Gender is not just a matter of chromosomes

 

Rare conditions that interfere with the process of sexual development make sex-characteristic tests for athletes problematic, writes MUIRIS HOUSTON

CASTER SEMENYA, an 18-year-old South African, convincingly won the women’s 800 metres at the World Championships in Berlin this week. Another young athlete with a bright future? Yes, but with one caveat – whether Semenya is 100 per cent a Ms.

Gender verification in sport first became a major issue in the 1960s, with suspicions that certain athletes were men posing as women in order to compete in female competition. Among the well-documented cases was that of the winner of the women’s world downhill skiing title in 1966 who later became a father.

This case and others were an indication that gender determination can be more complex that simply identifying the type of sex chromosomes an individual possesses. For most of us, our gender is determined by the presence or absence of a Y chromosome: men have a XY chromosome, while women carry two X chromosomes.

Normally a person’s anatomical sex is determined by these sex chromosomes. However, there are a number of genetic disorders that interfere with the process of sexual development. For example, some children with a male XY make-up develop as girls. They are referred to as XY females and many grow into normal looking women; apart from fertility issues they are otherwise healthy and because they are sometimes taller than average, they tend to do well at sport. These women may have gonadal dysgenesis, in which no male hormones are produced, or may have a condition called androgen insensitivity. Also referred to as testicular feminisation syndrome, it is caused by the failure of the body’s cells to respond to the male hormone, testosterone.

Androgen insensitivity syndrome and other rare conditions are the source of controversy in sport. Some athletes find it hard to understand why the presence of hormone-secreting testes (in women with normal external genitalia and breast development) does not confer competitive advantage. But because the heart, muscle and other body parts are insensitive to testosterone, these women do not experience athletic “benefits”. This is proven by the finding that these women do not respond to anabolic steroids.

The problem for athlete testing is that by using the sex-characteristic test, women with the syndrome would be declared male and unfairly excluded from competition.

The response of the medical community has been to criticise the process of gender verification of female athletes. In 2000, the International Olympic Committee (IOC) decided to end laboratory screening of female athletes. The decision was a welcome acknowledgement that previous policy had discriminated against women with disorders of sexual development. And because testing was performed under the public glare, “failing” the test was a humiliating experience.

A person’s sexual status may be determined by a number of factors: sex chromosome make-up, sex hormones, external genitalia; and the presence or absence of secondary sex characteristics. But a person’s apparent sex – the role in which the individual was reared – as well as gender identity issues must also be taken into account.

For a long time, sports administrators focused on just the chromosomal aspect. Now with the input of psychologists, psychiatrists and other medical specialists, a more humane approach is taken. Caster Semenya is to be congratulated.

Muiris Houston is Medical Correspondent of The Irish Times