Olympic boxer Imane Khelif ‘gender controversy’ explained by health experts

After 46 seconds in the Olympic ring with Algeria’s Imane Khelif, Angela Carini, a welterweight representing Italy, tapped out. “A punch hurt too much, and so I said enough,” Carini told reporters after the match. In most events, this would be a celebrated win. But because Khelif — and fellow women’s boxer, Lin Yu-Ting — allegedly “failed” the International Boxing Association’s gender eligibility testing, her blowout win over Carini has reignited a debate over biology, genetics and fairness in athletics. It’s also set off a firestorm of misinformation about her gender and eligibility to compete in the Olympics.

🔎 What started the controversy?

IBA president Umar Kremlev claimed last year that “it was proven they have XY chromosomes” (which are typically associated with males) during the organization’s testing. But neither the results, nor the names of the tests have been made public. The International Olympic Committee did not consider the tests conducted by the IBA — which is no longer the governing body of Olympic boxing — in its eligibility assessments. But that hasn’t stopped rumors about Khelif and Lin from circulating online.

Khelif, who competed in the 2021 Tokyo Olympics and other women’s tournaments, does not identify as either transgender or intersex, according to a statement from the Gay and Lesbian Alliance Against Defamation (GLAAD).

🧬 Khelif reportedly has a variation in her sex traits.

Several outlets have said that Khelif may have a developmental sex difference (DSD), sometimes referred to as disorders of sexual development, though she hasn’t commented publicly.

These are a wide array of rare conditions in which someone’s genitalia, reproductive organs and other characteristics may be “mismatched” with their genetics, according to the Cleveland Clinic. In some cases, that means that people are born with what are typically considered as male chromosomes — one X and one Y chromosome — but outwardly have female characteristics, including a vulva. Or people with these conditions may be born with female chromosomes (XX) and a penis.

False online claims about Lin’s and Khelif’s bodies have misrepresented how the condition can affect anatomy. Having a DSD can mean a wide variety of things in terms of how a person’s body develops. “The reason why the [intersex] athletes we’re talking about would have been recorded as being female at birth will probably be because that decision was based on outward genitalia,” which look like those of a typical female, says Williams. “In some cases, they could be quite different internally; they may or may not have a cervix, they may have internal testes, instead of ovaries, depending on the type of DSD.”

For example, women and girls with Swyer syndrome typically have a uterus and fallopian tubes. Some have ovaries that may not function properly, or instead have internal testes. Still others have completely normal internal reproductive systems, according to the University of California, San Francisco.

📊 How common is this?

Although these conditions are rare — estimates range from a fraction of a percent to nearly 2% of the population — there are likely “thousands” of people with DSDs worldwide, Alun Williams, a professor of sport and exercise genomics at the Manchester Metropolitan University Institute of Sport, tells Yahoo Life. But there are so many different specific conditions and physiologies that fall under this umbrella term that “almost no two individuals are the same,” he says.

♀️ Khelif and Lin are not transgender.

There’s no evidence that Khelif or Lin are anything other than cisgender women, and people with DSDs are not transgender. They are often described as intersex (although Khelif does not identify by this term, according to GLAAD), or as having a variety of sex traits. Unlike someone who is transgender, an intersex person has not gone through any form of transition; they were simply born with some male characteristics — typically unseen ones, including their chromosomes — and some female characteristics, which are often the outward, visible ones.

Being intersex and being transgender “are really quite different situations,” says Williams. Female transgender athletes “are, at birth, male, and then go through some transition later in life,” he adds. In many cases, intersex people go their entire lives without knowing that they have a DSD, as was the case for South African track star, Caster Semenya, who discovered she has Y chromosome as the result of competition testing.

⚖️ Do female athletes with DSDs have an unfair advantage?

“It’s not at all clear that athletes who happen to have DSD conditions have a performance advantage over others,” Roger Pielke, a professor of sports governance and the University of Colorado, Boulder, tells Yahoo Life.

One study suggested that higher testosterone levels in intersex athletes were linked to better performance than other female athletes, but it was controversial and not definitive. And Williams says there haven’t been many other high-quality studies of intersex people across various sports. However, “adult levels of testosterone can be associated with athletic advantage when acting on some tissues (like muscle) with the result that some advocate for using testosterone levels to assess eligibility for the female category in certain sports,” Dr. Joshua Safer, executive director of the center for transgender medicine and surgery at Mount Sinai Health System, tells Yahoo Life.

Differences in testosterone may make a bigger difference in athletics that involve a lot of upper body “power movements,” including boxing, says Williams. Chromosomes and other so-called gender tests aren’t the answer, experts say. “But when you get to contact sports like rugby or combat sports like boxing, you are introducing extra safety risk,” rather than just questions of competitive advantage in sports like track or swimming, Williams says.

🥊 Now what?

The IOC said in a Thursday statement that there’s nothing in its framework to disqualify either Khelif or Lin, and on Friday called the IBA’s tests “cobbled together” during a press conference. Despite her loss in the boxing match against Khelif, Carini was apologetic for not shaking her opponent’s hand, according to the Italian sports daily Gazzetta dello Sport. “All this controversy makes me sad,” Carini said. “I’m sorry for my opponent too.” She added that she respected the IOC’s decision and would “embrace” Khelif if she saw her again.

Khelif will be back in the ring on Saturday, while Lin will fight Sunday, with each competing in the quarterfinals in their respective weight classes.