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Essay: Gender verification of female athletes
Essay Gender verification of female athletes Myron Genel, Arne Ljungqvist Genetic-based laboratory testing of female athletes who compete in women-only events was instituted in the late 1960s to replace the degrading alternatives of having to parade nude before panels of judges or endure close genital inspection. Testing seemed both appropriate and fair in a cold-war era during which the sex of some successful female athletes was being questioned, and the buccal smear—then a fairly new cytological test that depends on condensation of one of two X chromosomes—was not terribly difficult to administer. Those who proposed the idea could not have foreseen the consequences or the subsequent explosion in numbers of women athletes that would ensue over the next 30 years. Undoubtedly, the increasing popularity of women’s sports contributed to the desire to maintain a level playing field, as was described in 1972 by Eduardo Hay, a member of the International Olympic Committee’s Medical Commission. Procedures were, therefore, defined that included full clinical assessment of female athletes detected without two X chromosomes who wanted to continue to compete. Most, however, preferred either to feign injury or to retire than to subject themselves to the inevitable publicity and public scrutiny. A shame, since, as pointed out by Finnish geneticist Albert de la Chapelle in 1986, buccal smears were technically unreliable and detected athletes with genetic disorders, such as androgen insensitivity syndrome and gonadal dysgenesis, who were undeniably female. Paradoxically, the test would have permitted men with Klinefelter’s syndrome or XX males, who have a portion of the testicular determining gene (SRY) transposed onto the X chromosome, to compete. Spurred by the advocacy of de la Chapelle and others, the charitable arm of the International Association of Athletic Federations (IAAF) convened an international group of professionals, in which we were included, in Monaco in late 1990 for our milestone workshop on methods of femininity verification. Our group concluded that laboratory-based gender verification should be discontinued and replaced by a comprehensive medical assessment of all athletes. After a few years such an assessment was recognised as impractical and unnecessary; contemporary athletic clothing and the need to provide a urine sample for doping control under direct supervision made male impostors easy to identify. Our group’s recommendations were, nevertheless, initially accepted by the IAAF, and subsequently by all but five of the Olympic sports federations. The International Olympic Committee first, however, replaced X chromosome testing with DNA-based methods to detect Ychromosomal material, principally the SRY sexwww.thelancet.com Medicine and Sport Vol 366 December 2005
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determining locus, beginning at the 1992 Winter Games in Albertville, France. When used at the 1996 Summer Games in Atlanta, Georgia, USA, eight of 3387 female athletes tested positive—seven had androgen insensitivity, either complete or partial, and one, previously gonadectomised, had an apparent 5--steriod dehydrogenase deficiency. All were allowed to participate. With the increasing number of female participants, the cost of administering the test, including confirmation and counselling of detected individuals, was substantial with limited return. The International Olympic Committee’s Athletes Commission hence called for its discontinuation, which their Executive Board agreed to in June, 1999, in time for the 2000 Sydney Summer Games. The five other Olympic federations soon also abandoned the test. The International Volleyball Federation was the last to cease genetic testing in 2004, 20 years after de la Chapelle first voiced his concerns about the procedure. The International Olympic Committee should be commended for the decision it took in 1999, which was misinterpreted by many. Gender verification has not, as some believe, been completely abandoned. The rules state that the medically responsible body at a competition maintains the authority to arrange for verification of an athlete’s sex if it is called into question. Since the 2000 Summer Games in Sydney, the organising committee has had the responsibility of ensuring the presence of a team of specialists in various areas—eg, endocrinology, genetics, gynaecology, psychology—at the Games, ready to verify the gender of an athlete at the request of the International Olympic Committee’s Medical Commission. International federations are expected to make similar arrangements at their own world championships. To satisfy those who oppose the abandonment of the screening procedure, the International Olympic Committee’s decision in 1999 contained a clause, which stipulated that the abandonment of gender screening was tentative and that the decision would be reviewed after the Sydney Summer Games. The Sydney experience was successful; no objections were heard from the participating teams either during or after the games—as was the case for the Salt Lake City Winter Games in 2002 and the Athens Summer Games in 2004. At none of these games has there been any need to apply the new verification procedure. Gender verification last appeared on an International Olympic Committee agenda in March, 2004, at the 3rd World Conference on Women and Sport in Marrakech, Morocco. No-one opposed the new policy. Thus, we conclude that laboratory-based genetic screening for female gender in sport is history, saving a lot of embarassment—and money.
Myron Genel is a paediatric endocrinologist and Professor Emeritus of Pediatrics, Yale University School of Medicine. Arne Ljungqvist is a pathologist and Professor Emeritus of Pathology and Cytology at the Karolinska Institute, Stockholm, Sweden, and Chairman of the International Olympic Committee´s Medical Commission. Yale Child Health Research Center, PO Box 208081, New Haven, CT 06520, USA (Prof M Genel MD); and Swedish Sports Confederation, Idrottens Hus, S-114 73 Stockholm, Sweden (Prof A Ljungqvist MD) Correspondence to: Prof Myron Genel [email protected]
Further reading Dickinson BD, Genel M, Robinowitz CB, et al. Gender verification of female Olympic athletes. Med Sci Sports Exerc 2002; 34: 1539–42. Ljungqvist A, Simpson J. Medical examination for health of all athletes replacing the need for gender verification in international sport. JAMA 1992; 277: 850–52. Simpson J, Ljungqvist A, de la Chapelle A, et al. Gender verification in competitive sports. Sports Med 1993; 16: 305–15. de la Chapelle A. The use and misuse of sex chromatin screening for “gender identification” of female athletes. JAMA 1986; 256: 1920–23.
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determining locus, beginning at the 1992 Winter Games in Albertville, France. When used at the 1996 Summer Games in Atlanta, Georgia, USA, eight of 3387 female athletes tested positive—seven had androgen insensitivity, either complete or partial, and one, previously gonadectomised, had an apparent 5--steriod dehydrogenase deficiency. All were allowed to participate. With the increasing number of female participants, the cost of administering the test, including confirmation and counselling of detected individuals, was substantial with limited return. The International Olympic Committee’s Athletes Commission hence called for its discontinuation, which their Executive Board agreed to in June, 1999, in time for the 2000 Sydney Summer Games. The five other Olympic federations soon also abandoned the test. The International Volleyball Federation was the last to cease genetic testing in 2004, 20 years after de la Chapelle first voiced his concerns about the procedure. The International Olympic Committee should be commended for the decision it took in 1999, which was misinterpreted by many. Gender verification has not, as some believe, been completely abandoned. The rules state that the medically responsible body at a competition maintains the authority to arrange for verification of an athlete’s sex if it is called into question. Since the 2000 Summer Games in Sydney, the organising committee has had the responsibility of ensuring the presence of a team of specialists in various areas—eg, endocrinology, genetics, gynaecology, psychology—at the Games, ready to verify the gender of an athlete at the request of the International Olympic Committee’s Medical Commission. International federations are expected to make similar arrangements at their own world championships. To satisfy those who oppose the abandonment of the screening procedure, the International Olympic Committee’s decision in 1999 contained a clause, which stipulated that the abandonment of gender screening was tentative and that the decision would be reviewed after the Sydney Summer Games. The Sydney experience was successful; no objections were heard from the participating teams either during or after the games—as was the case for the Salt Lake City Winter Games in 2002 and the Athens Summer Games in 2004. At none of these games has there been any need to apply the new verification procedure. Gender verification last appeared on an International Olympic Committee agenda in March, 2004, at the 3rd World Conference on Women and Sport in Marrakech, Morocco. No-one opposed the new policy. Thus, we conclude that laboratory-based genetic screening for female gender in sport is history, saving a lot of embarassment—and money.
Myron Genel is a paediatric endocrinologist and Professor Emeritus of Pediatrics, Yale University School of Medicine. Arne Ljungqvist is a pathologist and Professor Emeritus of Pathology and Cytology at the Karolinska Institute, Stockholm, Sweden, and Chairman of the International Olympic Committee´s Medical Commission. Yale Child Health Research Center, PO Box 208081, New Haven, CT 06520, USA (Prof M Genel MD); and Swedish Sports Confederation, Idrottens Hus, S-114 73 Stockholm, Sweden (Prof A Ljungqvist MD) Correspondence to: Prof Myron Genel [email protected]
Further reading Dickinson BD, Genel M, Robinowitz CB, et al. Gender verification of female Olympic athletes. Med Sci Sports Exerc 2002; 34: 1539–42. Ljungqvist A, Simpson J. Medical examination for health of all athletes replacing the need for gender verification in international sport. JAMA 1992; 277: 850–52. Simpson J, Ljungqvist A, de la Chapelle A, et al. Gender verification in competitive sports. Sports Med 1993; 16: 305–15. de la Chapelle A. The use and misuse of sex chromatin screening for “gender identification” of female athletes. JAMA 1986; 256: 1920–23.
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