Dear Thomas Bach: Two words for you—cheek swab

“If somebody is presenting to us a scientifically solid system how to identify men and women, we’re the first ones to do it.” This stunningly disingenuous statement was made by International Olympic Committee President Thomas Bach at a press conference where he vigorously defended two boxers who were found to have XY chromosomes, fighting in the female category. Though the IOC not only know about, but were using a scientifically solid system of sex screening from 1968 to 1999, Bach is now pretending that this technology doesn’t exist. Or at least, that sex determination is suddenly so difficult and confusing, they have no choice but to let anyone into the female category who claims to be. Similarly coached in the party line, IOC spokesperson Mark Adams warned that we don’t want to “go back to the bad old days of sex testing,” referencing “nude parades” used in the early 1960s, as if there had been no advancements in medicine since that time.

Such an insulting absurdity cannot go unanswered, and it didn’t. In short order, 32 of the world’s preeminent sport scientists authored Fair and Safe Eligibility Criteria For Women’s Sport, presenting the IOC with—tada!—cheek swab screening. The same methods that the IOC used with overwhelming female athlete support from 1968 to 1999. It’s a once-in-a-lifetime, simple, noninvasive, and effective (maybe too effective, if you want to include DSD and trans-identified males in women’s sport) screen that identifies the vast majority of athletes who are unambiguously XX or XY, and flags the tiny fraction who may be DSD for further testing.

Citing the unfortunate eligibility kerfuffle of the Olympic boxers, the editorial’s second paragraph details why the IOC needs to reinstate sex screening, which gets at that organization’s reluctance to protect the female category:

During press conferences at the 2024 Olympic Games, the International Olympic Committee (IOC) invited solutions to address eligibility for women’s sport. We take this opportunity to propose our solution which includes: (a) recognizing that female sport that excludes all male advantage is necessary for female inclusion; (b) recognizing that exclusion from female sport should be based on the presence of any male development, rather than current testosterone levels; (c) not privileging legal “passport” sex or gender identity for inclusion into female sport; and (d) accepting that sport must have means of testing eligibility to fulfill the category purpose.

The letter goes on to recap the history of sex screening, stating that cheek swabs were abandoned in 1999 because of the trauma and stigma that came with on-site (as opposed to the early career screening they now propose) identification of an athlete with previously undiagnosed DSD.

Twenty-five years later, we know more about male advantage, both in trans-identified males and athletes with DSDs, but are challenged by anti-science ideological pressure. The authors of the most recent editorial wrote:

“The participation of male-born competitors (e.g. transgender women) and athletes with certain XY DSDs in female sport is a growing concern. These athletes experience male-typical development from testes producing testosterone, with resultant physiological differences creating athletic advantages and safety risks, even in athletes with XY DSDs who might have been observed as female at birth.”

Another important point in this solution was early universal screening as opposed to the on-site screening done in previous decades.

“However, to preserve confidentiality and dignity, athletes must be screened early—perhaps when they first register in the female category in an affiliated competition and before they are thrust into the global spotlight…. An early, cohort-wide approach that treats all participants equally is overwhelmingly preferable to the current approach that invites targeted testing based on allegation, suspicion, subjective assessment, and bias.”

The editorial ends with a rebuttal to the argument used by advocates of inclusion of men who identify as women that any sort of protection of the boundaries of the female category amounts to “policing of women’s bodies.”

“Rather than ‘policing female bodies,’ screening followed by comprehensive follow-up in the rare cases that require extra consideration, with emphasis on the duty of care to every athlete, will ensure preservation of the female category for fair and safe sport.”

Tommy Lundberg, a Docent in physiology at Karolinska Institute and one of the authors of the letter, wrote in an email, “I think this editorial sends a clear message to the IOC and the sporting community in general about what constitutes fair and safe eligibility for women's sport. I am sure they have recognized the problem. They just seem to care more about appearing to be inclusive than prioritizing fair competition for female athletes.”

Given Bach’s ridiculous play-dumb display, I wondered if Lundberg thought their response would be taken seriously. “Probably not with the current leadership. But if new people come in, that could change,” he replied.

So, why was genetic screening stopped back in 1999? Linda Blade, cofounder of the International Consortium on Female Sport, provided me with another letter of persuasion, this one from a group of scientists and physicians published in 2000 calling for the abandonment of genetic sex verification (cheek swab screening). Ironically, one of the leading voices in favor of dropping the practice was track and field’s governing body, the IAAF (now called World Athletics), and according to this letter, it was the IOC who wanted to continue doing cheek swab screening. Now of course, World Athletics president Seb Coe has set sex boundaries around elite female track and field, and it’s the IOC who is balking at reinstating sex screening.

That turn-of-the-century letter provides some interesting insights into attitudes and knowledge about males in female sports. For one thing, this medically trained group thought athletes with DSDs, even those with 46 XY 5-ARD which is what Caster Semenya was determined to have, did not have unfair advantage. They wrote:

“…women with intersex conditions exhibit no differences in biophysical and anatomic scales relevant to sports performance outside the range of possibility for XX female athletes. Therefore, blanket on-site chromosome screening constitutes invasion of privacy, harassment, and discrimination based on arbitrary assumption of advantage.”

Prior to 2000, the attitude of sports organizations toward men who identify as women wanting to compete in the female category is that this population would be vanishingly small. Not a problem, especially since the bar for transsexual inclusion in track and field was quite high—an orchiectomy. Their use of the term transsexual shows they had not been hit with the firehose that is gender ideology yet. The authors addressed “transsexual” eligibility in the female category in this way:

“Individuals who had undergone prepubertal sex reassignment would be allowed to compete in women-only events. Decisions about postpubertal transsexual cases would be made on an individual basis by the appropriate medical committee within the sport involved.”

Note that, similar to policies today, prepubertal male advantage in sports, that I just wrote about, is ignored, though it’s logical that that advantage persists into adulthood. And it was assumed men who identified as women would be so rare as to be handled on a case-by-case basis. From the very beginning, sports organizations believed, or at least acted on those men’s claims, as they did in the case of Canadian cyclist Chris/Kristen Worley. Worley cut off his balls per the IOC’s eligibility rules for the female category, but he soon found he had no energy, couldn’t train as he used to, so he filed a complaint to get a Therapeutic Use Exemption for testosterone. And won! The IOC and the International Cycling Union agreed “trans women” needed testosterone to be healthy, though women have never been granted a TUE for testosterone, thus tacitly acknowledging trans women are biologically different from females. They’re male. Nevertheless, the IOC, and the people who were proposing the abolishment of genetic screening allowed trans-identified males to compete in the female category. Whether they thought castrated males had reduced their advantage enough to fairly compete with women, or whether they thought the numbers of these men would be so small as to be insignificant, they realized castrated men were still XY and would have been flagged by genetic screening.

The only males these authors were concerned about keeping out of women’s sports were “masquerading men—individuals reared and living as men.” Whatever that means. These men, they figured, would be caught by doping control. “…well-performed doping controls require direct observation of urine sample collection and should suffice as a deterrent for male masquerading.” It’s interesting that the letter writers were confident they could differentiate a “transsexual” from a “masquerading man.” In any case, not a single “masquerading man” was ever netted, but incidence of “females who were found to be SRY positive” were routinely identified, and allowed to compete. For example, at the Atlanta Olympics in 1996, eight athletes were found to have the SRY gene. All had DSDs—Androgen Insensitivity, Incomplete Androgen Insensitivity, or 46 XY 5-ARD. All except two underwent a gonadectomy, and all were allowed to compete. The athletes’ identities never came out.

Even though the prevailing scientific thought was that DSD athletes had no unfair advantage in the female category, the pre-2000 scientists were a little troubled by the frequency of “Y chromosome material” in elite women’s sports. They only give comparative stats for androgen insensitivity syndrome in the general population (quite rare), though the Y chromosome results of 1 in 421 from five Olympic Games could have come from a person with any XY DSD, a trans-identified male, or maybe even one of those “masquerading men”:

“The apparently high frequency of Y chromosome material in elite-class, female athletes is also interesting, but no statistical data are available in a sufficient number of age and ethnically matched, non-athletic females to test relative frequency (Table 2). A rough guess for the frequency of androgen insensitivity syndrome in the female population is 1:62,000.1.” Results from five Olympic Games when genetic testing was being done show Y chromosomes at a rate of about 1 in 421.

Regardless of scientific thought or male-run sports organization policy, or maybe because of it, female athletes supported gatekeeping of their category. They had the most face-to-face experience with XY athletes, and the most to lose. “Educating” women that sex screening was not necessary was one of the letter writers’ biggest tasks. In essence, they used the it’s-progressive-be-kind tack familiar today, framing female athletes’ concerns for fairness as ignorant, bigoted, and unwarranted. They wrote:

“Historically, many women athletes have reflexively supported sex/gender verification policy as a good faith effort to prevent unfair competition. Many initially welcomed it as a reaffirmation of their femininity at a time when cultural biases existed against and certain stigmas were attached to becoming a successful, top-flight woman athlete.' As sociocultural constructs of femininity have changed, so have attitudes toward the need for gender verification. As athletes are educated about the complexities of sex differentiation, the functional and ethical inconsistencies of genetic based screens, and the misconception of unfair advantage underlying the IOC mandate for gender testing, they begin to understand why blanket genetic screening is discriminatory, unnecessary and medically unsound. Because there is consistent anxiety about the potential for cheaters in sports, there are frequent expressions of nervousness among women athletes about the idea of abandoning per se gender verification. Typically, however, as athletes and sports governors become informed, their reflexive assumptions about the need for blanket screening change.”

In 1994, the Women's Sports Foundation “resolved to help educate women athletes about gender verification, issuing a lay review of the debate for athletes and media.” Yes, that Women’s Sports Foundation, the one that now continues to “educate” women that a woman is anyone who identifies as one, and that trans women have no advantage in sports. In 2011, Women’s Sports Foundation published this:

“The Foundation supports the abandonment of chromosomal screening for gender verification. The purpose of gender verification should be only to prevent men from masquerading as females at women-only competitions. Athletes and sports governing bodies should be educated as to the nature, both physical and psychological, of sexual differentiation disorders.”

While it’s possible the impact of androgenizing DSDs on sports performance was not well understood before 2000, it is now, as are the immutable advantages of trans-identified males, yet the arguments against cheek swab screening remain the same as when this group lobbied to end them in 2000:

“…chromosomal based gender testing is irrelevant, costly, and highly discriminating; that it has caused unknown numbers of female athletes emotional and social injury; and that on-site blanket gender verification via genetic screening at Olympic Games should be abolished.”

Back to Thomas Bach and the IOC’s current scientific system of using an F marker on one’s passport and a pinky swear to determine sex, I asked Tommy Lundberg why their group focused their solution on eligibility for the female category instead of Bach’s supposed male/female gotcha.

“I think it can be an advantage not to engage in the toxic debate about what a woman is,” Lundberg replied. “In sport, what matters is whether or not you have the male performance advantage that comes from typical male development. That's what we have been focusing on.”

Attempts to “educate” women out of their valid concerns for fairness and safety, and the need to protect the boundaries of the female category are even more vigorous today than they were 24 years ago. And with increasing numbers of trans-identified boys and men, a weakening acceptance of biological reality, and erosion of women’s sex-based rights, reinstating cheek swab sex screening can objectively protect the female category while maintaining all athletes’ dignity and privacy.