She/he controversy

The gender controversy surrounding Caster Semenya, SA's star 800m athlete, has been fanned by her comprehensive win last night in the World Athletics Championships in Berlin - she beat the second-placed runner by a full 15m. The results of a gender test will only be made known in a few weeks' time meaning that for all those convinced she will "fail", the 800m title is in limbo.

These tests used to be conducted on all female athletes taking part in the Olympics, but are only done these days when a claim is filed against a specific athlete. The Semenya case ilustrates how cruel this is, both for the athlete at the centre of the debate, and for those who hope to be promoted by a potential disqualification.

Gender testing

In the 1960s, athletes had to undress in front of a group of doctors – a practice which came to a swift end as it was deemed to be humiliating.

The current gender test, which is fortunately a lot more scientific, entails the following four steps:

• An anatomical evaluation (standard male-female anatomical distinctions, such as genitalia, facial hair etc.)
• A genetic analysis (checks for levels of sex hormones)
• A chromosomal analysis (women typically have two X-chromosomes in each cell, men typically an X- chromosome and a Y-chromosome)
• A psychological evaluation (does this person live as a woman/see herself as a woman?)

The problem is that even with all these tests, there can still be uncertainty, say experts. Some women do have the odd Y-chromosome, which can confuse the issue of gender testing no end. A dysfunction in any of the stages of male/female development can and does cause confusion. Genetic tests can therefore discriminate against women who have disorders of sexual development. It is possible for a person to have a make-up that is genetically male, but physiologically female.

Tests not always accurate
A commentary published in the Journal of the American Medical Association (vol 284, 2000) stated that "gender verification tests are difficult, expensive, and potentially inaccurate. Furthermore, these tests fail to exclude all potential impostors (e.g., some 46,XX males), are discriminatory against women with disorders of sexual development, and may have shattering consequences for athletes who 'fail' a test."

The article also states, "Gender verification has long been criticized by geneticists, endocrinologists, and others in the medical community. One major problem was unfairly excluding women who had a birth defect involving gonads and external genitalia (i.e., male pseudohermaphroditism)."

At the Beijing Olympics dubious cases were evaluated on external appearance, blood samples testing sex hormones, genes and chromosomes. But testing over the years has made it clear that the issue of gender is not nearly as clear as many people would like to think.

Health24's FitnessDoc, Dr Ross Tucker, has been following the story closely on his blog. Check it out.

(References: JAMA, vol 284, 2000; howstuffworks.com; National Institutes of Health; Health24.com)

(Susan Erasmus, Health24, August 2009)