5-ARD and differences of sex development
Why Olympic boxers Imane Khelif and Lin Yu-ting have been allowed to smash the shit out of women
I said in my previous newsletter that I’d return to the question of males in women’s Olympic events. The big story in August was of course the pair of male boxers who won two of the six women’s gold medals in boxing. And next up is Valentino Petrillo, a 50-year-old Italian man with a degenerative eye disease who is running in the Paralympics after a successful first career in male events.
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There’s a tendency in the sex’n’gender wars to make a sharp distinction between people with disorders of sex development (DSDs) and people with trans identities. Up to a point, I understand that. The former may have life-limiting medical problems and, in the rarest cases, will have spent years thinking they are one sex only to discover that they are in fact the other. They naturally attract a great deal of sympathy. When it comes to the latter, however, how much sympathy you feel depends on whether you think they have an innate identity (or perhaps a medical condition) as little under their control as a DSD would be, or are merely people who refuse to accept the reality of the human condition or are taking advantage of a loophole.
But in any case, when it comes to eligibility for female sports, it makes no difference whether a male person thought he was female because of a DSD, or whether he chooses to identify as female because of his wishes, feelings or desires. The entire point of the female category is to exclude male sporting advantage, and the details of why a particular male person seeks entry are not relevant: he doesn’t belong there.
I thought it might be useful, even well after this news story has moved on, to explain why those of us who have been covering this for a while were so sure that Imane Khelif of Algeria and Lu Tin-yu are actually male. Here are three useful Twitter/X posts/threads, in case you haven’t seen them.
The first is from Carole Hooven, author of the excellent book “Testosterone”.
Seems like a good time to re-post my older (now edited) post about athletes with XY DSDs (Disorder, or Difference of Sex Development). Lots of graphs and detail about the relevant biology at the end.
* * *
First: People living with DSDs…— Carole Hooven (@hoovlet) August 1, 2024
The second is by my colleague Maya Forstater.
What do we know about Imane Khelif & Lin Yu Ting who won Olympic gold medals in women's boxing?
1) We know there is a condition called 5-ARD which leads to males being born with undescended testes and female looking genitals.
The 3 women's medal winners at Rio in 800m had it. pic.twitter.com/YiDlIf9tr3— Maya Forstater (@MForstater) August 13, 2024
The third is a short series of tweets by Steven O’Rahilly, one of the world’s most distinguished endocrinologists.
To clarify. I have no personal or professional access to the relevant tests. The confirmation by at least one boxer's trainer that they had XY chromosomes (and that was the reason for the previous ban) combined with the striking body habitus easily observed by an experienced/ https://t.co/Hp9bMJnRuM
— stephen o'rahilly (its pronounced O-RA-hill-EEE) (@StephenORahilly) August 15, 2024
Here O’Rahilly uses a phrase that should get much more airtime than it does: “striking body habitus”. What he’s saying is that we can observe with extreme accuracy who has been through a testosterone-driven puberty and who hasn’t by looking at their body, both in motion and stationary, and not merely as a collection of organs but as a whole. It’s a reminder that male and female are immensely important physical categories, and we are physical beings. By looking at both these boxers, you can easily tell that they didn’t go through an oestrogen-driven puberty and did go through a testosterone-driven one.
If we take at face value the claim that Khelif and Lin were registered female at birth, that leaves only two possibilities. The first, very unlikely, is that they took testosterone during or after puberty. The second is that they have one of the (rare) disorders of sex development that affects the development of external genitalia in utero sufficiently severely that a male baby may be wrongly identified as female, but which doesn’t affect pubertal development. A baby with such a condition may be registered female, but will grow up to have the “striking body habitus” O’Rahilly speaks of, which makes him easily identifiable as male. The genitals may remain underdeveloped, but as that great thinker Rachel McKinnon once said to Martina Navratilova, we don’t play sports with our genitals.
The smart money is on both Khelif and Lin having 5-alpha reductase deficiency (5-ARD), the same DSD as Caster Semenya. That Semenya has 5-ARD is a matter of public record, by the way – it’s clear from the ruling of the Court of Arbitration for sport (CAS) in Semenya’s failed appeal against the ban imposed by World Athletics. All these statements are facts: Semenya is a male person who was wrongly registered female at birth; Semenya’s body responds normally to testosterone; Semenya went through male puberty; Semenya possesses male sporting advantage.
Semenya therefore doesn’t belong in a category that exists solely to grant fair competition to people who don’t enjoy that advantage – to female people, aka women and girls. It’s a disgrace how many journalists have fallen for the propaganda, spread by Semenya among others, that Semenya is “female with high testosterone”, when the most basic research quickly reveals that Semenya is male with normal testosterone levels for a male.
If you’ve never watched Semenya moving and speaking, I urge you to take five minutes to watch this video.
his is not a “masculine looking female person”; this is a male person and it’s completely obvious. This isn’t an insulting thing to say, by the way! Half of all humans are male, and there’s nothing wrong with being male. And nor is it racist, as some people would have it. I’m not saying that a black woman “looks masculine”; indeed even accusing someone like me, who recognises Semenya is obviously male, of racism is arguably racist in itself, because it’s suggesting that it’s easier to be confused about people’s sex when they’re black, and that black women are more masculine-looking than white ones. That Semenya is male is simply a fact, and moreover it’s a fact that’s relevant to Semenya’s chosen life activity, namely competing in women’s sport.
I did a lot of research on DSDs when writing my book, and there’s a FAQ on the Sex Matters’ website with a lot of information. Here’s the short version for 5-ARD.
5-ARD is a genetic mutation that means a person does not produce an enzyme called 5-alpha reductase. This enzyme turns testosterone into another hormone, dihydrotestosterone, which is what drives the development of male genitalia in utero. The genitalia of a newborn boy with 5-ARD will not have fully differentiated and developed along male lines. His scrotal sac will look more like a baby girl’s labia, and his testes may be concealed within those labia-like structures or be higher up within his abdomen. His penis will be small and not fully formed, and may look more like a clitoris. The opening may not be at the end but along its length.
This condition only affects males, since dihydrotestosterone isn’t needed to drive female development. It’s rare – too rare for its global incidence to be known – though it seems to be cluster in certain places, including isolated populations and cultures where first cousins often marry (both these situations tend to concentrate genetic diseases). In a developed healthcare system it is unlikely to be missed at birth, and once it’s established that a child has 5-ARD he will be registered male and referred for specialised evaluation and healthcare. In most countries, if by some chance he is wrongly registered female, there are procedures for correcting the birth register. This has nothing to do with any laws about gender identity; the point is to correct an error not rubber-stamp a falsehood.
Such situations used to be handled very differently. It used to be thought that baby boys who were not going to grow into men with normal-sized penises were better off being castrated, registered female and put on oestrogen from puberty until the age when a woman would go through menopause. This is, famously, what happened to David Reimer, one of a pair of identical twin boys born in 1965 whose penis was damaged beyond repair during a routine circumcision. His unfortunate parents fell into the clutches of psychologist John Money, who advised them to have their baby’s sex organs removed entirely and have him “assigned female”. I can only speculate, but I think Money (who died in 2006) was partly motivated by the prospect of a readymade twin study to prove his pet theory, namely that children could be “assigned” to one or other “gender” in infancy and would then grow up to believe themselves to be that sex and to act according to the relevant stereotypes.
I tell the story in my book, and it’s been told at greater length by others (the bibliography in the Wikipedia article about him includes the relevant texts). The story has a desperately unhappy ending; Reimer abandoned his “female identity” as a teen, and in adulthood both he and his brother killed themselves.
This tale of Reimer is usually told as evidence of how badly children with DSDs were treated (Reimer didn’t have a DSD, but his treatment was inspired by that Money and others meted out to baby boys born with micropenises). I think it tells us something else as well, though: how much medical professionals and others tend to regard the presence or absence of a “proper” penis as the determinant of whether someone should count as male or female.
For decades baby girls with enlarged clitorises would have them chopped down for fear that they would appear too male otherwise – even though a clitoris, no matter how large, is a different organ with different capabilities and functions. Meanwhile baby boys with micropenises would have them removed entirely (and their testicles too), and they would be reclassified as girls. It’s a model of male/female as presence/absence. It sees women as defined by a lack. If I’m right that Khelif and Lin have 5-ARD, then they were classified female not because they had female genitals (they didn’t), but because their genitals at birth didn’t look like they were going to grow up into a “properly” endowed man.
I’m sorry to be put in the position of speculating about named individuals’ medical histories and genitals – but if people want entry to female-only spaces it is not unfair to expect them to prove that they’re female. Here are two analogies. Employers don’t have the right to ask female employees if they’re pregnant, but if you actually are pregnant there will come a point that you can’t keep that secret any more. And if you are not obviously above the age at which it’s legal to buy alcohol, you can expect to be asked to prove your age. If you don’t want to, that’s fine, but you won’t be sold the alcohol. Similarly, you don’t have to answer random people asking which sex you are – but the reality is that most people will be able to tell, and if you’re not willing to answer that’s fine, but you can’t go into spaces where telling is a condition of entry.
The second fact about 5-ARD I learned when writing my book is one I’ve barely seen mentioned anywhere: its only known role in male puberty is to trigger the growth of male-pattern body and facial hair. Male people with 5-ARD develop entirely normally for boys in puberty – and their genitalia may also grow and become more clearly male – with the exception that they will never get hairy chests or legs, and they won’t grow a beard. I think this is really important in thinking through what happens with 5-ARD males in traditional cultures.
It’s just not possible that people around Khelif and Lin didn’t look at those bodies and think: that’s a boy’s body, not a girl’s. People with 5-ARD don’t grow breasts – and I mean, at all. They’re not like female athletes with very low body fat, or even ballerinas who are teeny-tiny and starve themselves – these women do still have breasts, albeit very little ones. Males with 5-ARD have completely flat, male chests. They have male shoulders, hips, stomachs, jaws and voices – everything except the genitals (in fact, some do have some genital development during puberty under the influence of testosterone) and the facial hair. But those are pretty big exceptions! If you know nothing about genetics and chromosomes, someone who looks like Khelif as an adult but was registered female at birth may be easier to imagine as a “woman with a male size, shape and muscle and a deep voice, without breasts and with strange-looking genitals (which you may not know about in any case)”, rather than as a “man who didn’t have a penis when he was born and now lacks facial and body hair”.
That’s no excuse for the national sporting federations, still less for the IOC, of course! Whatever this person’s socially understood identity, in every respect that is relevant to sport he is a man and belongs in male competition. Especially when women’s safety is at issue, as in boxing (and seriously, I never thought anyone would need to say that male people shouldn’t be punching women in the face for sport). But it shouldn’t have played out on the world stage, and should have been picked up much earlier. I’m slightly puzzled, by the way, that such a DSD might make it through in Taiwan, which has a pretty developed health-care system – I’d be interested if any readers have any thoughts on that.
If you haven’t got your head around the towering advantage that being male gives athletes, have a look at the website boysvswomen.com, which compares female Olympians with American boys. You’ll see that in every sport or athletic activity where size, strength or speed play a part – that is, pretty much all of them – good but not great under-18 boys outperform the world’s best females. As a male, Semenya isn’t even an elite athlete – no shade there, most of us aren’t – and yet was able to literally set a world record by competing in the wrong sex class.
And that’s in running, where the male advantage is one of the smallest in sport, at 10-12%. In boxing it’s absolutely huge. The most-cited statistic comes from a study that compared punching power in untrained individuals of various ages – the weakest man in that group punched harder than the strongest woman. There was literally no overlap. The average male punched two and a half times as hard as the average female.
That is because the upper-body difference between men and women is greater than the lower-body difference, but also because punching compounds several advantages. Men’s wider shoulders and longer arms mean they have a larger, more powerful swing. Men also have stronger backs, chests, shoulders, upper arms, lower arms, wrists and hands. They have a more stable stance and more stable hips, so the base from which they punch is more efficient, too.
And all of that is when they’re punching a bag, not another human being. Those on the receiving end of a punch also cope better if they’re male. Evolution has equipped men with thicker skulls, deeper-set eyes with more overhanging brows and much stronger and more stable necks. It is insanely dangerous for men to punch women, especially when those men are trained athletes – it’s literally like allowing Mike Tyson to compete as a flyweight. That’s why the women competing against Khelif and Lin conceded so fast. They didn’t want to end up paralysed or even dead.
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