAF did away entirely with screening for this purpose.10 The medical delegate at an IAAF event still retains the option of assessing the gender of a particular participant should suspicions arise; however, in the intervening 8 years this has not occurred at any IAAF competition. In particular, concurrent requirements (for participants in IAAF events and in the Olympics) to produce urine under direct visualization for drug testing would seem to render formal gender verification testing moot. Decisions concerning eligibility of postpubertal transsexuals (male to female) also were left to the medical delegate, who could seek consultation.8 Many physicians and professional organizations concurred with the IAAF in its abrogation of gender verification testing.21 All but 5 (Basketball, Judo, Skiing, Volleyball, and Weightlifting) of the 35 International Federations of Olympic Sports have abolished gender verification testing at their world championships. The IOC's revision of its stance on gender verification is long overdue. The new policy protects rights and privacy for athletes while safeguarding fairness of competition. This new policy of abolishing gender verification procedures for female athletes, for the millennium's first Olympic Games, should be applauded by the medical and scientific communities as well as athletes. References 1. de la Chapelle A. Why sex chromatin should be abandoned as a screening method for "gender verification" of female athletes. New Stud Athletics.1986;2:49-53.Google Scholar 2. de la Chapelle A. The use and misuse of sex chromatin screening for "gender identification" of female athletes. JAMA.1986;256:1920-1923.Google Scholar 3. Simpson JL. Gender testing in the Olympics. JAMA.1986;256:1938.Google Scholar 4. Ferguson-Smith MA, Ferris EA. Gender verification in sport: the need for change? Br J Sports Med.1991;25:17-20.Google Scholar 5. Carlson A. When is a woman not a woman? Women Sport Fitness.March 1991:24-29.Google Scholar 6. Ferris EAE. Gender verification testing in sport. Br Med Bull.1992;48:683-697.Google Scholar 7. Ferguson-Smith MA, Carlson A, de la Chapelle A. Olympic row over sex testing. Nature.1992;355:10.Google Scholar 8. Ljungqvist A, Simpson JL.for the IAAF Plan. Medical examination for health of all athletes replacing the need for gender verification in international sports. JAMA.1992;267:850-852.Google Scholar 9. Simpson JL, Ljungqvist A, de la Chapelle A. et al. Gender verification and the next Olympic Games [letter]. JAMA.1993;269:357-358.Google Scholar 10. Simpson JL, Ljungqvist A, de la Chapelle A. et al. Gender verification in competitive sports. Sports Med.1993;16:305-315.Google Scholar 11. Elsas LJ, Hayes RP, Muralidharan K. Gender verification at the centennial Olympic games. J Med Assoc Ga.1997;86:50-54.Google Scholar 12. Mascagni K. World conference on women and sport. Olympic Review XXVI.1996-1997;12:23-31.Google Scholar 13. Ljungqvist A. Women in sport. In: Drinkwater BL, ed. Olympic Encyclopedia. Vol 8. Oxford, England: Blackwell Science Ltd; 2000:183-193. 14. Hay E. Sex determination in putative female athletes. JAMA.1972;221:998-999.Google Scholar 15. de la Chapelle A. Sex chromosome abnormalities. In: Rimoin DL, Connor JM, Pyertiz RE, eds. Principles and Practice of Medical Genetics. New York, NY: Churchill-Livingstone; 1983:193-215. 16. de la Chapelle A, Genel M. Gender verification of female athletes. Lancet.1987;2:1265-1266.Google Scholar 17. Simpson JL. Genetics of sexual differentiation. In: Carpenter SEK, Rock JA, eds. Pediatric and Adolescent Gynecology. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000:1-41. 18. Serrat A, Garcia de Herreros A. Determination of genetic sex by PCR amplification of Y-chromosome-specific sequences. Lancet.1993;341:1593.Google Scholar 19. Dingeon B. Gender verification and the next Olympic Games [letter]. JAMA.1993;269:357.Google Scholar 20. Ferguson-Smith MA. Gender verification and the place of XY females in sport. In: Harries M, Williams C, Stanish WD, Micheli LJ, eds. Oxford Textbook of Sports Medicine. Oxford, England: Oxford University Press; 1998:355-365. 21. Stephenson J. Female Olympians' sex tests outmoded. JAMA.1996;276:177-178.Google Scholar

Journal

JAMAAmerican Medical Association

Published: Sep 27, 2000

Keywords: gender

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