Intersex and the Olympics
Historically, the Olympic Games started as an all-male competitions; later, female athletes were admitted in more and more disciplines. Almost all disciplines are gender-separated (sailing is, I think, the only exception), and female athlestes only were tested for sex and gender. The criteria what makes one ‘female’ have changed several times, with the interesting result that some athletes changed their sex or gender several times in their lifetime – not because they changed, but because the IOC changed its procedures, including their stance whether they test sex or gender.
This would be funny if it didn’t mean that the career of female athletes and specifically of intersex athletes is always under the risk of being terminated with the next change of rules. In the course of the 20th c., the IOC has defined women athletes in many ways, including phenotype, genitalia and chromosones. Currently, the test is called ‘gender verification’, and the main criterion is blood testosterone: women and intersex with a high level of testosterone (above 10 nmol/l) are not counted as female; men with a low level of testosterone (below 10 nmol/l), however, still are considered male. Such low testoterone levels are rare in men, but in fact common among some male elite athletes. In Basketball, men with Kinefelter syndrome (which comes with a very low testosterone level) are clearly overrepresented, as Kinefelter men can grow much taller than average – a natural advantage in basketball.
It is also important to remember that the IOC regulations, even if they change at regular intervals, put considerable pressure on athletes to undergo genital surgery. Fénichel et al. 2013 report that four female athletes underwent, in order to comply with 2011 gender verification rules of the IOC, genital surgery including gonadectomy and partial clitoridectomy. Neither surgery had to to with health issues:
Although leaving male gonads in SDRD5A2 patients carries no health risk, each athlete was informed that gonadectomy would most likely decrease their performance level but allow them to continue elite sport in the female category. We thus proposed a partial clitoridectomy with a bilateral gonadectomy, followed by a deferred feminizing vaginoplasty and estrogen replacement therapy, to which the 4 athletes agreed after informed consent on surgical and medical procedures. Sports authorities then allowed them to continue competing in the female category 1 year after gonadectomy.
Nominally, these medically unnecessary surgeries were cosmetic surgery to which the four athletes gave their free consent. Yet it is also clear that the 2011 IOC ‘gender test’ regulations made them choose between this surgery and the end of their professional careers. Personally, I think that these rules will be changed in the near future (like all earlier versions of these rules were changed relatively quickly) but this will not help the athletes who underwent irrevocable genital surgery.
For a few more posts on the issue (mostly in German), see here https://intersex.hypotheses.org/tag/sport
For recent (English) media coverage and other links, see Klinefelter syndrome: https://oii.org.au/30657/reporting-rio-olympics/
For the current (2011) IOC regulatios on gender testing, see https://stillmed.olympic.org/Documents/Commissions_PDFfiles/Medical_commission/2012-06-22-IOC-Regulations-on-Female-Hyperandrogenism-eng.pdf
The case of the four athletes undergoing genital surgery is documented by Patrick Fénichel, Françoise Paris, Pascal Philibert, Sylvie Hiéronimus, Laura Gaspari,Jean-Yves Kurzenne, Patrick Chevallier, Stéphane Bermon, Nicolas Chevalier and Charles Sultan, ‘Molecular Diagnosis of 5α-Reductase Deficiency in 4 Elite Young Female Athletes Through Hormonal Screening for Hyperandrogenism’, The Journal of Clinical Endocrinology & Metabolism 98 (2013), E1055-E1059. http://press.endocrine.org/doi/full/10.1210/jc.2012-3893