Sport, variations in sex development and equality of opportunities: what can we learn from the Khelif case

Imane Khelif and Angela Carini case. From the ring the fight has already become news and the debate immediately heated up, both on social media but not only.

Let's clarify.

Minerva interviewed professor and bioethicist Silvia Camporesi, Professor of Sports Integrity and Ethics all’KU Leuven University in Belgium, it is part of theEthics External Advisory Board della WADA and is the author of “Start (s)advantaged: bionic bodies and genetically modified athletes” for Fandango (2023).

  • Prof.ssa, what is the difference biologically between an individual with hyperandrogenism, variations in sex development, e transgender?

Based on what the IBA told us (link who), Khelif did not pass a chromosome test. Then, it is presumable to state that does not have chromosome 20. In the human species, females usually have two X chromosomes (46,XX), while males usually have one X chromosome and one Y chromosome (46,XY) but there are women and men with, in technical terms, “non-standard chromosome sets”, which differ from these two (Higher Institute of Health, link who).

These non-standard chromosome sets belong to a variety of conditions called “variations in sex development” (in inglese “differences of sex development”, link who), a broad term that includes a variety of conditions (circa 40 but the number varies depending on the classifications) therefore there is no linear correspondence between genotype and phenotype, between our genes and our appearance. International scientific literature indicates percentages generally ranging between 0,018% and 1.7%.

Chromosomes alone cannot tell us whether a person is male or female because the development of sex in our species is due to a complex interaction between our genes and proteins: you can be born a woman with a non-standard set of chromosomes and XY chromosomes.

Iperandrogenismo is a general term that refers to increased androgen levels (link who). Both men and women can be affected. In women, hyperandrogenism can be caused for example by genetic causes from polycystic ovary syndrome (PCOS), which according to the World Health Organisation there is one prevalence between 8 and 13 % (link who). Some variations in sex development are characterized by hyperandrogenism, which is expressed with a phenotype (I wait) androgynous who is often the trigger for debate. This was for example the well-known case of Caster Semenya in athletics (link who).

Transgender or 'trans' is an adjective composed of trans-, which in Latin means "beyond", e “gender”, type . In recent times in terms of broad language it is preferred to use only 'trans'.

a person trans is recognized in one misaligned gender identity with the sex/gender assigned at birth. Some trans people identify as the opposite gender to their birth gender (it is. a trans woman born as male, or a trans man born as a woman) but the term also includes those whose gender identity goes beyond the male-female binary. Please note that the adjective trans refers to a person's gender identity and has nothing to do with emotional orientation- sexual. Different adjectives such as androsexual are used for sexual orientation, gynosexual, pansexual. For a gender vocabulary see “Things Explained Well” publication of “Il Post”.

We read some fake news about the Khelif, so it bears repeating: Khelif is not trans, she was born female with a non-standard set of chromosomes: following the pressures suffered, her father even shared his daughter's birth certificate to confirm that his daughter was born a girl (link who).

  • These are pathologies?

Variations in sexual development they are not necessarily pathological for the individual. The use of the word 'disorder' or 'disease' is discouraged by the international scientific community, which since the beginning of the second decade of this century has adopted the more neutral term "differences of sex development” (link who). They are precisely variations in the expression of the sexual development of the human species. Some may require medical interventions due to comorbidities, while others throughout history have been subject to surgical interventions conditioned by society to restore standard phenotypes. These surgical interventions there are more and more object of criticism (link who).

L’iperandrogenismo as we said before, it is a general term that means "more androgenic". It is a physiological condition, not pathological, which may require cosmetic interventions, which are obviously socially conditioned, to eliminate or reduce acne or excessive hair. Only in some cases of severe polycystic ovary in which fertility is compromised or there are comorbidities (for example diabetes) it is intervened pharmacologically.

  • What checks are being carried out to date to ensure fairness between athletes? We know about anti-doping controls, eg. And then?

In 2021 the International Olympic Committee (CIO) publish a document, entitled “Principles for Equity, inclusion and non-discrimination based on gender identity and sex variations” (link who), which is currently the reference regulatory document for eligibility to participate in the female category. This affirms the need to ensure that all male and female athletes can “participate in fair competitions where no participant has a unfair and disproportionate advantage compared to others". The IOC, however, leaves the role of promulgating criteria for their own sport to the individual federations, on the basis of “robust scientific evidence” which must be sport-specific.

And here we come to the dispute between the IBA and the IOC which led to the outbreak of the Khelif case. The International Boxing Association (DIFFERENT) was deprived of its federation status international boxing by the IOC in June of 2023 (link who). According to the IOC, the IBA had failed to address repeatedly raised concerns about its governance and in particular its close financial ties with Russia. A new federation, World Boxing, it arose in place of the IBA, and awaits its official recognition by the IOC as the new federation that governs boxing at an international level. Meantime, the IOC took over the organization of the Paris boxing tournament in 2024. In fact, international sports federations, at the end of the day, remain subject to the IOC.

Among all these tensions then, which I already am - obviously – policies, Politics with a capital “P” entered the Khelif case, with the emergence of tensions between individual nations and the IOC. At the end of the day, when these tensions between federations and IOC emerge, and between nations and IOCs, It is always female athletes who lose out, despite everyone saying they "want to protect them".

  • What could be done to improve regulations to ensure fairness, inclusion and non-discrimination based on gender identity and developmental variation in sex in sport?

We could certainly improve the situation by producing robust scientific evidence sport-specific regarding the level of advantage derived from variations in sex development.

The solution to eligibility to compete in the women's category is complex, but not impossible to resolve: requires specific scientific evidence to demonstrate whether endogenous natural levels (therefore not due to doping) of testosterone confer a “disproportionate” advantage, that is, an advantage that cannot be achieved by other athletes without those high levels of testosterone.

  • Who would they be entitled to?, in his opinion, such controls?

They are up to the International Olympic Committee and then to the individual federations. I reiterate the need to robust scientific evidence in line with the principles enumerated in the IOC document of 2021 mentioned above.

Unfortunately in the Khelif case all of these tensions of sports and international politics have damaged both athletes: on the one hand, Carini, subjected to enormous media pressure, on the other the Khelif, so every victory from now on will necessarily be tainted by the shadow of doubt.

It could have been done better? Certainly, The IOC could have made its decision before the Olympics, explaining the reference principles for eligibility to compete in the women's category and that the IBA no longer has authority as it is deprived of its status as a federation that regulates boxing at an international level. The international federations, indeed, remain subject to the IOC. Instead, the IOC, he only spoke in retrospect, after the case broke out.