Archives of Sexual Behavior

, Volume 43, Issue 6, pp 1035–1042 | Cite as

Hurdling Over Sex? Sport, Science, and Equity

  • Nathan Q. Ha
  • Shari L. Dworkin
  • María José Martínez-Patiño
  • Alan D. Rogol
  • Vernon Rosario
  • Francisco J. Sánchez
  • Alison Wrynn
  • Eric VilainEmail author
Guest Essay


Between 1968 and 1999, the International Olympic Committee (IOC) required all female athletes to undergo genetic testing as part of its sex verification policy, under the assumption that it needed to prevent men from impersonating women and competing in female-only events. After critics convinced officials that genetic testing was scientifically and ethically flawed for this purpose, the IOC replaced the policy in 1999 with a system allowing for medical evaluations of an athlete’s sex only in cases of “reasonable suspicion,” but this system also created injustice for athletes and stoked international controversies. In 2011, the IOC adopted a new policy on female hyperandrogenism, which established an upper hormonal limit for athletes eligible to compete in women’s sporting events. This new policy, however, still leaves important medical and ethical issues unaddressed. We review the history of sex verification policies and make specific recommendations on ways to improve justice for athletes within the bounds of the current hyperandrogenism policy, including suggestions to clarify the purpose of the policy, to ensure privacy and confidentiality, to gain informed consent, to promote psychological health, and to deploy equitable administration and eligibility standards for male and female athletes.


Sex testing Gender verification International Olympic Committee Sports Ethics 



Eric Vilain is partially funded by the DSD Translational Research Network (National Institutes of Health grant 1 R01 HD068138). We thank Javier Blas for his assistance with translation during the symposium.


  1. Bhowmick, N., & Thottam, J. (2009, September 1). Gender and athletics: India’s own Caster Semenya. Time. Retrieved from,8599,1919562,00.html.
  2. Calandrillo, S. (2005). Sports medicine conflicts: Team physicians vs. athlete-patients. SSRN Scholarly Paper No. ID 755030. Rochester, NY: Social Science Research Network. Retrieved from
  3. Caplan, A. L. (2010). Fairer sex: The ethics of determining gender for athletic eligibility: Commentary on “Beyond the Caster Semenya controversy: The case of the use of genetics for gender testing in sport”. Journal of Genetic Counseling, 19, 549–550. doi: 10.1007/s10897-010-9322-0.CrossRefPubMedGoogle Scholar
  4. Carlson, A. (2005). Essay: Suspect sex. Lancet, 366(Suppl. 1), S39–S40. doi: 10.1016/S0140-6736(05)67842-7.CrossRefPubMedGoogle Scholar
  5. Cooky, C., & Dworkin, S. L. (2013). Policing the boundaries of sex: A critical examination of gender verification and the Caster Semenya controversy. Journal of Sex Research, 50, 103–111. doi: 10.1080/00224499.2012.725488.CrossRefPubMedGoogle Scholar
  6. Dworkin, S. L., & Cooky, C. (2012). Sport, sex segregation, and sex testing: Critical reflections on this unjust marriage. American Journal of Bioethics, 12, 21–23. doi: 10.1080/15265161.2012.680545.CrossRefPubMedGoogle Scholar
  7. Dworkin, S. L., Swarr, A. L., & Cooky, C. (2013). Sex, gender, and racial (in)justice in sport: The treatment of south african star Caster Semenya. Feminist Studies, 39, 40–69.Google Scholar
  8. Elsas, L. J. (2000). Gender verification of female athletes. Genetics in Medicine, 2, 249–254.CrossRefPubMedGoogle Scholar
  9. Elsas, L. J., Hayes, R. P., & Muralidharan, K. (1997). Gender verification at the centennial Olympic games. Journal of the Medical Association of Georgia, 86, 50–54.PubMedGoogle Scholar
  10. Fénichel, P., Paris F., Philibert P., Hiéronimus S., Gaspari L., Kurzenne J., … Sultan C. (2013). Molecular diagnosis of 5α-reductase deficiency in 4 elite young female athletes through hormonal screening for hyperandrogenism. Journal of Clinical Endocrinology & Metabolism, 98, E1055–E1059. doi: 10.1210/jc.2012-3893.
  11. Genel, M. (2000). Gender verification no more? Medscape Women’s Health, 5. Retrieved from
  12. Genel, M., & Ljungqvist, A. (2005). Essay: Gender verification of female athletes. Lancet, 366(Suppl. 1), S41. doi: 10.1016/S0140-6736(05)67843-9.CrossRefPubMedGoogle Scholar
  13. Ginsburg, G. S., O’Toole, M., Rimm, E., & Douglas, P. S. (2001). Gender differences in exercise-induced changes in sex hormone levels and lipid peroxidation in athletes participating in the Hawaii Ironman triathlon. Clinica Chimica Acta, 305, 131–139.CrossRefGoogle Scholar
  14. Hay, E. (1972). Sex determination in putative female athletes. Journal of the American Medical Association, 221, 998–999. doi: 10.1001/jama.1972.03200220032008.CrossRefPubMedGoogle Scholar
  15. Healy, M. L., Gibney, J., Pentecost, C., Wheeler, M. J., & Sonksen, P. H. (2014). Endocrine. profiles in 693 elite athletes in the post-competition setting. Clinical Endocrinology. doi: 10.1111/cen.12445.
  16. Heggie, V. (2010). Testing sex and gender in sports: Reinventing, reimagining and reconstructing histories. Endeavour, 34, 157–163. doi: 10.1016/j.endeavour.2010.09.005.PubMedCentralCrossRefPubMedGoogle Scholar
  17. Holterhus, P. M., Werner, R., Hoppe, U., Bassler, J., Korsch, E., Ranke, M. B., … Hiort, O. (2005). Molecular features and clinical phenotypes in androgen insensitivity syndrome in the absence and presence of androgen receptor gene mutations. Journal of Molecular Medicine, 83, 1005–1013.Google Scholar
  18. Howden, D. (2009, August 26). South Africa versus the world: The Caster Semenya affair. The Independent. Retrieved from
  19. IAAF Medical and Anti-Doping Commission. (2006). IAAF policy on gender verification. Retrieved from
  20. International Olympic Committee. (2013). Factsheet: The fight against doping and promotion of atheletes’ health. Retrieved from
  21. International Olympic Committee Medical and Scientific Department. (2012, June 22). IOC regulations on female hyperandrogenism. Retrieved from
  22. Lee, P. A., Houk, C. P., Ahmed, S. F., & Hughes, I. A. (2006). Consensus statement on management of intersex disorders. Pediatrics, 118, e488–e500. doi: 10.1542/peds.2006-0738.CrossRefPubMedGoogle Scholar
  23. Levy, A. (2009, November 30). Either/or: Sports, sex, and the case of Caster Semenya. The New Yorker. Retrieved from
  24. Ljungqvist, A. S. J. (1992). Medical examination for health of all athletes replacing the need for gender verification in international sports: The International Amateur Athletic Federation plan. Journal of the American Medical Association, 267, 850–852. doi: 10.1001/jama.1992.03480060096038.CrossRefPubMedGoogle Scholar
  25. Ljungqvist, A. (2000). Gender verification. In B. L. Drinkwater (Ed.), Women in sport (Vol. 8, pp. 183–193). Oxford: Blackwell Science.CrossRefGoogle Scholar
  26. Martínez-Patiño, M. J. (2005). Personal account: A woman tried and tested. Lancet, 366(Suppl. 1), S38. doi: 10.1016/S0140-6736(05)67841-5.CrossRefPubMedGoogle Scholar
  27. Nyong’o, T. (2010). The unforgivable transgression of being Caster Semenya. Women & Performance: A Journal of Feminist Theory, 20, 95–100.CrossRefGoogle Scholar
  28. Sánchez, F. J., Martínez-Patiño, M. J., & Vilain, E. (2013). The new policy on hyperandrogenism in elite female athletes is not about “sex testing”. Journal of Sex Research, 50, 112–115. doi: 10.1080/00224499.2012.752429.PubMedCentralCrossRefPubMedGoogle Scholar
  29. Sex-test failure attempts suicide. (2007, September 6). FoxSports. Retrieved from
  30. Simpson, J. L., Ljungqvist, A., Ferguson-Smith, M. A., de la Chapelle, A., Elsas, L. J., Ehrhardt, A. A., … Carlson, A. (2000). Gender verification in the Olympics. Journal of the American Medical Association, 284, 1568–1569. doi: 10.1001/jama.284.12.1568.
  31. Swamy, V. N. (2012, July 24). Asiad silver medallist Santhi Soundarajan labours at brick kiln. The Times of India. Retrieved from
  32. Vilain, E., & Sánchez, F. J. (2012). Athletes’ bodies, sexed bodies: Intersexuality in athletics. Nature Reviews: Endocrinology, 8, 198–199. doi: 10.1038/nrendo.2011.213.Google Scholar
  33. Wonkam, A., Fieggen, K., & Ramesar, R. (2010). Beyond the Caster Semenya controversy: The case of the use of genetics for gender testing in sport. Journal of Genetic Counseling, 19, 545–548. doi: 10.1007/s10897-010-9320-2.CrossRefPubMedGoogle Scholar
  34. World Health Organization. (n.d.). What do we mean by “sex” and “gender”? Retrieved from
  35. Wrynn, A. (2004). The human factor: Science, medicine and the International Olympic Committee, 1900–70. Sport in Society, 7, 211–231. doi: 10.1080/1461098042000222270.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Nathan Q. Ha
    • 1
  • Shari L. Dworkin
    • 2
  • María José Martínez-Patiño
    • 3
  • Alan D. Rogol
    • 4
  • Vernon Rosario
    • 5
  • Francisco J. Sánchez
    • 6
  • Alison Wrynn
    • 7
  • Eric Vilain
    • 1
    • 8
    Email author
  1. 1.Institute for Society and GeneticsUniversity of California Los AngelesLos AngelesUSA
  2. 2.Department of Social and Behavioral Sciences, School of NursingUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Faculty of Science Education and SportUniversity of VigoPontevedraSpain
  4. 4.Department of PediatricsUniversity of Virginia School of MedicineCharlottesvilleUSA
  5. 5.Department of Psychiatry & Biobehavioral Sciences, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUSA
  6. 6.Department of Counseling PsychologyUniversity of Wisconsin-MadisonMadisonUSA
  7. 7.Department of KinesiologyCalifornia State University, Long BeachLong BeachUSA
  8. 8.Department of Human Genetics, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUSA

Personalised recommendations