August 2008

The Chinese media today had a story on a visit to the Beijing Olympics Gender Testing Lab. The article makes it sound as though male athletes masquerading as women is a persistent problem. But, really, it’s one that has been made problematic anew for the Beijing Olympics.

The issue first came up decades ago when it was alleged that male athletes were trying to complete as women in international sports competitions.  So-called sex testing—basically chromosomal testing—began in 1966 for the European Track and Field Championships. Two years later, the Olympics also started testing women’s chromosomal type for the games in Mexico. Chromosomal testing continued to be the method of sex verification until 1999 when the International Olympic Committee (IOC) abandoned the practice following a resolution passed at the IOC conference on women and health where it was decided to discontinue the testing in part because it became clear that karyotype alone was not indicative of one’s sex. Apparently, however, the Olympic Council of Asia continues the practice, which explains why this is coming up again in the Olympics after having ended almost a decade ago.

The article says the lab, which is in the basement of a Peking Union Medical College Hospital (PUMCH) building, uses clinical observation, sex hormones, chromosomes, and genes to determine sex. In one sense, this approach is refreshing as it moves away from the outdated idea that chromosomes are indicative of one’s “true” sex. But on another level, although they appear to think that assessing more traits or factors will lead to a more precise analysis, it only complicates matters. Quite simply, more variables only creates more problems with interpretation. So let’s say a woman has XX chromosomes but high levels of circulating androgens. Well, previously she would have still been eligible to complete as a woman. But with this new approach, she might well be declared a male, or else too masculine to complete as a woman. This is not a thought experiment, women with congenital adrenal hyperplasia fit just this example.

So the other problem with this method is that it will put a much larger group of women at risk of being declared “men” and thus ineligible to compete. For example, while were often hear about androgen insensitivity syndrome in the context of sex testing because women with this condition have an XY karyotype, testing for hormone levels could also conceivably mark as men women with congenital adrenal hyperplasia, who have an XX karyotype, but who, owing to an enzyme deficiency, can have more circulating androgens than is typically found in women.

As gender assignment for children with intersex conditions shows, there is widespread variation in what clinicians think makes us male or female. That one lab is going to be verifying maleness or femaleness without oversight, using methods that are deeply disputed and whose interpretation is highly subjective is downright frightening.

Today, Good Morning America profiled Eden Atwood, a singer and actress with Androgen Insensitivity Syndrome. In general, it’s a sensitive portrait (aside from the screen caption “She’s a girl…or a boy?”) in which she discusses some of the pain that resulted from how her clinicians and parents responded to her condition. A priceless moment is when the interviewer is talking to physician Charmian Quigley. As she is describing the typical anatomy of a woman with complete AIS, the camera cuts back to the interviewer and you could see her confusion, “Huh? How does that work?”AIS is one of the conditions raised when people talk about some of the problems with sex testing at the Olympics (or more generally) because there is no one physical trait that makes us male or female. This was a promo for Medical Mysteries, also on ABC, that airs tonight. You can watch a clip of Medical Mysteries here.