Gender Testing in Sports

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Gender Testing in Sports

Post by BSharma » Mon Dec 18, 2006 2:04 am

Santhi Soudarajan won the 800m women's race at the Asian Games in Doha and today there is a newspaper report questioning her gender.  I posted about it in the Asian Games at Doha thread and the ever-vigilant and "don't believe everything that is told" Prasenjit questioned the validity of the report and asked me to comment on it.  Give a professor five minutes to expound on a topic and he or she will take five hours to show off (just kidding). 

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Re: Gender Testing in Sports

Post by BSharma » Mon Dec 18, 2006 2:17 am

Gender Testing in Sports
Part I - History of Gender Testing in Sports

Indians hailed the achievement of S. Santhi for winning a silver medal in the 800 meters race at the Doha Asian Games, and a story has been published today in The Times of India that Santhi may not be a woman.  Did she cheat or as Prasenjit questioned, there is more to the story than it meets the eye.

Men with their natural androgen-enhanced muscular strength have a distinct advantage over women in sports that require physical strength.  Male imposters competing as women were not an issue in the ancient Olympic Games in Greece where all competitors walked nude through the gates.  The modern Olympic Games were introduced in 1896, but it was not until the 20th century that women were allowed to compete at the Games. 

A German athlete named Hermann Ratjen assumed the name 'Dora' and competed in the high jump in the 1936 Olympics and finished fourth.  Ratjen went public in 1955 about his deception of binding his genitals at the Berlin Games and blamed the Nazi officials for the fraud.

Rumors swelled during the Cold War days of male athletes competing in women events and gender testing was introduced in competitive sports in mid-sixties.  The first test at the 1966 European Track and Field Championships required women athletes to walk nude or almost nude before judges. Two Russian sisters who won gold medals at the 1960 and 1964 Olympics abruptly retired rather than subject themselves to gender testing. 

Women athletes complained of the degrading nature of the gender testing and the International Olympic Committee (IOC) at the 1968 Mexico City Olympics introduced genetic testing in the form of a sex chromatin (Barr body) analysis of cells from inside the cheeks. 

Women usually are born with two X chromosomes (XX) and the second one is inactivated and appears like a small dot in the nucleus of the cell. There would be no such evidence in the cells of men, who have XY chromosomes.  However, women with Turner Syndrome (XO chromosome) would appear like a male and men with Klinefelter’s Syndrome (XXY chromosomes) would be classified as females based on the Barr body analysis. 

The International Amateur Athletics Federation (IAAF) in 1990 convened a committee of physicians in Monte Carlo to develop an alternative method for gender verification.  The group concluded that no gender testing was needed because the revealing contemporary style of athletic clothing left little doubt of the athlete’s gender and routine drug testing required officials to directly observe the passing of the urine sample, thus making gender cheating virtually impossible.  All winners and a random selection of other competitors undergo drug testing.

The IAAF abolished gender testing in 1992 but IOC at the Barcelona Olympic Games in 1992 used polymerase chain reaction to amplify the DNA extracted from a specimen to allow detection of a Y chromosome gene, SRY, that codes for male determination.

Eight of 3,387 female athletes had positive test results with the new DNA-based test at the 1996 Olympic Games in Atlanta.  Of these, seven had androgen (testosterone) resistance and were classified as varying forms of Androgen Insensitivity Syndrome, and the eighth athlete had previously undergone surgical removal of the testes because of presumed deficiency of an enzyme necessary to activate testosterone in responsive tissues.  All eight athletes were allowed to compete as women.

IOC's Executive Board, at its June 1999 meeting in Seoul, Korea decided to discontinue the practice of gender testing on a trial basis at the 2000 Olympic Games in Sydney, but reserved the right to have medical personnel examine individual athletes if there was any question regarding gender identity.

Legislation in Norway and some countries considered gender testing an unacceptable invasion of personal space of the athlete and prohibited such tests.  Medical professionals worried that the test has potential for causing great psychological harm to women, who unknowingly have disorders of sexual differentiation, yet gain no advantage over women in physical demanding sports.  Imagine the plight of a person who has been raised as a female, is legally a woman, has been married to a man and then finds out after gender test at a sporting event that she is a man!

A condition known as Androgen Insensitivity Syndrome occurs in 1 in 500-600 female athletes and the affected individuals have XY chromosomes similar to men, yet their body tissues do not respond to the male-type effect of the male hormone, testosterone, and they develop as women.  The testes are present in the abdomen or inguinal canal because there is no scrotum, and female organs such as uterus, fallopian tubes and ovaries are not present although some individuals may have a shallow vagina.  The testosterone is converted into a female hormone by the body resulting in development of breasts.

Athletes with Androgen Insensitivity Syndrome may not gain any advantage over a normal female, but some women with congenital adrenal hyperplasia and androgen-secreting tumors could develop bigger and stronger muscles than normal women yet their tests would reveal a normal XX chromosome and the DNA-based gender test would not pick them up. 

Is S. Santhi a woman or a man masquerading as a woman?  She has been competing as an elite athlete for many years and if there was any doubt about her gender, a medical board should have classified her status long time back.  She has competed as a woman for many years and must have undergone drug tests in the past.  So why is this issue being raised now?  Let her have her silver medal and her dignity.
Last edited by BSharma on Thu Dec 21, 2006 1:05 am, edited 1 time in total.

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Re: Gender Testing in Sports

Post by BSharma » Mon Dec 18, 2006 3:49 am

Here is a link to a report written by Mr KP Mohan titled Santhi fails gender test in The Hindu.  Apparently the Olympic Council of Asia (OCA) has withdrawn the silver medal from Santhi after its medical panel ruled on the gender classification.  The test was done when a team lodged a protest about Santhi’s gender and the dope control officers also reported their findings. 

Santhi had won a gold medal in the 1500m race at the South Asian games in Colombo in August 2006 and earned a silver medal in the 800m race at the Asian Championships in Korea last year.  How could dope control authorities in India and in other countries miss picking up the correct gender of Santhi?  Are obtaining of urine specimens from female athletes not done as per the prescribed rules?

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Re: Gender Testing in Sports

Post by Sandeep » Mon Dec 18, 2006 5:03 am

Santhi was not given a job in South Central Railways based on the doubts about her/his gender! How can our people send him/her to Asian games after knowing this? Absolutely disgraceful incident. Shame on our officials.

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Re: Gender Testing in Sports

Post by prasen9 » Mon Dec 18, 2006 6:44 am

Sandeep, I am still not convinced that the matter is that cut and dry.  There were other sports events where his/her gender had not come to the fore --- including events outside India.  So it seems we may be in the gray area for this case.

-pm

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Re: Gender Testing in Sports

Post by BSharma » Mon Dec 18, 2006 7:20 am

Prasenjit wrote in the Asian Games thread about Santhi Soudarajan’s gender issue, “I am even more confused now”.

I am confused also because of lack of proper and definitive information being put out in the Indian media.  The information about her gender identity should never have been published in the press until she had been found guilty and the reasons for the failed gender test had been released.  If Santhi is truly a man masquerading as a woman then the public should be made aware of the fraud, and action should be taken against all people who have helped in keeping this fact hidden. 

The Hindu report by KP Mohan makes it quite clear that the medical board at Doha has already ruled that Santhi is ineligible to compete with women thus ruling out conditions such as Androgen Insensitivity Syndrome (AIS). 

I have been involved in the care of patients with AIS, congenital adrenal hyperplasia (CAH) and other genetic disorders and there are few conditions where parents and family members are as distraught as when there is a birth of a healthy child, but with ambiguous genitalia (e.g., CAH).  A gender classification of the newborn child becomes imperative and consultation is sought from Pediatric Endocrinologists and Pediatric Surgeons.  The problem is magnified in rural India where medical expertise is lacking and the family members try to hush things up because of stigma and possible ridicule from society.

I do not want to comment on the specific issue of Santhi because I do not have all the facts, but I hope and pray that if her condition is related to a genetic disorder, she is handled with proper care and dignity that she deserves. 

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Re: Gender Testing in Sports

Post by BSharma » Mon Dec 18, 2006 8:22 am

Here is the link to the official IAAF Policy on Gender Classification.

2006 IAAF Policy on Gender Classification

After reading the "Process for Handling Cases of Gender Ambiguity" at the link provided, it appears to me that it should take quite a bit time to investigate a case.  The medical panel must comprise of gynecologist, endocrinologist, psychologist, internal medicine specialist, and expert on gender/transgender issues.  I am sure that Qatar has physicians specializing in these fields, but were these physicians readily available to the Asian Games officials.  Keep in mind that gender test is not a big issue at international championships, and much effort is placed for catching athletes taking illegal drugs to enhance their athletic performances.  Medical testing would include measurement of male hormones in the blood, chromosome analysis, etc and it takes time to get the results back to the medical panel. 

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Re: Gender Testing in Sports

Post by Sandeep » Mon Dec 18, 2006 8:44 am

Bsharma wrote, "Santhi is truly a man masquerading as a woman then the public should be made aware of the fraud, and action should be taken against all people who have helped in keeping this fact hidden".

Well she could be a eunuch too! It need not be a man masquerading as a woman.

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Re: Gender Testing in Sports

Post by BSharma » Mon Dec 18, 2006 6:07 pm

Sandeep quoted me as writing, “Santhi is truly a man masquerading as a woman then…”  Actually I wrote, “If Santhi is truly a man masquerading as a woman then…”

Sandeep wrote, “Well she could be a eunuch too! It need not be a man masquerading as a woman.”

It is inappropriate for me to comment on the true gender of Santhi until a competent medical panel gives its verdict.

The central issue is whether an athlete is getting an unfair advantage because of extra male hormones.  Some women (XX chromosomes) whose bodies produce a higher amount of male hormones because of some medical illness could gain an advantage over “normal” females whereas some males (XY chromosomes) could have Androgen Insensitivity Syndome (AIS) and will appear like females and will gain no advantage because their muscular build is similar to normal women.  One in 500-600 women have AIS and at the Olympic Games in 1996, 1 in 500 female athletes were found to have this condition and all of them were cleared to participate as women.

A bigger problem is the illegal use of male hormones by both male and female athletes to enhance their athletic performance.  IOC, IAAF and other sports bodies spend considerable efforts to detect this kind of cheating by normal male and female athletes and less effort is given to detect cheating based on gender.  All winners and randomly selected athletes have to undertake urine drug test and the athlete must be directly observed while in the process of urinating.  It is felt that this direct observation by officials will detect "female" athletes who have a male phallus and/or a scrotum containing testes.

Hijras are unique to Southeast Asia and are somewhat different from the eunuchs in Western countries and Middle East.  The latter usually are males who are castrated to serve multiple purposes in those societies while the Indian hijras are often transsexual or transgender although some have male phallus and testes that are often castrated before puberty.  Hijras consider themselves to be neither males nor females and prefer the third gender for their classification. 

Addendum:

I am not sure if any of my posts on this topic makes any sense; however, I am using this opportunity to help people understand this topic.
Last edited by BSharma on Mon Dec 18, 2006 6:12 pm, edited 1 time in total.

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Re: Gender Testing in Sports

Post by BSharma » Tue Dec 19, 2006 7:45 pm

Now the story of Santhi has gone international.  Washington Post has reported about it although the story by Emil Steiner appears sympathetic to santhi and raises some new issues.

What amazes me is that after the Indian Olympic Committee, the Athletic Federation of India and the Indian news media made a big deal by making statements perhaps without having much correct information on the subject from Doha or in India, Santhi and her family have been left bare to deal with this psychological trauma all by themselves.  What does a statement "not having the sexual characteristics of a female" mean?  Patients with Androgen Insensitivity Syndrome have the male sex chromosomes (XY), have testes and do not have uterus or ovaries or the female sexual characteristics of a female, yet they are legally allowed to compete as women in sports (it is the right decision from a medical point of view to allow them to compete as women). 

Of Gender, Identity & Running

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Re: Gender Testing in Sports

Post by prasen9 » Wed Dec 20, 2006 2:44 am

BSharma wrote: The central issue is whether an athlete is getting an unfair advantage because of extra male hormones. 
I don't know if the issue is that cut and dry.  If a person believes throughout the person's life that she is a female and let us say for argument's sake their phenotypical constitution is almost entirely female, but happens to take a gender test and it comes out that the person has extra male hormones or chromosomes (and I don't even know if such a case is possible, but hey I like to argue :-) ), then it may be draconic to classify the person as a male.  I am sure the doc did not mean to measure the level of male hormones in the body, for we may find that most female athletes have more male hormones than the average female.

Doc, I, for one, appreciate your posts.  Please keep us educated; thank you.

-pm

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Re: Gender Testing in Sports

Post by BSharma » Wed Dec 20, 2006 3:36 am

Prasenjit,

I will post additional information about the gender testing by tomorrow once I have completed my research.
prasen9 wrote:
BSharma wrote: The central issue is whether an athlete is getting an unfair advantage because of extra male hormones. 
I don't know if the issue is that cut and dry.  If a person believes throughout the person's life that she is a female and let us say for argument's sake their phenotypical constitution is almost entirely female, but happens to take a gender test and it comes out that the person has extra male hormones or chromosomes (and I don't even know if such a case is possible, but hey I like to argue :-) ), then it may be draconic to classify the person as a male. 
-pm
Prasenjit has described an athlete with Androgen Insensitivity Syndrome and these athletes are classified as females for sporting events by IOC, IAAF, etc based on the input of the medical panel in 1990 in Monte Carlo.  These athletes have more male hormones than normal women (unless the testes are removed surgically), but their muscles and other tissues respond similar to normal women because as the name of the condition suggests, the tissues are insensitive to male hormones. 

Prasenjit also wrote, "I am sure the doc did not mean to measure the level of male hormones in the body, for we may find that most female athletes have more male hormones than the average female."
The central issue of drug testing is to look for athletes taking performance enhancing drugs before and during competition.  There are two types of Anabolic Androgenic Steroids (AAS) that can be found in an athlete -- those produced endogenously by the body, and those present in body from exogenous source.  As far as endogenous AAS is concerned, the World Anti-Doping Code states that a urine specimen is deemed to NOT contain a Prohibited Substance in a case where the athlete proves that the concentration of prohibited substance and its metabolite or markers and/or the relevant ratio(s) in the athlete’s sample is attributable to a physiological or pathological condition.  Please note that the latter pathological conditions are what can occur in athletes with genetic conditions that lead to ambiguous genitalia. 

The WADA is trying to catch athletes with exogenous AAS and many other types of performance enhancing drugs.

I am glad that Prasenjit has found my posts on this subject helpful.   :D

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Re: Gender Testing in Sports

Post by BSharma » Wed Dec 20, 2006 8:06 am

Gender Testing in Sports
Part II - Who is a man and Who is a Woman?

S. Santhi has been asked to return the silver medal that she won in women’s 800m race at the Asian Games in Doha because as per the Indian news media reports, she does not have the “sexual characteristics of a woman”. 

What is the definition of a man or a woman?   It is simple if you ask a small child -- a father is a man and a mother is a woman.  Defining male and female is a lot more complex because gender has several viewpoints, and many of them are influenced by social and cultural values.  The human gender can be classified according to:

Anatomy:  The organs in the body of a man and woman differ in many ways.  Some of the primary sex characteristics of men are testes, scrotum and penis, whereas women have vulva, vagina, uterus and ovaries.  Secondary sex characteristics occur at or after puberty and include facial hair, chest hair, deeper voice and functional breasts. 

Physiology: Various hormones are present in different amounts in men and women and the effects of these hormones on the anatomy of the body are also different between the two sexes.

Chromosomes:  Women have two “X” chromosomes in each cell whereas men have an “X” and a “Y” chromosome in each cell.

Gender Identity:  People have a sense of being a male or a female and there are masculine and feminine personality traits.  Most boys tend to be more aggressive than girls from a young age.  Meanwhile most girls from a young age appear to be more motherly than boys, and girls who tend to be more rough and tough are often referred to as “tomboys”. 

Gender Role Play:  There are socially accepted patterns of behavior for men and women and people often present themselves to others influenced by these behaviors.  Women in many Middle East countries behave quite differently from those women raised in North America and many people in the Middle East might find the behavior of American women quite man-like. 

Identification of the gender of a person becomes complicated when all these factors are used because the various markers that we use to define gender may not agree.  A person with Androgen Insensitivity Syndrome has XY sex chromosomes seen in “males”, has testes in the abdomen because of lack of scrotum, lacks a uterus and ovaries yet has some sex characteristics of “females” and the physical characteristics are those of a woman.  A person with XX chromosome and congenital adrenal hyperplasia has uterus and ovaries and has male hormone levels that correspond to those of males, and if left untreated will start developing some male type external features.  The external physical examination and the chromosomal analysis are at odds in these two examples. 

How should the International Olympic Committee define male and female?  What is more important -- the external physical features that characterize the two genders as we normally know or the presence or absence of the Y chromosome?  When and how is the gender relevant in sports?

Before we go further, let us examine the development of the human embryo.  Until seven weeks after fertilization, the embryo is neither a male nor a female; it is considered “bipotential” because the gonads have not become testes or ovaries.  The embryo waits for signals from its DNA to start it on its path to become a male.  If no signal is received the embryo becomes a female and if a signal is received from the Y chromosome, a male will be formed.  A gene known as SRY found on the Y chromosome turns the bipotential gonads into testes.  The testes produce specific male hormones that influence the completion of the male gender.  The SRY gene could have a mutation that makes it inoperative, or it may be deleted, but the process of male development cannot occur without a functional SRY gene.

The IOC at the Barcelona Olympic Games in 1992 used presence or absence of the gene SRY for gender testing of athletes participating in women’s events. 

Does the presence of SRY gene mandate that the athlete should participate in events for men?  Do people with Androgen Insensitivity Syndrome have the SRY gene?

See the next post tomorrow for answers and lesson number two.  Please leave some feedback for me if you want me to continue on this topic.  My goals are to educate people about gender testing in sports and what went wrong in the case of Santhi.  My gut feeling is that there is a bigger problem in sports (India and abroad) that many officials have kept it quiet and I will try to bring it forward over the next few posts on this subject.   :D

Addendum:
If some people feel that I should continue putting information on this subject, let me know if my essays are simple enough for non-medical persons to understand.  Physicians are often guilty of communicating in a very technical manner.  :oops:
Last edited by BSharma on Thu Dec 21, 2006 1:07 am, edited 1 time in total.

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Re: Gender Testing in Sports

Post by jaydeep » Wed Dec 20, 2006 8:38 am

Doc great posts and please keep posting it ... I m too naive on this subject to comment, but I m reading ur posts to get information on this issue.

I m sympathise with Santhi.

Jaydeep.

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Re: Gender Testing in Sports

Post by BSharma » Wed Dec 20, 2006 2:58 pm

What is the correct way of writing Santhi's name?  Is it Soudarajan Santhi or Santhi Soudarajan?  Please give me your feedback about my ramblings  :oops: on gender testing because if there is no interest then I can communicate privately with Prasenjit and Jaydeep without taking up space at Sports-India forum.  :D
Last edited by BSharma on Wed Dec 20, 2006 3:00 pm, edited 1 time in total.

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