Gender Testing in Sports

[BSharma]

Gender Testing in Sports
Part VI – Urine Drug Test in Sports

Gender testing in sports was stopped because an expert panel of physicians concluded that the Barr body test and checking for the SRY gene had significant problems as tools for gender verification of athletes.  The proposed solution was to use trained observers to notice the external genitalia for any abnormality during the collection of urine for drug testing of athletes and asking a panel of medical experts to determine the correct gender, in case of any suspicion due to abnormal genitalia. 

Urine drug testing is done to detect athletes who have used banned performance-enhancing drugs during or prior to the competition.  Athletes have occasionally used various devices to pass off urine belonging to someone else as their own.  Some athletes have attached a urine-filled plastic bag to their body and tubing attached to the bag ends near their genitalia and fraud is thus committed.  An athlete at the 2004 Olympics attempted to defraud the test with a novel device that was not readily apparent to the observer. The athlete had a bulb of urine hidden in his rectum, with clear plastic tubing laced between his legs and attached underneath his penis. A valve permitted him to squeeze the bulb and he appeared to be urinating into a container.  Some athletes have been rumored to replace their urine with clean urine in their urinary bladder by inserting a catheter through the urethra.  Both male and female athletes have been caught cheating during urine drug testing.

The World Anti-Doping Agency (WADA) has set up elaborate rules for observation of the athletes during the urine collection process.  The medal winners, the fourth place finisher and random non-medal participants in individual sports are usually chosen to supply urine for drug testing.  Over 100,000 sportsperson are tested worldwide annually at a cost of several million dollars. 

The urine collection procedure requires the athlete to go into a bathroom, pull up the upper garment up to the chest and pull down the lower garment to the knees, turn 360 degrees in front of the trained observer (of the same sex as the athlete) and urinate into a container while the observer witnesses the stream of urine.  This procedure is applicable to both male and female sportsperson.

[BSharma]

Gender Testing in Sports
Part VII - How sports officials cheat; make life more difficult for athletes, and is there a conspiracy in athletics?

S. Santhi has won medals in India and abroad and must have undergone urine drug test at some point(s) before the Asian Games in Doha.  Why did the trained observers not bring to the attention of the authorities, as was done in Doha, that Santhi’s external genitalia are abnormal?  If the abnormality in genitalia was informed to the officials in India before the Asian Games, why did they not act on it and get proper medical experts to diagnose Santhi’s medical condition and recommend proper treatment for it? 

Medical experts require the sports officials to investigate suspected disorders of sex development (DSD) of athletes during competitions in private, and the news should be kept confidential because of grave psychological trauma to the athlete and risk of ridicule in society and the information should not be leaked to the press.  It is obvious that Santhi is not a real man masquerading as a woman so why was her medical condition leaked to the press in Doha? 

There are rumors that Santhi was denied a sports-related job in the Indian Railways because of her abnormal external genitalia and yet no sports official in India cared about getting her proper treatment, but sent her to Doha to represent India in the Asian Games.  While the Tamilnadu government should be applauded for giving Santhi a cash reward for winning the silver medal despite knowing about the controversy, why have the Indian sports officials been so reluctant to stand behind her in her time of need and support?

The Asian Games authorities in Doha sent all urine and blood samples of the athletes for testing at King’s College in London, UK since there are no WADA accredited laboratories in Middle East countries.  I could not find any information about the laboratory that processed blood samples if Santhi underwent testing to establish her correct gender for sports.

Santhi won the silver medal in 800m race on December 9, 2006 and a trained observer during urine collection process noticed the abnormal genitalia and informed the proper authorities.  A few days later, she was sent back to India prematurely by the Indian team officials because of her adverse gender result, and Indian newspapers reported on December 17, 2006 that Santhi had failed the gender test and she could be stripped of her medal. 

Is it possible to convene the proper medical experts to examine Santhi, obtain the relevant blood tests (karyotyping for XY chromosomes, test for SRY gene and androgen receptor gene, measurement of level of different male hormones and their metabolites in blood, hCG stimulation test, a mutation analysis of the 5-alpha-reductase type 2 gene (if available) and a pelvic ultrasound), get the laboratory test results back to all the medical experts for them to make the official decision on her medical condition and send the recommendations to the Doha Asiad sports officials and for the latter to disqualify her in less than a week?  It takes the laboratories in USA one to two weeks to get results back to the physicians once the blood specimen is received in the laboratory.   

Athletes found to have a banned substance in their urine sample A are given a guilty verdict although the athletes can challenge it and get their urine sample B tested, but gender testing is not as simple as a urine drug test for banned substances.  Most of the time these athletes are unaware of their medical condition, as was found at the 1996 Olympic Games in Atlanta when eight female athletes were found to have the SRY gene on routine gender testing of all female athletes, but were allowed to compete in the Olympics as women because they had Androgen Insensitivity Syndrome or 5-alpha-reductase deficiency.  Why was Santhi pronounced as guilty by the Doha officials if a confirmed medical diagnosis had not been made by the medical expert panel?  (The SRY gene test turn-around time is short because it is a PCR based test.)

There are many anecdotal reports of athletes smoking marijuana on the night before their competitions and the urine drug test not able to detect the banned substance the next day.  How did it happen?  Did the athlete use a masking agent or the observer was not doing his or her job properly and let the athlete put another person’s urine into the container?

If the trained observers in India were not able to detect Santhi’s abnormal genitalia, are they looking the other way and letting the athletes to cheat when the urine sample is being collected?  Indian athletes in weightlifting and other sports have been caught with banned substances in their urine at international competitions, yet their drug tests were negative or not done in India.  Are Indian sports officials, coaches, athletes and drug testing officials fooling the Indian public by being involved in a big scam together?

THE END.

Post script:

I do not know about all of you, but I enjoyed reading and learning about the subject.  I hope these posts of mine are educational to people.     BBS

[x_y_Z_a]

Bhushanji
Thanks for the informative posts. But someone in Indian Olympic Association should take up her case and get the proper medical tests done.
Otherwise she alone may not have the reach to repudiate the results so far.
May be we can send the links to these posts to someone at IOA.

[BSharma]

Mr. Mohan has taken upon himself to educate the Indian public about “gender testing in sports” and has now written a few articles in The Hindu on Androgen Insensitivity Syndrome (AIS) and 5-alpha-reductase deficiency.  I applaud Mr. Mohan’s efforts to highlight the problem being faced by Santhi, and when all the other newspapers in India have kept quiet after brandishing Indian silver medalist in women’s 800m race as a gender cheater, he has stood alone to correct the injustice.

I vividly remember my two month long rotation in Endocrinology during my residency training in the 1970s and discussing a patient who in all external physical appearance looked like a female, but had complete AIS (it was called testicular feminization then).  She had undergone surgical removal of her testes located in her abdomen because testes not located in the scrotum have a significant risk of turning cancerous.  This patient worked for a US based international airlines as a stewardess and her employers had classified her as a female. 

Now compare the above mentioned patient’s employment with a somewhat similar situation in India.

What did Indian Railways do when Santhi applied for a job?  Turn her down because it could not classify her as a female or a male!  Since when have the Indian Railways started doing gender testing of all its employees for employment purposes?  If the Indian Railways had heard rumors of Santhi’s “disorder of sex development” through its sports officials and had done gender testing because of it, was it ethical of Indian Railways to NOT send the medical report to the pertinent Indian sports officials, but persist in the rumor that Santhi had been denied a job in the railways?  Indian Railways authorities could have prevented the embarrassing episode at the Asian Games in Doha by contacting the proper sports authorities in India, and if they did so, why are they keeping quiet now?  Shouldn’t the Indian sports officials be disciplined if they knew about Santhi’s situation and still let her go to Doha?

Here is a link to Mr KP Mohan’s article in The Hindu. A condition that leads to `gender ambiguity'

Here is a link to see how the world media is poking fun at India and Indian athletics.  Full Coverage: Indian Runner Fails Gender Test

Where is mugu these days?  I need his help in the Indian athletics and hockey threads. 

[mugu]

BS, I have been coming in here only occasionally the past few months. But I have followed your posts on gender verification with keen interest. I congratulate you for the excellent, informative posts that should generally help the Indian media pursue all possible angles in this unfortunate episode involving the Tamil Nadu athlete.
I do not have much more information than what has appeared in the Indian media. I do agree with you that the media or sections of it has handled the subject in poor taste by giving headlines like "Is she man or woman?" etc. The international media has lapped it up, though there have exceptions like Washington Post and a few others which have treated the subject with the sensitiveness it deserves.
I doubt whether a detailed gender verification procedure was followed by the Railways at the time the athlete approached them for employment. I do not know whether the authorities were officially informed about her condition or whether anyone followed up such a situation before sending her to an international competition.
It is quite possible she was not dope-tested in Korea and Sri Lanka and thus there was no question of her gender coming into question in those competitions. I am not sure of this, though.
I believe efforts are now on at the federation level to pursue all angles. Even IOA will be looking into these angles and I am sure the OCA and the IOC are at this point further pursuing this case:
http://sport.indiatimes.com/IOC_hope_fo ... 903809.cms
It is unfortunate that this case has come out in the open and the media is discussing it. I cannot imagine the mental state of the athlete or her family but I believe she has been hounded by the media.
The TV channels here have been especially unbearable, with a few honurable exceptions. I hope eventually it is proved that the athlete was not trying to cheat and whatever be the uncertainties might have been caused by the ignorance of a poor family. One factor that has worried me ever since the story broke has been the position that the athlete herself had taken the past couple of years, even though she is educated and would have understood the implications of her ambiguous gender. It baffles me.

[BSharma]

Mr KP Mohan wrote about 5-alpha-reductase type-2 deficiency (5-ARD) in his article in The Hindu today and then added that it is a condition for which the International Association of Athletics Federations (IAAF) has not mentioned it among those for which the athletes can compete in sports as women. A condition that leads to `gender ambiguity' by KP Mohan

The IAAF Policy on Gender Verification states that athletes with complete or near complete AIS, gonadal dysgenesis, Turner’s syndrome, congenital adrenal hyperplasia, androgen producing syndrome and anovulatory androgen excess should be allowed to compete as women.  I had wondered about the absence of 5-alpha-reductase type-2 deficiency from this list when I had read this policy a few days back when I started my research on this topic. 

I believe that this list is not inclusive of every medical condition and IAAF probably lets its medical board of experts to decide on individual cases.  An athlete with 5-alpha-reductase type-2 deficiency was allowed to compete as a woman in the 1996 Atlanta Olympics.

While researching this topic, I found some interesting trivia.  Two athletes named Stella and Ewa won Olympic medals before gender testing was instituted at the 1968 Olympics and it was later discovered that the two athletes were 46XY individuals with mixed gonadal dysgenesis condition.  They would have been stripped of their medals if they had competed in 1968 Olympics when Barr bodies were checked to prove femininity, but IAAF allows athletes with this medical condition to compete as women now.  How times have changed.

Princess Anne of UK was the only woman athlete to not undergo a gender test at the 1976 Olympic Games.  She participated in Equestrian in Montreal Games.

[BSharma]

It is nice to know that mugu has been visiting the Sports-India forum although he has not posted much recently.   :D

mugu has mentioned in his previous post and I think Mr KP Mohan alluded in one of his reports that Santhi may not have undergone urine drug test in Korea and Sri Lanka and my question to mugu or Mr KP Mohan is why was she not tested? 

I do not know of Santhi's exact medical diagnosis and it should remain confidential, but I hope that she is getting the proper help now. 

mugu wrote, "One factor that has worried me ever since the story broke has been the position that the athlete herself had taken the past couple of years, even though she is educated and would have understood the implications of her ambiguous gender. It baffles me."

It baffles most people until a person realizes the extent of psychological trauma that the affected person with this medical condition and the close family members have to undergo.  There are not too many "Endocrine emergencies" that occur in newborn infants, but an ambiguous genitalia in a newborn child is one of them.  Some infants with congenital adrenal hyperplasia develop low blood sodium levels and very high potassium levels that can be life threatening if not recognized and treated immediately, but all medical conditions with ambiguous genitalia require asignment of sex of the newborn infant as soon as possible.  Family members and friends want to know the sex of the infant, and what should the parents say about it?  The Pediatric Endocrinologists are asked to come immediately to the hospital to help make the diagnosis and assign the sex of the infant.  The lab results take time to come back and hence the Pediatric Endocrinologist has to rely on his or her expertise and judgement to decide the sex of the newborn. 

Ambiguous genitalia bring a lot of shame, anger, depression and frustration to the affected individuals and their parents.  News is kept confidential because society is often not mature enough to deal with these people.  Santhi should have received proper medical therapy long time back, and I believe that lack of medical facilities in rural India, lack of proper knowledge about this condition in Santhi and her parents, the need to keep this condition hush-hush by the family to prevent ridicule, lack of money, etc played a role in Santhi not seeking proper care.  I wish that Santhi had been examined long time back by sympathetic Gynecologists, Endocrinologists and Psychologists who could have advised her proper therapy.

If Indian officials knew about her ambiguous genitalia then she should have never been sent to any athletic event (Doha, Sri Lanka, Korea or in India) until she had been checked by proper medical experts and approved to participate after receiving proper therapy and clearance by the medical board in India.  If she has ambiguous genitalia and has male hormone effects more than a normal woman should have then a complete and thorough medical test in Doha will show that she has failed the gender test.  

[mugu]

It is nice to know that mugu has been visiting the Sports-India forum although he has not posted much recently. 

mugu has mentioned in his previous post and I think Mr KP Mohan alluded in one of his reports that Santhi may not have undergone urine drug test in Korea and Sri Lanka and my question to mugu or Mr KP Mohan is why was she not tested? 

I understand that dope-testing at the Asian championships level is only random, meaning not all medallits would have been tested. The same goes for SAF Games also .I believe the Doha Asian Games also had only random testing. That perhaps explains your query BS.

[BSharma]

mugu wrote, "I believe the Doha Asian Games also had only random testing. That perhaps explains your query BS."

I read the 59 page Doping Control Guide a few times in the past few days and page 29 gives the type of athletes that were chosen for drug testing.  Medal winners and random athletes were checked for drug testing in Doha.

Doping Control Guide 15th Asian Games in Doha 2006

[mugu]

I read the 59 page Doping Control Guide a few times in the past few days and page 29 gives the type of athletes that were chosen for drug testing.  Medal winners and random athletes were checked for drug testing in Doha.

Doping Control Guide 15th Asian Games in Doha 2006

A little clarification here BS. This is what page 29 says:

2. SELECTION OF ATHLETES
For the Games, the Chair of the OCA MC, in consultation with DAGOC,
and the relevant IF/AF will determine the number of tests to be
performed.
Athletes will be selected based on:
I. Medal and random selections throughout preliminary and final
competitions.
II. All Athletes that establish or break a world record or an Asian record.
III. All Athletes participating in the 15th Asian Games will be subject,
during the Period of the Games, to Doping Controls initiated by the
OCA at any time or place, with No Advance Notice.


Not all the medalists were chosen. I did not base my post on what was available in the doping guide (which I am seeing now), but on the information I had gathered when the Indian team returned.
Thus, to my understanding and information that I have gathered over the past few days, only the top 2 (gold, silver) plus at random were chosen, at least in athletics. It might have been different in, say a sport like weightlifting. This has happend in the past also in Asian Games.

[BSharma]

It appears that the Chair of Medical Commission of International Olympic Committee, Dr Arne Ljungquist, is taking an interest in Santhi's case.  I am glad that other sports writers in India are bringing up important issues regarding gender in sports.  Do read Saibal Bose's article titled IOC hope for Santhi Soundararajan.

Some sports writers continue to address Santhi as "he" or "she".  I think that Santhi is not a male masquerading as a female or else the Doha Asian Games people and OCA would have banned her for life.  If Santhi has a disorder of sex development, she should be addressed using the gender she has chosen for herself.  Santhi has been brought up as a girl from birth and she should be addressed as a "she".  Sports writers should stop using "he/she" to refer to Santhi.

[BSharma]

I appreciate mugu’s comments to clarify which athletes underwent urine drug test at the Asian Games in Doha.  According to mugu, the gold and silver medalists plus random athletes were selected for this test.

The IOC has set a higher bar for drug testing at Olympics and has asked the organisers to test the first four finishers and random athletes in individual events and the procedure for team events is slightly different.  See page 8 of the Guide Book for the 2006 Winter Olympic Games where IOC went one step further and the top five finishers and random athletes were asked to be selected for the test.  AntiDoping Rules for 2006 Winter Olympic Games.

Why am I harping on urine drug tests in this thread about gender testing in sports?  Urine testing of athletes is the method how female athltetes are screened for proper gender.  A bigger problem than proper gender assignment in sports is the use of performance enhancing drugs including use of anabolic steroids by the athletes.  One effective way to stop illegal use of these drugs is to test the athletes for these drugs before, during and after the competitions.  See page # 2 of the report titled IOC’s Fact Sheet – The Fight against Doping to see how many athletes were tested and how many were caught in Olympic Games. 

[piranha]

I remember a debate a couple of years ago, when a transsexual won the women's national mountain-bike downhill championship in Canada. The winner was biologically a man, but the Canadian cycling federation allowed him to compete in the women's event. On the podium, the second place finisher and her cheering group made offensive remarks to the winner and she was fined. International press agencies reported this case.

[BSharma]

I remember a debate a couple of years ago, when a transsexual won the women's national mountain-bike downhill championship in Canada...

The Canadian Cycling Association suspended Canadian downhill cyclist Danika Schroeter for wearing a white T-shirt with black print that said "100 Per Cent Pure Woman Champ” during podium ceremony of Canadian National Mountain Bike Downhill Championship in Whistler in 2006.  Michelle Dumaresq won the race and Schroeter finished second.  Dumaresq underwent sex-reassignment surgery in 1996 and Union Cycliste Internationale has certified her to compete at world championships as a woman; however, some of her female cyclist competitors complain that Dumaresq has an unfair advantage because she was previously a man.

[jaydeep]

Thanks piranha and Bhushan for this interesting tit-bits on this gender issue.