Does Imane Khelif even have a DSD?

[BeLemonNow]

Giving the widespread reporting of a previous test showing Imane Khelif is biologically male / XY is there actually any evidence as to whether or not they even have a Disorder of Sexual Development (DSD). Or is this straightforward fraud? I know there was speculation before...

By DSD, going by NHS information, in this case I mean XY chromosomes with an abnormality causing a baby's genitals to look female (but not a DSD where there's XY and some sort of penis even if smaller than normal). To be clear, I am aware that these differences are usually apparent by puberty. It looks likely Imane went through male puberty.

Apologies if this has been covered in a different thread, but I cannot see it anywhere. I am aware that the only IOC criteria to compete at the Olympics was a female passport - ridiculous really - but that Imane has been claiming to be living as a woman since birth.

The latest from CNN

‘Harmed, outed, scrutinized’: How new sex testing rules affect athletes

https://edition.cnn.com/2025/09/18/sport/athletics-sex-testing-ruling-human-rights-intl

Nothing in here about the impact on female athletes that I can see. All about the women who are harmed by being excluded because of their medical condition.

This is one of the cases they have mentioned in the article.

“Ajok’s story is similar to that of Kenyan sprinter Maximila Imali, who showed great promise in track and field and qualified for the 800 meters at the world junior athletics championships, excelling in her heats but falling in the finals.”

”Determined to improve, she had her sights set on more competitions.”

”But in 2014, all that came crashing to a halt when she says she was told by an official from Athletics Kenya to take a blood test and undergo a physical examination, per a request by the International Association of Athletics Federations (IAAF), now known as WA.”

“My career ended just like that. Nobody is fighting for me. My country has just left me the way I am. I’m just like a past tense – I’m not just that person who was bringing glory to the country.”

“Now, I cannot do anything. I cannot provide for myself (or) my family; my family are depending on me. I have a son depending on me,” she told CNN.”

There is nothing in this case as reported by CNN that would lead a member of the public who doesn’t understand the situation to believe that the above person is a male athlete. This person mentions their son which will further add to the confusion. (But in my mind adds the potential that this athlete knew they were not a female athlete and that this test was not a surprise.)

Of course, there is nothing in the article about the female athletes who likewise could have supported their families if they were selected for the teams.

And plenty of confusing information from the experts they contacted. Including the old misinformation about the prevalence.

“Williams said estimates suggest that between 0.02% to 2% of the population have differences in sex development, depending on definition. With a global population of over 8 billion people, this could mean that tens of millions of people worldwide are affected.”

But there was nothing at all about the impact on female athletes in this long article. Yet anyone reading without the background would think this article on CNN was about female athletes. Just with high testosterone arising from a medical condition, and XY chromosomes….

Articles like this are deliberately taking advantage of people’s scientific illiteracy. There’s a deliberate attempt to confuse and have people think that DSDs are everywhere and women are unfairly being excluded from their own category.

Ive seen some comments on articles about World Athletics’ sex testing along the lines of, “some athletes are going to be very surprised when they test positive”, as though a lot of women, who have gone through normal female puberty and menstruated will somehow find out they are men🙄

I do have faith that Seb Coe will be very clear about the tests and who is being excluded though.

And of course, some of the confusion is created deliberately, by TRAs.

Adding to the above, something about the story of Maximila Imali doesn’t quite fit.

Imali was born in 1996. In 2014, he was 18 years old. Was told about the test results and then went on to compete in the events that he could under the rules at the time. Knowing full well that he was a male athlete.

Just the fact that these male athletes could simply change their distance and still compete at this elite level says quite a lot about the competitive advantage. Changing from 400 to 800 m and then to sprints of 100m to 200m is significant while still placing on the podium. Anyone remember a modern era female Olympian making this change and remaining at elite international level?

I wonder if this ever crosses their mind.

However, that many of these male athletes are making very considered and deliberate choices knowing they are male is very clear.

Yes. Except there is still the issue with the legacy clause in the current regulations. Maybe Coe believes that with suppression of testosterone to 2.5 nmol the harm will be limited. It still has the potential to block future female athletes from getting to the world championships and Olympics though.

I thought that was quite clever. 2.5nmol/L is high/normal for women - so “fair” but I think near impossible for a healthy male body to achieve, and still be able train at a high level with.

I think it might be too clever.

It doesn’t remove the physical advantages that are unchangable. It merely limits performance. What happens if training techniques are refined to overcome the limitations while we still have legacy competitors?

And even with that 2.5 nmol level, there is that athlete blocking the pathway of younger female athletes.

I think it was a damage control decision that still will have ramifications on this current generation of up and coming female athletes. Sadly, there may have not been another way to get the ruling passed.

Even so, this mess was caused by those campaigners of the late 1980s and the 90s. First the IAAF (WA) and then the IOC.

I think we really must keep reminding ourselves that there is now an abundance of evidence that male people have physical competitive advantage and retain many of those even with lowering testosterone.

These male athletes have access to the same studies and evidence we have. They are making carefully considered choices here. There is a degree of infantilising in these articles and the general call for sympathy to attempt to portray the new regulations cruel and unjust that I find concerning.

The decisions to remain competing are deliberate choices, made by these male athletes, and harmful to female athletes. There is no respect being shown by them and their supporters for the needs of female athletes at all.

The rule for lowering testosterone was not introduced because it entirely removes male advantage, as it doesn't (and even if it did, it shouldn't be permitted because there's no equivalent pathway for women to gain male advantage and have a fair crack in the men's contest; it simply means men have a choice of entering men's and women's contests but women haven't). It was introduced because it was possible, and they could claim they'd done something about the advantage they also clsim doesn't exist.

Times Scotland has an article about Lynsey Sharp in Rio 2016 today:
https://www.thetimes.com/article/8701c119-0a75-4386-b5a5-b58a6e76019c?shareToken=1b39a5954434a915df8153b1d3ad24a1

2.5nmol/L is very low though for a healthy male though - men in their 70s have higher levels. It was previously 10, and Semenya struggled with the side-effects of the anti-androgen medication even aiming for the higher number.

It’s not just the effects of training that would be difficult it’d be the brain fog, lethargy, bone loss, weight management and metabolic issues - all of which need to be managed for at least 24 months. It’s bad for the body and mind not to have a sex hormone present, as women plunged into menopause when their ovaries are removed can attest to.

Prior to exclusion from the female category, it was probably easier for TiMs to continue training as they are taking exogenous oestrogen.

ETA : I agree it’s wrong, and women are not men with lowered testosterone and male puberty’s benefits are undeniable - but, I think the criteria of hormone levels that low and for that long are pretty much infeasible for an otherwise healthy young man.

I said Kleinfelters was classified as a DSD, not that sex was ambiguous.

Yes I agree medical classifications can and should be questioned by experts working in the field, just not by lay people. The terminology you mention was changed by medical/scientific consensus.

Djok is described by a journalist who met them ias having a an adam's apple and wispy beard. Hard to have much sympathy really.

https://www.newvision.co.ug/news/1338971/star-athlete-ajok-proud

And the quote the journalist obtained of “it is common to have African women with male features”. Echoes of Caster “My testicles (sic) don’t make me less of a woman” Semenya where everyone who correctly thought he was male were told they were racist.

That CNN article is such a weird combination of genuinely useful information, journalistic snark, and talking heads with an apparent undeclared agenda of creating confusion.

I love the creative use of quote marks and words like 'assert' and the way they throw shade on WA for not defining this made-up arcane concept of so-called 'male puberty'.

Why are they like this?

Yes. It is far too low for their health.

I wonder though. Semenya’s natural level is high at 22 nmol/L from the top of my head. I wonder if the adverse reaction would be as detrimental if the natural level was on the low side already say half that.

One of our local labs has normal reference ranges of 11-30nmol/L of testosterone for adult men IIRC, (I’m not a man, just look at results in a work capacity). So half of Caster’s level of 21 would be 10-5 which is quite low for a healthy man.

Clearly the previous cut off of 10nmol/L was not low enough (no level is low enough, males shouldn’t be shoehorned into female completion) but 2.5nmol/L is extremely low.

If they are on anti androgens like cyproterone that’ll block androgen receptors as well, so the blood test may be an over representation?

Levels that low would be very hard to maintain. Surely they wouldn’t use GnRH agonists?

It’s not the journalist protecting Djok here at least, it’s obvious they are questioning the athlete’s sex and this theme runs through the article.

It’s made clear that the questions aren’t welcomed by the management team, who act to protect from the ‘distraction’ of the queries. It’s hard to get a sense of how much Djok understands about DSDs. “I feel normal”.

Interesting when the journalist directly asks the coach “Don’t people think you have a boy on your team?” and he says “Yes, but we know how to answer them”.

She's been interviewed by Sky as well. https://x.com/SkyNews/status/1969330081517408620?

I wonder whether the journo actually understands though. If you genuinely haven’t bothered to read up for yourself, and you believe that these athletes are women being discriminated against for their medical conditions. Plus that if they identify as women, they are women because [ you are not going to apply racist ideals of what female athletes should look like / experts are telling you these athletes are female / they have been raised female / their passport says they are female/ insert answer here] . Why would you look further?

After all, there are experts such as Arne Ljungqvist and Alun Williams that have assured you that this is wrong.

Arne Ljungqvist has been part of the decision making process all along as the one time chairman of the medical commission for the IOC. He was right there reviewing the evidence at the time.

olympics.com/ioc/news/ioc-approves-consensus-with-regard-to-athletes-who-have-changed-sex-1

https://edition.cnn.com/2004/SPORT/05/17/olympics.transsexual/

http://www.nature.com/articles/gim2000258.pdf?origin=ppub&utm_medium=affiliate&utm_source=commission_junction&utm_campaign=CONR_PF018_ECOM_GL_PHSS_ALWYS_DEEPLINK&utm_content=textlink&utm_term=PID100045542&CJEVENT=f4d4c8630a0411ed831b01a80a1c0e11

I once wondered if he had regretted his decisions now that Dr Tommy Lundgren had been so instrumental in showing male advantage and they both work for the Karolinska. He is quoted in the CNN article

“Ljungqvist, who has served as chairman of the IOC’s Medical Commission, though not during the time that the Barr tests were used, explained that since the Barr test has been abandoned and a new PCR swab test to identify the SRY gene is now used, “the problems are still there. They will single out those women who do have an Y chromosome.”

“One of the reasons why most of those methods were done away with was that they singled out wrong persons because many of those XY women have no advantage, they have complete androgen insensitivity,” he explained.”

Either he didn’t then point out or the journo cut off his quote in clarifying ‘but of course, those athletes wouldn’t be disqualified if the testosterone is not being used at all by the body to masculinise and create advantage.’

Maybe he said it and it was cut. Maybe he didn’t made that clear for reasons of his own. Maybe he believes still that to protect the dignity of a group of athletes who have testes but don’t process testosterone at all or who have XY chromosomes but don’t have working testes or testes at all, that inclusion of those other athletes who do have the pubertal advantages is just acceptable collateral.

Maybe he is still that idealist who approved the cessation of sex testing in the late 1990’s and who then approved the 2004 inclusion of post surgical male athletes who declared they too were female.

Either way, sadly, this is not an uncommon article even today. And with all the misinformation and lack of clarity around language, it is possible that the journo doesn’t understand the issue they are writing about. They are after the human interest part of the story that feeds into that emotional reaction.

This encapsulates the philosophical aspect of the debate very neatly.

How would anyone with no androgen sensitivity, male or female, ever develop the physique needed for competitive sports?

CAIS individuals are over-represented in elite female sports.

Androgens aren't the only hormones that cause muscle growth, otherwise women would be like cooked spaghetti! And yes, CAIS are overrepresented in elite sport.

Yes. They are. And I expect that their inclusion will be reviewed regularly as the competition of female athletes who do not have xy chromosomes becomes ever tighter with training advances.

There may come a point when those athletes too will be excluded.

I get that, but I did think that female athletes did tend to have relatively higher testosterone, although nowhere near male levels, because it does produce an advantage. I'd have thought that without any sensitivity to androgens, or partial insensitivity, a woman wouldn't be able to develop enough muscle to compete at a high level, but no?

Well, we just know empirically that individuals with no T-response can be highly competitive, even though they're missing out even on the small boost that a woman normally gets from her endogenous T.

Maybe other hormones are doing the heavy lifting. I can't believe there's a significant muscular deficit that's being completely counterbalanced by the advantages of being more than averagely tall and not menstruating.

It's an interesting area, and I look forward to the threads about whether or not to ban CAIS in a few years time...