426293

3SullivanJournal of Sport and Social Issues

JSS35410.1177/019372351142629

Journal of Sport and Social Issues

Gender Verification 35(4) 400­–419

© 2011 SAGE Publications
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DOI: 10.1177/0193723511426293
in Elite Sport: Eligibility http://jss.sagepub.com

and “Fair Play”

Claire F. Sullivan1

Abstract
Sex-segregated sports require governing bodies to clearly and accurately place
athletes in two categories, one labeled “men” and the other labeled “women.”
Sports governing bodies such as the International Olympic Committee (IOC) and
International Association of Athletics Federation (IAAF) used sex testing procedures
to attempt to verify the sex of athletes competing in women’s events. In 2004, the IOC
introduced the Stockholm Consensus to regulate the inclusion of, primarily, male-to-
female transsexual athletes, to compete at the Olympic Games. These governing
bodies, and others, are dealing with society’s basic categorization of humans and thus
are entangled in attempts to scientifically and medically define sex. This article will
focus on the history and implications of gender-verification testing and gender policy
on notions of “fair play” and athlete eligibility.

Keywords
gender verification, fair play, gender policy

The notion of what constitutes “fair play” is one of the fundamental questions con-
cerning the future of sport in society. One contentious area that has recently called the
notion of fair play into question involves gender verification and the development of
gender policy in sport. Sex-segregated sports require sports governing bodies to clearly
and accurately place athletes in two categories, one labeled “men” and the other
labeled “women.” These governing bodies have found themselves in the awkward

1
University of Maine, Orono, ME 04469, USA

Corresponding Author:
Claire Sullivan, University of Maine, 5724 Dunn Hall, Orono, ME 04469, USA
Email: claires@maine.edu

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Sullivan 401

position of developing and implementing testing procedures and policies to categorize

athletes into two distinct groups for the purpose of participating in sanctioned sporting
events. The regulation of gender grants power to sports governing bodies to make
decisions about what bodies should look like, and what standards those bodies must
conform to, to participate in sanctioned events.
The International Olympic Committee (IOC) is an international nongovernmental,
nonprofit organization that exists to serve as the authority organization of the Olympic
Movement (IOC, 2007a). According to the official IOC web site, its role is to “encour-
age and support the promotion of ethics in sport as well as education of youth through
sport and to dedicate its efforts to ensuring that, in sport, the spirit of fair play prevails
and violence is banned” (p. 14). The International Association of Athletics Federation
(IAAF) is the international governing body for the sport of Athletics (track and field).
According to the IAAF web site, its primary role is “first and foremost to guarantee the
fairness and integrity of the competitions that are organized under its Rules.” (IAAF,
2011). The concept of “fair play” was traced back to the ancient Olympic Games
where emphasis was on the honorable and just behavior through obedience to the rules
(Gardiner, 1955). According to Reeser (2005), “all international sports federations
have . . ., by necessity, adopted regulations governing the conditions under which a
given sport is played, which athletes must (in principle) accept as a precondition of
participating in that discipline” (p. 695). This article will outline the history of the
creation of gender testing and policy in sport as it relates to the notion of fair play and
the “advantage thesis” (Cavanagh & Sykes, 2006). Several gender policies put forth
by various sports governing bodies were reviewed and analyzed, including policies
approved by the International Olympic Committee, the International Association of
Athletics Federations, the Federation of Gay Games, the Gay and Lesbian International
Sports Association, the United States Golf Association, the Ladies Golf Union, and
the English Ladies Golf Association.

The Advantage Thesis, “Fair Play” and the Gender

Binary
The “advantage thesis” permeates discourse about female, intersex, and transsexual
athletes’ rights to compete. In keeping with the ethic of “fair play,” most international
sports federations organize their competitions along sex-segregated lines, with only a
few rare exceptions (Reeser, 2005). This is said to be especially important at the most
elite levels where the stakes are high in terms of financial gain, fame, and international
politics. According to Sheridan (2003),

The notion of “fair play” is generally understood to be important in sport and

in life yet it is not clear what precisely it refers to, why it is valued, what
ethical principles, if any, it is grounded upon and what kinds of good it
involves. (p. 163)

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402 Journal of Sport and Social Issues 35(4)

Embedded in the fair play discourse is the persistent assumption that all males
(born or “made”) have a physical advantage over all females (born or “made”). Within
the context of sport, it is clear that there is a strong, prevalent societal belief in the
superiority of hegemonic masculinity (Cavanaugh & Sykes, 2006). Within gender
policy, it is further assumed that some birth males would be driven to change their
gender to participate in women’s sports to reap the benefits of inevitable success.
Ironically, the creation of a system that provides a place and protection for girls and
women to compete in sport is also the same system that necessitates their competitive
inferiority (Wackwitz, 2003).
According to the International Committee of Fair Play’s document Fair Play for All
(1992), it is the responsibility of sports governing bodies to determine that athletes are
competing against others of similar size, strength, and capacities (in Wigmore, Tuxill,
& Hallman, 1995). Yet, it is rare for such determinations to be directly made. Sex
determination has been the persistent criteria chosen to “level the playing field.”
Sports governing bodies are dealing with society’s basic categorization of humans and
thus are entangled in attempts to scientifically and medically define what it means to
be “male” and what it means to be “female” for the purposes of sport competition.
What has been determined overall, is that there is no universally agreed upon defini-
tion that can place all humans into the traditional binary. Yet, the definitions estab-
lished through the creation of testing and policies have far reaching personal and
societal impact. It appears that these governing bodies are being pressured to formu-
late these policies more likely designed to manage binary gender designations than
they are in creating a climate of fair play.

The Markers of Gender and the Development of

Gender Policy
Sports governing bodies have felt societal and cultural pressures to find the most
sophisticated scientific and medical procedures to determine the sex of athletes wish-
ing to compete in women’s events. In this process of determining who can compete
as a woman in sporting events, numerous markers of sex have been used. These mark-
ers include Chromosomal sex (XX, XY), sex of internal reproductive organs (internal
morphological sex: seminal vesicles, prostate, vagina, uterus, and fallopian tubes),
and sex of external genitalia (external morphologic sex: penis, scrotum; clitoris, labia;
Money & Ehrhardt, 1972; Money, 1985). Gender verification testing procedures
could also call into play such markers as gonadal sex (primary sex characteristics
including the ovaries and testes), hormonal sex, chromosomal/genetic sex, sex of
assignment, as well as psychological or gender role. Phenotype can also be looked at
in terms of secondary sexual characteristics such as facial hair, chest hair, and breasts
(Martin, 2003). Some other ways in which sex/gender have been defined and debated
are in terms of one’s sexual identity; sexuality; gender roles, gender identity, and the
process of transitioning (Diamond, 1999).

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Sullivan 403

Confusion arises over sex categorization when two or more of these markers are
incongruent (Brannon, 2002; Lippa, 2002; Lips, 2001). According to Blackless and
colleagues (2000),

The belief that Homo sapiens are an absolutely dimorphic with the respect to
sex chromosome composition, gonadal structure, hormone levels, and the struc-
ture of the internal genital duct systems and external genitalia, derives from the
platonic ideal that for each sex there is a single, universally correct developmen-
tal pathway and outcome. (p. 151)

Sports governing bodies are realizing the complexity involved in verifying one’s
sex, yet this has not deterred the development of policy to include and exclude certain
athletes from competing. The decisions over which markers to pay attention to shifted
as gender testing and policy were developed.

Suspicion and Gender-Verification Testing

Gender-verification testing, also called “femininity testing” or “sex testing,” has been
a contentious issue in competitive sport and one of the most controversial tests in
sports history. It came about after claims that some males were masquerading as
females during international athletic competitions (Elsas et al., 2000). According to
Cole (1993), “the female athletic body was and remains suspicious both because of its
apparent masculinization and its position as a border case that challenges the normal-
ized feminine and masculine body” (p. 90).
Gender verification is considered by many to be a by-product of the Cold War’s
competition over the medal count race between the United States and the Soviet Union
(Warren, 2003). Two sisters, Tamara and Irina Press, who collectively set 26 world
records and won six Olympic gold medals in track and field were suspected of “being
male” (Carlson, 2005). Suspicions grew stronger when the two retired after gender-
verification testing was first instituted. The sisters were never banned from competi-
tion and their records held (Warren, 2003). The suspicion of gender deviance in sport
has been used to produce both nationalism and anticommunist sentiment (Cole, 1993).
For these two women, and others, traditional cultural views of femininity did not
match up with their powerful and muscular bodies. Although other accusations were
made, there has been only one Olympic documentation of a man knowingly mislead-
ing officials and competing as a woman. In 1957, German high jumper, Hermann
Ratjen, confessed that he was forced under Nazi order to bind his genitals and compete
as a woman in the 1936 Berlin Olympics. As “Dora” he placed fourth in the women’s
high jump, out of medal position (Carlson, 2005; Ferguson-Smith, 1998). It is appar-
ent that pressures were put on sports governing bodies to unequivocally prove the sex
of all female competitors when doubts were raised.
“Femininity testing” was first introduced by the IAAF in the 1966 European Track
and Field Championships (Fox, 1993). The notion of fair play was used to justify the

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404 Journal of Sport and Social Issues 35(4)

testing on all female athletes. Little public attention was paid to the fact that males
were not simultaneously tested. The strongly held cultural belief in male athletic supe-
riority precluded such an observation. These early sex tests used external genitalia as
the predominate marker of sex. The first tests were described as “naked parades”
where female athletes walked naked in front of a panel of judges and occasionally
underwent gynecological examinations (Larned, 1976). At the 1966 Commonwealth
Games in Kingston, Jamaica, an examination of external genitalia was conducted by a
gynecologist on all female athletes. A sex test also took place at the 1967 Pan American
Games in Winnipeg. At the 1967 European Cup Track and Field event in Kiev, USSR,
visual inspection of the genitalia was used to establish one’s eligibility. These physical
exams were both humiliating and degrading, propelling the International Olympic
Committee (IOC) to search for a more scientific solution. The IOC first opted to use
the Barr body, sex-chromatin test, shifting the marker used to determine sex from
genitalia to chromosomes. Cells from the inside of the female’s cheek were scraped
and examined under a microscope, called the buccal smear (Genel, 2000). This test
relied on the fact that most female cells contain two X chromosomes and that most
male cells contain one X and one Y chromosome. The Barr body is the inactivated
second X chromosome found in genetic female cells (Doig, Lloyd-Smith, Prior, &
Sinclair, 1997; Genel, 2000). Genetic males (46, XY) do not show this Barr body since
they typically only have one X chromosome, which remains active.
After initiating this test on an experimental basis in the 1968 Winter Games in
Grenoble, it was formally adopted at the 1968 summer games in Mexico City (Hay,
1972; Simpson et al., 1993). The committee officially justified testing every female
Olympian to establish physical equality and prevent unfair, physical advantage. After
passing the test they would receive a gender certificate, which became known as a
“Fem card.” They were expected to carry their card to all competitions (Elsas et al.,
2000; Simpson et al., 1993).
The IOC and other governing bodies grew to learn that there is no scientifically
accurate way to determine sex. The Barr body test was not a fail proof method and the
focus on XX chromosomes alone could not stand up the “advantage thesis” discourse
being used to justify verification testing. For example, women with Turner’s syn-
drome would fail the test since these women have only one X chromosome (46, X0)
and therefore would not show the Barr body (Doig et al., 1997). Other women have an
XY “male” chromosomal pattern, yet their bodies are resistant to testosterone (andro-
gen insensitivity syndrome, AIS). They have testes, but they usually do not descend
and their external genitalia appear female. These women would also fail the test. Other
females with gonadal dysgenesis (46, XY) are phenotypically females who do not
form functioning testes; therefore, they do not produce “male levels” of testosterone.
These women would confer no advantage over XX females in athleticism (Doig et al.,
1997). Women with medical conditions that could be seen as giving them an edge in
greater muscle mass and strength, such as congenital adrenal hyperplasia (CAH) and
androgen-secreting tumors would not be identified through this verification testing
(Doig et al., 1997; Ferguson-Smith, 1998; Stephenson, 1996). Genetic (XX) women

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Sullivan 405

with CAH are likely to have a masculine phenotype, with well-developed skeletal
muscle mass, due to their high levels of produced testosterone (Pilgrm, Martin, &
Binder, 2003). An ovulatory androgen excess, also called “Polycystic Ovary Syndrome”
is a fairly common condition in females that often leads to higher than normal levels
of “male” hormones. Also, this test would not be suitable for mosaic persons who can
test XY, XX, XXY, XO or other combinations in various parts of their bodies. They
have multiple chromosomal patterns in different tissues (Goswami, 2003). Ironically,
men with Klinefelter’s Syndrome (XXY karyotype), if given the test, would pass as
women due to the presence of the extra X chromosome (de la Chapelle, 1986;
Ferguson-Smith, 1998). Male XXYs often have a slender physique that could give
them an advantage in some sports such as ice skating and gymnastics. In XX males
part of the Y chromosome containing testes determining genes gets transferred to one
of the X chromosomes. These men have masculine bodies and muscle strength. Yet,
these XX males would also pass the sex chromatin test as women (Doig et al., 1997).
Over the years, 13 women failed the IOC gender-verification test, most of whom
were reinstated (Carlson, 1991; Genel, 2000). The first woman to fail the Barr body test
was 21-year-old Ewa Klobukowska, a Polish sprinter, even though she had passed a
visual inspection of her genitalia the previous year and was said to have a “normal”
appearing female phenotype. The doctors at the 1968 Olympics stated she had “one
chromosome too many to be declared a woman for the purposes of athletic competition”
(Genel, 2000). Accounts suggested that she likely had XX/XXY mosaicism (Carlson,
2005). Klobukowska was disqualified, stripped of her Olympic and other medals, and
removed from the competition. Her 100 m world record was removed from the record
books. Although her chromosomal pattern gave her no athletic advantage, she was
barred from international competition (Warren, 2003). Interestingly, reports indicated
that she later gave birth to a health baby (Doig et al., 1997).
Due to the complex nature of intersexual bodies, some competitors would be
unaware that there would be a problem in determining their sex for the purpose of
sports competitions. Therefore, the rationale of using testing to uncover acts of decep-
tion and cheating could not justifiably be used. At the 1985 World University Games
in Kobe, Japan, a Spanish track and field hurdler, Maria Jose Martinez Patino, was
asked to withdraw from the competition because she had failed the sex test. She had
passed a verification test at the Helsinki World Championships in 1983, but forgot to
bring her “Fem card” to Japan. In shock, she did as she was told and feigned a foot
injury. The results of the buccal smear indicated that her chromosome pattern was XY.
She had no prior knowledge of this genetic anomaly and had no reason to doubt her
sex (Carlson, 1991; de la Chapelle, 1986; Fausto-Sterling, 2000). She was ridiculed,
lost her athletic scholarship, and her records and titles were deleted from the books.
She went into hiding, trying to cope with the new knowledge. She was quoted as say-
ing, “What happened to me was like being raped. It must be the same sense of viola-
tion and shame. Only in my case, the whole world watched . . .” (in Carlson, 2005).
After months of medical testing it was revealed that she was androgen insensitive. She
protested her disqualification and carried on a strong legal campaign against the IOC,

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406 Journal of Sport and Social Issues 35(4)

with sex-test opponents on her side. Three years later, in 1988, she was officially rein-
stated and became the first person to be requalified as a woman for the purpose of sport
(Carlson, 1991). She never was able to regain her prior athletic status. Maria’s case
helped to spark increased opposition to gender-verification testing for women in
sports. It was during this time that Dr. Albert de la Chapelle (1986) of the Department
of Medical Genetics at the University of Helsinki called for an end to gender-verification
testing.

An End to Gender Verification?

In 1990, the International Amateur Athletic Federation (IAAF) convened a commit-
tee in Monte Carlo for a workshop on methods of gender verification. Participants
included physicians from various specialties such as genetics, pediatrics, endocrinol-
ogy, and psychiatry. The committee recommended that the gender verification be
discontinued (Ljungqvist & Simpson, 1992; Warren, 2003). The group contended
that athletic clothing and urine voiding for drug testing, observed by an official,
made sex disguising virtually impossible (Simpson et al., 1993). It is interesting that
an athlete’s external body was once again used as a marker to determine sex.
Furthermore, athletes whose sex was under suspicion, may be observed for purpose
of gender verification, without prior consent or notification during mandatory urine
voiding drug testing. Although gender-verification testing was recommended to be
discontinued it did not end.
Endorsements from such organizations as the American Medical Association, and
the American College of Obstetricians and Gynecologists were made supporting the
end of testing. Not one male had been found “masquerading” as a woman since testing
began and there was no evidence that those who failed the test had any athletic advan-
tage. On the other side, great emotional harm and burden was placed on those who
were singled out and declared not to be a woman as well as the discrimination against
all female athletes required to undergo this testing (de la Chapelle, 1986).
The IOC did not abolish sex testing at that time. Instead, they replaced the sex
chromatin test with what was considered to be a superior, scientific method of deter-
mination: the DNA-based, polymerase chain reaction test. The shift in sex determina-
tion occurred by focusing on the genetic makeup of the Y chromosome (Doig, et al.,
1997). The sex-determining region Y gene (SRY) analysis tests for the presence of a
single important gene in male development, particularly testis formation (Elsas et al.,
2000). Up to this point female athletes had to prove they were “female” according to
the IOC definition of what constitutes female at that time (XX). Now, female competi-
tors were asked to prove that they were “not male” (XY). This costly and cumbersome
test was first implemented at the 1992 Winter Olympics in Albertville (Ferguson-
Smith, 1998; Serrat & Garcia de Herreros, 1993, Simpson et al., 1993).
At the summer Olympics in Atlanta in 1996, 8 of the 3,387 (1 in 423) female ath-
letes had positive test results. Of these, seven had androgen insensitivity syndrome
(AIS), four partial AIS, and three complete. The eighth athlete had previously

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Sullivan 407

undergone a gonadectomy, the surgical removal of the testes, and was presumed to
have 5-alpha-reductase deficiency. Many born with this enzyme deficiency have tes-
tes and male internal structures along with female appearing external genitals or
“ambiguous” genitals (Crawford & Unger, 2000). They are often identified and raised
as girls throughout childhood. Masculinization occurs at puberty when their testes
secrete testosterone (i.e., voice deepens, penis and testicles enlarge; Crawford &
Unger, 2000). Having a gonadectomy would not result in masculinization. After fur-
ther testing and discussion, all eight women were given appropriate gender-verifica-
tion certificates and were permitted to compete (Genel, 2000). Chromosomal testing
of female athletes constituted an invasion of privacy, harassment, and discrimination
against women (Elsas et al., 2000).
It was not until the IOC’s Athletic Commission called for discontinuation of the
IOC system of gender verification that the IOC’s executive board, at its June 17, 1999
meeting in Seoul, decided to discontinue the practice on a trial basis at the summer
Olympics in Sydney in 2000. The IAAF and IOC reserved the right to test if there was
any question regarding a female competitor’s sex put forth by officials and/or com-
petitors. Both sports governing bodies have gone to “suspicion-based” medical exami-
nations for questionable cases (Genel, 2000). According to Cole (1993), “Gender
verification tests can be seen as one element in a matrix of surveillance and policing
practices of the boundaries around gendered bodies” (p. 90).

Gender Policies: Transsexual

and Transgender Athletes
Transsexual and transgender athletes have further challenged sport’s binary classifica-
tion system.. High profile male-to-female (MTF) transsexual athletes such as tennis
player Renee Richards, mountain biker Michele Dumaresq, Canadian cyclist, Kristen
Worley, and golfer Mianne Baggar have challenged policies governing eligibility to
compete in women’s sporting events for decades (Sykes, 2006). Although not sub-
jected to “naked parades,” sex chromatin tests, and polymerase chain reaction tests,
these athletes are required to prove their sex in various ways, to be eligible to partici-
pate in elite sport. Once again, sports governing bodies have situated the process of
determination within a discourse of fair play while arguing a medicalized conceptual-
ization of sex within the gender binary categorization.
In October, 2003, an ad hoc committee convened by the IOC Medical Commission
met in Stockholm to discuss and issue recommendations on the participation of com-
petitors who had undergone sex reassignment. It was recommended that any person
who has undergone sex reassignment before puberty should be accepted in sport under
the new assigned sex. Those who had undergone sex reassignment after puberty pre-
sented a more difficult problem for the policy makers. Once again, the advantage
thesis came into play.
It was determined that individuals undergoing sex reassignment after puberty
would be eligible to compete, under the following conditions: (a) Surgical anatomical

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408 Journal of Sport and Social Issues 35(4)

changes completed, including external genitalia changes and gonadectomy; (b) Legal
recognition of their assigned sex conferred by the appropriate official authorities; and
(c) Hormonal therapy appropriate for the assigned sex administered in a verifiable
manner and for a sufficient length of time to minimize gender-related advantages in
sport competitions. Furthermore, it was recommended that eligibility should begin no
sooner than 2 years after gonadectomy, surgical removal of testes. In the event that the
sex of a competing athlete is questioned, the medical delegate of the relevant sporting
body would have the authority to take appropriate measures for the determination of
the sex of the competitor (IOC, 2007b). Definitions were conspicuously avoided, such
as transgender, transsexual, and transitioned, whereas other sports governing bodies
attempted to define such terms. The Executive Board of the International Olympic
Committee approved this “Stockholm Consensus,” as it has come to be known, and
the policy was put into effect at the 2004 Olympic Games in Athens.
The Stockholm Consensus has been hailed by some organizations as a progressive
gender policy granting Olympic access to transsexual athletes rather than barring them
from competition (Cavanagh & Sykes, 2006). This gender policy was framed as a
policy created to protect the notion of fair play for female competitors. In reviewing
the policy, and others like it, the Stockholm Consensus can be viewed as an attempt to,
once again, scientifically and medically define sex. Sykes (2006) takes a similar view
in noting that the Stockholm Consensus uses conservative medical criteria to deter-
mine access for transsexual athletes into Olympic competition. The Stockholm
Consensus did little to address the local, economic, cultural, and racial differences in
access to sex reassignment surgeries or hormone usage (Sykes, 2006). The intention of
the policy was called into question by transsexual advocates and scholars since the
practical aspects of carrying out the policy were largely ignored. The assumption made
was that there is one correct, medical way to handle sex reassignment. This reasoning
is similar to the view that there is one, universally correct developmental pathway and
outcome leading to absolute dimorphic sex categories (Blackless et al., 2000). The
sentiment appears to support the view that the two sex category system must be main-
tained, whether through early sex assignment surgeries and treatments or through sex
reassignment surgeries and treatments later in life. Mandating particular types of sur-
gery and hormonal treatments as criteria for participation in elite sport competitions
grants power to sports governing bodies and not the athletes whose bodies are affected.
Furthermore, in all the policies reviewed, a “2-year” time period was indicated as vital
to eligibility, without references to research given for why this time period was cru-
cial. Furthermore, little discourse can be found around the opposing view that male to
female athletes can be at a disadvantage in sports. For example, hormone therapy and
removal of male organs result in considerable decline in speed, muscle mass, and
strength. Transathletes who carry “male” skeletal structure and height on “female”
musculature have been found to be more prone to injury (Carlson, 2005).
Mandating sex reassignment surgery and hormonal treatment as a regulation for
eligibility in elite sport cannot be considered an ethical resolution of the “fair play”
principle. This power differential is similar to the “emergency medical treatment” of

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Sullivan 409

intersexual infants to “normalize” genitals that do not match with established criteria.
According to Holmes (2002),

Intersexuality is a historical and cultural construction rather than a simple bio-

logical phenomenon. The categorization of intersex is related to ideological
commitments to a presumed binary “nature” of male and female, coupled with
a paradoxical assumption that gender is so fluid that we are entitled to make of
infants and children whatever we will. (p. 175)

In general, very little concern has been given to female-to-male sex reassignment
in sport. The Stockholm Consensus is clearly biased in the direction of male-to-female
sex reassignment. Specific surgical anatomical changes are not mentioned for female-
to-male sex reassignment in the policy. The lack of attention clearly indicates the
pervasive belief in female inferiority in all sport, however “female” is defined. Also, a
clear discriminatory bias is indicated in the “Explanatory note to the recommendation
on sex reassignment and sports” written by Ljungqvist (2007). He states, “Although
individuals who undergo sex assignment usually have personal problems that make
sports competition an unlikely activity for them, there are some for whom the partici-
pation in sports is important.” (p. 1)
The notion of biological advantages of “male” hormones on athletic achievement
appears to have propelled policy formation. Both males and females naturally produce
testosterone in varying amounts with various impacts on the body. It is not yet clear
how the conflated issue of female-to-male athletes who are prescribed testosterone as
a treatment and testosterone as a banned substance in sport will be reconciled. The
Olympic committee’s gender policy did not address the contradictory nature of allow-
ing testosterone injections with the current drug olicy banning testosterone injections
for all other competitors. For transsexuals to compete, transsexuality had to be recog-
nized by the World Anti-Doping Agency (WADA) as a legitimate medical condition
and the therapeutic use of hormone treatment must be approved by one’s respective
sporting federations and national antidoping organization (Cavanagh & Sykes, 2006).
As with other “medical conditions,” athletes must request a Therapeutic Use Exemption
(TUE) since testosterone falls under WADAs Prohibited List. Under the requirements
of all such requests, athletes must provide proof of the following: (a) The athlete
would experience significant health problems without taking the prohibited substance
or method, (b) The therapeutic use of the substance would not produce significant
enhancement of performance, and (c) There is no reasonable therapeutic alternative to
the use of the otherwise prohibited substance or method (WADA, 2009). According to
Cole (1993), the athletic body is always a suspicious body. Sport participation itself
seems sufficient to suspect tampering with the “biological body.” Cole (1993) stated,
“The athlete as suspect, is, to a great extent, produced at the intersection of the myth
of sport, the myth of the pure/natural body, and the significance of sport in the produc-
tion of national identities” (p. 90).

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410 Journal of Sport and Social Issues 35(4)

According to the Women’s Sports Foundation (2008) web site, the Foundation sup-
ported the guidelines for “elite level sport” and particularly supports, the 2-year hor-
mone requirement “intended to remove any size and strength advantage that, for
example, a male-to-female transsexual athlete may have.” Female sports delegates and
gender advocates have tended to be disconnected from or at times objected to, the pres-
ence of male-to-female transathletes competing in women’s sporting events (Sykes,
2006). According to Sykes (2006), some intersex athletes, with ambiguous genitalia,
are not clearly protected under the gender categories of Title IX. Many European del-
egates at the IOC Third Women and Sport World Conference in Marrakech expressed
little awareness about, or involvement in, transsexual issues in sport (Sykes, 2006). On
occasion, nontranssexual competitors have opposed transsexuals’ rights to compete in
women’s athletic events. The underlying message of male superiority in sport that per-
meates gender testing and policies appears to be in opposition to equality messages put
forth by some feminist advocates, namely, that differences in performance have more
to do with lack of opportunity than biology. Many feminist scholars have relied on “an
immutable notion of sex to argue for the social construction of gender” (Hird, 2000, p.
349). Surprisingly, many women’s sports organizations and advocates, who have been
quite successful in promoting equality in girls and women’s sports have done little to
promote education and awareness about gender variation in sport. Hird (2000) contends
that on a practical level “much feminist theory continues to operate from largely undis-
turbed two-sex model” (p. 349).
According to Cavanagh and Sykes (2006),

Transsexuals and intersexed athletes—the groups most often subject to dis-

crimination and disqualification—have always confounded a static and unchang-
ing two sex model based on biology, and so their gendered subjectivities were
erased (Namaste, 2000) and/or largely ignored in competitive sport prior to the
21st century. (p. 77)

The Search for Inclusive Policy

The Federation of Gay Games, like other sport governing bodies, struggles to create
an inclusive gender policy for sport. Sykes (2006) stated, “When it comes to sport,
even gay sport, the anxiety about gender variation is fossilized due to ongoing psychic
attachments to the binary gender structure of ‘women’s and men’s events’ as the de
facto structure for organizing competitions” (p. 9).
In 1994 at the New York Gay Games, protests were made over the restrictive poli-
cies set forth by the Federation of Gay Games asking competitors to prove they had
undergone surgery or took appropriate hormones for a period of 2 years. Due to these
protests, some changes were made in the gender policy, yet these protests and changes
had little bearing on future IAAF and IOC regulations.
At the 1998 Amsterdam Gay Games, competitors who changed their birth sex were
required to provide medical proof of “completed gender transition” (Warren, 2003).

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Sullivan 411

Transgender participants had to document that they were undergoing hormonal treat-
ment and had their local documents or passports changed (Sykes, 2006). Organizers of
the games decided that mixed-sex couples, including transgendered persons who
could not document their “transition” would not be allowed to compete in the ball-
room-dancing event (Warren, 2003). Gay Games organizers, explained that concerns
over fairness and legal liability made it imperative that transgender athletes be put into
the proper physical category, due to greater body strength. Levels of physical strength
were merely assumed and not attempted to be measured. The reason for the condem-
nations of the Gay Games policy rests in advocates’ belief that gender is a social con-
struct, and therefore an individual’s self-definition of gender should be all that
matters.
During the 2002 Sydney Gay Games, all competitors had to choose one of the two
categories to compete in, for those events organized under male or female divisions
(Gay Games Board, 2002; Warren, 2003). Legal documentation was required to verify
one’s chosen division. Accreditation officials could exercise discretion when evaluat-
ing the adequacy of the type of documentation submitted for proof of gender, such as
personal letters or testimonials, recognizing the difficulty in changing legal docu-
ments. In cases of a mismatch, a person needed “a letter from a medical practitioner
stating that person has been actively involved in hormone treatment for a minimum of
two full years” and/or “proof of the participant living as the chosen or self-identified
gender for a minimum of two years.” Interestingly, and similar in many respects to
“Fem Cards,” the Gay games administrators would provide an Accreditation Pass to
registered participants.
Attempts were also made to make the gender policy more inclusive by formulating
a “diversity principle” and an “equity principle” (www.gendercentre.org.au). The pol-
icy recognized one’s birth sex as falling into the categories of male, female, transgen-
der, or intersex. Definitions of transgender, for the purposes of the policy, were given:
“A transgender person is someone who was born anatomically male or female, but has
a strong and persistent, bone fide identification with the gender role other than that
assigned at birth. A transgender person may or may not have had medical treatment to
transition to their chosen or self-identified gender.” Intersex was also specifically
defined: “Persons with intersex conditions may have one of many long-established
biological conditions where a person is born with reproductive organs and/or sex chro-
mosomes that are not exclusively male or female. A person with an intersex condition
may identify as male, female, both or as intersex.”
These policies took into account regional, racialized variations in gender identities
for athletes, such as Indigenous Australian Sistergirls, Indonesian Waria, Thai Kathoey,
South Asian Hijra, and Samoan Faafafine (Lamas, 2002; Sykes, 2006; www.gender-
centre.org.au).
The 1st World Outgames in Montreal, 2004, initially adopted the IOC gender policy.
Due to much criticism of previous gender policies, they revised their policy, which
distinguished between transitioned athletes and trangender athletes. Transition persons
were “considered to be those persons who undergo sex or gender reassignment through

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412 Journal of Sport and Social Issues 35(4)

surgery and/or hormone therapy.” Transitioned athletes were required to confirm their
gender through appropriate legal (valid passport) or medical documentation (letter from
a physician indicating the athlete has undergone hormone therapy for a minimum of
2 years as part of a process of gender transition. Transgender was defined as “individu-
als whose gender identity (or psychological identification as male or female) does not
conform to stereotypical gender norms.” For the purposes of the policy, transgender
persons are considered to be those who have not pursued sex or gender reassignment
through surgery and/or hormone therapy. These athletes were required to compete “in
their physical gender.” Exemptions to these policies could be granted through a review
process. Interestingly, physical gender was not defined. This definition stood n contrast
to the earlier definition provided by the Gay Games policy developers. Once again, it is
still uncertain whether antidoping rules will apply to transitioned male athletes (1st
World Outgames, 2006).
Other governing bodies, including USA Track & Field (USATF) and the United
States Golf Association, have adopted gender policies. The USATF Board of Directors
adopted the International Olympic Committee’s (IOC) policy at its February 27, 2005
meeting. The USGA adopted its policy in March, 2005. Other sports governing bodies
have adapted existing policies in response to individual athlete’s requests for permis-
sion to compete. Various markers for indicating sex were used in their development,
and not all pertain to one’s present anatomy and physiology. Furthermore, different
sports bodies have accepted or rejected the various markers. For example, the Canadian
Cycling Association accepted Michelle Dumaresq’s birth certificate that was changed
to indicate her newly assigned status as a woman (Hui, 2004). Other sports bodies did
not accept birth certificates as documentation of sex. Mianne Bagger was ineligible for
the Lady’s European Golf Tour at the start of 2004 even though both her birth certifi-
cate and passport indicated her status as female. Yet, she was accepted into other golf
tours (Kelso, 2004). Furthermore, Women’s Golf Australia dropped its female-at-birth
policy to allow Bagger to compete in the 2004 Women’s Australian Open (Fields,
2004). In 2005, the Ladies’ Golf Union finalized its gender policy, clearing the way
for Bagger and others to enter qualifying tournaments for the British Open (BBC
Sport, 2005).
The revised Women’s Golf Association policy stated that “members must presume
that a person is of the sex they assert themselves to be” and the “members must not
require any person to take biological or chromosomal tests to demonstrate their birth
gender” (Women’s Golf Australia, 2004). At the same time, proof of gender was in the
form of a birth document or equivalent was still required. The Australian policy has an
underlying assumption that “[genetic] women are not disadvantaged by permitting
transgender persons to participate in the playing and administration of the game of
golf” (Women’s Golf Australia, 2004, p. 1).
Before the Stockholm consensus, most governing bodies either had no gender pol-
icy that addressed transsexual or intersexed athletes inclusion or they used a “female
at birth” policy. According to Cavanagh and Sykes (2006), “the range of policies

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Sullivan 413

being developed by sport organizations indicate different commitments to human

rights protection for trangendered/transsexual/intersexed persons” (p. 89).

The Gender-Verification Testing

Controversy Continues Today
It appears that gender verification policy has been driven by time constraint pressures
as well as intense media coverage of “suspicious” athletes. In December, 2006,
India’s Santhi Soundarajan was stripped of the silver medal in the women’s 800 m at
the Asian Games in Doha, Qatar, after she failed a sex test. It had been reported that
an official became “suspicious” while observing Soundarajan’s urine voiding drug
testing procedure. Neither the Olympic Council of Asia nor the Athletics Federation
of India released an official statement about what type of gender testing was con-
ducted. One Associated Press report (2006) quotes an anonymous Indian athletics
official as saying that Soundarajan had “abnormal chromosomes” and more Y chro-
mosomes than allowed. If so, it may be that Santhi was born with androgen insensitiv-
ity syndrome (AIS) and therefore, could have been cleared for competition, based on
the acceptance of seven women with AIS in the 1996 Olympic games. Further infor-
mation has not been made available to the public, although there have been reports
that on September 5, 2007, the traumatized Santhi Soundarajan attempted suicide
(India Times, 2007), which she has denied.
More recently, Caster Semenya, a South African middle-distance runner was
ordered by the IAAF to take a gender test for the purposes of verifying her sex after
winning the gold medal at the World Championships in Berlin on August 19, 2009
(Clarey, 2009). It was not until July 6, 2010 when the IAAF cleared her to compete in
international competitions. It appears that several violations of the IAAF’s gender
policy occurred during that time. For example, it was unclear who made the initial
formal complaint or challenge and under what circumstances they were made. News
sources indicated that testing was mandated due to marked improvement in her 800 m
time over a short period, arousing “suspicion” over possible drug violations. Other
reports leaked to the media indicated that Caster may have an intersex condition, or a
disorder of sex development as it has more recently been termed. Her story brought
renewed pressures on sports governing bodies to develop new rules for ways to handle
athletes with disorders of sex development who wish to compete in women’s competi-
tions. Drug-testing policy and gender testing policy appear to have been crossed over
in ways that had not been previously aligned.
The IOC and IAAF recently worked together to set up eligibility rules pertaining to
female athletes with hyperandrogenism, According to the IAAF, hyperandrogenism
(HA) is a term used to describe the excessive production of androgenic hormones in
females, primarily testosterone. In April 2011, The IOC Medical Commission recom-
mended that females recognized in law should be eligible to compete in women’s
competitions as long as she has androgen levels “below the male range (as shown by
serum concentration of testosterone)” or if she has an “androgen resistance,” deriving

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414 Journal of Sport and Social Issues 35(4)

no “competitive advantage” from levels within the “male range” (IOC, 2011). There was
no indication yet as to what constitutes the “male range,” but the normal range of total
testosterone for an adult premenopausal woman is typically defined as 15 to 70 nano-
grams per decilitre, compared with 260 to 1,000 nanograms per decilitre for a man
(Marchant, 2011). The International Association of Athletics Federations (IAAF) was
the first group to approve the new gender policy. If the testing reveals that an athlete
is not in the normal range, she will be informed of the conditions to meet for eligibility,
such as undergoing treatment to normalize her androgen level. If she decides to meet
those conditions, compliance will be monitored. If an athlete fails to comply with the
process, she will be deemed ineligible for competition (IOC, 2011). Furthermore, the
IAAF Council abandoned its existing Gender Verification Policy concerning the par-
ticipation of athletes who have undergone male to female sex reassignment. It is likely
that other sports governing bodies will follow suit in the near future. Therefore a per-
son could be eligible under one set of guidelines and denied under another, perhaps
repeatedly proving her gender. These Regulations do not apply to female-to-male sex
reassignment participants. Although, it is not clear how the administration of testoster-
one to these athletes will play out. Kristen Worley and others founded the Coalition of
Athletes for Inclusion in Sport. This coalition immediately developed a position state-
ment that counters these regulations recommendations (Worley, 2011). As in the past,
it is likely that the regulations will continue to be updated as societal views change and
further research is conducted.
The new policy was said to rest on the longstanding belief that androgen levels are
the sole reason for differences in sporting performance between males and females
(IAAF, 2011). Yet, this ruling is the first to use the hormone levels as the marker for
sex. The hyperandrogenism ban is similar to the ban placed on an athlete who is found
to be using performance-enhancing drugs, except for the fact that the former is natu-
rally occurring and the latter case involves deception. Putting an emphasis on hor-
monal variation can open a floodgate for potential opposition on other types of genetic
variations such as height, oxygen carrying capacity, and lactate thresholds. The fact is
the playing field has never been level. There will always be genetic variations that
provide a competitive edge for some athletes over others. We readily accept the
genetic, athletic gifts that elite athletes possess without trying to find ways to “level
the playing field.” The IOC and IAAF labels androgens as “male sex hormones”
although women naturally produce androgens as well. It is clear that the aim is to keep
the binary classification system intact although there is mounting evidence and grow-
ing recognition of the diversity of human sex and gender identities.

Conclusion
It is clear that creating fair and equitable gender policies for the purpose of sport
competition is a complex task. Gender-verification testing and the development of
gender policies have put into question the very meaning of “man” and “woman.”

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Sullivan 415

The IOC and IAAF, as well as other sports organizations and governing bodies,
have continued on a long, cumbersome road toward understanding what it means to be
a woman for the purpose of sport competition. Gender policies have regulated access
to sports events by using binary classifications when there is no scientific or biological
proof that a binary exists.
Most people accept the division between men and women in sport with little thought
given. Segregated sports is rooted in the historically discriminatory practices of male-
dominated sports competitions. The “myth of fair play” plays a central role in the
reproduction of masculinity hierarchies (Giuilianotti, 2005). The problem of gender
discrimination comes with the gender categories themselves, not the individual ath-
letes who challenge and transcend socially constructed gender boundaries. Within the
“advantage thesis” discourse, assumptions of fairness appear to receive priority over
the impact of discrimination. Other types of classifications systems that fit within the
fair play discourse have rarely been addressed.
Various markers have been used to classify sex and gender, including external gen-
italia, internal reproductive organs, hormonal patterns, phenotype, genetic sex, and
gender identity (Martin, 2003). Deciding which of the numerous markers one focuses
on to determine sex is a social decision. According to Fausto-Sterling (2000) “the
more we look for a simple physical basis for ‘sex’ the more it becomes clear that ‘sex’
is not a pure physical category” (p. 4). Sports governing bodies have chosen various
markers of sex to make their determinations of who is eligible to participate and who
is not. Trouble arises on many fronts when too much emphasis is put on one or a few
of sex-determining criteria. Fausto-Sterling (2000) argues that scientific discoveries
about the ways our bodies function employ cultural understandings and the language
of existing social models. Milton Diamond (1995) argued that the truth of the body is
also a cultural view of the body through the lens of science. In writing this analysis, it
is apparent that the “scientific lens” can be manipulated to uphold the two-category
sex classification system.
Gender policies are mandating particular types of surgery and hormonal treatments
as criteria for participation in elite sport competitions, granting power to the sports
governing bodies and not the athletes themselves. It is not accurate to say that mandat-
ing particular types of medical treatments and testing can be used to ensure a
“level playing field.” Decisions over who is included and who is excluded from sex-
segregated, elite sporting competitions is imbedded in the communicative structure of
our society. How gender policies are written, implemented, protested, and mediated all
involve a network of communicative acts. Cavanagh and Sykes (2006) contend that
gender policies are driven by a compulsive attempt to validate and manage the gender
binary, in the face of social, medical, and legal uncertainty of its legitimacy. Some
feminist scholars have pointed out that gender-verification testing came about not in
the “spirit of fair play,” as the IOC and IAAF contend, but was implemented to man-
age the inconsistency between female athletic achievement and dominant societal
beliefs about female bodies and athletic abilities (Kolata, 1992; Wackwitz, 2003). It

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416 Journal of Sport and Social Issues 35(4)

appears that elite sport evokes anxieties about gender instability and the changeability
of the human body (Cavanagh & Sykes, 2006).
Both the scientific and social interpretations of sex are increasingly complicated
and controversial. Sports governing bodies are finding themselves at the center of the
controversy. Just as opportunities for women in sport have expanded, a panel of
experts began scrutinizing female athletes’ genitals, genes, and chromosomes. What
the IOC and other sports governing bodies have determined is that there is no funda-
mental, medical, or scientific way to clearly categorize all humans into the female–
male binary. Although not their aim, through the debates and controversies that have
ensued, sports governing bodies have given a considerable amount of attention to the
diversity of sex.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.

Funding
The author received no financial support for the research, authorship, and/or publication of this
article.

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Bio
Claire F. Sullivan received her PhD at the University of Washington, Seattle. She is presently
an associate professor of communication at the University of Maine, Orono.

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