The Sunday Story: The History of Sex Testing in Sports

0:00The 2024 Olympic Games come to an end today. For weeks, the best athletes in the world have been competing in Paris for the chance to claim a medal. I love watching Simone Biles and the U.S. gymnastics teams with my daughters. Just, you know, seeing that excellence and them winning big, it's been just incredible to witness. Now, it's par for the course for us to see extraordinary female athletes on the international stage. But there's something many people don't know about the women who compete in elite sports. For nearly a century, women athletes have faced questions about whether they were in fact women.

0:42And over the years, they've had to take tests to prove it. This is the subject of a new podcast series called Tested. It's from NPR's Embedded and CBC in Canada. Tested digs into the history of sex testing in elite sports, and it focuses on a particular group of runners who these days are labeled DSD athletes. DSD stands for Differences of Sex Development. As a catch-all medical term used to describe a condition in which a person's chromosomes, sex hormone balance, internal anatomy, or external genitalia don't develop as expected. And sports authorities believe some women with DSDs have an unfair advantage in sports because they have higher levels of testosterone than what is considered average for a woman.

1:41These questions about fairness and who can compete as a woman are alive and well. Just last week in Paris, two female boxers, Iman Khalif of Algeria and Lin-Yu Ting from Taiwan, faced questions and hateful commentary about their gender. Last year, the International Boxing Association had disqualified the two boxers, saying they failed unspecified sex eligibility tests. But the International Olympic Committee, known as the IOC, defended them and said they were eligible to compete in the women's category in the Olympics. Over in track and field, the people who govern the sport say that in order to be eligible for the female category, athletes with DSDs must lower their testosterone.

2:30And that requires taking medications that can have pretty bad side effects. Rose Eveleth is the host of Tested, and they've been reporting on the story for a whopping 10 years. Before the latest boxing controversy broke out last week, my colleague A. Martinez spoke with Rose about the series, how it came about, and how this history of sex testing continues to resonate today. Stay with us.

3:00This message comes from NPR sponsor Walmart. Did you know that Walmart is one of Fortune's 100 best companies to work for in 2025? It's no surprise. Walmart is investing$1 billion in training and development to help associates build lasting careers with or without a degree. In fact, 75 % of Walmart management started in hourly roles. With benefits like health care, paid parental leave, and tuition support, Walmart isn't just a place to work. It's a place to grow. Learn more at walmart.com slash spark. Rose Eveleth joins me today. They are a journalist and producer whose new series, Tested, examines the history of gender sex testing in sports.

3:46Rose, welcome to The Sunday Story. Thanks for having me. All right, so the series is all out now for people to binge if they want. Six parts in total covers over 100 years of sports history. That is a lot, Rose, 100 years. So how did you discover this topic and what made you want to tell the story? Yeah, so this for me started a long time ago, actually. I've always been a sports guy. I love sports. I love playing sports. I love doing sports and following sports. And I was an intern actually at Scientific American way back when I was first starting my career in journalism. And I was always looking for sports stories to write about.

4:21And I had also been assigned a lot of stories about really fancy prosthetic devices, you know, bionic arms and all that stuff. And so I was looking for something to write about to prove my worth as an intern. And I found the story of Oscar Pistorius, who at the time was very famous for being sort of this bionic man. They called him the Blade Runner. He's a double amputee who ran on these two cheetah blades. He really, really wanted to run against able-bodied runners. And there was a big debate about whether he should be allowed. And, you know, there were rival labs and these questions of how do you measure an unfair advantage?

4:54And as I was researching that, I came across Castor Semenya. another South African runner who in 2009 had sort of burst onto the world stage and won an incredible race in Berlin at the world championships. And it sort of, instead of being celebrated, wound up being sort of thrust into this media circus around her gender, people saying things like, well, she's maybe not totally a woman. So it's, of course she won. She has this advantage. I had sort of seen that happen in 2009, but I think it was so confusing to me that I It didn't really register. And then when I got interested again, it just hit some neuron for me where I just could not stop thinking about it.

5:33And I spent the last 10 years researching this. I've been pitching this story for eight years, actually. And so I'm very thankful that both the CDC in Canada and NPR picked it up. So before we dive in more on Semenya's story, because, yeah, that's also a very fascinating case. For me, Rose, this goes back a long, long way. I remember specifically when Tiger Woods left Stanford early to become a professional golfer. And then about a year after that, he got LASIK surgery. So one of the most physically gifted golfers out of college now all of a sudden has the eyes of an eagle in his head in a sport where you need great eyesight.

6:10So I always thought about what exactly means to have an unfair advantage or just an advantage. And what exactly does that mean when it comes to how we judge people's performance? Are they getting too much of an advantage, if that makes any sense? Totally, totally right. And it is this ongoing question in sports, right? There are certain kinds of injections that baseball players get into their shoulder, right, to like rejuvenate the tendons of the shoulder. There are people who have said, this is a rumor that I have never been able to confirm, that some pitchers are getting preemptive Tommy John surgery, right, to replace the tendon in their elbow.

6:42Is that unfair? I think it's such a fascinating question. And so much of sports is about these tiny margins and these little advantages that you're going to get by doing one thing or another that it is so fascinating. OK, so back to Semenya for a second. So tell us about her story, what wound up happening to her, because that's one of these stories that I think is in so many ways so unfair because we kind of don't understand a lot of what happens when it comes to someone in her situation. Yeah, so Kastor Semenya, incredible runner from South Africa. She is known in the track and field world in 2009.

7:18You know, she's winning races. She's looking really strong. But because of the way sports media works, there's not a lot of coverage of races in South Africa, in Southern Africa, in Africa in general. But I did talk to somebody who was covering track in Africa at the time, a journalist named Celestine Caroni. Some athletes told us, oh, there's this new girl in the 800 meters. We really doubt. whether she's female. And I'm like, yo, back up, what do you mean? And they were like, we are not sure about her. For them, it was how she looks and how she speaks. And one of them actually was like, I thought she was just too fast for a girl.

7:57And I honestly didn't make anything of it until the 2009 World Championships, when now all hell, so to speak, broke loose. Because Kastner doesn't really get global attention until she goes to the world championships in 2009. They're held in Berlin. And she wins this 800-meter race. And she wins it handily, right? She kind of runs away with it. This is a junior, an African junior champion who has come out of nowhere and is running away with this world championship final. 1.55.46, the fastest time again in the world this year for this unknown, Castor Semenya of South Africa. Castor's really strong.

8:40She's got this really great personality that you see in, you know, athletes where she's flexing at the camera. She's really confident. And she shows up and she wins. And, again, instead of being able to celebrate that win, she winds up being accused of maybe being a man or at least some percent a man. You have the head of the track and field organization say, you know, yes, she is a woman, but maybe not 100%. And there's all this speculation about her body and her biology and who she is and all of this. And it was really confusing, I think, for everybody at the time because there was – most people weren't saying, oh, she's actually a man in disguise or anything.

9:21That's not really what people were saying, but it was this much murkier there's something wrong about her. She's not a correct woman in some way or another. And this conversation wasn't just happening privately among athletes. It was also happening very publicly. We have more now on a controversy that has erupted in Germany after a championship track meet there. The big question this morning is whether one of the runners should be in the men's or women's race. Officials ordered her to undergo a series of tests. They are looking for proof that South Africa's golden girl is not a boy. Semenya might seem masculine even for an 18-year-old boy.

9:57And to most eyes, she does not look like a girl. Castor winds up in this really weird position because at the time, in 2009, there weren't really any rules on the books that regulated the participation of athletes like Castor who have variations in their sex biology. So there was no rule saying that she couldn't run or that she had to run with certain restrictions. but also apparently the track and field organization uh which at the time was known as the IAAF is now world athletics they decided that still it wasn't quite right so according to her memoir they kind of come to an agreement her team and the IAAF come to an agreement and they say okay you can run but you have to get your testosterone level she is castor has higher testosterone level than um the quote-unquote average woman you have to get your testosterone level down to below a certain number for six months, and then you can race again.

10:46But this all happens in private. And just to be clear, Rose, there's no suspicion that she's injecting herself with testosterone. No, no, yes. This is naturally occurring testosterone, no fault of her own. Correct, yes. Her body makes more testosterone, and there are a lot of reasons why this can happen. They're sort of broadly in medical terms called differences of sex development, DSDs. She's a DSD athlete is the way that world athletics refers to her. And yeah, so there's no cheating going on here. This is how Castor was born. There are other women like this. They're born like this. And so Castor in this situation was asked to regulate, which meant taking medications to lower her testosterone level.

11:21And so she does that. And she actually gets back on the track. But because this deal that she's made with the IAAF was in private, nobody knows. And so there's this moment where she gets back out on the track, but everyone thinks that nothing has changed. And then again, you get this new cycle of people saying, well, should she really be here? Is this really fair? So Castor is kind of the biggest name in this sort of modern era from 2009 onward. And she's kind of the first big sort of famous case of this happening. But she's certainly not the only one. And how has what happened with her impacted other athletes?

11:54Yeah. So, you know, Castor burst onto the scene. Like I said, there's no policy. And I think that the governing body of track and field, I think they probably realize that this is not sustainable. You can't have this situation where you have one deal in private with this one athlete, but no rule that says this or that. So they put together a working group. And in 2011, they come out with this new set of regulations that regulate testosterone. And we're kind of living in that era. We're living in the sort of testosterone era of regulation of female athletes. Those exact terms of the testosterone rules have changed over time.

12:25In 2023, last spring, they updated them again. But now what it means is that some women with certain DSD conditions have to regulate their testosterone. And again, this is naturally occurring testosterone. They have to bring it down to a certain level. So I've been traveling around the world to meet these athletes who are regulated by these policies, including Christine Boma. So Christine Boma is this superstar in Namibia. She won the silver medal last Olympics in Tokyo in the 200 meters. And she is one of these athletes who is now sort of being regulated and told that she has to take this medication.

12:55So she is actually choosing to go for the medication, try and lower her testosterone so that she can stay on the track. There are other athletes who I talked to for the series who chose not to do that and went different directions. But Christine is trying. She tried to make it to Paris and tried to kind of get it back out there. So, Rose, the two athletes we've been talking about are both from Africa, the southern part of Africa. But generally, who is most impacted by these policies? It's a good question. I think it's an important question. As far as I know from all my reporting, all of the women who have been impacted in this more modern era since 2009, since Castor, are all black and brown women from the global south.

13:32I don't know of any woman who is not in that category who's been impacted by these policies. So what do you think? I mean, why them? Why is that? Yeah, I think there are a lot of reasons for this. One is that these tests are not done on every single woman. They're only done if a woman seems like perhaps she might fall into the DSD category. And it's not really clear what that means and who gets to decide. The actual process by which an athlete gets tested is really opaque. But there are a lot of folks who have suggested that there is a racial component to that, that some women look more like women and some don't.

14:10And there's a long history of black and brown women being, you know, written about and perceived as less female, less womanly, less feminine, right? There's a very long eugenic colonial racist history there. There is also the fact that there is a big gap in health care between different places. And a lot of people point to this as one of the reasons why you're seeing this. So in general, broad strokes, folks in the global north tend to be born in hospitals, tend to go to regular checkups when they're babies, and will probably be diagnosed with some of these DSD conditions, differences of sex development, early and maybe treated.

14:43But in general, if you're an athlete in the global north, by the time you're 18, 19, breaking onto the world stage, running in these big events, you already know that you maybe are one of these athletes and maybe you're already taking some kind of medication. That is not true in the global south. You know, the women I've been traveling around and visiting, they are not born in hospitals. They're not going to regular, you know, pediatric checkups. They are learning this about themselves when they're 18 or 19, when world athletics asks them to take a test. So all of a sudden, you know, Christine is being told, hey, actually, there's this thing that you didn't know about your body, that you're different in this way.

15:14And that's total news to them. And so I think there's also that going on. So there's many, many layers here of why this is the case. Now, World Athletics has rejected any suggestion that their policies are racist. There was a Human Rights Watch report that came out about these distinct racial imbalances. And in response, World Athletics put out a press release, which I have here, and I'll read a quote to you from. They say, quote, we remain committed to fairness for women in sport and reject the allegation that biological limits are based on race or gender stereotypes. And I should also say that I did reach out to World Athletics for the podcast, but they declined to be interviewed.

15:49So, Rose, I mean, none of this is brand new. I mean, we're talking about the latest stuff here, but I mean, this goes back a while. How far back does this go? Yeah, I mean, this really goes back to the very first time women step on the track at the Olympics. 1928 is the first year women are allowed to compete in track and field at the modern Olympics. And immediately you have men pointing at athletes saying, that's not a woman. There's something wrong with her. And 1936 is the first policy on the books where they have a rule that says, you know, if there are questions of a physical nature, they're very vague about what those questions might be, but that these women could be examined.

16:26And for many years, for decades after that 1936 policy, there was this kind of case-by-case basis examination. And then in 1966, they decide that actually we need to test every woman. And the way we're going to do that is what are called the nude parades or the peak and poke tests, as some of the athletes called them, which are kind of what they sound like. They would take women into a room and they would ask them to get naked so that they could examine their body. And we actually talked to some women who had to go through this and who were very bewildered as to why they had to do this, what was going on, and about how terrible it was.

17:01Women like Carol Martin, who threw the discus at the 1966 Commonwealth Games. And she told me just how shocked she was. I remember we were taken under the stands before the competition into a large room and had to pull my pants down in front of this woman so she could see I had a vagina. I remember thinking, what the f*** is this? And I was a nice person. I never said that at the time, but I remember thinking, whoa, this seems a little invasive. This seems a little inappropriate. I mean, can't you see I'm a girl? Oh, unsurprisingly, those tests were very unpopular. And I think sports organizations knew that that was sort of not long for this world.

17:52So nude parades really only last a couple years. And then they decide, OK, well, we still need to test all athletes to make sure they're women. But we need to do so in a way that does not involve these very invasive and terrible physical examinations. And so they come out with a new test called the bar body test, which is a way you look into the microscope, you look at someone's cells. And if you have XX chromosomes, you'll see this little black dot. And that's called the Barr body, named after Canadian Murray Barr, who, fun fact, actually wrote to the IOC several times being like, please stop using my test like this.

18:22This is not an appropriate test. And it does not actually show what you think it shows. But they committed to that. Then from 1968 all the way to 1999, for 30 years, every woman who competed at the Olympics had to go through one of these chromosome tests and get a certificate of femininity, a little card. It looks a little bit like your, like, library card or your driver's license that has your photo on it. And you had to show it for every event. There's one woman who did not have to do this. One exception was ever made, and that was a princess. Princess Anne did not have to do this. She got an exemption because she was a literal princess.

18:54Every other woman had to do this and show their card, which is sort of mind-blowing to me. I mean, if you wear the crown, can't you just wear the crown and not show the card? Yeah. Yeah, it's very funny. Princess Anne was like, I'm not doing that. And they were like, okay. When we come back, Rose and A get into the question of fairness in sports. Stay with us.

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20:05So let's get into the science because these systems and these systems of evaluation are developed by sporting bodies. They aren't necessarily experts on human bodies. So what does the science say about these women and whether they actually have an advantage or not on their fellow competitors? It's such a good question. And as a science reporter, it is one of the most frustrating ones that I encountered in reporting this because the real answer is that we don't know. We don't have good science done here. There is a really big debate in this space around what evidence is appropriate evidence and which kinds of studies are actually worth looking at when we look at these women and which ones are not.

20:47And so right now, the argument that World Athletics is making is that these women that we're talking about, these women with DSD conditions, are, in their words, biological males. And what that means is that they don't need necessarily to study these women in particular. all they have to do is look at all of the literature that exists in science around the sports performance of men. Now, there are a lot of other experts who say that's not how evidence is built, right? That's not appropriate. These are not equivalent populations. What you would want to do if you were going to do an ideal study here is that you would look at these DSD athletes that are being regulated and you would compare their performance and their testosterone levels against the women who don't have those DSD conditions and aren't performing.

21:29That study, as far as I know, and I have asked every single person I could find, that study has not been done. So we don't know. We have a lot of sort of tangential evidence. We have some ideas around, you know, what testosterone maybe does to the body. But we don't have good evidence, really, to pinpoint the advantage that these women have, which means that this conversation gets really complicated and confusing, I think, because both sides come into the argument saying, no, no, the science is on our side. And so if you are a layperson or even a science reporter and you're hearing both sides say that, it is very confusing to figure out who is right.

22:06So this brings us back then, Rose, to the age-old question of fairness and what is fairness. How do you go about answering a question that might not really have an answer? I mean, can you tell me what fair is? I cannot. I mean, I can tell you what I believe fair is, but I cannot tell you what you should believe fair is. And I don't think there is an objective value for fair, right? And this is, I think, a thing that is one of the reasons this story is so interesting to me is that I think we would love for there to be a scientific test for fairness. That would make our lives so much easier. But that's not how it works, right?

22:39We can use science to try and help us understand what's going on. But science can't tell you what is fair. That is, at the end of the day, a value judgment that you have to make. And then, in my opinion, you have to then own that choice that you've made. And that's why this gets so thorny, right? Why is this fair? And some people say, yeah, this is fair because these women, I believe these women have an advantage even if it is small and these other women on the track don't. And so it's important for me to create as much of a quote unquote level playing field as possible, right? And that's what I think is fair.

23:10And then there are other people who say, well, wait a minute, this isn't fair because these women, again, aren't doing anything. They were born like this. How is it fair to ask them to remove whatever potential small advantage they may or may not have? and that's a subjective decision at the end of the day and that's I think why this is such a complicated topic is that it isn't like oh we'll just do a blood test and we'll tell you what's fair you know we'll make a measurement we'll do a calculation and that's why you can debate this till the end of the day and in some ways that's also why some sports organizations can just kind of do whatever they want because there isn't necessarily an objective truth here or an objective, like correct answer.

23:53Yeah. I mean, is it fair that Michael Phelps has the lungs of a whale? Usain Bolt has a stride that's longer than anyone else. So I guess, yeah, that those are questions that we can debate and argue over for a long, long time and never really have a great answer. So, I mean, where do we go from here? I mean, what does the future of this issue look like? You know, the Olympics just happened and we saw, you know, incredible athletes doing incredible things. And the International Olympic Committee has a charter. And they, in fact, in 2021 came out with a framework for fairness and inclusion that argues that sports organizations, if they are going to regulate these athletes, have to do so with evidence that comes directly from the populations that we're talking about.

24:36So that sort of ideal study I mentioned earlier, that you're studying really literally the people that you are trying to regulate. World athletics at this point has not done that. So some people would say, okay, well, IOC, you have this framework. World Athletics is not following it. Are you going to do anything about that? And the answer seems to be no. We'll sort of see what happens. I think that there is a growing movement to try and ask questions about this, but World Athletics has been very clear that this is their sport. They get to make the rules of their sport, and this is the rule that they think is appropriate.