Imane Khelif Paris Olympics 2024 controversy: Understanding science behind high testosterone levels in women

The world of Olympic boxing was shaken on Thursday, August 1, when Italy’s Angela Carini withdrew from her 66 kg bout against Algeria’s Imane Khelif after a mere 46 seconds.

Carini’s startling reason for her withdrawal — that she had never been hit so hard before — has thrust the gender eligibility debate in sports back in the spotlight. This incident has gained particular attention because Khelif is one of the two boxers permitted to compete in the Paris Olympics despite failing a gender eligibility test at the International Boxing Association’s (IBA) World Championships in New Delhi in March 2023.

However, the International Olympic Committee (IOC) derecognised the IBA in June last year following disputes related to management and finances.

An indianexpress.com report said that in 2021, the IOC left it to international sports federations to develop their own set of rules but keeping in mind key principles of “fairness, inclusion, non-discrimination, evidence-based approach, no presumption of advantage, and prevention of harm.”

This advisory meant every sport could have its own set of regulations, according to the report. “Testosterone levels were no longer part of IOC’s regulations. Before this, the IOC had specified a testosterone limit — below 10 nanomoles per litre (nmol/L) for women athletes who had transitioned from male to female if they wanted to participate in the female category.”

So, how does testosterone affect the performance of athletes in different sports?

Dr Suri Raju V, best-selling author and senior consultant urology at Regal Super Speciality Hospital, Bengaluru, told indianexpress.com, “Testosterone, often called the ‘male hormone,’ isn’t just about masculinity. It’s a potent anabolic steroid that influences muscle growth, strength, and even red blood cell production. That’s why it plays a role in sports performance, particularly in those requiring power and endurance.”

Higher testosterone levels generally translate to greater muscle mass and strength in weightlifting, sprinting, and throwing events.

In endurance sports, the picture is less clear. According to Dr Suri, while testosterone helps build red blood cells, carrying more oxygen, too much might hinder endurance due to increased muscle mass making you less efficient.

In sports like gymnastics or archery, where finesse and precision matter more than raw power, the impact of testosterone is less clear. It’s worth noting that testosterone doesn’t work in isolation; factors like training, genetics, and mental fortitude also play significant roles.

It’s worth noting that testosterone doesn’t work in isolation. (Source: Freepik)

Differences between people with DSD (Differences in Sex Development) and those without

“People with Differences in Sex Development (DSD) are born with variations in sex characteristics that don’t fit typical male or female categories. Some DSD conditions can lead to naturally higher testosterone levels,” Dr Suri said. He also said that DSDs can involve a variety of genetic variations affecting hormone production and response.

Sports organisations like World Athletics have implemented testosterone limits for female athletes in certain events, requiring some athletes with DSD to undergo hormone therapy to compete, he noted. “This remains a contentious issue with ongoing discussions about finding a fair and inclusive solution.”

Health issues one might face if their testosterone levels go very high

While testosterone can enhance performance, too much of it can lead to a host of health issues in women, said Dr Suri.

Cardiovascular risks: High testosterone is linked to increased risk of heart disease, stroke, and blood clots. This might be due to its impact on cholesterol levels and blood pressure.

Liver damage: Some studies have associated excessive testosterone use with liver damage, especially with long-term use or abuse.

Mental and emotional changes: Aggression, mood swings, and even depression have been reported as potential side effects of high testosterone levels.

Other concerns: Acne, sleep apnea, and increased risk of certain cancers are also potential health risks.

It’s important to emphasise that these risks primarily pertain to individuals who abuse testosterone through external supplementation, not those with naturally occurring high levels. However, monitoring testosterone levels is still important for everyone, as even natural variations can have health implications.

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