Algerian boxer Imane Khelif won the Olympic gold medal in women’s boxing on August 9, 2024. Many people allege that Khelif is a man and, therefore, his boxing match against a woman was not only unfair, but immoral. His supporters argue that Khelif doesn’t have male genitals (e.g., a penis), so he can’t be a man.
There was a flurry of unhelpful and confusing accusations about Khelif’s sex for the weeks leading up to (and after) the gold medal match. Part of the problem is that Khelif’s medical records are private, so there isn’t any definitive information to go on.
Is there a scientific and effective way to discern whether someone is male or female? The answer is yes. There have been established methods for a long time. It’s only with the recent rise of transgender ideology that there has been any substantial pushback to these methods. Here are three ways to determine whether someone is male or female.
First, a person’s genitalia are a reliable indicator of a person’s sex. Males have a penis and testes, while females have a vagina and ovaries. In most cases, a visual inspection of a person’s anatomy (or ultrasound to detect ovaries) is all that’s needed to determine a person’s sex. Some people, however, have a condition that results in malformation of their genitals. In these cases, we need a deeper level of assessment.
Second, a person’s chromosomes can be a reliable indicator of a person’s sex. In most cases, discovering a person has XY chromosomes indicates they’re male, and discovering they have XX chromosomes indicates they’re female. Chromosomes, however, do not determine sex. Rather, the Y chromosome contains a specific gene, the SRY gene. The SRY gene is known as the “male-determining” gene because it triggers a cascade of genetic events that develop the human embryo into a male body with a penis and testes. Without the SRY gene, the embryo develops into a female body with a vagina and ovaries.
Not all males and females have chromosomes that are XY and XX respectively. There are instances where chromosomes are not a definitive marker of whether a person is male or female. In these rare cases, we need to dig even deeper to understand what’s going on.
Third, a person’s genes determine a person’s sex. Although males typically have XY chromosomes, it’s possible for a male to have XX chromosomes. For example, in de la Chapelle syndrome, the SRY gene is translocated to the X chromosome. This results in a human embryo with XX chromosomes that has the “male-determining” gene, thereby triggering the body to develop a penis and testes. It’s also possible for a female to have XY chromosomes. In Swyer syndrome, a female has XY chromosomes, but a mutation deletes the SRY gene from the Y chromosome. With no “male-determining” gene, the embryo with XY chromosomes develops a vagina and ovaries and is, therefore, female.
What this means is that chromosomes don’t determine sex. In fact, people can be born with a myriad of chromosomal variations such as XXY, XXXY, XYY, XYYY, XXYY, etc. None of these conditions negate the sexual binary, though. They don’t indicate that there is a third sex, a spectrum of sexes, or an “in-between” of sexes. Chromosomal differences simply represent variations within the two categories of male and female.
It’s the genes that determine whether a human embryo will become male or female. Genes determine sex. Humans are, therefore, “sexed” at conception.
For this reason, it’s incorrect and strategically unwise to defend the sexual binary (that there are only two sexes) by stating, “If you’re XX, you’re a female. If you’re XY, you’re a male.” Such a statement is easily dismissed by someone pointing out that there are people born with XXY, XXXY, XYY, XYYY, XXYY, etc., thereby implying there are more than two sexes. We know, however, that chromosomes don’t determine sex. Genes determine sex. Therefore, don’t make a person’s chromosomal makeup the focus when defending the sexual binary.
Keep in mind that there is a difference between what determines sex and what defines sex. I’ve only described what determines sex: genes. They trigger and regulate the pathways that guide a human embryo to become male or female. How you define sex is a different matter. Sex is defined by the type of reproductive cells (gametes) your body is designed to produce. A body that is organized around producing sperm is male. A body that is organized around producing eggs is female.
Is Khelif male or female, then? It’s difficult to give a definitive answer since we don’t have access to the athlete’s medical records. What is known, however, is that Khelif was disqualified from competing as a female by the International Boxing Association (IBA) in 2023. The IBA requires XX chromosomes to qualify as a female, thereby suggesting that Khelif has XY chromosomes. In addition, Khelif’s trainer, Georges Cazorla, told French magazine Le Point that Khelif has a high testosterone level.
Given this limited information, it’s possible Khelif has a disorder of sex development (DSD). DSDs are congenital medical conditions of the reproductive system caused by variations in the chromosomes (this is often referred to as the misnomer “intersex”). Based on the likelihood that Khelif has XY chromosomes, high levels of testosterone, and presented as female-like at birth, we can narrow down the possible DSDs that Khelif could have.
One possible DSD is 5-ARD, which affects XY chromosomal males. A genetic mutation prevents the conversion of testosterone into a chemical that masculinizes the male genitalia. As a result, the penis and scrotum don’t form and the testes don’t descend (though testes still exist and remain in the abdomen). Visually, people with 5-ARD look more female-typical since they don’t have a penis or external testes. But their internal testes still produce testosterone, which surges during puberty, thereby masculinizing their skeletal, muscular, and cardiovascular system. If Khelif has 5-ARD, then he is male without external genitalia, but he still has the athletic advantages of a male.
The other possible DSD is partial androgen insensitivity syndrome (PAIS), a condition that also impacts XY chromosomal males. It’s caused by a genetic mutation that affects the body’s testosterone receptors. Though the testes produce testosterone, the body’s receptors are only partially sensitive to it, thereby preventing normal male genital development. This could lead people to believe Khelif was born a female because of his underdeveloped sex organs. During puberty, though, testosterone levels would have surged and his body would still have been masculinized, thereby conferring typical skeletal and muscular advantages.
Without access to medical records, it’s impossible to be certain of Khelif’s condition. Based on the available data (high testosterone levels and XY chromosomes) and an understanding of both possible DSDs, it’s very likely he has testes. That means he’s probably a male who has benefited in his sport from the advantages of going through male puberty. It’s no surprise, then, that people are upset that he’s competing in an activity that involves punching women.
Let me summarize some important takeaways:
- Sex is binary. People are either male or female.
- In most cases, a person’s genitals indicate whether a person is male or female. If the genitals are malformed, chromosomes can be the next reliable indicator of a person’s sex. If the chromosomes have mutations (the person has a DSD), then we have to look at the genes to determine the correct sex.
- Stop saying, “If you’re XX, you’re a female. If you’re XY, you’re a male.” Chromosomes don’t determine sex. Genes determine sex.
- People can be born with chromosomal variations (DSDs) like XXX, XXY, XYY, etc., but these variations do not represent a third sex, in-between sexes, or a spectrum of sexes. These conditions are simply variations within the categories of male and female. Sex is still binary.
- Just because determining a person’s sex might be complicated, it does not follow that sex is not binary. It just means that sometimes it’s more difficult to determine a person’s correct sex.
Given what I’ve written, how should we treat someone who has a DSD? The appropriate response is truth, love, and compassion. People with a DSD are made in the image of God, intrinsically valuable, and deserving of dignity and respect. There is no place for dehumanizing talk or degrading insults toward Khelif or anyone with a DSD. While it’s appropriate to argue for fair and safe rules in sports, it’s never appropriate to mock an image bearer of God, even if you vigorously disagree with them.
The challenge for believers is to avoid getting caught up in the confusion or the mudslinging. Though the culture might want to advance a politically or ideologically driven answer about Khelif’s sex, we can stand on scientifically known principles. When we do, we should communicate those ideas in a precise, persuasive, and gracious manner. There’s no need to act like a bully. There’s no need to name-call.
I like what former ambassador Alan Keyes said: “[We] move forward...not to calculate the victory or to fear the defeat. But to do our duty. And to leave the rest in his almighty hands.” Remember, it’s not our responsibility to convince everyone of our ideas. It’s our responsibility to be faithful to the truth. Like an ambassador, present your case as best you can, and then leave the results up to God.