By Mary Kearl
Who does a person born with both male and female sex organs, but who identifies as one gender, compete against in sex-segregated sporting events?
Sarah Gronert, a 22-year-old tennis pro from Germany who was born with both male and female genitalia, has chosen to compete against women, and that has some in the tennis community up in arms. "There is no girl who can hit serves like that, not even Venus Williams," says the coach of an opponent Gronert recently beat. The coach, Schlomo Tzoref, also claims, "This is not a woman, it's a man." Is Tzoref just a disgruntled coach, trying to stir up controversy, or is there any validity to his claim? What makes a man a man, and what makes a woman a woman -- and how does being either affect one's ability to win?
The Olympics has one answer; the WTA has another; across the board at national and international levels there seems to be a free-for-all in deciding how to allow players who do not fit into the binary division of traditionally defined female and male to compete. Meanwhile, science has its own explanations and advice for the sports community.
Continue reading below the pop-up photo gallery. Note you'll need to disable your pop-up blocker to view the slide show.
The Biology of Being Born in Between Male and Female
"It sounds like this person, from a medical standpoint, would have an intersex condition, where you have an identifiable genetic hormonal problem," says Jack Turco, M.D., endocrinologist at the Department of Endocrinology at Dartmouth-Hitchcock Medical Center and director of Dartmouth College's Health Services Center. "If she had both male and female genitalia, that's describing a hermaphrodite -- which is a rare condition. More likely her genitalia didn't look male and didn't look female. Without knowing what the person had and without knowing what operations the person had," it is hard to say how she would be affected and what advantage she would have, if any.
Dr. Turco explains that Gronert may have had one of about 20 or 30 different interesex conditions, each of which may have different levels of testosterone and require different procedures.
"Depending on which specific condition the person has, the person may have male hormones, which could lead to elevated testosterone levels and muscle mass. Of course, there are a lot of women who lift weights and have a lot of muscle mass, and a lot of men who don't," Dr. Turco explains. For example, if she’d been born a true hermaphrodite, with "an ovary on one side and testicle on one side and opted to remove the testicle, afterwards the testosterone no longer would be elevated," Dr. Turco says.
In other words, Gronert would be just like any other female -- ovulating and menstruating -- meaning she wouldn't have any advantage over any other female tennis player, says Naomi Neufeld, M.D., Clinical Professor of Pediatrics at the David Geffen School of Medicine at UCLA and board certified pediatric endocrinologist.
Another possibility is that Gronert might have been born with congenital adrenal hyperplasia, a more common disorder that affects one out of 15,000 births and leads to the production of excess male hormones in females, says Dr. Neufeld, a spokesperson for the American Association of Clinical Endocrinologists. "While the internal genitalia of these girls is purely female in this disorder," exterior genitalia would appear male, she explains. "With surgery you can fix how you look on the outside, [but] you don't get rid of the underlying metabolic disorder, which spins off an extraordinary amount of testosterone, so the only way to control it is with medication."
If this is in fact the condition Gronert has, and it was left untreated, she would have an unfair advantage because her testosterone levels would be higher compared to women her own age, says Dr. Neufeld. "It's as if she's got her own source of a steroid. Depending on the rules, she could be disqualified."
The New Definition of a Woman
"What it really comes down to is, how does the given sports organization define who is eligible to compete? One of the problems is they may say 'only females,' but do they mean biological females or people who identify as female? There are individuals that society may not identify as female, who consider themselves female. I would recommend writing rules keeping someone like [Gronert and others like her] in mind. But very often these rules are written by people who don't understand these intricacies," says Dr. Turco. "The Olympics, in effect, allow someone who had been transgendered and had an operation to play. Other people are just then saying 'Well, that isn't fair.' Well, what's fair is what's written in the rules. I suspect tennis versus soccer versus another sport would have lots of little variations."
Other Inherent Biological Advantages Allowed to Persist Among Famous Athletes
Should athletes be disqualified for a disorder that gives them an "unfair" advantage? Dr. Turco points out that recent sports history has not only not done so, many athletes have become champions because of their "birth defects."
"Andre the Giant" was a wrestler who made millions of dollars, perhaps partly because of his being born with a pituitary tumor, which means he was producing his own growth hormone, says Dr. Turco. "It's illegal in competition to get injections of human growth hormone," but because he was making excessive amounts on his own, Andre had the legal advantage.
Another seemingly advantageous disorder for athletes is Marfan syndrome, a condition in which those who are affected "have very flexible joints and can be very tall," says Dr. Turco. He says being born with this condition gave Olympic volleyball player Flo Hyman the upper hand on the court, but complications related to the syndrome also led to her early death.
Who does a person born with both male and female sex organs, but who identifies as one gender, compete against in sex-segregated sporting events?
Sarah Gronert, a 22-year-old tennis pro from Germany who was born with both male and female genitalia, has chosen to compete against women, and that has some in the tennis community up in arms. "There is no girl who can hit serves like that, not even Venus Williams," says the coach of an opponent Gronert recently beat. The coach, Schlomo Tzoref, also claims, "This is not a woman, it's a man." Is Tzoref just a disgruntled coach, trying to stir up controversy, or is there any validity to his claim? What makes a man a man, and what makes a woman a woman -- and how does being either affect one's ability to win?
The Olympics has one answer; the WTA has another; across the board at national and international levels there seems to be a free-for-all in deciding how to allow players who do not fit into the binary division of traditionally defined female and male to compete. Meanwhile, science has its own explanations and advice for the sports community.
Continue reading below the pop-up photo gallery. Note you'll need to disable your pop-up blocker to view the slide show.
Tennis Players to Watch
Sarah Gronert, 22, is ranked 619 in the world. According to Fanhouse, at age 19 harsh treatment from peers about her ambiguous-gendered past almost led her to quit tennis.
Westfalen Tennis
Gronert decided to have surgery to have her male sex organs removed. Then she had to petition the WTA to become eligible to compete as a woman again. Currently the WTA has ruled that she can compete.
Westfalen Tennis
Ranked number 5 in the world, Ana Ivanovic of Serbia jokes with her practice partners during a session in the lead-up for the Australian Open in Melbourne on January 16, 2009.
Paul Crock, AFP / Getty Images
US player Venus Williams reacts after beating French player Alize Cornet on the second day of their French Tennis Open first round match at Roland Garros, 28 May 2007 in Paris. Williams won 6/4,6/3.
Jacques Demarthon, AFP / Getty Images
US player Serena Williams celebrates after winning her match against French Emilie Loit during their 17th WTA French Open tennis match on February 13, 2009 in Paris. Serena Williams won 6/4 6/1.
Bertrand Guay, AFP / Getty Images
Maria Sharapova of Russia poses while holding the women's singles trophy on a boat along the Yarra river in Melbourne following her victory at the Australian Open tennis tournament, 26 January 2008. Sharapova won the championship 7-5, 6-3 over Ana Ivanovic of Serbia.
Greg Wood, AFP/Getty Images
Andy Roddick practices on a outside court on day two of the Australian Open 2007 at Melbourne Park on January 16, 2007 in Melbourne, Australia.
Aaron Francis, Getty Images
Novak Djokovic of Serbia celebrates during the Men's Singles Final match against Rafael Nadal of Spain on Day 7 of the Artois Championships at Queen's Club on June 15, 2008 in London, England.
Matthew Stockman, Getty Images
Rafael Nadal of Spain looks on during the Men's Singles Final match against Novak Djokovic of Serbia on Day 7 of the Artois Championships at Queen's Club on June 15, 2008 in London, England.
Matthew Stockman, Getty Images
Roger Federer of Switzerland lifts the trophy as he celebrates victory following the Men's Singles final match against Rafael Nadal of Spain during day thirteen of the Wimbledon Lawn Tennis Championships at the All England Lawn Tennis and Croquet Club on July 8, 2007 in London, England.
Clive Brunskill, Getty Images
The Biology of Being Born in Between Male and Female
"It sounds like this person, from a medical standpoint, would have an intersex condition, where you have an identifiable genetic hormonal problem," says Jack Turco, M.D., endocrinologist at the Department of Endocrinology at Dartmouth-Hitchcock Medical Center and director of Dartmouth College's Health Services Center. "If she had both male and female genitalia, that's describing a hermaphrodite -- which is a rare condition. More likely her genitalia didn't look male and didn't look female. Without knowing what the person had and without knowing what operations the person had," it is hard to say how she would be affected and what advantage she would have, if any.
Dr. Turco explains that Gronert may have had one of about 20 or 30 different interesex conditions, each of which may have different levels of testosterone and require different procedures.
"Depending on which specific condition the person has, the person may have male hormones, which could lead to elevated testosterone levels and muscle mass. Of course, there are a lot of women who lift weights and have a lot of muscle mass, and a lot of men who don't," Dr. Turco explains. For example, if she’d been born a true hermaphrodite, with "an ovary on one side and testicle on one side and opted to remove the testicle, afterwards the testosterone no longer would be elevated," Dr. Turco says.
In other words, Gronert would be just like any other female -- ovulating and menstruating -- meaning she wouldn't have any advantage over any other female tennis player, says Naomi Neufeld, M.D., Clinical Professor of Pediatrics at the David Geffen School of Medicine at UCLA and board certified pediatric endocrinologist.
Another possibility is that Gronert might have been born with congenital adrenal hyperplasia, a more common disorder that affects one out of 15,000 births and leads to the production of excess male hormones in females, says Dr. Neufeld, a spokesperson for the American Association of Clinical Endocrinologists. "While the internal genitalia of these girls is purely female in this disorder," exterior genitalia would appear male, she explains. "With surgery you can fix how you look on the outside, [but] you don't get rid of the underlying metabolic disorder, which spins off an extraordinary amount of testosterone, so the only way to control it is with medication."
If this is in fact the condition Gronert has, and it was left untreated, she would have an unfair advantage because her testosterone levels would be higher compared to women her own age, says Dr. Neufeld. "It's as if she's got her own source of a steroid. Depending on the rules, she could be disqualified."
The New Definition of a Woman
"What it really comes down to is, how does the given sports organization define who is eligible to compete? One of the problems is they may say 'only females,' but do they mean biological females or people who identify as female? There are individuals that society may not identify as female, who consider themselves female. I would recommend writing rules keeping someone like [Gronert and others like her] in mind. But very often these rules are written by people who don't understand these intricacies," says Dr. Turco. "The Olympics, in effect, allow someone who had been transgendered and had an operation to play. Other people are just then saying 'Well, that isn't fair.' Well, what's fair is what's written in the rules. I suspect tennis versus soccer versus another sport would have lots of little variations."
Other Inherent Biological Advantages Allowed to Persist Among Famous Athletes
Should athletes be disqualified for a disorder that gives them an "unfair" advantage? Dr. Turco points out that recent sports history has not only not done so, many athletes have become champions because of their "birth defects."
"Andre the Giant" was a wrestler who made millions of dollars, perhaps partly because of his being born with a pituitary tumor, which means he was producing his own growth hormone, says Dr. Turco. "It's illegal in competition to get injections of human growth hormone," but because he was making excessive amounts on his own, Andre had the legal advantage.
Another seemingly advantageous disorder for athletes is Marfan syndrome, a condition in which those who are affected "have very flexible joints and can be very tall," says Dr. Turco. He says being born with this condition gave Olympic volleyball player Flo Hyman the upper hand on the court, but complications related to the syndrome also led to her early death.
