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Integrity and fairness are at the forefront of sporting events worldwide. At present, there has been an increasing emphasis on inclusivity in almost every facet of society—including sports. One particular topic that has sparked debate and controversy is the participation of individuals in competitive sports with Differences in Sex Development (DSD). With this in mind, it leads many to the question of whether this pursuit of inclusivity will compromise fairness in sports.

 

Differences in Sex Development (DSD), often known as intersex variants, refer to a wide spectrum of medical conditions in which individuals have chromosomal, gonadal, or anatomical alterations that do not conform to conventional notions of male or female. Individuals with DSDs may exhibit features of both sexes or differ in sex hormone levels, posing particular issues in assessing their eligibility to participate in sports. Particularly, the preexisting issue continues to spark a heated debate wherein the potential for higher levels of testosterone are deemed to give an unfair advantage to DSD athletes against their (typically female) cisgender competitors.

 

The hormone testosterone is oftentimes associated with sex drive and is critical in sperm production. It also influences bone and muscle mass, fat distribution, and red blood cell production. Although women produce testosterone in their ovaries and adrenal glands, the amount is significantly lower compared to men. Normal testosterone levels in women typically range from 15 to 70 nanograms per deciliter (ng/dL) while it varies from 300 to thousand ng/dL in men. As such, this disparity contributes to the advantages possessed physically by males. Thus, defining the line for the creation of male and female categories in sporting events wherein athletes sharing the same athletic ability can fairly compete with one another. In fact, anti-doping agencies listed testosterone and its esters as prohibited substances due to the biological effects that were cited earlier. An athlete taking a supplement that artificially increases testosterone levels is considered doping and is subject to suspension for a specified period from participating. 

 

With the goal of keeping inclusivity while prioritizing fairness, international sports governing bodies such as the  International Association of Athletics Federations (IAAF) and the International Olympic Committee (IOC) have implemented regulations, establishing specific testosterone thresholds for female athletes with DSDs competing in certain events. According to the updated regulation they published in March 2023, DSD athletes are mandated to lower their testosterone levels below 2.5 nmol/L for at least six months to compete internationally in the female category in any event. This is contrary to the rule they instigated in 2019 that only DSD athletes competing in events between 400 meters and the mile had to do so. Moreover, athletes in the previously restricted events must also adhere to the 2.5 nmol/L testosterone threshold for at least 24 months in order to compete. 

 

This, however, only added fuel to the fire with many citing that these regulations were discriminatory and based solely on biological characteristics. Athletes with DSD argued that they contradicted the principles of opportunity and fairness. Additionally, in 2019, the World Medical Association (WMA) and the Court of Arbitration for Sport (CAS) criticized the validity of their regulations citing that the research did not back the notion that DSD women acquire an unfair advantage such as in the 1500-meter races. 

 

“They are based on weak evidence from a single study, which is currently being widely debated by the scientific community,” former president of the WMA  Dr. Leonid Eidelman explained.

 

At present, the constant tug-of-war between fairness and inclusivity remains to be a challenge for governing bodies. Defining the line will require careful consideration of the implications that these policies may be instigating in the future. After all, in this age of fluid identity and inclusion, striving for fair competition, ensuring the well-being of all athletes, and meaningful discussions will be instrumental in shaping the future landscape of sports. Will the scales tip in favor of equality or tilt towards maintaining the traditional definition of integrity in competition, or will a completely new domain of sports be established in the name of diversification?