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Well, Is She Or Isn't She?

Sex testing an athlete isn't nearly as simple as it sounds

As Caster Semenya, the gold medalist in the women's 800 meters at last month's track world championships, was receiving a hero's welcome last week upon her return to South Africa—she got a new house and an audience with Nelson Mandela—one significant question about her achievement remained: Should she really have been running against women?

In the track world the question of what constitutes a man or a woman is not new, nor is it straightforward. In Berlin, Semenya needed less than two minutes to thrust the issue back into the spotlight. A virtual unknown two months ago, the 18-year-old blew away the 800 field in 1:55.45, winning by more than two seconds. Her time—not to mention her deep voice, ripped physique and narrow hips—had observers openly questioning her womanhood. "Just look at her," spat Russia's Mariya Savinova, the fifth-place finisher.

But just looking at her is of dubious value. By the early 1960s, track and field's governing body, the International Association of Athletics Federations, had seen enough burly Eastern bloc women (many of whom were on intense doping regimens) that it began to establish rules to ensure that those athletes were not men masquerading as women. Sex verification was a low-tech affair then: Drop your drawers, ladies, and parade around in front of the resident sawbones. By the 1968 Olympics that demeaning process had been scuttled in favor of cheek swabs that were tested for chromosomes. Blessedly objective science would save the day, since women have XX chromosomes and men have XY.

Except, of course, when they don't.

Never mind what you slept through in high school biology, XX does not necessarily a woman make. María José Martínez-Pati√±o, the 1986 Spanish national champion in the 60-meter hurdles, looked female and had never in her life doubted her womanhood. So she was understandably shocked when routine testing showed that she had XY chromosomes, and she was stripped of her title. "I lost friends, my fiancé, hope and energy," Martínez-Pati√±o wrote in a 2005 article in the journal The Lancet. Though Martínez-Pati√±o was genetically male, she had what's called complete androgen insensitivity. She produced manly doses of testosterone, but her body could not properly process it, so she never developed external male genitalia. (Since her body couldn't use any testosterone, Martínez-Pati√±o might actually have been at a competitive disadvantage.)

Faced with the case of a competitor whose genes and genitals were clearly at odds, the IAAF in 1990 convened an international group of experts—geneticists, a psychologist, an endocrinologist—to answer the question of how to determine, once and for all, if a woman is a woman.

Their answer? You got us. They recommended that the IAAF drop sex-verification testing altogether. The group later wrote in the Journal of the American Medical Association that while testing "superficially seems endorsable on the grounds of fairness .?.?. in reality, gender verification tests are difficult, expensive and potentially inaccurate." As it turned out, the human body isn't engineered to always fit neatly into the distinct male and female competitive categories convenient for athletics.

The IAAF heeded the group's recommendation and got out of the sex-verification-testing business in 1991. (The International Olympic Committee followed suit before the Sydney Games in 2000.) But the IAAF reserved the right to conduct tests in suspicious cases, and it has done so with Semenya. The IAAF has been mum on exactly what tests it performed on her, and Semenya isn't talking either. But there have been no groundbreaking scientific advances in testing in the past two decades. Says Myron Genel, professor emeritus of pediatrics at Yale and a member of the IAAF's 1990 committee, "I don't see how one could come up with anything different than we did 20 years ago."

Not even reports that Semenya's test results showed triple the testosterone level of a "normal" woman constitute anything near a smoking gun. Hormone patterns vary tremendously among people and can fluctuate throughout the day. And any number of circumstances—a birth defect, ovarian disease, a hormone-producing tumor—could cause a woman to have unusually high testosterone.

Thus, short of contriving arbitrary competitive hormone classes—undisputed welter-testosterone champ?—screening for natural hormone levels won't provide a just and practical solution. Nor would setting up new categories for athletes who have a mixture of stereotypical male and female biological traits. "You'd have to run international competitions like the Westminster dog show, with competitions for every breed," says Genel.

So what does that leave? The guideline that the IAAF advisers put forth 20 years ago. "If they believe they're female and they're raised as female, they should be allowed to compete as females," says one of the advisers, Dr. Joe Leigh Simpson, an executive associate dean at Florida International's medical school. Unless the IAAF finds that Semenya is intentionally masquerading as a female (and all indications from her family are to the contrary)—or unless it wants to set a standard the medical community says would be arbitrary—it is difficult to imagine a scenario in which Semenya could rightfully be separated from her title.

"I knew that I was a woman," Martínez-Pati√±o wrote in 2005. "I never cheated." Who's to tell her any differently?

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The human body isn't engineered to always fit neatly into MALE AND FEMALE categories.