Experts stress need for broader gender tests for sports eligibility

Taipei, Aug. 11 (CNA) Gender eligibility rules in sports are complex and should consider multiple criteria and the broader context, experts said recently amid the gender controversy involving a Taiwanese and Algerian female boxer at the Paris Olympics.

Relying on a single factor, such as testosterone levels -- a key criterion for eligibility in Olympic events -- could be considered dogmatic, the Science Media Center Taiwan said in a press release on Aug. 8, citing experts.

Hsu Mei-chich (許美智), a professor at Kaohsiung Medical University's Department of Sports Medicine, said it was not appropriate to use testosterone levels as a definitive criterion for determining gender, as some females have naturally high reading of the hormone.

For males, normal testosterone concentrations range from 10 to 35 nanomoles per liter (nmol/L), while for females, the normal range is lower, typically below 2.5 nmol/L, she said.

Hsu stressed that those ranges can vary depending on the laboratory and testing methods used.

"It is crucial that any interpretation of testosterone levels should consider the individual's overall health status and medical background," she said.

The Olympics implemented stricter regulations regarding athletes with differences of sex development (DSD) ahead of the Paris Games, following the vote of the World Athletics Council in March 2023 to halve the maximum blood testosterone level for females to below 2.5 nmol/L.

But Hsu argued it was wrong to conclude that someone is not female simply based on high testosterone readings, as a 2014 study published in Clinical Endocrinology indicated that there could be a significant overlap in testosterone concentrations between men and women.

According to the study of 693 elite athletes, 16.5 percent of "male" athletes had testosterone levels below the normal range, while 13.7 percent of "female" athletes had levels above the normal range, she said.

Tsai Meng-che (蔡孟哲), a pediatrician at National Cheng Kung University Hospital, said sexual development is very complex because it involves diverse definitions of sex.

High testosterone levels do not necessarily indicate that a person is male or that banned substances are being used, he said, because people with androgen resistance might have high testosterone but still be anatomically female.

"Based on my training as a physician, unless the individuals choose to disclose their condition, they are just like any other person to me, not patients with chromosomal abnormalities or those with DSD," he said.

In addition, Tsai said, although DSD affects sexual development, it is not a direct cause of differences in athletic performance.

Other factors include nutrition, training, genetics, psychology and disease, with their influence on performance varying from person to person, he explained.

The debate over gender in sports and testing standards was triggered at the Paris Games by Lin Yu-ting (林郁婷) of Taiwan and Imane Khelif of Algeria, who were both disqualified from the World Women's Championships in 2023 for not meeting undisclosed gender tests.

The discredited International Boxing Association (IBA), which ran those championships, pressed its position during the Olympics that neither boxer should have been allowed to compete in Paris, and both boxers faced online abuse.

But the International Olympic Committee stood by its decision to allow them to compete, and they both won gold medals in their respective weight classes.