Santhi Soundarajan

NEW DELHI: Did the Medical Committee of the Olympic Council of Asia (OCA) obtain all the necessary laboratory investigation reports before declaring athlete S. Santhi as having failed a gender verification test?

No confirmation is available from sources familiar with the procedures in Doha, but independent medical observers have pointed out that the requisite test reports would take weeks rather than days to prepare.

Premature decision

A source privy to the happenings leading to Santhi's disqualification confirmed that not all blood test reports, especially reports of endocrinological tests, were available when the decision was made in Doha.

In Santhi's case, was Androgen Insensitivity Syndrome (AIS) excluded? "That can only be determined by endocrinological (blood) tests and to the best of our knowledge such test reports were not ready when the expert panel took the decision to disqualify Santhi," said an Athletics Federation of India (AFI) official on Wednesday.

No protest

Santhi's gender verification case, taken up after a doping control officer reported `suspicions' about her during a urine sample collection procedure, was determined within a matter of four days in Doha, forcing the athlete to leave the city in distress. It has now been confirmed that there was no `protest' from another team or any athlete and the gender verification process was initiated only because of the reporting by the doping control officer.

It is pertinent to note here that Santhi did not go through gender verification either at Incheon, Korea, when she participated in the Asian championships there last year, or in Colombo during the recent South Asian Games.

Gender testing was discontinued by the International Association of Athletics Federations (IAAF) in 1991 and by the International Olympic Committee (IOC) in 1999 (applicable from the 2000 Sydney Olympics) following protests about the sex chromatin test through buccal smear examination.

However, in the event of a question being raised about the gender of an athlete or being reported by a doping control officer, verification is carried out nowadays.

(Buccal smear test is no longer approved by the IOC while blood tests are done. Gross karyotyping, the quickest method that was employed in Doha takes a day. The IOC allows only polymerase chain reaction (PCR) technique to determine the chromosomal pattern. That according to experts would take nothing less than two weeks).

While urging everyone to provide psychological and emotional support to Santhi and her family at this time, medical experts have argued that a condition like the Androgen Insensitivity Syndrome or any genetic or hormonal disorder could be excluded only through elaborate clinical findings and laboratory evaluations. In a case like Partial Androgen Insensitivity Syndrome, even the family history would be required.

AIS, formerly known as testicular feminisation, is a condition resulting in a variety of complications depending on whether androgen insensitivity is complete or partial. AIS individuals are genetically male, will have 46,XY chromosomal (male) pattern, may have male or female genitalia or predominantly male or female genitalia, will not have a uterus, fallopian tubes and ovaries and will not menstruate.

No advantage

AIS is characterised by the human body's failure to respond to androgens (male hormones), affecting sexual development. Though these individuals are genetically male, the IAAF allows them to compete with other females on the argument that they do not have any advantage over others since there is practically no effect of testosterone.

At the Atlanta Olympics in 1996, a few AIS athletes were allowed to compete alongside the women. In 2004, the IOC approved participation of transsexuals (converted sex) in the Olympics.

Individuals with a few other specific conditions are also allowed by the IAAF irrespective of the chromosomal pattern in the women's events.

(Normally 46,XX denotes female and 46,XY male. The XY female or the XX male, though rare, have however been reported. There could be extreme variations like XXY or XXXY also in rare cases).

Hormonal and genetic evaluation would be required to exclude all conditions in gender verification process, irrespective of the findings of a panel about the anatomical status of an athlete. Unless of course the panel rules that there has been impersonation and actually a male has competed in a women's event.

It is significant that the expert medical panel in Doha comprised an endocrinologist, a gynaecologist, a psychologist and an internal medicine specialist. There was no expert in the field of gender/transgender in the panel.

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