The Algerian Boxer Controversy in Paris: The Science Behind the Gender Dispute

Last week’s victory of the Algerian boxer Iman Khalifa over her Italian opponent at the Paris 2024 Olympics has brought the issue of gender eligibility for Olympic athletes to the forefront, sparking significant controversy around female Olympic boxers whose gender identity is disputed. In this context, there have been numerous claims from various boxing figures that Khalifa, who will compete in the semi-finals at the Olympics tomorrow (Tuesday), should not have been competing in the women's category at all, because a testosterone test conducted on her last year, prior to the World Championship, showed levels that were quite high and even disqualified her from participating in the competition.

Carmelov, the President of the International Boxing Association (IBA), claimed that after a series of DNA tests, the association 'revealed athletes who attempted to deceive their peers and pretended to be women.' According to him, the tests 'proved that they had XY chromosomes, and therefore they were excluded from sporting events.' On the other hand, the Algerian Olympic Committee condemned the attacks on their boxer and stated that she meets all the criteria for participating in the Olympics.

While Olympic committees and international organizations are required to reassess protocols related to equal opportunities and creating as fair a competition as possible, the Genetics Institute outlined the scientific explanations for the phenomenon. 'By the 6th week, the embryo begins to develop as either male or female,' she explained. 'Normally, males and females have 22 pairs of identical chromosomes, with the 23rd pair determining the sex of the embryo. Females have two copies of the X chromosome, while males have one X chromosome and one Y chromosome

There are several syndromes related to disorders in the development of males and females that can result in a situation where even if an embryo has a Y chromosome, the baby may be born with female characteristics. This collection of syndromes is generally referred to as Disorders of Sexual Development (DSD), and they can be caused by changes in various genes. One of the more common conditions involving the presence of a Y chromosome in a female is Androgen Insensitivity Syndrome, or AIS for short. This is a medical condition that occurs in about 1 in 20,000 births. 'In this condition, there is a genetic mutation in the gene that codes for the androgen receptor,' she explained. 'This causes the body, despite having a high level of the male hormone testosterone, not to respond to the effects of testosterone due to the genetic mutation in the receptor. Testosterone cannot have a normal effect, and therefore male secondary sexual characteristics do not develop.

When a baby girl is born, we won't know if she has a Y chromosome unless, for example, the mother underwent amniocentesis. This can reveal a discrepancy between the baby's gender and the expected gender based on chromosomes. If no amniocentesis was performed, the issue starts to become apparent at the beginning of puberty, with the absence of normal sexual development. There might be signs of sexual development, but menstruation does not occur. Sometimes women seek evaluation for DSD when fertility issues arise, as many of these syndromes involve an inability to have children due to the absence of a uterus or ovaries. Hormonal treatment is required to aid sexual development. I remember a case in our clinic where a family had three daughters, and all three discovered they had a Y chromosome

In cases where there is a suspicion of a syndrome, the first step is to perform a karyotype test conducted in genetic laboratories. 'This test counts the chromosomal composition under a microscope—checking for 44 chromosomes in both males and females, and XX in females and XY in males.' If the karyotype test reveals that a female has a Y chromosome, additional specific genetic tests are carried out. 'These genetic changes can be detected through genetic sequencing,' she added. 'There are over 900 different genetic changes in the gene coding for the androgen receptor that can lead to this issue.'

This medical condition can be hereditary, but not exclusively. 'The change can be inherited even over several generations within a family, with a mother being a healthy carrier of the genetic change who is not affected by it. However, the change can also occur spontaneously, unrelated to family inheritance,' Bassal-Shalmon emphasized. 'It is essentially caused by an error in copying genetic material: as the body develops, cells need to replicate and copy themselves, but sometimes an error occurs during this process, and as a result of this genetic change, the receptor loses its ability to respond to testosterone. Despite having female external characteristics, if an internal examination is performed, there is no uterus or ovaries, but there may be testicular tissue that could even be hidden within the abdomen

How does this relate to the Olympic field?

There are many discussions about whether excess testosterone provides any advantage in sports for a woman with a Y chromosome, and there are no clear answers for different medical conditions. The effect of hormones depends on precise diagnosis, meaning the specific gene involved, the particular genetic change, and the activity of the receptor: if hormone levels are high but the receptor is inactive, the effect of male hormones will not produce the result that the hormone is supposed to have. Both the testosterone level and the receptor response need to be considered. The problem is that it is very difficult to objectively assess the receptor's ability to respond to testosterone, which makes the field very complex and controversial.

The Italian competitor defeated by Khalifa raised claims of unfairness. 

There are rules within sports organizations that determine which genetic conditions allow participation in certain categories. Many variables are taken into account: testosterone levels, receptor activity, accurate diagnosis, and more. However, it is not certain that the rules are suited to every genetic or non-genetic condition, and further discussions and considerations are needed due to the complexity and multitude of diagnoses in this field.

she should have been allowed to compete?

the established rules for different genetic conditions should be adhered to. As long as her condition fits the criteria set by these rules, there is no reason not to allow her to compete. It is a matter for Olympic committees or other sports committees to decide.