At the Paris Olympics this week Algerian boxer Imane Khelif was allowed to fight in the women's competition despite having high levels of testosterone. The Italian boxer Angela Carini was forced to pull out within 46 seconds of the beginning of her fight, collapsing to her knees in despair in the boxing ring.
Khelif appears to be registered as a biological female, but Khelif's hormone regulation appears to be more that of a male, along with various other male-like characteristics of build and stature. In 2023 Khelif was excluded from the 2023 IBA Women's World Boxing Championships because of a positive test for the XY male chromosome according to the International Boxing Association. The International Olympic Committee has also said that Khelif was exhibiting signs of high testosterone.
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Needless to say, the constant pitching of people who walk, talk, behave, look like and have the strength of a man (regardless of genitalia), against females who do not exhibit any male attributes, has left a lot of people understandably very angry.
The chromosome and hormone explanations the organising bodies give above might sound like a load of muddled mumbo jumbo. How can someone be externally female, at least from a genitalia point of view, and have male chromosomes and extra testosterone?
It would be a fair guess to think that Khelif might have had gender reassignment surgery in order to compete as a woman. Though I'm not entirely sure that Algeria is the kind of place males can gain access to gender reassignment surgery, being a largely Sunni Muslim state. Is it possible for a person with female genitalia to be born with XY chromosomes? Can this person have a mixture of male and female features externally? Can a female have extra testosterone? Can males have variations in their sex chromosomes? Can males have extra oestrogen and so on?
If any of these and more combinations are possible, how on earth can we gauge how male or female someone is, to be able to put them in to a specific sex grouping, where they do not have a unfair advantage over the rest of the competitors?
In this article and the following I will explain how it is possible for females to have male chromosomes, for males to have female chromosomes, and what might have caused this to happen.
This certainly doesn't seem a natural part of evolution!
WHERE DID THIS ALL START?
Exposure to transgender issues has been fairly limited until recently. Many also, up until recently, seemed to be learning a mutual acceptance of people who were simply a bit different. But the launching of 'transgenderism' on to the international stage has, in the last decade or so, thrown everything in to disarray.
The transgender call has been getting louder and now is somewhat of a din, being disproportionately pushed by media, politicians and activists.
So disproportionate is the noise it warrants a much closer look.
Transgenderism began as a public movement way back in 1952 with a trans woman called Virginia Prince from California who wrote, together with peers, Transvestia Magazine. From a young age Prince was inclined to dress in female clothing. Prince was under the care of a psychiatrist called Karl Bowman who advised Prince to 'enjoy' the feeling of being feminine.
Karl Bowman, according to Susan Stryker in the book Transgender History, headed up research on sexuality and gender at the Langley Porter Clinic starting during the Second World War. Some of his subjects were soldiers. Bowman set to work to discover the cause of the deviations in sexual orientation, and according to Stryker, to find a 'cure'. Some of Bowman's treatments were pretty brutal, including castration of male sex offenders and administration of hormones in an attempt to change subjects sexual 'deviances' (Stryker, 2019 p.42). He also collaborated with Louise Lawrence, a male who started living as a female in 1942, who would recruit subjects for study.
Stryker details Bowman's written observations of both male to female and female to male subjects as follows:
'I have records of two males, both of whom have asked for complete castration, including amputation of the penis, construction of an artificial vagina, and the administration of female sex hormones. I also have two cases of females who have requested a panhysterectomy and the amputation of their breasts, together with the giving of male sex hormones, in the hope that in some way the clitoris may finally develop into a penis. Male homosexuals of this type are called “Queens” and seem to differ markedly from the main group of homosexuals who are more nearly like the average man. Here we have an extremely interesting field for further investigation. We are therefore setting up a careful plan to study a group of these so-called “Queens.”
Bowman would be an expert witness in a case in 1949 on the question of surgical genital modification. Both he and Alfred Kinsey gave the opinion 'that transsexual genital modification would constitute “mayhem” (the willful destruction of healthy tissue) and would expose any surgeon who performed such an operation to possible criminal prosecution.'
Both Kinsey and Bowman were clearly against this type of surgery. This set a legal precedent to legitimately refuse transexual surgery in America. The transgender community responded by fighting tirelessly for something that they felt they were being denied, and something they felt they desperately needed.
Far from being isolated to the 20th and 21st Centuries, the author Stryker details a number of case studies of people with transgender tendencies. There seemed to be entire communities of women, or men at very real odds with their gender at birth from the later part of the 1800's.
The phenomenon of transgenderism was believed to be psychiatric at first, hence the in depth study by teams of psychiatrists. In some circles today it is also considered to be a delusional condition, one spurred on by intense media interest, overindulgence by some groups and vilification by others. The simple explanation given by the later that if a person has male genitalia they are male and female genitalia they are female. Perhaps we need to scour the photographs of the naked bike ride through London that is often supported by the so-called transgender movement. You might need a pair of binoculars to spot some of the penises and to establish whether someone has breast tissue or not. And there is a good reason for that.
Probably the most influential of forerunners to Bowman's work was a man called Magnus T Hirschfeld. He was a Jewish gay man from German Pomerania who trained as a physician. He set up the Institute for Sex Studies in response to the alarming number of suicides in the gay community, and became prominent in the Weimar Republic (post WWI Germany) for his studies around sex, sexuality and gender.
Hirschfeld was influenced by Karl Ulrichs from Hanover, Germany (Washington post article by Simon LeVay), who made the initial observations of a broad spectrum of 'gayness', where some would be very male, and others’ behaviour was more towards the female. It was the movement towards the female that provided the kernel for study in to transexual drive and behaviour. He divided this spectrum of male sexuality up in to groups as follows as seen in descriptions from the LGBTData Karl Ulrich's sexual orientation classification scheme :
A. Dioning - Comparable to the modern term “heterosexual.”
A Dioning that sexually behaves like a Urning is termed an “Uraniaster.”
B. Urning - Comparable to the modern term “homosexual.”
1. Mannling - A manly Urning
2. Weibling - An effeminate Urning
3. Zwischen - A somewhat manly and somewhat effeminate Urning
4. Virilised - An Urning that sexually behaves like a Dioning
C. Urano-Dioning - Comparable to the modern term “bisexual.”
Ulrich described the state of sexuality as a continuum along a line of infinite variations. This concept would be picked up by Hirschfeld and developed further.
In the article by the Washington Post, Hirschfeld makes a clumsy attempt, however, to simplify the apparent intersex nature of some of his subjects only by aspects that he could physically see. By the end of this article it will become apparent why that methodology is erroneous.
'Hirschfeld even speculated that some gays and lesbians were intersexed in terms of their reproductive physiology: he suggested that it would be worthwhile to examine the vaginal secretions of lesbians for the presence of spermatozoa, and the urine of gay men for menstrual blood. In part, such groundless speculations were the result of Hirschfeld's failure to clearly distinguish among homosexuals, transsexuals, genital intersexes, and gonadal hermaphrodites. But another factor was Hirschfeld's need for visual proof of his theories: he could not rest his case, it seemed, until "lesbian sperm" were laid out for the world to behold.'
It is only in recent years that work has been done to establish whether there is a link between gender dysphoria and actual clinical features. But it seems that STILL the broader clinical understanding of gender dysphoria (or any dysphoria for that matter) seems to try and FIX the problem by pushing the child of increasingly younger age to hormones, drugs and surgery, rather than to understand exactly what is happening within them.
Some explanations given to date for the ‘cause’ of gender dysphoria include exposure to too much estrogen and other hormonal causes (a catch all which doesn't really tell us very much) including congenital adrenal hyperplasia and androgen insensitivity syndrome. Even defects in normal human bonding and child rearing are blamed, ie it is the parents’ fault.
Well isn't everything these days?
Talking therapies have been given, mental health assessments and gender blocking hormones have been given. The premise being that if there is no visible difference in a child or young adult from their sex assigned at birth, then it MUST be something in the mind. Alternatively that person, if they really do not feel they are in the ‘right body’, then everything must be done to push them in to another body. We hear stories about parents attempting to force gender reassignment treatment on children who seem to be neither completely one sex or the other. A futile attempt to normalise a child in to a more socially acceptable version of their parents no doubt.
Perhaps we should not be attempting to normalise them either. Looking deeper in to the issue from a scientific point of view, there seems to be a combination of physically significant developmental issues that are appearing with increasing frequency. These can involve everything from the inappropriate expression of sex hormones as mention above, to the incorrect mixing (recombination) of the parents' DNA in the early stages of development (Note: these are NOT genetic flaws in the parents, but a functional problem with correctly mixing the genes in the fertilised egg), to having too many or too few sex chromosomes, or having a different sex chromosomes in different cells lines. In fact the possible variations are so vast, that the whole sex profile issue seems to echo Ulrich's proposal of a spectrum of sexuality, rather than people being entirely one defined sex or the other.
There is a lot of material on all of the above but I have narrowed it down to Chromosomes for this article to try and keep things bearable.
EXTRA CHROMOSOMES
A number of sex chromosome abnormalities have been identified. To stress, these abnormalities are NOT genetic, these are caused by the processes of fertilisation and the first cells of an embryo going wrong.
Many people with chromosomal issues may be completely unaware of them. Others may exhibit very obvious external signs of a mismatch between genitalia and other physical characteristics. These are the conditions I have looked at so far, with a few details of how people are affected by them. I won't include photographs of diagnosed patients but you can search for photographs of people who have been diagnosed with these conditions, which are often externally imperceptible.
XXY or Klinefelter syndrome is a condition where a male gains an extra X chromosome. This happens in the first cells right at the beginning of fertilisation. Some of the conditions and traits associated with this condition can be:
In boys
Taller than average
Longer legs, shorter torso, broader hips
Absent, delayed, incomplete puberty
Post puberty - less muscle mass, less facial and body hair
Small testicles and penis
Breast tissue
Weak bones
Low energy levels
Neural developmental issues: Autism spectrum, ADHD
Shyness, sensitivity, depression, anxiety, impulsiveness
Social difficulties
Speech delays
Learning difficulties
In men
Low or no sperm
Small testicles and penis
Low sex drive
Taller than average height
Weak bones
Decreased facial and body hair
Less muscle
Breast tissue
Increased belly fat
The diagnosis of this condition is thought to be 1 in 500 males but there are a number of factors that indicate that number could be a lot higher. According to Professor Rob McLachlan, from the Hudson Institute of Medical Research “Worldwide figures suggest that less than half of men with Klinefelter syndrome are ever diagnosed,”
A small number of babies are diagnosed with the condition, but often men will not discover they have an extra X chromosome until they attend a fertility clinic and undergo testing. A study of a large biobank of samples in the UK showed that only 23% of males of the 213 who tested positive knew they had Klinefelter syndrome.
Other conditions in this group include XXYY, which has many of the same features as XXY but three features, learning, behavioural difficulties and height, are more pronounced than in Klinefelter syndrome males.
XXXY Syndrome males may display unusual facial features including skin folds across the inner corners of the eye or wide set eyes, unusual hand features such as a single palm crease or incurving fifth fingers, and malformations in the elbow alongside the other features of Klinefelter Syndrome.
XYY is called Jacob's syndrome where the child gains another Y chromosome from their father. This group may have similar features to the other two groups. In the linked paper, asthma, seizure disorder, and tremors are noted as complications, which may also be present in the other variations.
XYY was also tested for in the biobank sampling mentioned above. Only 0.7% of the 149 who tested positive for this condition, actually knew they had it.
The two groups, XXY and XYY, together numbered 356 in a total of 207,067 males tested, which is approximately one in every 581 males. The samples were gathered from males around the UK aged between 40 and 70 years of age. The paper was written in 2022. This suggests that these males were affected in utero between 1952 and 1982. There is no data included for males born after that date, but I suspect the numbers would increase the closer we get to 2024
In females an extra X chromosome can be acquired resulting in XXX or Trisonomy X syndrome.
This is diagnosed at a rate of 1 in 900 or 1000 girls but again the real numbers are thought to be a lot higher. Features can include some language-based learning and coordination disabilities, above average height, low muscle tone and curving of the pinky fingers towards the ring finger. Around 70% are fertile but some may have issues with menstruation and early menopause. The large majority of females with XXX are never diagnosed.
CHROMOSOME LOSS
Turner's syndrome proper 45,X is normally only found in females, where they carry one sex chromosome X and are missing all or part of the second. It has a number of different types. Females can be short and suffer premature ovarian failure. Some conditions associated with the syndrome are thyroid autoimmunity, congenital heart issues, liver abnormalities, high blood pressure, hearing loss and kidney anomalies.
The condition, like the others mentioned above, can remain undiagnosed. Only 20% are diagnosed at birth, and this is purely down to a pronounced webbed neck, but this is not always apparent in all Turner's females. This paper suggests that females of small stature should be tested for the condition.
Whilst those with the syndrome may have lost the second X chromosome, there is a possibility that the developing fertilised egg lost a male Y chromosome which may account for the loss of ovarian viability. There are cases of males born with the same 45,X but it is very rare because X is the chromosome which conveys femaleness. In this paper the researchers found part or all of the missing Y chromosome, which is a lot shorter than the female chromosome, was still present, except it had somehow fused to one arm of chromosome pair 2.
There is another condition called Swyer syndrome where the person has the male XY chromosomes but there is variation in the failure of gonad development. This variation with gonadal dysgenesis, XY female type, may be the condition the boxer, Imane Khelif, has.
Again there are many variations of this syndrome, where sex identity can be ambiguous externally and/or internally or the person can have a full female set of organs. The only thing they lack are ovaries, meaning they cannot become naturally pregnant. They can gestate an embryo from a donated egg to full term if implanted artificially and supported with hormones to maintain the pregnancy. The exact incidence is unknown of all variations, but births with visible genital anomalies occur in approximately 1 out of 4,500 births. Swyer syndrome can be caused by genetic mutation, or be can linked to X or Y chromosome abnormalities.
MOSAICISM
Mosaicism means that the person carries two or more different genetic sets in their bodies. This can include one normal gene set, and one abnormal gene set, or a combination of abnormal gene sets, with or without a normal set. People with mosaicism may have a higher or lower percentage of abnormal cells. The higher the percentage the more marked the features. Many chromosomal abnormalities can be mosaic conditions.
In fact, in an online article by Yale Medicine, whilst mosaicism can occur at fertilisation affecting up to 50% of cells, it appears that we can all have some level of mosaicism, where some cells express chromosomes incorrectly, and others are perfectly fine! Some people may show small variations in stature or build, hair growth patterns, seem more effeminate as males, masculine as females or being androgynous in appearance. Some may never receive a diagnosis as these small changes are just accepted as normal variations from person to person. Therefore the current estimates could be many times lower than the actual figures of people affected.
Even more confusing is that mosaicism of the inactivated X chromosome (extra X chromosomes should normally stay silent) increases in women with age, and can increase the chances of the development of cancer. In addition the Y chromosome can be lost in males as they age. By the age of 90, according to this study by the National Cancer Institute, almost half of males have lost the Y chromosome in some of their blood cells. This is thought to make males more susceptible to certain types of cancer.
For context approximately 42.9% of all foetuses are estimated to have chromosomal abnormalities, and many do not make it to full term. The older the maternal and paternal parents get, the greater the likelihood of a chromosomal abnormality. A mother aged 39 and above has only an 11% chance of carrying a baby with NO chromosomal abnormalities whatsoever.
This is a staggering level of potential for sex and other chromosome abnormalities, many of which will go undetected for life.
If a mathematician reads this and wants to work out the number of variables for the following it would give us some idea of how vast this particular section of sex variation is (of course there are variations not listed):
cells with 1 sex chromosome only (X and variations)
cells with 2 sex chromosomes (either XY or XX)
incorrectly expressed cells with two sex chromosomes (XY or XX)
cells with three sex chromosomes (eg XYY, XXY)
cells with four sex chromosomes (eg XXXY)
cells with five sex chromosomes (XXXXY)
people with two or more variations of the above.
A BRIEF NOTE ON SEX AND SEXUALITY
Each person may 'feel' more or less male or female, depending on each very unique mix of chromosomes, the impact they have on development either of male or female genitalia and the degree of associated hormone signalling.
These chromosomal abnormalities have been shown to play a role in sexual identity but there is no one particular gene that can be labelled a transgender gene as much as there isn’t one for gay or lesbian people.
Sex and sexuality of transgender and intersex people should certainly be considered as inextricably linked, in the same way we associate mothering instincts with full chromosomal females, and a healthy sex drive with full chromosomal males. If these people feel different from what they can see in the mirror, then perhaps they actually are different, from a chromosome perspective.
But because there is such a wide variation of combinations, percentages of affected cell lines and physical features, it is impossible to tell by two points alone - sex chromosome testing and hormone levels - where a person is exactly on a measurable scale of maleness to femaleness.
Before I move on to how on earth this all happened right under our noses, there are two more questions.
IS THIS NORMAL?
It appears to me that the incidence of transgender and intersex conditions is much greater than it was say 10 years ago. I am certain, having read just the small amount of material linked in this article, that these states of being are not down to psychiatric conditions. However, the affects of being incorrectly 'combined' chromosomally, altered hormonally, structurally and in appearance, must have an impact on the inevitable crisis of identity for these people, many of whom are neither fully chromosomally female nor fully chromosomally male.
Much of the drive to transition from one ‘gender’ to another may be based on the need to feel comfortable internally and externally. But neither the administration of hormones, the creation of plastic surgery genitalia, nor the removal of genitalia can change the chromosomal makeup of these people. Perhaps this is why many detransition and begin the long journey to try and accept themselves as they are, as much as they can after the irreversible deeds of unscrupulous clinicians and surgeons.
Chromosomal conditions cannot be ‘cured’.
And finally...
CAN CHROMOSOMAL CONDITIONS BE ABUSED?
Yes, and they clearly are being. Taking the example of the athlete Imane Khelif, if this person does have Swyer Syndrome, regardless of female genitalia, their build and the presence of XY chromosomes and testosterone all suggest that this person is strongly positioned on the spectrum, of maleness to femaleness, FIRMLY in the male camp.
Perhaps a scale measuring many more factors should be introduced in to sport, to group athletes in a more appropriate way. This would certainly prevent injury to those women who are suffering at the hands of the poor judgement of Sporting Bodies.
Amazing stuff!
Thank you Caroline. A really useful article, it looks like it was a lot of work.