Olympic boxers reignite debate over inclusion in women's sports

A boxing match that lasted 46 seconds has dominated the conversation around the Paris Olympics in recent days and reignited the debate about who is eligible to compete in women's sports.

Algerian boxer Imane Khelif advanced to the quarterfinals of the 66-kilogram (145.5-pound) division on Thursday when Italy's Angela Carini withdrew after being struck in the face by Khelif.

"I felt a severe pain in my nose, and with the maturity of a boxer, I said, 'Enough,' because I didn't want to, I didn't want to, I couldn't finish the match," Carini said.

The Italian said she did not abandon the fight to make a political statement.

"I am not here to judge or pass judgment," Carini said. "If an athlete is this way, and in that sense it's not right or it is right, it's not up to me to decide."

Some people near and far from the ring felt otherwise. Commentators on sports shows and celebrities on social media criticized the inclusion of Khelif, referring to her as a "biological male" and, in some cases, as a "man."

In 2023, Khelif, along with an Olympic boxer from Taiwan, had been disqualified from the International Boxing Association world championships. The IBA said Khelif and Lin Yu-ting, who competes in the 57-kilogram (125.6-pound) division, were disqualified because they failed gender verification tests. The IBA did not specify what type of test or the manner in which the boxers failed other than to say that it was not a "testosterone examination but [the athletes] were subject to a separate and recognized test." The IBA has not responded to a request for comment and clarification.

The IOC considers the boxers eligible for the Paris Olympics and said the IBA decision to disqualify the boxers last year was arbitrary. The IOC is managing Olympic boxing because it cut ties with the IBA in 2023 after years, it says, of governance issues, opaque finances and questions about possible corruption.

"These two athletes were the victims of a sudden and arbitrary decision by the IBA," the IOC said in a statement on Thursday. "Towards the end of the IBA world championships in 2023, they were suddenly disqualified without any due process."

Neither Khelif nor Lin has addressed the controversy publicly, and neither has commented on the recent issues surrounding their eligibility. For their entire careers, they have both participated in women's boxing, winning medals and losing matches without incident. Until now.

Khelif, 25, is 37-9 in her career. She competed in the delayed 2020 Olympics in Tokyo and was eliminated in the quarterfinals. She won the silver medal in the 2022 IBA World Championships, losing to Ireland's Amy Broadhurst in a unanimous decision in the final. She was notified of her disqualification before her gold medal match at the 2023 world championships.

"Personally I don't think she has done anything to 'cheat'," Broadhurst posted on X shortly before Khelif defeated Carini at the Olympics. "I thinks it's the way she was born & that's out of her control. The fact that she has been [beaten] by 9 females before says it all."

Lin beat Uzbekistan's Sitora Turdibekova on points Friday to advance to the quarterfinals. Lin, 28, is 41-14 over her career and a three-time world championship medalist with two golds and a bronze. She made her Olympic debut in Tokyo, where she did not advance beyond the round of 16.

The controversy comes at a time when the policy landscape has moved in favor of restrictions for transgender and intersex women. But it also is part of a long history. For as long as women's sports have existed, there has been monitoring of who gets to participate.

Sex verification testing and regulating eligibility for the women's category has historically fallen into four buckets: looking for cisgender men masquerading as women, policing doping, creating policy for intersex athletes and those with differences in sex development and creating policy for transgender athletes.

At the core of these issues is the desire to pursue fairness and to regulate what many see as possible unfair advantages. This has taken multiple forms, but testosterone levels and testosterone-driven puberty have become the focal point of policy in recent years. Testosterone is a hormone that is typically substantially higher in those assigned male at birth and who have experienced puberty. Testosterone can provide metabolic and physiological advantages such as greater speed and the ability to build muscle mass.

Differences in sex development (DSD) or intersex traits describe a group of conditions that are statistically atypical from the norm when it comes to biological sex. "These are individuals who have a hormonal or genetic condition where they have characteristics of both male and female," endocrinologist and former IOC consultant Dr. Myron Genel said. Sometimes differences in sex development can result in higher levels of testosterone. Athletes competing in women's sports with those types of DSD are a focus of policymakers because of the concern that higher testosterone could confer a competitive advantage.

An example is someone who is partially or completely insensitive to androgens, such as testosterone. They may be assigned female at birth but have XY chromosomes because of their body's physiological insensitivity to androgens.

A person with XY chromosomes who has a difference of sex development may not present with characteristics associated with maleness and therefore can be assigned female at birth and identify as a woman. Sometimes these conditions are lumped together as "46 XY DSD." Forty-six is the typical number of chromosomes, XY refers to the chromosomes present and DSD stands for differences of sex development.

There is a difference between transgender athletes and intersex athletes. Someone who is transgender has a gender identity that is not in alignment with their sex, and they may or may not medically transition to address that dysphoria.

Policy regulating eligibility for women's sports can address both of these populations, but in the case of Khelif and Lin, it's unclear if such policy would even apply. There is no evidence that either boxer is transgender, and beyond the failed IBA tests, there is little to no evidence that either athlete has a difference in sex development.

"There has been some confusion that somehow it's a man fighting a woman, this is just not the case," IOC spokesperson Mark Adams said about the Khelif-Carini bout in a news conference on Thursday. "On that, there is consensus. Scientifically this is not a man fighting a woman."

The fight between Khelif and Carini and the subsequent outrage hearkens back to South African runner Caster Semenya's experience in Berlin at the 2009 track and field world championships. After crossing the finish line first in the 800 meters, Semenya was whisked away for a sex verification exam since her gender was questioned. The moment began a nearly 15-year battle between the South African middle-distance runner and World Athletics over her eligibility and that of other athletes like her.

Following Semenya's win in Berlin, World Athletics (then IAAF) instituted policies that required Semenya to medically lower her testosterone, a process she described in an interview with Andrea Kremer as making her sick. "Made me gain weight," Semenya said. "Panic attacks. It's like stabbing yourself with a knife every day, but I had no choice. I'm 18 and I want to run."

She returned to competition in 2010 and competed in 2012 at the London Olympics, where she finished second in the 800 but was elevated to gold following the disqualification of Mariya Savinova for doping. In 2015, Indian sprinter Dutee Chand challenged the World Athletics testosterone requirements at the Court of Arbitration for Sport (CAS), which ruled in her favor. That allowed both her and Semenya to compete in the 2016 Olympics without reducing their testosterone levels. Chand didn't advance beyond the 100-meter heats. Semenya won gold in the 800.

New regulations were adopted in 2018 that affected Semenya's events and would have required her to medically lower her testosterone levels to stay eligible. She challenged the rules at CAS. During the hearing, World Athletics argued that the overrepresentation of athletes with DSD in elite women's athletics speaks to the advantage present. "Approximately 1 in 20,000 of the general population have a 46 XY DSD," the organization argued. "In elite women's competition, however, the proportion is approximately 7 in 1,000 -- a prevalence that is 140 times higher. This is strong evidence of a performance advantage."

Semenya lost her legal battle. She chose not to medicate and therefore was ineligible to compete in her preferred events in the Tokyo Olympics, effectively ending her career.

The study World Athletics used to inform its argument was published in 2017 in the British Journal of Sports Medicine. Four years after it was published, the journal issued a correction, saying, "There is no confirmatory evidence for causality in the observed relationships reported." In plain English: the paper, funded by World Athletics, failed to scientifically prove the relationship between higher testosterone levels in female athletes and a performance advantage.

"I feel that [World Athletics] has confiscated a large part of my life," Semenya wrote in her memoir, "The Race to Be Myself." "I've spent as much time fighting them as I have training and racing. They have stolen years of performances not only from me but also from the audience."

The regulations that have kept Semenya from competing have also impacted other athletes, such as the 800-meter silver medalist at the Rio 2016 Olympics, Francine Niyonsaba.

The controversy surrounding Khelif and Lin is the first around DSD athletes in combat sports at the Olympics. There have been examples of transgender athletes competing in lower levels, such as Fallon Fox in mixed martial arts and Mack Beggs in high school girls wrestling, but neither of those examples are good comparisons because neither Khelif nor Lin is known to be transgender.

Regulating women's sports, however, has been happening for as long as the category has existed. When the modern Olympics began in 1896, women were not allowed to participate. Women did compete in Paris in 1900 and, as women's sports grew, sport governing bodies began exploring sex verification testing for women's competitions. An early flashpoint emerged in the 1930s after Zdeněk Koubek, an athlete from what was then Czechoslovakia, began publicly identifying as a man. Koubek is one of the subjects of the book "The Other Olympians: Fascism, Queerness, and the Making of Modern Sports" by Michael Waters. According to the book, Wilhelm Knoll, then head of the International Federation of Sports Physicians and a member of the Nazi party, wrote an op-ed in a German magazine accusing Koubek of "deliberately fooling" officials about his sex. Knoll called for examinations of all women competitors.

Over time, sex verification has taken many forms, from visual inspections to chromosome tests to monitoring testosterone levels.

Since October 2021, the IOC has allowed each international sports federation to set its eligibility requirements for the Olympics. Many international federations have adopted policies that set specific rules for transgender athletes and those with differences of sex development, though much of the focus is on transgender athletes.

United World Wrestling, which governs wrestling at the Olympics, has a transgender athlete policy, but that policy is vague about athletes with differences of sex development. World Athletics, which governs track and field, has a specific policy for both populations. Transgender women seeking to compete in the women's category may do so provided they began testosterone suppression before puberty or age 12, whichever is first, and maintain a testosterone level below 2.5 nmol/L. It requires athletes with certain DSD to medically lower their testosterone level to under 2.5 nmol/L for 24 months prior to competition, maintain that level throughout and be legally recognized as female or intersex.

Since the IOC moved away from a blanket policy, there has been an increasing patchwork of policies governing transgender and intersex athletes at all levels of sports. The NCAA amended its policy in January 2022 in response to collegiate transgender swimmer Lia Thomas and now follows the rules of each national governing body for its championships. Since 2020, 25 states have passed laws restricting access to girls' and women's sports for transgender women. Depending on which organization (or state or country) has jurisdiction over an event, eligibility policies (and laws) can vary widely. This is true of Olympic competition, collegiate competition, youth club sports, Olympic feeder programs and school sports within the United States.

Khelif competes in the quarterfinals on Saturday, and Lin's quarterfinal is scheduled for Sunday against Bulgaria's Svetlana Kamenova Staneva. The IOC has vigorously defended its decision to include both athletes and it is not expected that either athlete will be ruled ineligible during this competition.

Khelif will face Hungary's Anna Luca Hamori in her quarterfinal bout. The Hungarian Boxing Association says it plans to send letters of protest to the IOC and Hungary's Olympic committee, according to The Associated Press. Hamori is reportedly expected to fight Khelif.

"I'm not scared," Hamori said to the AP. "I don't care about the press story and social media."

USA Boxing released a statement on Thursday in support of the IOC's process. "The eligibility rules in place for the Olympic Games have been in place for years and USA Boxing has confidence that the IOC and the [Paris 2024 Boxing Unit's] eligibility requirements consider medical expertise and prioritize the safety of the athletes," the statement read. "USA Boxing prioritizes the safety of our boxers and would not knowingly enter our boxers into competitions unless eligibility rules relied on sufficient medical support. All boxers competing in Paris have qualified under their specific eligibility rules and regulations." Though the United States had boxers in the same divisions as Khelif and Lin, neither athlete advanced to the quarterfinals.

Carini, who didn't shake Khelif's hand after her loss, has since expressed a desire to apologize to Khelif. "All this controversy makes me sad," Carini said to Italian newspaper La Gazzetta dello Sport. "I'm sorry for my opponent too. If the IOC said she can fight, I respect that decision."