Skip to main content
SpringerLink
Log in

Gender Verification in Competitive Sports

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Summary

The possibility that men might masquerade as women and be unfair competitors in women’s sports is accepted as outrageous by athletes and the public alike. Since the 1930s, media reports have fuelled claims that individuals who once competed as female athletes subsequently appeared to be men. In most of these cases there was probably ambiguity of the external genitalia, possibly as a result of male pseudohermaphroditism. Nonetheless, beginning at the Rome Olympic Games in 1960, the International Amateur Athletics Federation (IAAF) began establishing rules of eli-gibility for women athletes.

Initially, physical examination was used as a method for gender verification, but this plan was widely resented. Thus, sex chromatin testing (buccal smear) was introduced at the Mexico City Olympic Games in 1968. The principle was that genetic females (46,XX) show a single X-chromatic mass, whereas males (46,XY) do not. Unfortunately, sex chromatin analysis fell out of common diagnostic use by geneticists shortly after the International Olympic Committee (IOC) began its implementation for gender verification. The lack of laboratories routinely performing the test aggravated the problem of errors in interpretation by inexperienced workers, yielding false-positive and false-negative results. However, an even greater problem is that there exist phenotypic females with male sex chromatin patterns (e.g. androgen insensitivity, XY gonadal dysgenesis). These individuals have no athletic advantage as a result of their congenital abnormality and reasonably should not be excluded from competition. That is, only the chromosomal (genetic) sex is analysed by sex chromatin testing, not the anatomical or psychosocial status. For all the above reasons sex chromatin testing unfairly excludes many athletes. Although the IOC offered follow-up physical examinations that could have restored eligibility for those ’failing’ sex chromatin tests, most affected athletes seemed to prefer to ’retire’. All these problems remain with the current laboratory based gender verification test, polymerase chain reaction based testing of the SRY gene, the main candidate for male sex determination. Thus, this ’advance’ in fact still fails to address the fundamental inequities of laboratory based gender verification tests.

The IAAF considered the issue in 1991 and 1992, and concluded that gender verification testing was not needed. This was thought to be especially true because of the current use of urine testing to exclude doping: voiding is observed by an official in order to verify that a sample from a given athlete has actually come from his or her urethra. That males could masquerade as females in these circumstances seems extraordinarily unlikely. Screening for gender is no longer undertaken at IAAF competitions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Anonymous. Athletes’ sex secret. Guardian, January 26, 1981

  • Berger R, Abonyi D, Nodot A. Hermaphroditism vrai et ‘garcon XX’ dans une fratrie. Revue Europeene de Etudes Clinique Biologie 15: 330–334, 1970

    CAS  Google Scholar 

  • Boscze P, Szamel I, Molnar F, Laszlo J. Non-neoplastic gonadal testosterone secretion as a cause of vaginal cell maturation in streak gonad syndrome. Gynecologic Investigation 22: 153–156, 1986

    Article  Google Scholar 

  • Brown M, Markland C, Dehner LP. Leydig cell hypoplasia: a case of male pseudohermaphroditism. Journal of Clinical Endocrinology and Metabolism 46: 1–7, 1976

    Article  Google Scholar 

  • Carlson A. Chromosome count. Ms Magazine, October, pp. 40–44, 1988

    Google Scholar 

  • Carlson A. When is a woman not a woman. Women’s Sports and Fitness, March, pp. 24–29, 1991

    Google Scholar 

  • Carson SA, Simpson JL. Virilization of female fetuses following maternal ingestion of progestational and androgenetic steroids. In Mahesh & Greenblatt (Eds.) Hirsutism and virilization, pp. 177–187, PSG Publishing Company, Littleton, 1984

    Google Scholar 

  • Comite National Consultarif d’Ethique (Berta P, Boué A, Weissenbach J). Questions ethiques posées par l’obligation de tests genetiques pour les concurrentes des jeux, Comite National Consultarif d’Ethique, Paris, 1992

    Google Scholar 

  • Cussen LK, McMahon R. Germ cells and ova in dysgenetic gonads of a 46,XY female dizygotic twin. Archives of Disease in Childhood 133: 373–375, 1979

    CAS  Google Scholar 

  • de Grouchy J, Gompel A, Salmon-Bernard Y. Embryonic testicular regression syndrome and severe mental retardation in sibs. Annals Genetique 28: 154–160, 1985

    Google Scholar 

  • de la Chapelle A. Analytical review: nature and origin of males with XX sex chromosomes. American Journal of Human Genetics 24: 71–76, 1972

    PubMed  Google Scholar 

  • de la Chapelle A. The etiology of maleness in XX males. Human Genetics 58: 105–108, 1981

    Article  PubMed  Google Scholar 

  • de la Chapelle A. The use and misuse of sex chromatin screening for ‘gender verification’ of female athletes. Journal of the American Medical Association 256: 1920–1923, 1986a

    Article  PubMed  Google Scholar 

  • de la Chapelle A. Why sex chromatin should be abandoned as a screening method for ‘gender verification’ of female athletes. New Studies in Athletes 2: 49–53, 1986b

    Google Scholar 

  • de la Chapelle A. The complicated issue of human sex differentiation. American Journal of Human Genetics 43: 1–3, 1988

    PubMed  Google Scholar 

  • de la Chapelle A. Sex chromosome abnormalities. In Emery & Rimoin (Eds) Principles and practice of medical genetics, 2nd ed., pp. 273–299, Churchill-Livingstone, Edinburgh, 1990

    Google Scholar 

  • de la Chapelle A, Genel M. Gender verification in female athletes. Lancet 2: 1265–1266, 1987

    Article  Google Scholar 

  • de la Chapelle A, Koo GC, Wachtell SS. Recessive sex determining genes in human XX male syndrome. Cell 15: 837–839, 1975

    Article  Google Scholar 

  • Dingeon B. Gender verification and the next Olympic games. Journal of the American Medical Association 269: 357–358, 1993

    Article  PubMed  CAS  Google Scholar 

  • Dingeon B, Hamon P, Robert M, Schamasch P, Pugeat M. Sex testing at the Olympics. Nature 358: 447, 1992

    Article  PubMed  CAS  Google Scholar 

  • Donohoe T, Johnson N. Drugs and the female athlete. In Foul play, pp. 66–79, Basil Blackwell, Oxford, 1986

    Google Scholar 

  • Ferguson-Smith MA, Carlson A, de la Chapelle A, Ehrhardt A, Ferris E, et al. Olympic row over sex testing. Nature 355: 10, 1992

    Google Scholar 

  • Ferguson-Smith MA, Ferris EA. Gender verification in sport: the need for change? British Journal of Sports Medicine 25: 17–20, 1991

    Article  PubMed  CAS  Google Scholar 

  • Ferris EAE. Gender verification testing in sport. British Medical Bulletin 48: 3-10, 1992

    Google Scholar 

  • Green S, Zachmann M, Mannella B. Comparison of two tests to recognize or exclude 5α-reductase deficiency in prepuberal children. Acta Endocrinologica 114: 113–117, 1987

    Google Scholar 

  • Hay E. Sex determination in putative female athletes. Journal of the American Medical Association 221: 998–999, 1972

    Article  PubMed  CAS  Google Scholar 

  • Heremans GFP, Moolenaar AJ, Van Geldere HM. Female pheno-type in a male child due to 17alpha-deficiency. Archives of Disease in Childhood 51: 721–723, 1976

    Article  PubMed  CAS  Google Scholar 

  • Hsu LYF. Prenatal diagnosis of chromosome abnormalities through amniocentesis. In Milunsky (Ed.) Genetic disorders and the fetus, 3rd ed., pp. 155–210, Johns Hopkins Press, Baltimore, 1992

    Google Scholar 

  • Imperato-McGinley J, Gautier T, Pichardo M, Schackleton C. The diagnosis of 5α-reductase in infancy. Journal of Clinical Endocrinology and Metabolism 63: 1313–1318, 1986

    Article  PubMed  CAS  Google Scholar 

  • Imperato-McGinley J, Guerrero L, Gauiter T, Peterson RE. Steroid 5α-reductase deficiency: an inherited form of male pseudohermaphroditism. Science 186: 1213–1215, 1974

    Article  PubMed  CAS  Google Scholar 

  • Imperato-McGinley J, Peterson RE, Stoller R, Goodwin WE. Male pseudohermaphroditism secondary to a 17α-hydroxysteroid dehydrogenase deficiency: gender role with puberty. Journal of Clinical Endocrinology and Metabolism 49: 391–395, 1979

    Article  PubMed  CAS  Google Scholar 

  • Jost A. Recerches sur la differenciation sexuelle de l’embryon de lapin IL Action des androgenes de syntheses sur l’histogenese genitale. Archives d’Anatomie Microscopique et de Morphologie Experimentale 36: 242–270, 1947

    Google Scholar 

  • Krawczynski M. Zagadnienie intersekusulizmu w sporcie kwali-fikowanum. Wiadomosci Lekarskie 3: 189–191, 1978

    Google Scholar 

  • Larned D. The femininity test: a woman’s first Olympic hurdle. Women Sports 3: 8–11, 1976

    Google Scholar 

  • Lee PA, Rock JA, Brown TR, Fichman KM, Migeon CJ, et al. Leydig cell hypofunction resulting in male pseudohermaphroditism. Fertility and Sterility 37: 675–679, 1981

    Google Scholar 

  • Ljungqvist A, Simpson JL (for the IAAF). Medical examination for health of all athletes replacing the need for gender verification in international sports. Journal of the American Medical Association 267: 850–852, 1992

    Article  PubMed  CAS  Google Scholar 

  • Marcelli M, Tilley WS, Zoppi S, Griffin JE, Wilson JW, et al. Androgen resistance associated with mutation of the androgen receptor at amino acid 722 (Arg Cys) results from a combination of decreased messenger ribonucleic acid levels and impairment of receptor function. Journal of Clinical Endocrinology and Metabolism 73: 318–324, 1991a

    Article  PubMed  CAS  Google Scholar 

  • Marcelli M, Zoppi S, Grino PB, Griffin JE, Wilson JW, et al. A mutation in DNA binding domain of the androgen receptor gene causes complete testicular feminization. Journal of Clinical Investigation 87: 1123–1126, 1991b

    Article  PubMed  CAS  Google Scholar 

  • McDonough PG, Tho PT. The spectrum of 45,X/46,XY gonadal dysgenesis and its implications (a study of 19 patients). Pediatric and Adolescent Gynecology 1: 1–18, 1983

    Google Scholar 

  • McElreavey K, Rappaport R, Vilain E, Abbas N, Richaud F, et al. A minority of 46,XX true hermaphrodites are positive for the Y-DNA sequence including SRY. Human Genetics 90: 121–125, 1992

    Article  PubMed  CAS  Google Scholar 

  • Minowada S, Fukutani K, Hara M, Shinohara M, Kamioka J, et al. Childbirth in a true hermaphrodite. European Urology 10: 410–414, 1984

    Google Scholar 

  • Morris JM, Mahesh VB. Further observations on the syndrome ‘testicular feminization’. American Journal of Obstetrics and Gynecology 87: 731–748, 1953

    Google Scholar 

  • Opitz JM, Simpson JL, Sarto GE, Summitt RL, New M. Pseudovaginal perineoscrotal hypospadias. Clinical Genetics 3: 1–36, 1972

    Article  PubMed  CAS  Google Scholar 

  • Page DL, Mosher R, Simpson EM, Fisher G, Mardon J, et al. The sex-determining region of the human Y chromosome encodes a finger protein. Cell 51: 1091–1094, 1987

    Article  PubMed  CAS  Google Scholar 

  • Perez-Palacios G, Scaglia HE, Kofman-Afaro S, Saavedra DO, Ochoa S, et al. Inherited male pseudohermaphroditism due to gonadotropin unresponsiveness. Acta Endocrinologica 98: 148–155, 1981

    PubMed  CAS  Google Scholar 

  • Peterson RE, Imperato-McGinley J, Gautier T, Starla E. Male pseudohermaphroditism due to steroid 5alpha-reductase deficiency. American Journal of Medicine 62: 170–191, 1977

    Article  PubMed  CAS  Google Scholar 

  • Prior L, Bordet S, Trifiro MA, Mhatre A, Kaufman M, et al. Replacement of arginine 773 by cysteine or histidine in the human androgen receptor causes complete androgen insensitivity with different receptor phenotypes. American Journal of Human Genetics 51: 143–155, 1992

    PubMed  CAS  Google Scholar 

  • Ramsay M, Bernstein R, Zwane E, Page, DC, Jenkins T. XX true hermaphroditism in South African Blacks: an enigma of primary sexual differentiation. American Journal of Human Genetics 43: 4–13, 1988

    PubMed  CAS  Google Scholar 

  • Raspa RW, Subramanian AP, Romas NA. True hermaphroditism presents as intermittent hemitura and groin pain. Urology 28: 133–141, 1986

    Article  PubMed  CAS  Google Scholar 

  • Ris-Stalpers C, Kuiper GGJM, Faber PW, Schweikert HU, van Rooij HCJ, et al. Aberrant splicing of androgen receptor mRNA results in synthesis of a nonfunctional receptor protein in a patient with androgen insensitivity. Proceedings of the National Academy of Sciences of the United States of America 87: 7866–7870, 1990

    Article  PubMed  CAS  Google Scholar 

  • Ryan AJ. Sex and the singles player. Physician and Sports-medicine 4: 39–41, 1976

    Google Scholar 

  • Sakamoto H, Nakanoin K, Lomatsu H, Michimoto T, Takashima E, et al. Femininity control at the XXth Universiade in Kobe, Japan. International Journal of Sports Medicine 9: 193–195, 1988

    Article  PubMed  CAS  Google Scholar 

  • Saldanha PH, Arnhold UP, Mendonca BB, Bloise W, Toledo SPA. A clincogenetic investigation of Leydig cell hypoplasia. American Journal of Medical Genetics 26: 337–344, 1987

    Article  PubMed  CAS  Google Scholar 

  • Sarto GE, Opitz, JM. The XY gonadal agenesis syndrome. Journal of Medical Genetics 10: 288–293, 1973

    Article  PubMed  CAS  Google Scholar 

  • Schwartz M, Imperato-McGinley J, Peterson RE, Cooper G, Morris PL, et al. Male pseudohermaphroditism secondary to an abnormality in Leydig cell differentiation. Journal of Clinical Endocrinology and Metabolism 53: 123–127, 1981

    Article  PubMed  CAS  Google Scholar 

  • Schwinger E. Problems of sex differentiation in athletics. Atlecticastudi 5: 72–80, 1980

    Google Scholar 

  • Simpson JL. Disorders of sexual differentiation: etiology and clinical delineation, Academic Press, New York, 1976

    Google Scholar 

  • Simpson JL. True hermaphroditism. Etiology and phenotypic considerations. Birth Defects 14 (6c): 9–35, 1978

    PubMed  CAS  Google Scholar 

  • Simpson JL. Gender testing in the Olympics. Journal of the American Medical Association 256: 1938, 1986

    Article  PubMed  CAS  Google Scholar 

  • Simpson JL. Disorders of gonads and internal reproductive ducts. In Emery & Rimoin (Eds) Principles and practice of medical genetics, 2nd ed., pp. 1593–1616, Churchill-Livingstone, Edinburgh, 1990

    Google Scholar 

  • Simpson JL, Golbus MS (Eds). Disorders of sex chromosomes and sexual differentiation, in Genetics in obstetrics and gynaecology, 2nd ed., pp. 133–164, WB Saunders, Philadelphia, 1992

    Google Scholar 

  • Simpson JL, Ljungqvist A, de la Chapelle A, Carlson A, Ehrhardt A. Gender verification and the next Olympic games. Journal of the American Medical Association 269: 357–358, 1993

    Article  Google Scholar 

  • Simpson JL, New M, Peterson RE, German J. Pseudovaginal perineoscrotal hypospadias (PPSH) in sibs. Birth Defects 7 (6): 140–144, 1971

    PubMed  CAS  Google Scholar 

  • Simpson JL, Photopolus G. The relationship of neoplasia to disorders of abnormal sexual differentiation. Birth Defects 12 (1): 15–50, 1976

    PubMed  CAS  Google Scholar 

  • Sinclair AH, Besta P, Palmer MS, Hawkins JR, Griffiths BL, et al. A gene from the human sex determing region encodes a protein with known homology to a conserved DNA-binding motif. Nature 346: 240–244, 1990

    Article  PubMed  CAS  Google Scholar 

  • Skordis NA, Stetka DG, MacGillvrya MH, Greenfield SP. Familial 46,XX coexisting with familial 46,XX true hermaphrodites in same pedigree. Journal of Pediatrics 110: 244–247, 1987

    Article  PubMed  CAS  Google Scholar 

  • Tachezy R. Pseudohermaphroditism and physical deficiency. Journal of Sports Medicine and Physical Fitness 9: 119–122, 1969

    PubMed  CAS  Google Scholar 

  • Tegenkamp TR, Brazzell JW, Tegenkamp I, Labodi F. Pregnancy without benefit of reconstructive surgery in a bisexually active true hermaphrodite. American Journal of Obstetrics and Gynecology 135: 427–428, 1979

    PubMed  CAS  Google Scholar 

  • Ulloa-Aguirre A, Carranza-Lira S, Mendez PJ, Angeles A, Chavez A, et al. Incomplete regression of Mullerian ducts in the androgen insensitivity syndrome. Fertility and Sterility 53: 1024–1028, 1990

    PubMed  CAS  Google Scholar 

  • Van Niekerk WA. True hermaphroditism, Harper and Row, New York, 1974

    Google Scholar 

  • Vergnaud G, Page DC, Simmler MC, Brown L, Rouyer F, et al. A deletion map of the human Y based on DNA hybridization. American Journal of Human Genetics 38: 109–112, 1986

    PubMed  CAS  Google Scholar 

  • Verp MS, Simpson JL. Abnormal sexual differentiation and neoplasia. Cancer Genetics and Cytogenetics 25: 191–218, 1987

    Article  PubMed  CAS  Google Scholar 

  • Walsh C, Madden JD, Harrod MJ, et al. Familial incomplete male pseudohermaphroditism, type 2. New England Journal of Medicine 291: 944–949, 1974

    Article  PubMed  CAS  Google Scholar 

  • Wilson JD, Carlson BR, Weaver DD, Kovacs WJ, Griffin JE. Endocrine and genetic characterization of cousins with male pseudohermaphroditism. Evidence that the Lubs phenotype can result from a mutation that alters the structure of the androgen receptor. Clinical Genetics 26: 363–370, 1984

    Article  PubMed  CAS  Google Scholar 

  • Wilson JD, Harrod MJ, Goldstein JL, Hemsell DL, MacDonald PC. Familial incomplete male pseudohermaphroditism, type 1. Evidence for androgen resistance and variable clinical manifestations in a family with the Reifenstein syndrome. New England Journal of Medicine 290: 1097–1103, 1974

    Article  PubMed  CAS  Google Scholar 

  • Zachmann M, Vollmin JA, Hamilton W, Prader A. Steroid 17,20-desmolase deficiency: a new cause of male pseudohermaphroditism. Clinical Endocrinology 1: 369–385, 1972

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The University of Tennessee College of Medicine, 853 Jefferson Avenue, Memphis, Tennessee, 38103, USA

    Joe Leigh Simpson

  2. Karolinska Institute, Stockholm, Sweden

    Arne Ljungqvist

  3. University of Helsinki, Helsinki, Finland

    Albert de la Chapelle

  4. Cambridge University, Cambridge, England

    Malcolm A. Ferguson-Smith

  5. Yale University, New Haven, Connecticut, USA

    Myron Genel

  6. Hastings-on-Hudson, New York, USA

    Alison S. Carlson

  7. Columbia University, New York, USA

    Anke A. Ehrhardt

  8. Great Britain Modern Pentathlon Association, Hants, England

    Elizabeth Ferris

Authors
  1. Joe Leigh Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arne Ljungqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Albert de la Chapelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Malcolm A. Ferguson-Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Myron Genel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alison S. Carlson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anke A. Ehrhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Elizabeth Ferris
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simpson, J.L., Ljungqvist, A., de la Chapelle, A. et al. Gender Verification in Competitive Sports. Sports Medicine 16, 305–315 (1993). https://doi.org/10.2165/00007256-199316050-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-199316050-00002

Keywords

Search

Navigation