As others in the field, Italian endocrinologist Luigi Di Luigi considers the International Olympic Committee’s latest policy update that bans transgender women from competing in the female category a retrograde move that puts DSD athletes at risk.
While the tug-of-war between political conservatives and those opposing what they label a privacy violation persists worldwide, with longtime affected parties like former middle-distance runner Caster Semenya and other current sportsmen and women chiming in while different national bodies align themselves at both sides of the spectrum, voices from the medical sector have risen to the forefront as well; mostly unfavourable to the IOC’s change of stance.
In France, Sports Minister Marina Ferrari said on Friday that the global body’s reintroduction of sex testing “raises major concerns, as it specifically targets women by introducing a distinction that undermines the principle of equality”. Her rebuttal was echoed in the border country of Italy, who just hosted the Milano Cortina 2026 Winter Olympics and Paralympics, voiced again with the extended authority of a curriculum devoted to science at an elite level.
A Professor of Endocrinology at the University of Foro Italico, Di Luigi addressed the complex issue at the Sports Medicine Congress currently taking place in Rome, where many colleagues agreed with the French authorities’ take that the decision “is a step back 30 years” and faces an uphill climb in its plight to ensure what its backers call “ensuring a level playing field”.
Hoping to shine some light on the complex issue, the Italian specialist considered the tests that the Lausanne-based organisation is proposing “aren’t fair” and that the sports world needs “more comprehensive ones” if it indeed intends to respect every athlete’s rights in the leadup to the Los Angeles 2028 Summer Games, and beyond. “The IOC’s move is merely a step forward in research, but it does not yet make the system of sporting competition fair: a number of issues that are, in fact, significant are being overlooked,” Di Luigi pointed out Saturday.
The IOC announced the new policy on the ‘Protection of the Female (Women’s) Category’ in Olympic Sport on Thursday, which effectively bars transgender athletes from competing in LA28, where United States President Donald Trump has been pushing to enforce his ultra-right wing agenda while proclaiming the country is set to “stage the best Games ever”.
During her public address after the IOC’s Executive Board meeting, its Zimbabwean leader, Kirsty Coventry, the first woman and African to hold world sport’s top chair, detailed that the new vetting process would be carried out via a mandatory, one-off Sex Determining Region Y gene test for those willing to enlist in the female category. “As a former athlete, I passionately believe in the rights of all Olympians to take part in fair competition. The policy that we have announced is based on science and has been led by medical experts,” she assured. “Every athlete must be treated with dignity and respect, and athletes will need to be screened only once in their lifetime. There must be clear education around the process and counselling available, alongside expert medical advice.”
Sidestepping the political quagmire that the move has brought back to the surface, Professor Di Luigi focused the scientific debate on the research commissioned into the SRY gene responsible for triggering male sexual development. “We must distinguish the issue of transgender people from that of hyperandrogenism and Differences of Sex Development: the measure treats them in the same way and on the same level, but they are two completely different matters,” he warned, detailing that “the first is essentially ideological, cultural and ethical” while, on the other side, what can be detected using the SRY antigen, which forms the basis of the IOC measure, “is only a fraction of the ‘critical’ situations.”
South Africa’s Caster Semenya looks on as she sits for the start of her hearing at the European Court of Human Rights in 2024
Backed by science, the medical expert explained that the proposed tests fail to identify all those conditions in which female athletes have female chromosomes but suffer from a medical condition that places them in the same situation as athletes in whom hyperandrogenism is detected. “To be fair, impartial and honest, either we address all similar issues not detected by the SRY antigen test, or we do nothing at all,” Di Luigi laid out. “It’s all or nothing, in short.”
Asked what the announced protocol encompasses, he insisted the scientific data remains unclear. “There are individuals who test positive for the SRY antigen yet are entirely female: this can happen with certain medical conditions. The IOC tells you, ‘I will test you positive first and then study you’; but the problem comes first, not later. There is also a question of consistency. There is a lack of scientific rigour and thoroughness,” he pointed out.
While the global sporting body assured that the one-off SRY gene test would be carried out via a non-intrusive cheek-swab or saliva test, precedents of sex testing in sports have not been kind to those portraying it as unharmful. Examples of men transitioning to women in order to gain a competitive advantage, meanwhile, are marginal despite the challenging debate, which has been ongoing for decades, gaining traction in the political arena of late.
“When these issues are discussed, it can happen that ideology pushes us towards one aspect rather than another, based on ideological prejudices. But the issue is more complex,” Di Luigi underlined. “As for transgender people, the problem exists because a man becomes a woman. Trump said it, but anyone else could have said it. Scientifically, there is a solid basis for this. On the other aspect, that of medical conditions, the matter is different. These are illnesses that need to be identified, diagnosed and, where possible, treated. This must be done first and foremost for the athlete’s health and then also for fairness in sport. The tests do not cover all possible clinical presentations relating to hyperandrogenism and DSD: they cover only a part of them, and not even the most common ones…”
Records indicate that New Zealander weightlifter Laurel Hubbard became the first transgender woman to compete at an Olympics after transitioning back in 2021, while Difference of Sex Development athletes like Semenya, who won women’s 800m Olympic gold at London 2012 and Rio de Janeiro 2016 Games and has since retired, remain under threat, now with the extended pressure of the announced mandatory SRY test.
Last week, a coalition of more than 70 human rights and sports advocacy groups, led by organisations such as the Sport & Rights Alliance, ILGA World and Humans of Sport, signed a joint statement criticising sex testing, describing it as intrusive and discriminatory.
In his remarks to Italian news agency ANSA, Di Luigi also referenced the controversial case of boxers Lin Yu-Ting, of Taiwan, and Imane Khelif, from Algeria who competed in the female category at the Paris 2024 Olympics despite having been disqualified from the 2023 World Championships by the International Boxing Association for failing to pass is gender eligibility guidelines.
“The scientific basis of the current IOC criteria adopted to admit athletes to sporting competition is not clearly established. It isn’t specified at what stage it is possible to compete, whether with a condition or not; nor is it made clear to athletes whether they could have sought treatment as children in order to be able to compete later. Athletes would like to understand whether, after the medical examination, there is a way to compete,” the Italian professor concluded, as he pondered the basics. “The question is simple: ‘If she had been treated as a young person, could Imane Khelif have competed even if she had tested positive?'”.