To simplify, screening should be:
- XY gene?
- do they produce testosterone?
- can their body use testosterone?
Therefore as I understand the consensus - Female category therefore excludes XY genes, except for the special case where their body does not produce male levels of testosterone, or cannot use testosterone.
Rolfe can probably put numbers on the prevalence of each category.
We're talking about
tiny numbers. The number of births where the baby can't be accurately sexed simply by eyeballing what's between its legs has been estimated at 0.018%. In developed countries with decent neonatal care a fair proportion of these are going to be spotted at birth or soon afterwards, so the proportion that are undiagnosed at puberty will be even smaller.
The issue is two-fold. One is that a mis-sexed 5ARD boy is going to stand out athletically if he's competing with girls, even as a child, and so that diagnosis may be disproportionately represented among the élite athletic stream simply for that reason. The other is that countries (South Africa is the one where it's known about, they appointed a German coach specifically for this purpose, but others are probably at it too) actively scout for these boys, who have been registered as girls, in pursuit of medals.
We have to remember that we're not discussing normal variants like red hair or green eyes that just happen to have an athletics advantage, we're talking about pretty major medical conditions which
should be diagnosed as early as possible for the well-being of the person involved. Fertility is the obvious issue, but there are other problems.
So I think it's wrong to look at this simply as a matter of sports eligibility. What the screening process is going to turn up, in a very few cases (and they'll be a damn sight fewer if things like 5ARD are not going to get past, thus ending the incentives to scout for these conditions like "talent"), are actual medical conditions. Whether or not the decision is to let the person compete as a woman becomes secondary to getting the best care possible for someone in need of medical attention.
Initial screening for XX/XY chromosomes might be an approach, but I think it better to go straight for the SRY gene. It would go something like this, for girls aged about 14, who are embarking on the pathway towards élite sports.
A coach, obviously a woman, would introduce the girls to the concept, explain that it's non-invasive and no embarrassing examinations are involved. She would then tell the girls that anyone who has started her periods doesn't have any reason at all to doubt their result, and suggest that anyone who hasn't should have a word with her mother in the first instance, but that her own door is open if the girl wants to discuss it further.
Hopefully this would channel any doubtful cases to their own doctors in the first instance. The majority of these girls will either just be on the high end of the distribution curve of normal age for puberty, or be experiencing a delayed puberty as a result of too strenuous training, which needs to be addressed for its own sake. One would hope that the small numbers of CAIS, Swyer's, 5ARD, PAIS and the more rare things would then mostly be identified and cared for by the medical profession. Swyer's and (probably) CAIS girls might come back into the women's athletics stream when they've had their diagnosis.
5ARD and PAIS are obviously more difficult, if these are really boys who have been misidentified as girls at birth. They're probably beginning to experience male puberty and wondering what's going on. It's never going to be easy for them, but the sooner they can be treated (if necessary) and counselled about how to manage their condition, the better. Obviously nobody is going to insist that they transform themselves into boys overnight, but absent pressures to keep up a pretence to secure a lucrative athletics career many might find that as puberty progresses they're happier acknowledging their true sex. See Erik Schinneger. Who I suspect is not answering his phone right now.
So if all this was in place, the number of mis-sexed boys actually showing up for "sex testing" should be pretty damn small.
First, SRY gene testing. The vast majority are going to be negative, end of issue. This athlete has that result permanently appended to her record and is eligible for women's events. SRY positive cases are regarded not as a simple matter of inclusion or exclusion, but as a medical issue which needs to be investigated for the sake of the child's health. A testosterone test (assuming one can be sure no cheating is happening) will identify the Swyer's cases, but still, this is something a girl needs to know about and come to terms with. The high testosterone cases need to be separated into CAIS on the one hand, and 5ARD, PAIS and the vanishingly rare other conditions that might cause a male to appear female at birth.
The biggest issue is deciding exactly where the dividing line is between CAIS and marked PAIS, and that's above my pay grade. It's a matter for specialist endocrinologists, and there are some people who think that even CAIS - which allegedly confers some marginal male advantages as regards skeletal morphology etc - shouldn't be allowed. But these are extraordinarily rare edge situations where the endocrinologists need to advise the sporting authorities where the line should fairly be drawn, clear guidelines should be drawn up, and adhered to with the maximum attention to sensitivity and care for the mental health of these children.
At the moment the free for all that's going on is about the worst thing possible. There is no incentive at all to identify these DSD cases while the athletes are still children, and every incentive to plough on regardless, constantly assuring a child who is clearly going through male puberty that he's "really a girl" and stoking anger and resentment against anyone who dares to point out the truth. These children need medical and psychological support to navigate their condition as they mature, not gaslighting to railroad them into becoming medal factories.
So I'd say the absolute opposite of what I read in a broadsheet newspaper recently. This debacle shows the absolute
necessity of early, thorough and sensitive sex testing for all girls entering the élite athletic pathway, and absolutely not "look at what happens when you sex-test someone, this needs to be banned outright."
Because, as these boys grow to manhood, as they start to find their full adult strength as they approach their mid-twenties,
people are going to talk anyway. Defeated athletes are going to protest. Repeated debacles are not going to be prevented by saying she's a girl because it's on her passport and look here is a photo of some random child with ribbons in her hair. You bigot.
The only way to fix this is to make sure that female means female, and telegraph it loud and clear that male children are not going to be allowed into the women's events, regardless of passports or upbringing. This will ensure early diagnosis of problematic DSDs so that the children can be helped, and (if appropriate) steered away from élite sports before too much has been invested in this pathway. It will also take the pressure of tall, muscular, successful female competitors, where jealousy and spite might give rise to false accusations. If everyone has been properly tested as a child, then everyone can have confidence that there are no ringers.
Then maybe they could look at enforcing actual drug misuse cases as well.
