What is hyperandrogenism and why is it related to the intersexuality of boxer Imane Khelif?

Imane Khelif returns to compete this Friday at the Olympic Games in Paris. The Algerian boxer will be fighting in the -66kg category against China’s Liu Yang, aiming to secure Olympic Gold.

Follow live the action between Imane Khelif and Yang Liu, boxing final

Khelif’s participation in Paris has been surrounded by controversy. The boxer, who has hyperandrogenism, has been falsely accused of being transgender after defeating Italy’s Angela Carini in the quarterfinals. But what exactly is hyperandrogenism?

Hyperandrogenism is a condition characterised by an excess of androgens, or male sex hormones, in a woman’s blood. This excess leads to symptoms typically more common in men, such as acne, seborrhea, excessive hair growth in sensitive areas like the face, back, or chest, alopecia, and even sterility. Hyperandrogenism causes Khelif to have elevated levels of testosterone—a sex hormone produced by both men and women, though men produce about 20 times more than women.

It’s important to clarify that Khelif is not transgender, but cisgender, meaning she was assigned female at birth and continues to identify as female. Despite this, some people incorrectly label her as intersex due to her condition.

Amnesty International defines intersex people as “a broad group whose sexual characteristics fall outside the typical binary ‘norms’ of male or female.” These characteristics may include variations in primary sex characteristics (such as internal and external genitalia, reproductive systems, hormone levels, and sex chromosomes) or secondary sex characteristics that emerge during puberty.

Being intersex has nothing to do with gender identity or sexual orientation; it is simply a biological variation, much like being born with atypical reproductive organs. The Committee Against Torture and the Committee on the Rights of the Child have urged countries not to perform surgeries on intersex children.

The XY Chromosome: According to the U.S. National Human Genome Institute, an individual’s sex is determined by the combination of X and Y chromosomes: males typically have one X and one Y chromosome, while females have two X chromosomes. This chromosomal combination guides the development of the organism.

However, in intersex individuals, chromosomal patterns can vary in different ways, and the effects may not become apparent until puberty. This complexity makes the concept of intersexuality challenging to explain, as there are various types of intersex conditions.

What are the Different Types of Intersexuality?

At least four different types of intersex conditions have been identified:

46 XX: In this condition, the individual has ovaries and male genitalia. The labia majora and clitoris may enlarge to resemble a penis, although the internal reproductive system is female. Causes can include congenital adrenal hyperplasia, exposure to male hormones by the mother, the presence of male hormone-producing tumors in the mother, or aromatase deficiency.

46 XY: The individual’s genitalia are not fully formed or may appear female, even though internal testes might be present but not fully developed. Causes may include insufficient production of male hormones due to underdeveloped testes or issues with testosterone formation or utilization.

Ovotesticular DDS: The individual has both ovarian and testicular tissue, which could result in the presence of an ovary or a testicle. Chromosomes can be either XX or XY, and the external genitalia may vary.

Complex DDS: In these cases, individuals may have an atypical number of sex chromosomes, such as XXX or XXY. While there may be no visible differences between external and internal genitalia, there are significant variations in sex hormone levels.