Has World Athletics found a solution for intersex athletes with genetic testing? There are at least ethical concerns about the mass testing.

Sport has tried many things. Gynecological examinations and testosterone limits, for example. The goal of these measures was to exclude biological men from competing in women's categories. It all began relatively harmlessly: the International Olympic Committee (IOC) once feared that men in disguise would compete in women's competitions; a sporting blunder.

The issue became more serious when intersex athletes such as the South African Caster Semenya and the Algerian boxer Imane Khelif came into focus. Semenya, at least, is confirmed to be intersex. She has male XY chromosomes, underwent male puberty due to a birth anomaly, and therefore has a physical advantage over other athletes in sports. The phenomenon is called disordered sex development, or DSD. The United Nations estimates that up to 1.7 percent of the world's population is affected by intersexuality.

Semenya won Olympic gold in the 800 meters in London in 2012 and Rio de Janeiro in 2016. Boxer Khelif became Olympic champion in Paris in 2024 after her opponents had no chance of winning—it was a man fighting a woman, it was said. Public outrage was intense for both Semenya and Khelif.

The criticism also expressed the perplexity of sports officials about how to deal with those affected. The problem: Intersex people are highly superior in certain women's disciplines, but would hardly be competitive among men. There is a fine line between discrimination against intersex people and fairness for biological women.

World Athletics recently announced that all female athletes must undergo DNA testing to determine their gender. Has World Athletics found the solution to the problem?

At first glance, the idea is compelling, and the rules are clear: Anyone with XY chromosomes is barred from competing in the women's event. Gender determination via DNA testing is also likely to be legal under sports law. While intersex athletes would be discriminated against by the ban on competing in the women's event, experts say the right of biological women to fair competition should be given greater weight.

The Court of Arbitration for Sport (CAS) has repeatedly confirmed this stance. And behind closed doors, even biologically female track and field athletes advocate a hard line. However, no one likes to talk about it publicly.

The situation is less clear from an ethical perspective. Jürg Streuli is a medical ethicist, palliative care physician, and pediatrician. He works, among other things, at the Eastern Switzerland Children's Hospital, for the Health Compass Foundation, and conducts research at the University of Zurich. Streuli considers widespread genetic testing in elite sports to be questionable.

He says: "Genetics is very personal information; this information belongs only to the person concerned." It's important that these tests be voluntary, says Streuli. And therein lies the crux of the matter: Do female track and field athletes have to undergo DNA tests because it's part of the rules of the sport – similar to doping? Or is the infringement on personal rights too great?

Streuli also considers it problematic that the tests are ordered without medical necessity. DNA tests can reveal a wide range of genetic information, including the risk of developing certain types of cancer. The most well-known example is actress Angelina Jolie, who underwent such a test and subsequently decided to have a preventative mastectomy.

Streuli says that in clinical settings, DNA testing is strictly regulated in Switzerland and may only be performed for medically relevant reasons. "There is no such regulation in sports; World Athletics would now have to introduce it." Another important question is how incidental findings are handled. Will an athlete be informed if, for example, she is diagnosed with an increased risk of cancer during a DNA test? Is this information even collected? The medical ethicist also has no clear answer to such questions.

He is not aware of any case of an intersex athlete in track and field in Switzerland. This is what sports physician Peter von Stokar says. He is a member of the medical team of the Swiss Athletics Federation and is responsible for the issue. However, he also expresses ethical concerns, for similar reasons to Streuli. Von Stokar says: "The results of such tests should only be shared with the tested person and not with an organization."

It's also possible that female track and field athletes are tested early in their careers, says von Stokar. World Athletics stipulates that DNA testing will be mandatory before the first elite competition. However, at international Swiss meetings, such as Weltklasse Zürich or Athletissima in Lausanne, there are also races for aspiring young athletes. Not all of them reach world-class level or qualify for major events. However, according to World Athletics' guidelines, these young women must already be tested. Is this proportionate?

Von Stokar says the tests must be conducted by an independent body; in Switzerland, for example , by Swiss Sports Integrity (SSI) . The examination would have to be conducted in a neutral laboratory. "A federation doctor would be biased, since they don't conduct doping tests," says von Stokar.

Medical ethicist Streuli and sports physician von Stokar agree that sports must find a way to include intersex people. Open categories for those affected are conceivable. Streuli says: "The Olympic Games must take a pioneering role in inclusion." A completely new competition system with different scoring is conceivable, says Streuli. But that's likely to remain a thought experiment.

Von Stokar also believes that the Olympic movement should take a pioneering role. However, he himself doesn't yet know how the inclusion of intersex people can be achieved convincingly. Like so many athletes, doctors, and officials in global sports, too, there are too many ethical questions left unanswered.