Sex Testing in Sports: Bias & the Science of Genetic Variation

A conversation with Shoumita Dasgupta, PhD, a geneticist, anti-racism educator, and the author of Where Biology Ends and Bias Begins: Lessons on Belonging from Our DNA about transgender athletes in women's sports, the science of human genetic variation, and the relationship between our genetics and our sex, gender, race, and identity.

EPISODE TRANSCRIPT

Susanna Smith

Hi everyone. This is Genetic Frontiers. A podcast about the promise, power and perils of genetic information find us wherever podcasts are found and go to geneticfrontiers.org to join the conversation about how genetic discoveries are propelling new personalized medical treatments, but also posing ethical dilemmas and emotional quandaries. I'm your host, Susanna Smith.

On today's episode, I will be talking with Dr. Shoumita Dasgupta, PhD, who is a Professor of Medicine and Assistant Dean for Diversity and Inclusion at Boston University. Professor Dasgupta is a geneticist by training, and she is an internationally recognized anti-racism educator and the author of a new book, Where Biology Ends and Bias Begins: Lessons on Belonging from Our DNA.

In this book, Professor Dasgupta tackles a number of really big subjects, including the relationships we derive between our DNA and aspects of our identity, such as our race or ethnicity, our sex, gender, or sexual orientation and our understandings of genetic difference and disability. She digs into what is actually known about the inner workings of our bodies and our genetics versus the stories we, as humans, have created to make meaning of our DNA for ourselves. Many of the stories we tell ourselves are detached from the realities of what scientists have learned about human biology. Often these stories are laced with bias and grounded consciously or subconsciously in the idea that human beings can be categorized, organized, understood, and assigned value based on aspects of our biology. It's an overly simplistic idea, but it's foundational to how the United States was built, and how this country and many others continue to operate.

What scientists have found over the last century is that human biology exists on a wide spectrum of diversity, plurality, and complexity that we are only now beginning to understand. Human beings aren't easily categorized or understood through their DNA. What Professor Dasgupta offers in Where Biology Ends and Bias Begins is a guide and a challenge to everyone who wants to dig into how our understanding—and misunderstandings—about human genetics shape how we see ourselves and other people.

Thank you, Professor Dasgupta, for joining me today on Genetic Frontiers.

Shoumita Dasgupta

Thank you so much, Susanna. It's my pleasure to be here with you today.

Susanna Smith

So I want to start with a topic that is very much in the news and the political crossfire today, and has been a hot-button topic in the United States for a long time, which is transgender athletes in women's sports.

In your book, you give a bit of history about how, before genetic testing, women athletes were made to parade themselves, their bodies were certain of their femaleness by viewing, and then only after were they allowed to compete in women's sports. Then in the early to mid-1980s, various forms of chromosomal analysis started to be used in athletics, and in some cases turned out unexpected results. And in the book, you write about a particular athlete, Maria José Martínez Patiño, who was the Spanish national champion in hurdles in the 1980s, and went on to compete internationally.

Could you share a bit of Maria's story with our listeners?

Shoumita Dasgupta

Absolutely, I'd be delighted to. Maria José Martínez Patiño was a track and field athlete. And when she was competing, there were a variety of different sex-based tests that they did to determine eligibility of athletes. And so, in this testing, there was really a major conflation between sex and gender, so it's somewhat helpful to understand the difference between the two. Sex has to do with the biology of one's body. You know, what's in your DNA? What organs do you have? What sex hormones are circulating through your system? And it turns out that sex is typically assigned at birth, based entirely on external anatomy. So, this particular way of determining sex just really doesn't kind of capture the overall complexity of the spectrum of sex, and the fact that sex is not binary, it's not simply male or female, but there are many, many intersex people on the planet as well. Then there's gender. And gender has to do more with, you know, who you identify with in your heart and in your mind. Do you feel like a boy, a girl, a man, a woman, a mix, or none of the above? That has to do with what gender is. And sexual orientation is an entirely different category, which has to do with who you are attracted to and who you love.

Now, in sport, there's a real fixation on binary categorization. The competitive categories tend to be men's sport and women's sport, which are gender designations, but the idea behind it is that there may be biological advantage to having been exposed to certain sex hormones, for instance, during development. So that's really to do with sex, not gender.

When Maria José Martínez Patiño was competing, she had to go through these sex tests, many of which were focused on her chromosomal makeup. So what tends to typically happen is that males typically have XY chromosomes, and females typically have XX chromosomes. When she was first competing, she passed these tests and was given a certificate of femininity, as it was called at the time. But then when she went on to compete in a subsequent competition, she didn't have her certificate with her, so she had to go through a retest. The retest indicated that she did not have two X chromosomes, which is what the previous test had said. So her test had to be repeated.

And this was, you know, kind of humiliating, or at least it called a lot of attention to her, and so she faked an injury to just kind of be out of the limelight while all of this was happening. Once the results came back, it actually showed that she had XY chromosomes, which are more typically associated with male development. If we dig deeper, though, what we found in the case of her own health was that she had androgen insensitivity syndrome. What that refers to is testosterone, which is an androgen, requires different kinds of biological components to elicit a response in human development. She didn't have those components, so she was not responsive to any testosterone in her system, even though she had XY sex chromosomes. Because she was unresponsive to testosterone, her body developed in the typical female fashion. She developed breasts and a vagina, and she identified as a woman in terms of her gender. Probably, if you really think about it, she was likely at a disadvantage compared to other women in her competitive category, and that's because testosterone is present in females and males. So typical females will have the ability to respond to testosterone, whereas she did not. So you could say that she was at a disadvantage. Nevertheless, because she didn't pass this repeat testing, it turns out that she was disqualified from further participation. That disqualification led to her losing her scholarship, her housing in the athletes' residences, her fiancé, her life just was completely blown up. And she, you know, to her credit, really took this as a call to action to work on behalf of other athletes who have different sorts of intersex characteristics and to really to fight and advocate for people to be able to compete in sport, regardless of, you know, kind of not fitting into the typical categorizations.

Susanna Smith

So, I want to back up to something I understood from the book, which was that

Maria didn't have any questions about her sex or her gender when she walked into these competitions. And also just to clarify for our listeners, the testing Maria underwent to receive this certificate of femininity was applied to all female athletes, it wasn't because she was different. This was every female athlete underwent this testing. So could you just clarify that point? But also what did Maria know when she walked into these competitions?

Shoumita Dasgupta

That's a great question and a really important point. It's notable that they engaged in this sort of sex testing or gender testing, depending on their framing, only for women athletes. There's no similar process in place for men athletes. So this was already, you know, kind of a process that has misogyny baked into it. As you said, she didn't have any suspicion or reason to believe that she was anything other than a typical cisgender woman. These tests often will unearth facts about people's identity that they themselves were unaware of.

When I said that sex is often assigned at birth. That really means that a lot of differences or variations in sex development are not actually identified until later on. Sometimes that can happen at puberty. Sometimes that can happen in the context of sport testing. Sometimes that can happen when people are trying to have children. So in Maria's case, you're right, she didn't know at all that this result was potentially in the cards.

Susanna Smith

Yeah, and I think one important point to point out is sometimes that could never be identified, right? Like in Maria's case, it was identified because she was this elite athlete who had to undergo this testing or that's what the sport required. But there's a possibility you could walk throu