There Isn’t a Gender Test

Caster_Semenya_croppedThere is no gender test. There is not one known to man, woman, or anyone on the spectrum in between.

The media circus and travesty surrounding the recent “gender testing” of South African runner Caster Semenya has led to South Africa’s Minister for Women and Children filing a complaint with the United Nations over how her case was handled.

There hasn’t been complete information in the media about the results of Caster Semenya’s testing. In fact a decision isn’t expected until late November. There has been insinuation and discussion of her testosterone levels. This 18-year-old athlete was forced to expose herself in gynecological stirrups so that photographs could be taken of her genitals. Information about her testing was released to the media without her consent, and without any counseling for her.

I’ve been watching this story unfold with fascination, sorrow, and outrage.

I’m captivated by discussion and issues of gender. I’m equally interested in human genetics. And, while I’m not an expert in either, I know enough to say that they’re not the same thing at all.

A few years ago I found myself taking a bucket-load of biological science classes, in preparation for a possible career change. When I was done and still had a little steam left, I did something I’ve always wanted to do – took a human genetics class. I loved the class and to my surprise, I ended up with the highest score I’ve ever received in a college class, even higher than anything in my major. That’s enthusiasm at work, and while it didn’t make me a geneticist – far from it – I did learn a few things.

Genetics is fascinating stuff. Working out Punnett squares is cool, but learning about all of the ways that humans differ from one another is the coolest thing of all.

Gender is a term that simply refers to a set of characteristics that we use to define people as male or female. Biology doesn’t determine gender, and people are frequently born feeling that their phenotypical sex isn’t in sync with their gender. Gender can be changed.

Chromosomal sex doesn’t determine our gender either, and in some cases, chromosomal sex doesn’t determine our phenotypical sex either.

After all, genes are drama queens. It’s all about the expression. And just like drama queens, throw in a few hormones and it gets more complicated.

Generally, sex skews toward one end of the spectrum or the other, leading to what most people think of as a binary system consisting of male and female. And generally people think of women as having an XX chromosomal makeup, and men as having that problematic Y chromosome that keep them from asking for directions, making them XY.

However, scientists have long known that there is a spectrum in between with many variations that we call “intersex”. (Being intersex does not mean being transgender or transsexual.)

Don’t call these variations “hermaphrodites”. Not only is this rude, it’s incorrect. A true hermaphrodite is a being that has both ovaries and testes and the associated functioning duct systems. This is a normal situations for some creatures, such as earthworms. It’s extremely rare in humans, and usually the result of sex chromosome mosaics, and even then, there is usually a resulting degree of “maleness” or “femaleness” in the expression of the gonadal hormones, resulting in a more specific description.

I just want to be clear. Calling intersex people hermaphrodites is like calling all short people “dwarves” or all people with developmental disabilities “retarded”. These are words with specific meanings, not blanket descriptions.

(There is great information about intersex conditions on the website of the Intersex Society of North America. The organization is no longer active, but the website is still useful.)

Among the intersex variations is a type called androgen insensitivity, in which the the pattern of gene expression is disrupted and a person with XY chomosomes may develop as phenotypically female.

You see, we were all female right after conception, everyone from Pamela Anderson to Hulk Hogan.

In the fetal sexual developmental process of a male, a Y-linked gene creates testosterone receptors that cause the early female fetal reproductive tract to develop male characteristics, such as testes and external male genitalia. However, if there are no receptors for testosterone (for a variety of reasons) testes may form, but no external male genitalia or secondary sexual characteristics. This can result in a phenotypic female, who usually doesn’t menstruate but has well-developed breasts. Often these women are tall and rather thick-waisted, and ironically, often with the height and bust we associate with supermodels, one of our society’s feminine ideals. Androgen insensitivity occurs in one in 13,000 births. Often women don’t know they’re actually genetically XY until they’re tested for infertility. Because they aren’t affected by testosterone like other persons XY who develop phenotypically male, they don’t get the muscle development or strength that mark male development.

In other words, people with androgen insensitivity aren’t feminine-looking guys who should be prevented from competing athletically against XX females.

There is another variation called pseudohermaphroditism, where phenotypic sex can change after birth, and a XY baby doesn’t have the ability to turn testosterone into DHT, the hormonal variation that develops secondary male sexual characteristics such as genital developmental, voice deepening, hair growth, etc. This condition results in genitalia that may appear more female than male, and these individuals are usually identified and raised female.

Other variations are more common than these. The Intersex Society of North America estimated that one in 100 births results in a person with a body that differs from what we think of as the standard male or female.

Some of the intersex variations can result in what are called “ambiguous genitalia,” meaning it’s not just about about having an “innie” or an “outie”. There are all sorts of variations from large clitorises to micro-penises, and fused labia to tiny scrotums. Vaginas can be deep or barely dents. They can end in a cervix and a uterus, or be a simple pouch. Often these can’t be differentiated and these variations don’t always go hand-in-hand with genetic makeup. In fact, it’s been shown in studies that “experts” – doctors and scientists – can’t look at a person’s genitals and correctly predict their genetic makeup.

Then why did the the IAAF, athletics’ world governing body, force an 18-year-old to spread her legs so they could take pictures?

Ironically, my genetics text book (Human Heredity: Principals and Issues by Michael R. Cummings, 7th edition) which was last revised in 2006 includes a section called “Sex Testing in the Olympics – Biology and a Bad Idea”. It details how, in the 1960s, rumors about males attempting to compete as females led the International Olympic Committee (IOC) to require sex testing of all females athletes, beginning with the 1968 Olympic Games.

The IOC’s test involved analysis of Barr bodies in cells collected by scraping the inside of the athlete’s mouth. This was an incredibly bad idea because Barr body testing is notoriously unreliable and results in false negative and false positive results.

The section also explains:

It fails to take into account phenotypic females who are XY with androgen insensitivity and other conditions that result in a discrepancy between chromosomal and phenotypic sex. In addition, the test does not take in account the psychological, social, and cultural factors that enter into one’s identify as a male or a female. Ironically, no men attempting to compete as women were identified, but the test unfairly prevented females from competition. Of the more than 6,000 women athletes tested, 1 in 500 had to withdraw from competition as a a consequence of failing the sex test. The Spanish hurdler Maria Martinez Patino led a courageous fight against sex testing. She has complete androgen insensitivity, was raised as a female, and competed as a female.

In response to criticism, the IOC and the International Amateur Athletic Federation (the IAAF) reconsidered the question, based on recombinant DNA technology to detect the presence of the male-determining gene SRY, which is carried on the Y chromosome… However, again the test was flawed because it fails to recognize several chromosomal combinations that result in a female phenotype, even though an SRY gene is present. At the 1996 Summer Olympic Games in Atlanta, 8 of 3,387 females were SRY positive, of these, 7 of the 8 had partial or complete androgen insensitivity. Again, no males attempting to compete as females were identified.

Finally, in the face of criticism from medical professional and athletes, in 1999, the IOC decided to band the use of genetic screening of females athletes at the 2000 Olympic Games in Australia. However the IAAF still retains the option of testing a competitor should the question arise.

A 1992 Time magazine article about Maria Martinez Patino and genetic sex testing emphasized what I’ve tried to explain:

In instances such as Patino’s, male hormones may be present, but the body lacks the proper receptors to respond. Such individuals look female and, significantly for sports, have the size and musculature of a woman; the Y chromosome is irrelevant.

In other words, a Y chromosome, or even a high level of testosterone in her blood doesn’t make Maria Patino or Caster Semenya a dude. Even an examination of private parts can’t reveal that information. And it blows the old joke, “How do you tell a boy chromosome from a girl chromosome? Pull down its genes.”

Maria Patino spent three years fighting to re-establish herself as a female athlete.

Caster Semenya deserves apologies, restitution for a an athletic career damaged and a life disrupted. She deserves privacy and dignity.


6 responses to “There Isn’t a Gender Test

  1. Awesome, thanks for this. Trying to explain intersex to family and friends has been difficult… I don’t know that much myself but you’ve put together a great summary. I’ll be passing this around. Cheers!

  2. Androgen insensitivity, or a similar intersex condition was the theme of Jeffrey Eugenides’ Pulitzer Prize-winning novel Middlesex. The main character, Callie, discovers that she has testicles that developed and remained internally in her body, and in the story, decides to live her life as a man.

    I have to point out that this is contrary to the sources in my essay, which point to the XY phenotypic female’s inability to utilize testosterone in their system, and their lack of male features.

  3. awesome piece and one of the best articles I’ve read so far 🙂
    I’m glad you pointed out the difference between hermaphrodites and intersexuals, this mixup made me even more furious than the repetitive, incorrect use of gender tests.

  4. Great post. Thank you for the in-depth descriptions and explanations, which helped me understand a few things that have been mis- or under-reported (surprise) in the news stories I’ve read.

    While this story is infuriating and saddening, I also find it fascinating to learn about – like you said – all the things that make us different.

  5. Icing on the cake: Caster (or Castor) is usually a boy’s name – which means “beaver”…

  6. I stumbled upon this article by chance, but I’m really glad I did because it is one of the many things I am fascinated by. Although I’m fairly certain I’m actually transgendered rather than intersex it kinda makes me want to push harder for this to be checked… The insurance I am on would actually pay for certain surgeries and even testosterone if I were to be proven congenitally intersexed.

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