“The smirk of a male who’s enjoying the distress of a woman he’s just punched in the head”
Transphobes have rallied to a new cause: calling out intersex women in boxing as men who abuse women. When Iman Khelif beat Italian boxer Angela Carini, former swimmer Sharron Davies tweeted:
This is a biological male fighting a female & absolutely everyone can see it, they have also failed gender screening, twice & have XY chromosomes. There is no ambiguity that the IOC do not care if a female gets seriously hurt. Or worse. I’m astonished at the weakness of the media
J. K. Rowling was furious:
Could any picture sum up our new men’s rights movement better? The smirk of a male who’s knows he’s protected by a misogynist sporting establishment enjoying the distress of a woman he’s just punched in the head, and whose life’s ambition he’s just shattered.
This is pretty strong even by Rowling’s standards. Rowling provided her followers with links to helpful “factsheets” from an organisation called “Sex Matters“. These fact sheets explain that there are 40 intersex conditions, some of which are OK, in their opinion, for athletes competing in women’s sport, but that Khelif probably has a condition called 5-ARD (no evidence is provided for this assertion) which makes her male – thus she “really is” a man beating up women.
Sex Matters is an organisation founded by Maya Forstater, who was sacked by her employer for transphobic tweets but managed to win a high court judgement on appeal that her gender-critical beliefs were protected under the equalities act. Although ostensibly an organisation with biological sex as its focus, the team of 10 running Sex Matters does not contain a single biologist (or any other kind of scientist). One of them has a maths degree but that’s as close as it gets. Its advisory group consists of 22 people, none of whom is a scientist. The only person with scientific training associated with the organisation is a postdoctoral researcher (a junior, non-tenured researcher) at the University of Manchester who is one of the 5 members of its board of trustees. This organisation – a lobbying group that masquerades as a body promoting understanding of biological sex – reminds me of the institutes in the US established to defend young earth creationism; they have the trappings of organisations that do evidence-based scientific work but none of the expertise to do it.
Sex Matters has made its diagnosis on the basis of no evidence at all, because the nature of the test carried out by the International Boxing Association (IBA) has not been revealed. In a statement on 31/7/24 they said
“Point to note, the athletes did not undergo a testosterone examination but were subject to a separate and recognized test, whereby the specifics remain confidential. This test conclusively indicated that both athletes did not meet the required necessary eligibility criteria and were found to have competitive advantages over other female competitors.”
Khelif, her family and the Algerian Olympic Committee have vigorously asserted that she was idenfitied as female at birth and has lived her whole life as female. Nobody has said that Khelif has 5-ARD. If (and this has not been confirmed) she has an intersex condition, we do not yet know what it is. A lot is being concluded on the basis of no evidence.
There is of course a political dimension to this. The IBA is Russian-controlled and one could quite well imagine that intersex athletes would be a useful tool in attempts to undermine the International Olympic Committee, which banned Russian athletes from the Olympics because of widespread concerns about doping. The leaking of information by the president of the IBA is quintessentially consistent with Russian tactics in the propaganda war, knowing that an army of transphobes would willingly do their work of undermining the IOC. The award of a $50,000 prize by the IBA to Carini in the aftermath of her defeat is laden with political significance.
Sky News and BBC News have provided a very interesting analysis of the politicisation of the IBA. Sky News reports
“The timing [of Khelif’s disqualification by the IBA] has also raised warning signs, with Khelif disqualified three days after she won a match against Azalia Amineva, a previously unbeaten Russian prospect. The disqualification meant Amineva’s official record was perfect once again.“
It has been assumed that Khelif is a cheat, that she somehow “knows” she is “really” a man, that she has knowingly sought to deprive women of their just desserts. None of this is proven – it is conjecture. Add to this that Algeria, a poor African nation, has won few medals in any olympics, and the debate becomes very complex. On the strength of supposition and groundless conjecture, the transphobes have poured bile on Khelif. Of course they recognise that she is not a transwoman, but they have turned her into a convenient type – the man pretending to be a woman who abuses women – to further their broader agenda. I know that Rowling was abused by a partner earlier in life, and of course I am sympathetic to the pain that she suffered, which must have been unspeakable. But attempting to cast anybody who deviates from gender norms as a type of her abuser seems to be as wrong as it is inaccurate.
Intersex Conditions
At present, it remains a matter of conjecture whether or not Khelif has an intersex condition; for now, she continues to assert that she is a woman and that she has been female since birth. However, the prevalence of disorders of sex development (DSD) among elite female athletes is significantly greater than that in the broader population.
The biology of intersex conditions is complex. Wikipedia provides a list of the bewildering number of intersex conditions. Among these are a number in which the individual has external female genitalia despite XY chromosomes. These include congenital adrenal hyperplasia, in which the individual leads to the formation of an apparent vulva, and androgen insensitivity disorder (AIS) in which the body’s cells are unable to respond, during development, to androgens, or “male” hormones. The Intersex Society of North America (ISNA) has provided a wealth of helpful information on interesex conditions. In relation to AIS it says:
“In an individual with complete AIS and karyotype 46 XY, testes develop during gestation. The fetal testes produce mullerian inhibiting hormone (MIH) and testosterone. As in typical male fetuses, the MIH causes the fetal mullerian ducts to regress, so the fetus lacks uterus, fallopian tubes, and cervix plus upper part of vagina. However, because cells fail to respond to testosterone, the genitals differentiate in the female, rather than the male pattern, and Wolffian structures (epididymis, vas deferens, and seminal vesicles) are absent.”
For such individuals, the genotype (the genetic make-up) is male but the phenotype (the observable characteristics or traits) is female. It is very likely that an individual with AIS would remain unaware that they had an intersex condition unless a specific test was carried out. Such tests are not routinely performed in any nation. Thus Rowling’s claim, that Khelif is “a male who’s knows he’s protected by a misogynist sporting establishment enjoying the distress of a woman he’s just punched in the head” may be as baseless as it is offensive.
The ISNA goes on to say:
“When an AIS girl is diagnosed during infancy, physicians often perform surgery to remove her undescended testes. Although removal of testes is advisable, because of the risk of cancer, ISNA advocates that surgery be offered later, when the girl can choose for herself. Testicular cancer is rare before puberty.”
Although the ISNA recommends allowing each intersex individual to make their own decision about gender, the phraseology is significant here: “ISNA advocates that surgery be offered later, when the girl can choose for herself“.
Testosterone and Performance in Sport
A number of hormones are referred to as “androgens”, the most important of which is testosterone. Although often referred to as the “male sex hormone”, testosterone is also produced by women, and oestrogens, the most important female sex hormones, are also found in men but at lower levels. In women, hormones are produced in the ovaries, while in men they are produced in testes. Both testosterone and oestrogen are synthesised in the body from androstenedione, and this in turn is synthesised from cholesterol, an essential molecule in the endochrine (hormonal) system. The human body produces cholesterol in substantial quantities because it is a precursor to many important molecules, including hormones; disregulation of this pathway plays a critical role in causing heart disease, and the revolutionary impact of statins on the prevention of heart disease comes from the way that they enable clinicians to regulate the biosynthesis of cholesterol.
All other things being equal, a typical post-pubertal male born with testes produces significantly more testosterone than a typical female born with ovaries. In puberty, the surge in testosterone is associated with development of increased physical stature (according to NHS data the average heights of men and women in the UK are 1.76 m and 1.62 m, respectively) and muscle mass in males, together with the development of facial hair, while in pubertal females the commencement of menstruation and the development of larger hips and breasts are associated with the higher levels of female sex hormones.
Thus, it seems natural to assume that increasing the concentration of testosterone in the body would lead to enhanced athletic performance. To test this hypothesis, one Swedish research group recently compared the concentrations of androgens and their metabolites in samples taken from 106 female Swedish Olympic athletes with values measured in samples obtained from a control sample of 117 age and body mass index-matched women.1 The two groups displayed similar mean testosterone concentrations. However, the athletes displayed elevated levels of three testosterone metabolites, dehydroepiandrosterone (DHEA, 7.3 ng/mL vs 5.5 ng/mL for the control), 5-androstene-3β, 17β-diol (5-DIOL, 713 pg/mL vs 626pg/mL for the control) and etiocholanolone glucuronide(Etio-G, 30.0 ng/mL vs 23.7 ng/mL for the control). They also displayed significantly lower body fat (18.4% vs 31.7% for the control group) and enhanced lean mass (78.0% vs 66.0% for the control group).
These data are consistent with the hypothesis that elevated levels of androgens lead to performance improvements in athletes. However, for the athletes in the study by Eklund et al, the androgens were endogenous (i.e. produced by the athletes themselves). The athletes in the group did not include any individuals with disorders of sex development, so the explanation must lie elsewhere. The authors noted that there were significantly increased levels of menstrual dysfunction among the athletes (15% compared to only 3% in the control group). One possible explanation for this is that there is a higher incidence of polycystic ovary syndrome (PCOS) among elite athletes. PCOS is a condition that leads to androgen production at levels about twice those in other typical females, together with increased hair growth, irregular periods and difficulties in conception.
PCOS is known to be prevalent at much higher levels among elite female athletes than among the general population. In an early effort to define eligibility for female sports, World Athletics (formerly the International Association if Athletic Federations, IAAF) set an upper limit for serum testosterone in female athletes of 10 nmol dm-3. [2] This was adjusted more recently to 5 nmol dm-3. [3] Levels in healthy men are in
the range 7.7 to 29.4 nmol dm-3, whereas for healthy women the range is 0 to 1.7 nmol dm-3.[4] Women with PCOS typically have significantly increased testosterone levels – approximately double the concentrations reported for women who do not have PCOS. However, PCOS rarely leads to testosterone concentrations above 5 nmol dm-3.
Thus, PCOS causes an increase in testosterone concentrations in serum that is inaccessible to women who do not have PCOS. Many elite athletes benefit from anomalous physiologies. For example, Sharron Davies benefitted from a height advantage that was an accident of birth but left her needing to swim fewer strokes than women of typical height to traverse the length of a pool; girls with unusually large feet were targetted by team GB in its development programme for rowing because this large shoes sizes were found to be correlated with better performance in rowing; and of course elite basketball players are typically freakishly tall. Nobody is earnestly seeking “typical” physiology in the quest to identify potential elite athletes. In relation to testosterone levels the question concerns “what is fair?”
The upper testosterone limit for female athletes has been set in such a way that most women with PCOS are included. This upper limit remains below the lower end of the “typical” range for male athletes. However, it plainly confers a significant performance advantage over women who do not have PCOS. But what of intersex athletes? How much additional advantage might an XY intersex woman have over an XX woman?
Giving exogenous testosterone supplements to XX women leads to an increase in athletic performance. But the relationship between athletic performance and serum androgen concentrations is complex. Writing in Scientific American [5], Grace Huckins discusses a paper by Stéphane Bermon, head of World Athletics’ scientific team, in which data from two international athletics competitions were analysed and which reported that women with higher levels of testosterone performed better, on average, than women with lower levels. Huckins comments that because this study is based on real-world data from elite female runners, it arguably represents the most relevant findings in the hyperandrogenism controversy to date. However, when she trawled through the data, Huckins reports:
“When I performed a procedure called correcting for multiple comparisons—a statistical method that takes into account the increased probability of finding at least one false positive when many statistical tests, as opposed to only one, are conducted—on his reported results, these effects disappeared. This complication does not imply that there is no relation between testosterone and athletic performance in women. What is certainly the case, however, is that far more research is needed before a firm conclusion can be reached.“
While there is an obvious connection between testosterone and muscle mass, Huckins comments that the real nature of the connection could be much more complex.
“One fascinating example comes from the work of neuroscientist Melissa Hines, who studied girls with congenital adrenal hyperplasia, a condition in which intersex traits arise in XX females because of unusually high levels of androgens. Hines showed that these girls tend to engage in play behavior seen relatively more often in boys, such as horseplay. More recently, however, she demonstrated that the girls do not necessarily prefer horseplay over dolls: they just do not care about what other girls tend to do. Most young girls will prefer to play with a red ball over a blue ball if they see that other girls are playing only with red balls, but girls with congenital adrenal hyperplasia will happily play with either toy. Testosterone does not make girls more likely to wrestle than to read; it simply changes the extent to which they respond to social cues about gender.“
She goes on to add
“When critics argue that intersex women are basically “biological men” who just happen to have clitorises and labia, they are completely neglecting the enormous influences that the categories “men” and “women” have on all of our lives—and on all of our bodies. Testosterone is not some mysterious entity that comes from nowhere to exert a huge influence on our bodies and our minds: it both changes and is changed by gender norms.”
Moreover, in men, the relationship between testosterone and athletic performance is surprising. As I described previosly, one study recently reported blood testosterone concentrations for elite athletes from a wide range of sporting disciplines (for a summary, see this web page). There were two really striking findings. First, a quarter of male athletes had low testosterone concentrations – thus among men testosterone is perhaps less well correlated with athletic prowess than might at first be expected. Second, a significant number of femqale athletes had serum testosterone levels that exceeded 5 nMol. The women who displayed very high testosterone concentrations were found to be predominantly competing in track and field and rowing, disciplines where muscle mass is of course important.
Its Obvious
Debbie Hayton, the transphobes’ favourite tranny says:
“The truth is that everyone knows the difference between men and women. Distinguishing between the sexes is an evolved instinct that we share with other species, and we were doing it long before anybody knew anything about chromosomes and genetics.“
However, evidence to the contrary is abundant. Many intersex athletes have been unaware that they had disorders of sex development until testing revealed this to be the case later in life. Possessing female sex characteristics, and female genitalia, they quite naturally assumed that they were women. If sex differentiation really is an evolved instinct that operates perfectly well in the absence of chomosomal data, these women are surely…women.
There is plainly a need for debate about what rules must be laid down to determine eligibility to compete in athletic competitions. The rules may ultimately involve stipulations about serum androgen levels and genotype. However, it is first necessary to have an intelligent, thoughtful and respectful debate about the issues. For an athlete like Khelif who grew up as a girl, and developed to adulthood as a woman, Rowling’s outrageous and offensive allegations of misogynistic violence are entirely inappropriate.
Rowling was abused by a partner earlier in life; in response, we can only express sympathiy and compassion, and join with those campaigning to raise public awareness of the problem of misogynistic violence and abuse, and support calls for the police to more effectively prosecute perpetrators of rape and abuse. However, one gets the impression that for Rowling, many of the issues around trans rights are viewed through a distorting lens formed from the premise that everybody with a Y chromosome is an abuser, and that those with Y chromosomes should be assumed guilty until proven innocent. Thus, Khelif becomes another manisfestation of the abusive partner. This is simplistic, unreasonable and unjust. The reality of misogynistic violence cannot be denied. But it does not characterise or define every relationship between a woman and somebody with a Y chromosome, still less who was idenitifed as female at birth and who has lived her whole life as a woman.
References
- E. Eklund, B. Berglund, F. Labrie, K. Carlström, L. Ekström, A. L. Hirschberg, Br. J. Sports Med. 2017, 51, 1301–1308. doi:10.1136/bjsports-2017-097582
- M. Sudai, J. Law Biosci., 2017, 4, 181–193. https://doi.org/10.1093/jlb/lsx004
- https://www.npr.org/sections/thetwo-way/2018/04/26/606039409/iaaf-sets-new-limits-on-testosterone-levels-in-women
- https://www.ese-hormones.org/media/kjaokqdu/femaleathletes_hirschberg_pr_final.pdf
- G. Huckens, Sci. Am. 2019, 324.
Mrs Benn 
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