When Is a Girl Not a Girl?

Sex Testing: Gender Policing in Women’s Sports

By Lindsay Parks Pieper

Urbana: University of Illinois Press, 2016, 250 pp., $22.50, paperback

Reviewed by Laura Pappano

An e-mail arrived recently from a college student I had met several times. Embedded in the electronic signature below the year of graduation, residential college, and major was a quick line of text: “Pronouns: he/him/his.”

It surprised me. Not because the pronouns were different from what I had expected—I had perceived this student as male—but because he chose to include them. He was proclaiming don’t assume you know what I am. He was reminding me, and everyone else he e-mails, that gender identity is neither fixed nor obvious.

Ambiguity is a hallmark of our time, from confusion over the sources of extremist danger to the state of race relations, the future of the planet, the purpose of a college degree, or the true healthfulness of so-called healthy foods (must we eat kale?). When it comes to gender and biological sex, we are getting used to a fluid view of “male” and “female,” and overturning old norms. This is not simply a nod to surgery and hormone therapy, or the rising profile of transgender people, but the recognition that biological sex is more complicated than many once believed.

This wiggly reality has been a stubborn adversary for Olympic and international sport officials, who insist on dividing competition into neat categories: male and female. The desire for certain sex identity—for dichotomy, where nature offers a spectrum—has spurred a costly, complicated, and fraught process to “prove” that female athletes are, indeed, female. (Males require no such proof).

Questions of why, how, and for what purpose athletic associations have so fervently sex tested female athletes is at the heart of Lindsay Parks Pieper’s Sex Testing. In it, she digs into the history, politics, and mangled logic for sex testing elite female athletes, particularly in Olympic competition. She argues that the process is more about enforcing western ideals of womanhood than about procuring that elusive “level playing field” for competition. Top sport officials, she writes, “found it inconceivable that strong, muscular women could be authentic or natural,” and attempted to enforce a “vision of appropriate female athleticism.” They seemed to believe “that any man could don a wig or a skirt and defeat all women in athletic competition.”

On-site sex testing was officially instituted during the Mexico City Olympics in 1968 and suspended just this year: there was no sex testing in Rio. However, the International Association of Athletics Federations (IAAF), founded as a governing body for track and field, and the International Olympic Committee (IOC) sought sex verification as early as the 1920s. Questions arose most often in track and field when an athlete was taller, more muscular, or faster than was deemed possible.

At the 1928 Amsterdam Olympics, for example, when Hitomi Kinue of Japan came in second in the 800-meter event behind Lina Radke of Germany, some in the press speculated that Kinue was a man. The race became famous because six runners fell exhausted to the ground, prompting the cancellation of women’s distance events for years. “Based largely on Hitomi’s athletic success and her unmarried status,” writes Pieper, one reporter “deduced that she was ‘40 or 50 percent male and 50 or 60 percent female.’” Years later, in a 1936 article in the New York Times, reporter Grantland Rice alluded to the 1928 games in which “the investigating committee was out two hours before it decided predominant sex” of a Japanese woman competitor.

The requirements of femininity have long been at odds with sport. Female athletes who didn’t appear classically feminine fed the myth that sports such as track and field weren’t appropriate for women and, worse, could have a masculinizing effect. The brash, all-around athlete Babe Didrikson was criticized as unladylike. She and the track stars Helen Stephens and Stella Walsh were “lambasted [for] their muscular physiques, unfeminine appearances, working-class backgrounds,” observes Pieper. “Mannish” female athletes threatened a gender order in which men were powerful and women lithe and delicate. “Calls to implement sex testing,” writes Pieper, were not about fair play but about ensuring heterofemininity.

Over the years, the testing has taken different forms. In the 1920s and 1930s, the only way to tell if an athlete was female was to look. Whenever there was “a definite question as to sex,” explains Pieper, the IOC and IAAF called for an exam. This created problems. For one thing, only muscular women were singled out. Then there was the exam itself. Here Pieper is less than clear. How extensive were the exams? Who performed them? The allusion to the Japanese athlete who left examiners puzzled for two hours is intriguing: visual inspection had limitations. Pressure to verify all female competitors—not just suspicious ones—led the IAAF in 1947 and the IOC in 1948 to require certificates signed by a doctor. Yet these could be easy to obtain.

During the cold war, Soviet and eastern-bloc female athletes were encouraged to train more aggressively than American women, who feared “unsightly” muscles. This made Russians and Eastern Europeans—excluding the “pixie-like” child-gymnasts Olga Korbut and Nadia Comaneci—suspect. And indeed, some of this suspicion turned out to be justified: East German female swimmers were subjected to a horrific doping program that led to illnesses and ruined lives.

As with the East Germans, the separate issues of sex testing and doping are often conflated, writes Pieper. Sports authorities first tested for steroids in 1974 at the Commonwealth Games in New Zealand—although none who failed were penalized—and then at the 1976 Montreal Olympics. At the time, it was acceptable for male athletes, particularly weightlifters, to take steroids: the drugs enhanced their masculinity. “The most serious and dangerous use of drugs by females,” one journalist warned, “is the taking of male hormones.” The press erroneously reported that a “new infamous sex test”—sex chromatin testing, developed in the late 1940s and used at the 1968 Olympics—would offer an ideal scientific solution. But it did no such thing.

In the chromatin, or Buccal smear test, a small amount of DNA, usually from a scrape inside the cheek, is amplified to reveal an athlete’s chromosomal makeup. The test is difficult to read: in a medical journal, two scientists pointed out that even the scientist who invented it, Murray Barr, read some tests incorrectly. And in a 1956 article in the British medical journal, the Lancet, Barr himself begged “physicians to act with ‘caution and diplomacy’ when labeling sex and to use the chromosomal check sparingly.” He was ignored.

Biological sex simply cannot be clearly categorized. The chromatin test has humiliated women born with chromosomal differences, such as those with mosaicism, who have cells containing both XY and XX chromosomes, and those with androgen insensitivity, who have Y chromosomes and test as male, yet have many female physical characteristics. These and other intersex states have been common enough to raise questions about the test’s validity or usefulness—but not before many female athletes were publicly shocked by results they never anticipated. The chromatin test also results in a fair number of false positives, reports Pieper:

From a sample of “normal appearing males,” the Barr body test labeled one out of seven hundred as female. The test also identified one out of two hundred women as male, which was of particular significance for the Olympics.

Yet, rather than question testing itself, the IOC medical commission in the 1990s embraced a new test: the polymerase chain reaction (PCR) test, which seeks out a specific DNA sequence—the sex-determining region or SRY—to identify the presence of a Y gene, a sign of “maleness.” Because the test was susceptible to contamination, female workers were assigned to take the samples from female athletes.

In 1999, the IOC announced an end to official sex testing—yet in a nod to old fears, at the 2000 Sydney Olympics, officials required inspectors to visually scrutinize athletes’ genitalia during the urination required for antidoping exams. Such scrutiny, argues Pieper, marks yet another instance of the troublesome conflation of doping and sex testing.

Pieper makes a powerful case for the folly and pain of sex testing, sharing the case of the Spanish hurdler Maria Patiño. When Patiño forgot to bring her verification card to international competition in Japan in 1986, she underwent and failed a chromatin test—stunning herself and the world. Pieper chronicles the controversy in detail, as Patiño, with the help of a Finnish physician, sparked doubts about the value of sex testing, and its hold began to unravel.

Although Sex Testing is thorough and well documented, we need more science. Chromosomal abnormalities are explained early on, but later, as we hear about Barr’s doubts about his sex chromatin test and about limitations of PCR testing, we need more. What, precisely, are the tests’ weaknesses? Why do intersex conditions go undetected and unsuspected, even by those who have them?

The strength of Sex Testing is its detail, though at times the structure seems weak; the book is more a jumble of gems than a necklace. Still, because it is chock full of terrific research from primary sources, it will be useful for academics. And Pieper’s message comes through loud and clear: sex testing is a political act. It is about enforcing gender norms, not ensuring fair play.

In Pieper’s epilogue, she notes that although sex testing has officially ended, sports authorities have not let go. Instead, they’ve raised a new question: what is biological fairness? Should women with hyperandrogenism, or higher-than-average levels of androgenic hormones––be allowed to compete?

Just prior to the 2014 Glasgow Commonwealth Games, the Indian sprinter Dutee Chand was pulled aside, tested, and deemed ineligible. Although she had always thought of herself as female, the tests showed higher-than-average testosterone levels. Chand was offered medical “treatment,” which she refused. Instead, she appealed to the Court of Arbitration, which decides sports cases. On July 24, 2015, the court permitted Chand to return to competition, ruling that the IAAF had failed to prove the benefit of higher testosterone levels: “There is presently insufficient evidence about the degree of the advantage,” the court wrote, as it suspended the hyperandrogenism regulations for two years.

“Fairness,” observes Pieper in her conclusion, “is an abstract concept that does not exist in elite sport.” The fact is, birth advantage helps many athletes excel. The Olympic swimmer Michael Phelps has a longer-than-average arm span, an elongated torso, short legs, size 14 feet, and double-jointed ankles that enable him to bend fifteen degrees farther than most swimmers. At 6́́ 5́́́́ ́, the sprinter Usain Bolt has a height advantage. While abnormalities and variations give many athletes an edge, women have born an unfair share of scrutiny. As Pieper reminds us, “only sex/gender differences resulted in disqualification.”

Laura Pappano is writer-in-residence at Wellesley Centers for Women. A journalist who writes on education and gender and sport, Pappano is co-author of Playing With The Boys: Why Separate is Not Equal in Sport (2007), was a varsity college athlete, and continues to be an avid sports participant (though has never been sex tested).


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