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International Association of Athletics Federations
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IAAF POLICY ON GENDER VERIFICATION

Prepared by the IAAF Medical and Anti-Doping Commission 2006

Purpose
The purpose of this paper is to establish a policy and mechanism for managing
the issue of gender amongst participants in women’s events.

Background
Gender has since many years been an issue that surfaces from time to time in
women’s events at athletic meets. Gender verification for the purpose of
competition has undergone significant evolution since attempts were made to
introduce measures aimed at ensuring fair competition amongst female athletes.
The first mechanism (introduced for international competition in the mid sixties)
involved rather crude and perhaps humiliating physical examinations. This very
quickly gave way to the method of determining ‘sex’ chromatin through buccal
smear examination. However as there were too many uncertainties associated
with this method, many experts in the field clamored for its discontinuance
resulting in it being abandoned first by IAAF in 1991 and then the IOC since
Sydney 2000. However a search has continued for an acceptable and equitable
solution in order to be able to address the occasional anomalies that do surface
either as a chance observation during the ubiquitous anti-doping controls these
days or through a ‘challenge’ by a competitor.
Whilst this issue is far from completely resolved there is sufficient consensus of
opinion amongst experts in the field as well as sports medicine specialists to be
able to introduce a formal policy and mechanism, at least ad interim, so that
proper guidelines can be given to event organizers, national associations,
athletes and officials as to how to approach this problem and to come up with a
satisfactory solution when faced with a case.
The IOC has also been looking into this issue and in October 2003 came up with
a ‘consensus document’ which we have used as a guide in the development of
our own policy.

A. THE POSITION OF IAAF
1. There will be no compulsory, standard or regular gender verification during
IAAF sanctioned championships;
2. In resolving cases that may arise, determination should not be done solely
on laboratory based sex determination;
3. Any problems related to this issue are expected to be picked up by the
national team doctors during health checks or by medical/doping
delegates at specimen collection during doping control at major
championships;
4. If there is any ‘suspicion’ or if there is a ‘challenge’ then the athlete
concerned can be asked to attend a medical evaluation before a panel
comprising gynecologist, endocrinologist, psychologist, internal medicine
specialist, expert on gender/transgender issues. The medical delegate can
do an initial check;
5. Reconstructive surgery and sex reassignment
- if sex change operations as well as appropriate hormone replacement
therapy are performed before puberty then the athlete is allowed to
compete as a female
- if the sex change and hormone therapy is done after puberty then the
athlete has to wait two years after gonadectomy before a physical and
endocrinological evaluation is conducted
(The crux of the matter is that the athlete should not be enjoying the
benefits of natural testosterone predominance normally seen in a male)
6. Conditions that should be allowed:
(a) Those conditions that accord no advantage over other females:
- Androgen insensitivity syndrome (Complete or almost complete -
previously called testicular feminization);
- Gonadal dysgenesis (gonads should be removed surgically to avoid
malignancy);
- Turner’s syndrome.
(b) Those conditions that may accord some advantages but nevertheless
acceptable:
- Congenital adrenal hyperplasia;
- Androgen producing tumors;
- Anovulatory androgen excess (polycystic ovary syndrome).

B. PROCESS FOR HANDLING CASES OF GENDER AMBIGUITY
1. The gender related issues will be handled as per the ‘position paper of
IAAF’ and the consensus agreement of IOC on the subject.
2. The gender issue is likely to arise as a result of:
a. ‘challenge’ by another athlete or team as brought forward to authorities
at an athletic event, including the President of the meet, technical
delegate, medical delegate;
b. ‘suspicion’ raised as to an athletes’ gender as witnessed during an antidoping
control specimen collection;
c. an approach made to the IAAF/regional AAA or National federation by
an athlete or his representative for advice and clarification.
3. The matter can be expected to be handled at the level of the
- national federation;
- the medical delegate of an athletic event;
- the IAAF medical committee.
4. Steps:
a. The case is brought to the attention of the relevant medical
authority at the above level where the issue is first brought up;
b. The authority decides if there is a case to investigate;
c. The authority then determines who will investigate the matter, e.g.
special panel appointed at an international event;
d. The athlete is referred to the investigating authority in confidence
for further investigation and advice;
e. The verdict is passed on to the national federation with advice for
further action including appropriate advice to the athlete as the
need to ‘withdraw’ from competition until the problem is definitively
resolved through appropriate medical and surgical measures;
f. Evaluation of the effects of such measures to determine if and
when the athlete can return to competition as per the IOC
consensus on this matter.
5. The IAAF should also set up a resource panel at the HQ level that may
need to be called upon if there is a need for resolution of difficult cases.

Attachment A
IOC Explanatory note to the recommendation on sex
reassignment and sports
In the past there have been rare cases of athletes who have competed under
one gender and later in life undergone sex reassignment. Occasionally, such an
athlete has gone on competing under the new gender. Such cases seem to have
been dealt with individually by the responsible sports federations without any
clear rules. They have, however, been extremely rare and do not seem to have
created a significant problem for sport in general.
With the arrival of improved methods for the identification of transsexual
individuals, and improved possibilities to rectify any sexual ambiguity, the number
of individuals undergoing sex reassignment has increased. The increase has
become particularly significant after the introduction of legislation with respect to
sex reassignment in many countries.
The increasing number of cases of sex reassignment has also come to affect
sport. Although individuals who undergo sex reassignment usually have personal
problems that make sports competition an unlikely activity for them, there are
some for whom the participation in sport is important. Thus, the question has
been raised whether specific requirements for their participation in sport can be
introduced, and what any such requirements should be.
Hormonal therapy appropriate for the assigned sex has been administered in a
verifiable manner and for a sufficient length of time to minimize gender-related
advantages in sport competitions.
The first international sports organization to address the issue was IAAF in 1990.
An expert seminar unanimously recommended that any person who has
undergone sex reassignment before puberty should be accepted in sport under
the assigned gender. Individuals who have undergone sex reassignment after
puberty were considered to represent a more complex problem, since they have
been under the influence of hormones under their former gender during their
puberty. In particular, a male puberty would mean an influence of testosterone,
which could, in theory, be of importance even after a reassignment to female
gender. It was, therefore, recommended that any
such case be evaluated on an individual basis by competent experts before a
decision be taken by the relevant sports authority. These recommendations have
served as guiding principles also by the IOC when questions have been asked.
In recent years it has become apparent that the recommendation to make a
case-by-case evaluation of athletes who have undergone sex reassignment after
puberty is insufficient. The IOC has been asked to explain what such an
evaluation should include. What requirements should be fulfilled before the
athlete be allowed to compete under the new gender?
The present recommendation is the result of an updating of the IAAF guidelines
by a panel of experts and to which clear requirements have been added with
respect to eligibility for competition under the new gender following sex
reassignment after puberty. The most debated aspects have been: (A) For how
long will the hormonal influence of the earlier puberty be of importance? (B) Will
the testosterone influence on the muscular strength during male puberty ever
disappear? (C) For how long should the treatment with female hormones last in
order to be considered sufficient? (D) How can one make sure that the required
treatment with female hormone does really take place? All those questions were
addressed by the panel, which also sought advise from further outside experts,
before the enclosed recommendations were agreed upon.
Arne Ljungqvist
IOC Medical Committee Chairman

Attachment B
Statement of the Stockholm consensus on sex reassignment in
sports
On 28 October 2003, an ad-hoc committee convened by the IOC Medical
Commission met in Stockholm to discuss and issue recommendations on the
participation of individuals who have undergone sex reassignment (male to
female and converse) in sport.
This group was composed of:
Prof. Arne Ljungqvist (SWE)
Prof. Odile Cohen-Haguenauer (FRA)
Prof. Myron Genel (USA)
Prof. Joe Leigh Simpson (USA)
Prof. Martin Ritzen (SWE)
Prof. Marc Fellous (FRA)
Dr Patrick Schamasch (FRA)
The group confirms the previous recommendation that any “individuals
undergoing sex reassignment of male to female before puberty should be
regarded as girls and women” (female). This applies as well for female to male
reassignment, who should be regarded as boys and men (male).
The group recommends that individuals undergoing sex reassignment from male
to female after puberty (and the converse) be eligible for participation in female
or male competitions, respectively, under the following conditions:
.. Surgical anatomical changes have been completed, including external
genitalia changes and gonadectomy
.. Legal recognition of their assigned sex has been conferred by the
appropriate official authorities
.. Hormonal therapy appropriate for the assigned sex has been administered
in a verifiable manner and for a sufficient length of time to minimise
gender-related advantages in sport competitions.
In the opinion of the group, eligibility should begin no sooner than two years after
gonadectomy.
It is understood that a confidential case-by-case evaluation will occur.
In the event that the gender of a competing athlete is questioned, the medical
delegate (or equivalent) of the relevant sporting body shall have the authority to
take all appropriate measures for the determination of the gender of a competitor.
Sch 12.11.03