It might seem easy to determine which athletes are male and which female, but it turns out to be much, much more complicated and since the 1960’s the International Olympic committee has been struggling to make the procedure fair.

Today’s article in The Lancet (“The unfinished race: 30 years of gender verification in sport”) was written in part by a Spanish woman who experienced discrimination by the Royal Spanish Athletics Federation from competing in women’s hurdles events because genetic testing showed that she had an XY chromosome instead of a female’s DNA (XX chromosome.)

Not a cheat - she neverknew true sex

María José Martínez-Patiño was later found to have a rare condition, complete androgen insensitivity syndrome which caused her body to produce the proper response to the male hormone testicular androgens.Since all fetuses are female sex unless they develop into males due to the male hormone, she was physically a female with no particular muscular advantages of a male.Therefore a few years later she was again qualified to compete in the women’s hurdles by the European Athletic Association.

How did the IOC test for sex in the past?

Until genetic testing became possible more than 50 years ago, the test was simple, look for the presence of male genitalia.But in 1961 the Medical Commission of the International Olympic Committee began testing the sex of athletes by looking at the XY/XX chromosome.

What is fair in deciding sex?

That might seem even simpler than checking the genitals but it led to athletes such as physically fully female athletes (such as Ms. Martinez--Patiño) who had no male development being banned.Later, since an XY athlete who had no normal response to testosterone could be given extra doses of the male hormone, the IOC added hormone level blood tests to the sexual determination testing.

How many genders are there?

Think that is complicated enough? Well today Australia, Bangladesh, Denmark, Nepal, and New Zealand say there is a third gender.What will the future hold for Olympic athletes? Probably even more complications since the situation today isn’t whether tests can be conducted, but just what results should result in a disqualification for a self-identified female athlete.