Imane Khelif, Gender, and the Paris Olympics

Algerian boxer Imane Khelif's path to a gold medal in the Paris Olympics was marked with speculations about her biological sex. Although there is no evidence that Khelif is not a woman, the controversy once again raised questions about gender in elite sports.

Italian boxer Angela Carini, who quit her boxing match with Khelif just 46 seconds into the fight and refused to shake opponent's hand, later broke down in tears saying that she has never been hit so hard.

The dramatic footage caught the world's attention, including celebrities Elon Musk and J. K. Rowling, known for their anti-trans rhetoric, who argued that allegedly male Khelif doesn't belong in women's sports.

The controversy that quickly made the headlines was traced back to the International Boxing Association (IBA) that barred Khelif and Taiwanese fighter Lin Yu-ting from fighting in last year's championship due to failing to meet gender eligibility criteria. The athletes took two tests, the results of which have never been made public, as they constitute protected personal data, the IBA said.

The IBA is not currently recognized by the International Olympic Committee as the international boxing federation because it has been involved in multiple corruption scandals. Moreover, the IBA president, Umar Kremlev, has ties with the Russian government, which has targeted the Paris Olympics with several misinformation attacks.

Russia, which is currently under Western sanctions for launching an unprovoked invasion of neighboring Ukraine, often poses as the defender of "traditional values" as opposed to the United States and Europe, despite well-documented Russia's crimes against women and children.

Who is Imane Khelif?

There is no evidence that Khelif, 25, was born as a man and underwent transitioning. In fact, her home country, Algeria, is far from being LGBT-friendly: transgender citizens are not recognized, while sexual activity between people of the same gender is criminalized.

In the interview for UNICEF, Khelif spoke about her journey on a rocky road to becoming a professional athlete, including her father's disapproval of boxing, which he thought was inappropriate for girls. Khelif had to sell scrap metal for recycling to raise money for bus tickets so she could go to the nearby village for boxing training.

Her work soon started paying off: at the age of 19, Khelif represented Algeria at the 2018 World Championships in New Delhi, where she came 17th. She had less success in the 2019 World Championships in Russia, where she came 33rd.

In the Tokyo 2020 Olympic Games, Khelif reached the quarterfinals, where she lost 5-0 to eventual champion Kellie Harrington from Ireland.

The question of chromosomes

The IBA's decision fueled speculation that Khelif and Yu-ting may be intersex, meaning they

have differences in sexual development (DSD), particularly androgen insensitivity syndrome (AIS), where individuals with XY chromosomes are resistant to androgens, hormones that produce male appearance.

People with AIS often have testosterone levels as the body produces more to try to exert its actions.

Ashley Winter, M.D., a urologist and sexual medicine specialist, recently wrote on a social network X that women with complete AIS have no advantage because their bodies are not sensitive to androgens.

Women with complete androgen insensitivity syndrome (AIS) have no advantage because their body is not sensitive to androgens. An average XX female has actually quite a bit of testosterone & would have a performance advantage over an XY female with complete AIS. hope that helps https://t.co/PChHNRixHy

undefined Ashley Winter MD || Urologist (@AshleyGWinter) August 2, 2024

"An average XX female has actually quite a bit of testosterone and would have a performance advantage over an XY female with complete AIS," Winter wrote.

While there is no evidence that Khelif or Yu-ting has AIS or any other type of DSD, it was the case for South African runner Caster Semenya, a two-time Olympic champion.

After Semenya's victory at the 2009 Berlin World Championships, the athletics governing body, World Athletics, requested that she take a gender test. If it was proven that the athlete was not female, the world title could have been withdrawn.

Semenya was eventually cleared to return to athletics. The investigation results were never made public, but media leaks suggested that she may have both male and female characteristics. Semenya's autobiography later revealed that it was the time she found out she didn't have a uterus or fallopian tubes.

In 2018, World Athletics proposed new rules restricting testosterone levels in female runners competing in track events from 400m up to the mile. Semenya appealed the proposal at the Court of Arbitration for Sport and lost.

The ruling cited Semenya's specific disorder of sexual development, 46 XY 5-ARD, which is characterized by having male XY chromosomes. The court ruled that Semenya's higher testosterone levels give her a significant sporting advantage over athletes with female chromosomes. The outcome attracted criticism from some in the scientific community.

Julian Savulescu, professor in biomedical ethics, wrote in an article on The Conversation that the decision discriminates against some forms of hyperandrogenism — increased testosterone — like congenital adrenal hyperplasia. The condition may raise testosterone levels in women with XX chromosomes.

The difference testosterone makes between males and females in all events is estimated to be up to 12% (all other items being equal). But Semenya's best time is only 2% faster than her competitors. It is not possible to determine how much of this 2% is due to testosterone, and how much due to other factors about her as an athlete, or her psychology.

Savulescu

According to a 2020 study, top female athletes are more likely to have higher testosterone levels and disorders that raise their testosterone, ranging from polycystic ovary syndrome (PCOS) to rare conditions that increase levels of testosterone in the male range.

The study authors said women having 10 to 20 times higher testosterone levels than normal may have a significant advantage. Acknowledging that drawing a line on an acceptable level is difficult, they recommended a limit that makes allowances for women with mild conditions like PCOS.

Do trans women athletes have an advantage?

Speculations over Khelif's biological sex added fuel to the already hot debate about transgender women's participation in sports, despite only a few of them being elite athletes.

In 2021, New Zealand's weightlifter Laurel Hubbard, 43 at the time, became the first openly trans woman to compete at the Olympics, where she failed to register a successful lift at 120 kg and 125 kg. Competing in men's competitions two decades ago, Hubbard was lifting a total of 300 kg.

Douglas J. Oberlin, assistant professor of exercise sciences and recreation at CUNY, Lehman College, says that over time, the performance of transgender women who underwent gender-affirming hormone therapy (GAHT) approaches that of cisgender women — those whose gender identity matches the sex they were assigned at birth.

"Studies show enlisted transgender servicemen looked more similar to their affirmed gender over time while transitioning and that while trans women had larger body mass and height than cisgender women, they performed similarly to cisgender women on several performance measures when accounting for body mass," Oberlin tells Healthnews.

A 2023 study conducted in nonathletic trans women found that muscle mass decreased by 5% at 12 months after feminizing hormone therapy and steadily declined beyond three years. Moreover, their relative percentage of lean mass and fat mass, hemoglobin, and VO2 peak were not different for cisgender women.

Two years after hormone therapy, trans women had no advantage in physical performance measured by running time compared to cisgender women. By four years, there was no advantage in sit-ups.

Oberlin, whose lab analyzes physiology changes during and following transition using GAHT, says there is no conclusive evidence that transgender women athletes have an advantage over cis women athletes, but says it is a difficult question to answer.

It seems that as individuals transition, not all things change at an equal rate. Certain physiologic parameters that relate to aerobic performance seem to change rather quickly, other parameters related to body composition and strength transition more slowly, and certain traits, like stature are unlikely to change at all.

Oberlin

Oberlin points out that various traits may be advantageous or disadvantageous depending on the type of competition. For example, an American Football player may benefit from having greater body mass, which would generally disadvantage a distance runner.

"This is true for the entire population; all people, cis or trans, have traits that benefit or hinder their performance at a given athletic event," Oberlin adds.

The Paris Olympics is approaching its end, but the debate on gender and sports will undoubtedly continue. Research on how transitioning and DSDs affect physical performance is complicated and takes time, while speculations spread quickly, especially on social media.