Differences in sexual development (DSD) have become a central point of controversy at this year’s Olympics after “biologically male” Algerian boxer Imane Khelif beat a female opponent in the women’s boxing event.
Khelif had been banned from a previous women’s tournament after failing a “gender assessment” but was controversially given the green light to compete at this year’s games.
And facing Italian Angela Carini, Khelif emerged victorious after just two strokes as her opponent cried “this is unfair” and the match was abandoned.
Khelif has yet to comment on the matter, but speculation is rife that he has DSD, a rare condition that affects only about 1.7 percent of the population.
DSDs, also called “intersex” disorders, can result in apparently female individuals having male chromosomes or anatomy.
The Italian stumbled after a pass from Algeria’s Imane Khelif (in red), who had previously been expelled from the world championships for being “biologically male”.
Khelif faced Carini in this morning’s controversial Olympic welterweight bout
DSD is an umbrella term for more than 40 individual conditions that develop in the womb.
For example, a person may be born with female genitals but have the typical XY chromosome combination of males, as well as hidden internal testes.
They can provide people with unusual combinations of chromosomes and reproductive organs that, in the context of sport, can enhance their performance.
For example, an athlete may be born with female anatomy but have a DSD that increases his or her level of testosterone, a hormone essential for building muscle and strength.
While many DSDs are detected at birth, some only come to light during puberty or as a result of medical operations, tests and even autopsies.
In some cases, athletes have only found out they have a DSD during pre-competition medical testing, leading to their disqualification and ending their dreams of representing their country.
One of the most famous examples of DSD in sport is South African runner Caster Semenya.
Olympic gold medalist Semenya has a DSD called 5-alpha-reductase deficiency, which means she has male XY chromosomes and produces higher levels of testosterone than normal for women.
This DSD can occur in people with female reproductive anatomy and genitalia, as in Semenya’s case.
She has previously detailed how she has male testicles, but they are internal, and she does not have a uterus, but she does have a vagina.
Semenya, who dominated women’s road racing from 2009 to 2019, learned at the same time as the rest of the world that she had DSD.
She was controversially forced to take drugs such as the contraceptive pill to reduce her testosterone to comply with new rules limiting the level of the hormone in women’s events.
Semenya had previously shared how this triggered her ‘panic attacks’, caused her severe stress and made her ‘want to throw up every day’.
The issue of her DSD, and whether she was discriminated against by sporting bodies, has been the subject of a lengthy legal battle.
And she’s not the only athlete caught in the storm.
Fellow runners Francine Niyonsaba of Burundi, Margaret Nyairera Wambui of Kenya and Christine Mboma and Beatrice Masilingi of Namibia have also been declared ineligible to compete in competitions due to DSD.
The rules on testosterone limits had already been clearly laid out following the very public and famous case of Caster Semenya.
While most people with DSD lead perfectly normal, healthy lives, some conditions can be serious and require specialized medical care.
While some DSDs may be inherited, in most cases it is unknown what exactly triggers them during development in the womb.
Globally, up to 1.7 percent of people have intersex traits (roughly the same proportion of the population as those with red hair), according to the Office of the United Nations High Commissioner for Human Rights.
UK charity DSD Families estimates that around 130 babies born in the UK each year need screening for possible intersex conditions.
Historically, people with DSD have sometimes been subjected to shocking medical treatments and still are in some parts of the world.
For example, so-called “corrective surgeries” have sometimes been used to “fix” babies’ genitals to better match one sex, without medical necessity.
For example, male babies born without a penis, a DSD called aphalia, have sometimes undergone “feminization surgery” to create an artificial vagina.
But these surgeries only take into account the appearance of the genitals and not the actual structure of a person’s body.
In the example above, this has resulted in people being raised as girls only to grow facial hair and a deeper voice when male puberty begins, which can cause them incredible distress.
DSD charities have also criticised this “corrective” approach as it is usually driven by societal expectations of how a person should look rather than any medical benefit to the patient.
Olympic gold medalist Semenya (center) has a DSD called 5-alpha-reductase deficiency, which means she has male XY chromosomes and produces higher levels of testosterone than normal for women.
The topic of DSDs and the potential advantage women with these conditions may have has become a controversial issue at this year’s Olympics.
At the centre of the storm is Khelif, who was banned from competing in a previous international women’s competition after tests found she had “male sex chromosomes”, prompting comments that she is a “biological male”.
At the time, International Boxing Association president Umar Kremlev claimed that tests had shown Khelif “had XY chromosomes,” which are an indicator that someone is male.
He added that “they discovered athletes trying to deceive their colleagues and pretend to be women.”
However, amid much controversy, he was allowed to participate in the Paris Games.
In a shocking match today against Italy’s Carini that lasted only 46 seconds, Khelif dominated and the fight was abandoned after she landed two powerful blows.
Sports scientists told MailOnline that pitting a “biological male” against a female opponent was equivalent to pitting a 90kg wrestler against a 60kg competitor.
Khelif has yet to comment on speculation about his medical history, but previously told Algerian media that he has had high levels of the hormone testosterone since birth.
But before the fight, the Algerian Olympic Committee (COA) condemned what it called “unfounded” attacks against Khelif.
“The COA strongly condemns the unethical attacks and defamation against our esteemed athlete, Imane Khelif, with unfounded propaganda by certain foreign media outlets,” they said.
“These attacks on her character and dignity are deeply unfair, especially as she prepares for the pinnacle of her career at the Olympic Games. The COA has taken all necessary measures to protect our champion.”