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In the world of high-stakes competitive sports, ensuring a level playing field is paramount, which is why doping is strictly prohibited and athletes are subjected to regular testing. This concern extends to the ongoing tension between the U.S. and China regarding alleged doping incidents that have supposedly been concealed by China and international sporting bodies.
However, a different yet related issue arose this week at the Olympics in Paris, surrounding the implications of elevated testosterone levels stemming not from anabolic steroids, but due to genetic variations or what is known as Differences of Sex Development (DSDs). This conversation diverges from the discussions on whether transgender women, who were assigned male at birth, hold an advantage in women’s sports. Today’s focus is on Imane Khelif from Algeria, who identifies as a woman but faced disqualification from the 2023 world championships after not passing a gender eligibility test.
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Yet, Khelif was permitted to compete in an Olympic boxing match, which she won after her visibly apprehensive opponent submitted within a minute. Is this fair? Yes, it is. We should not question the International Olympic Committee for upholding her right to compete without concrete evidence suggesting otherwise. I also commend her opponent, Italian boxer Angela Carini, for her apology regarding her earlier outburst of frustration following the bout. Both of these actions represent commendable integrity. Nonetheless, a critical medical question persists: what constitutes a competitive advantage, and how do we define it?
Algeria’s Imane Khelif (in red) gestures to Italy’s Angela Carini in the women’s 66kg preliminaries round of 16 boxing match during the Paris 2024 Olympic Games at the North Paris Arena, in Villepinte on August 1, 2024. (MOHD RASFAN/AFP via Getty Images)
It is widely accepted that prolonged elevated testosterone levels provide a competitive edge, which is why such substances are banned.
Regarding Khelif, as well as Taiwanese boxer Lin Yu-ting, who was also disqualified from her championship in 2023 by the International Boxing Association for allegedly not passing gender eligibility tests, the IOC has deemed both decisions sudden and arbitrary, allowing them to participate in the Olympics. I trust the IOC’s judgment in this matter and agree with their resolution. However, I question: Is an individual’s genetic profile defined by the presence of X and Y chromosomes significant? I believe it is, particularly regarding whether the hormones produced due to these genetic markers confer a competitive advantage similar to that obtained through hormone supplementation.
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In essence, we should focus on testing pertinent hormone levels rather than the genes responsible for their production.
While there are variations in hormone levels among members of the same gender, the presence of a Y chromosome might indicate the potential for testosterone levels that exceed the range typical in biological females.
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It appears to me that without a clearly defined standard (a rigorously enforced testosterone level applicable to all), determining the appropriate boundary will remain elusive. Meanwhile, the IOC correctly refrains from implementing bans based on conjecture or alleged genetic differences. Testing athletes’ chromosomal configurations could represent an invasion of privacy and is unwarranted. Instead, assessing hormone levels, including testosterone and cortisol, is more relevant and pragmatic. The specifics of differences in sexual development, as noted in these two athletes, should remain private. Nevertheless, establishing a standard for hormone levels and their influence on athletic performance is essential.
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