The Sunday Story: The History of Sex Testing in Sports

Now, it's par for the course for us to see extraordinary female athletes on the international stage. But there's something many people don't know about the women who compete in elite sports. For nearly a century, women athletes have faced questions about whether they were, in fact, women. And over the years, they've had to take tests to prove it. This is the subject of a new podcast series called Tested.

It's from NPR's, Embedded and CBC in Canada. Tested digs into the history of sex testing in elite sports. And it focuses on a particular group of runners who these days are labeled DSD athletes. DSD stands for differences of sex development. As a catch-all medical term used to describe a condition in which a person's chromosomes, sex hormone balance, internal anatomy, or external genitalia don't develop as expected.

And sports authorities believe some women with DSDs have an unfair advantage in sports because they have higher levels of testosterone than what is considered average for a woman.

These questions about fairness and who can compete as a woman are alive and well. Just last week in Paris, two female boxers, Iman Khalif of Algeria and Lin Yuting from Taiwan, faced questions and hateful commentary about their gender. Last year, the International Boxing Association had disqualified the two boxers, saying they failed unspecified sex eligibility tests. But the International Olympic Committee, known as the IOC, defended them and said they were eligible to compete in the women's category in the Olympics. Over in track and field, the people who govern the sport say that in order to be eligible for the female category, athletes with DSDs must lower their testosterone.

And that requires taking medications that can have pretty bad side effects. Rose Eveleth is the host of Tested and they've been reporting on the story for a whopping 10 years. Before the latest boxing controversy broke out. last week, my colleague A. Martinez spoke with Rose about the series, how it came about and how this history of sex testing continues to resonate today.

Stay with us.

Here at Shortwave Space Camp, we escape our everyday lives to explore the mysteries and quirks of the universe. We find weird, fun, interesting stories that explain how the cosmos is partying all around us. From stars to dwarf planets, to black holes and beyond, we've got you. Listen now to the Shortwave podcast from NPR.

And I was an intern, actually, at Scientific American way back when I was first starting my career in journalism. And I was always looking for sports stories to write about. And I had also been assigned a lot of stories about really fancy prosthetic devices, you know, bionic arms and all of that stuff. And so I was looking for something to write about to prove my worth as an intern. And I found the story of Oscar Pistorius, who at the time was very famous for being sort of this bionic man.

They called him the Blade Runner. He's a double amputee who ran on these two cheetah blades. He really, really wanted to run against able-bodied runners. And there was a big debate about whether he should be allowed. and, you know, there were rival labs and these questions of how do you measure an unfair advantage?

And as I was researching that, I came across Castor Semenya, another South African runner, who, in 2009, had sort of burst onto the world stage and won an incredible race in Berlin at the World Championships. And, instead of being celebrated, wound up being sort of thrust into this media circus around her gender, people saying things like, well, she's maybe not totally a woman, so it's of course she won, she has this advantage. I had sort of seen that happen in 2009,, but I think it was so confusing to me that it didn't really register. And then, when I got interested again, it just hit some neuron for me where I just could not stop thinking about it. And I spent the last 10 years researching this.

I've been pitching this story for eight years actually. And so I'm very thankful that both the CBC in Canada and NPR picked it up.

where in a sport where you need great eyesight. So I always thought about like, what exactly means to have an unfair advantage or just an advantage. And what exactly does that mean when it comes to how we judge people's performance? Are they getting too much of an advantage, if that makes any sense?

To replace the tendon in their elbow. Is that unfair? I think it's such a fascinating question. And so much of sports is about these tiny margins and these little advantages that you're gonna get by doing one thing or another. That it is so fascinating.

And one of them actually was like, I thought she was just too fast for a girl. And I didn't, I honestly didn't make anything of it until the 2009 world championships, when now all hell, so to speak, broke loose.

. They're held in Berlin and she wins this 800 meter race and she wins it handily, right? She kind of runs away with it.

You have the head of the track and field organization say, yes, she is a woman, but maybe not 100%. And there's all this speculation about her body and her biology and who she is, and all of this. And it was really confusing, I think, for everybody at the time, because there was, most people weren't saying, oh, she's actually a man in disguise or anything. That's not really what people were saying, but it was this much murkier, she's, there's something wrong about her. She's not a correct woman in some way or another.

And this conversation wasn't just happening privately among athletes. It was also happening very publicly. We have more now on a controversy.

You have to get your testosterone level down to below a certain number for six months, and then you can race again.

And yeah, so there's no cheating going on here. This is how Kastor was born. There are other women like this. They're born like this. And so Kastor, in this situation, was asked to regulate, which meant taking medications to lower her testosterone level.

And so she does that. And she actually gets back on the track. But because this deal that she's made with the IAAF was in private, nobody knows. And so there's this moment where she gets back out on the track, but everyone thinks that nothing has changed. And then again, you get this new cycle of people saying, well, should she really be here?

Is this really fair? So Kastor is kind of the biggest name in this sort of modern era from 2009 onward. And she's kind of the first big, sort of famous case of this happening, but she's certainly not the only one.

And we're kind of living in that era. We're living in the sort of testosterone era of regulation of female athletes. Those exact terms of the testosterone rules have changed over time. In 2023, last spring, they updated them again. But now what it means is that some women with certain DSD conditions have to regulate their testosterone.

And again, this is naturally occurring testosterone. They have to bring it down to a certain level. So I've been traveling around the world to meet these athletes who are regulated by these policies, including Christine Boma. So Christine Boma is this superstar in Namibia. She won the silver medal last Olympics in Tokyo in the 200 meters.

And she is one of these athletes who is now sort of being regulated and told that she has to take this medication. So she is actually choosing to go for the medication, try and lower her testosterone so that she can stay on the track. There are other athletes who I talked to for the series who chose not to do that and went different directions. But Christine is trying. She tried to make it to Paris and tried to kind of get back out there.

But there are a lot of folks who have suggested that there is a racial component to that, that some women look more like women and some don't. And there's a long history of black and brown women being written about and perceived as less female, less womanly, less feminine, right? There's a very long eugenic, colonial, racist history there. There is also the fact that there is a big gap in healthcare between different places. And a lot of people point to this as one of the reasons why you're seeing this.

So, in general, broad strokes, folks in the Global North tend to be born in hospitals, tend to go to regular checkups when they're babies, and will probably be diagnosed with some of these DSD conditions, differences of sex development, early, and may be treated. But in general, if you're an athlete in the Global North, by the time you're 18, 19,, breaking onto the world stage, running in these big events, you already know that you maybe are one of these athletes and maybe you're already taking some kind of medication. That is not true in the Global South. You know, the women I've been traveling around and visiting, they are not born in hospitals, they're not going to regular pediatric checkups. They are learning this about themselves when they're 18 or 19,, when World Athletics asks them to take a test.

So all of a sudden, Christine is being told, hey, actually, there's this thing that you didn't know about your body, that you're different in this way, and that's total news to them. And so I think there's also that going on. So there's many, many layers here of why this is the case. Now, World Athletics has rejected any suggestion that their policies are racist. There was a Human Rights Watch report that came out about these distinct racial imbalances, and, in response, World Athletics put out a press release, which I have here, and I'll read a quote to you from.

They say, quote, we remain committed to fairness for women in sport and reject the allegation that biological limits are based on race or gender stereotypes. And I should also say that I did reach out to World Athletics for the podcast, but they declined to be interviewed.

And then in 1966, they decide that, actually, we need to test every woman. And the way we're gonna do that is what are called the nude parades, or the peek and poke tests, as some of the athletes called them, which are kind of what they sound like. They would take women into a room and they would ask them to get naked so that they could examine their body. And we actually talked to some women who had to go through this and who were very bewildered as to why they had to do this, what was going on, and talked about how terrible it was. Women like Carol Martin, who threw the discus at the 1966 Commonwealth Games.

And she told me just how shocked she was. I remember we were taken under the stands before the competition into a large room and had to pull my pants down in front of this woman so she could see I had a vagina. I remember thinking, what the is this? And I was a nice person. I never said that at the time, but I remember thinking, whoa, this seems a little invasive.

This seems a little inappropriate. I mean, can't you see, I'm a girl? Unsurprisingly, those tests were very unpopular. And I think sports organizations knew that. that was sort of not long for this world.

So nude parades really only last a couple of years. And then they decide, okay, well, we still need to test all athletes to make sure they're women, but we need to do so in a way that does not involve these very invasive and terrible physical examinations. And so they come out with a new test called the Barr Body Test, which is a way you look into the microscope, you look at someone's cells, and if you have XX chromosomes, you'll see this little black dot. And that's called the Barr Body, named after a Canadian, Murray Barr, who, fun fact, actually wrote to the IOC several times being like, please stop using my test like this. This is not an appropriate test and it does not actually show what you think it shows, but they committed to that.

Then, from 1968 all the way to 1999, for 30 years, every woman who competed at the Olympics had to go through one of these chromosome tests and get a certificate of femininity, a little card. It looks a little bit like your library card or your driver's license that has your photo on it. And you had to show it for every event. There's one woman who did not have to do this. One exception was ever made, and that was a princess.

Princess Anne did not have to do this. She got an exemption because she was a literal princess. Every other woman had to do this and show their card, which is sort of mind-blowing to me.

And what that means is that they don't need necessarily to study these women in particular. All they have to do is look at all of the literature that exists in science around the sports performance of men. Now, there are a lot of other experts who say that's not how evidence is built, right? That's not appropriate. These are not equivalent populations.

What you would want to do if you were gonna do an ideal study here is that you would look at these DSD athletes that are being regulated and you would compare their performance and their testosterone levels against the women who don't have those DSD conditions and are performing. That study, as far as I know, and I have asked every single person I could find, that study has not been done. So we don't know. We have a lot of sort of tangential evidence. We have some ideas around what testosterone maybe does to the body, but we don't have good evidence, really, to pinpoint the advantage that these women have, which means that this conversation gets really complicated and confusing, I think, because both sides come into the argument saying, no, no, the science is on our side.

If you are a layperson or even a science reporter and you're hearing both sides say that, it is very confusing to figure out who is right.

And that's why this gets so thorny, right? Why is this fair? And some people say, yeah, this is fair, because these women, I believe these women have an advantage, even if it is small, and these other women on the track don't, and so it's important for me to create as much of a quote-unquote level playing field as possible, right? And that's what I think is fair. And then there are other people who say, well, wait a minute, this isn't fair because these women, again, aren't doing anything.

They were born like this. How is it fair to ask them to remove whatever potential small advantage they may or may not have? And that's a subjective decision at the end of the day. And that's, I think, why this is such a complicated topic, is that it isn't like, oh, we'll just do a blood test and we'll tell you what's fair. We'll make a measurement, we'll do a calculation.

And that's why you can debate this till the end of the day, and in some ways, that's also why some sports organizations can just kind of do whatever they want, because there isn't necessarily an objective truth here, or an objective, correct answer.

World athletics is not following it. Are you gonna do anything about that? And the answer seems to be no. We'll sort of see what happens. I think that there is a growing movement to try and ask questions about this, but world athletics has been very clear that this is their sport.

They get to make the rules of their sport, and this is the rule that they think is appropriate. There's not a lot of ways of holding an organization like that accountable. They are not a government organization. They don't have to follow international human rights law. So they can kind of do as they please.

And so it will be very interesting to see if they change their minds or not, depending on how much pressure they may or may not get. Sports is in a really complicated position, because sports is binary. There are men's sports and women's sports, but we know that human bodies are not binary. And then also, on top of that, human gender is not binary, right? Neither sex nor gender in the human world are binary.

And so what do you do with that information? And I don't think there's an obvious, clear answer. And I think we can do better. I really think we can do better.

I'm Aisha Roscoe. Up first, we'll be back tomorrow with all the news you need to start your week. Have a great rest of your weekend.

npr.

org. That's plus.npr.org. On this week's episode of Wildcard, musical icon, Ani DiFranco.