Transsexual Women and Female Sports

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					Maria Patino und der Wettkampf der Chromosomen
Aus dem Biologieunterricht wissen wir, dass unser 23. Chromosomenpaar über das Geschlecht eines
Menschen entscheidet: zwei X-Chromosomen kennzeichnen eine Frau, während Männer über ein X- und
ein Y-Chromosom verfügen. So einfach ist es für die spanische Hürdenläuferin Maria Patino jedoch nicht.
1966 wurde damit begonnen, bei internationalen Sportwettkämpfen das Geschlecht der Teilnehmerinnen
zu bestimmen. Dieses Vorgehen wurde eingeführt, um den Gerüchten zu begegnen, bei einigen
Teilnehmerinnen aus der Sowjetunion und aus Osteuropa handle es sich in Wahrheit um Männer.
Anfänglich bestand die Überprüfung darin, dass die Sportlerinnen vor einer Gruppe von Gynäkologen
nackt Aufstellung nehmen mussten. Später ging man dazu über, durch einen Abstrich von der
Wangenschleimhaut einige Hautzellen von der Innenseite der Wange zu entnehmen und sie unter einem
Hochleistungsmikroskop zu untersuchen. Bei genetischen Frauen ist im Zellkern ein dunkler Punkt zu
sehen, das Barrkörperchen. Dabei handelt es sich um das inaktive der beiden X-Chromosomen, das in
kondensierter Form vorliegt. Es ist, anders ausgedrückt, außer Funktion und kann daher sehr Platz
sparend im Zellkern verstaut werden. Das eine X-Chromosom von Männern ist hingegen immer aktiv.
Darum ist bei ihnen kein Barrkörperchen zu entdecken.
1985 wurde anlässlich der internationalen Wettkämpfe in Kobe, Japan, festgestellt, dass auch Maria
Patinos Zellkerne keine Barrkörperchen aufweisen, sie also genetisch ein Mann ist. Obwohl sie überzeugt
davon ist, eine Frau zu sein, wurde sie aus der spanischen Nationalmannschaft ausgeschlossen, ihre Titel
wurden ihr aberkannt und sie durfte nicht mehr an Wettkämpfen teilnehmen. Maria ist nicht transsexuell,
sie hat ganz offensichtlich ein weibliches Erscheinungsbild, war ihr Leben lang eine Frau – aber sie hat
auch tatsächlich ein Y- anstelle des zweiten X-Chromosoms. Zweieinhalb Jahre später wurde sie von der
internationalen Vereinigung der Amateurathleten wieder aufgestellt. Aber erst im Jahre 2000 wurde der
Geschlechtsnachweis (es mussten immer nur Sportlerinnen ihre Weiblichkeit nachweisen, Männer wurden
nicht untersucht) unter enormen internationalem Druck auch vom Internationalen Olympischen Komitee
(IOC) wieder eingestellt. Vorerst provisorisch.
(Aus: Peel, 1994).




Transsexual Women and Female Sports
Women’s sport is currently trying to cope with new rules that allow male-to-
female transsexuals compete as women. Danish/Australian golfer Mianne
Bagger is currently leading the way in Europe, and deserves great credit for
her moral courage and determination. However, I personally have some
reservations concerning the new rules - correct although they undoubtedly
are.
I was once a 5ft 9in [post puberty] male, ten years later I may be externally
as female as any other woman, but I still remain a rather substantial 10 stone
and 5ft 9in. Despite my regular fitness routine I know that I'm much weaker
than years ago when I did almost nothing to keep in shape, but even after
kilos of female hormones and being years post-orchidectomy/SRS I remain
bigger and perhaps stronger than most women. I have no doubt that my
male origins still benefit me in my occasional social games of tennis and
squash with other women.
Physical differences between Men and Women
For sometime, experts have been saying that women are rapidly closing the performance gap on men in
sports, and some studies even optimistically claim that women could overtake them in the future (e.g. "Will
Women Soon Outrun Men?" by Brian Whipp and Susan Ward, Nature, 1992). But the brutal reality is
most men are still taller, heavier, faster, stronger, bigger, and more powerful than most women, and are
likely to remain so. A controversial but perhaps realistic study by Seiler and Sailer published in
Sportscience News found a male-female performance difference of 11 per cent in the 1980s - and 12 per
cent today.


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Upon investigation, the list of physical differences between men and women is substantial, even if we only
consider factors directly related to sports.
Males typically have greater bone strength and density, greater muscle bulk and broadness in the
shoulder area, and greater subcutaneous fat in the upper half of the body. At maturity, females are
generally shorter in height, have more flexibility in their joints, have more delicate ligaments and tendons,
have more subcutaneous fat in the hips and lower body regions, have less erythrocyte and haemoglobin
mass (which directly affects the ability to of the blood to carry oxygen and get rid of carbon dioxide), and
exhibit a greater degree of pelvic tilt and obliquity. The female elbow offers a greater carrying angle and
tendency toward cubitus valgus (i.e. the lower arms stick out more), and the female has smaller lungs,
heart, liver, and kidneys than the male. Female joints are more subject to injury in sports requiring an
expulsive effort, sudden stopping, sudden checking of speed and turns, and landing in jumps. These
differences are partly to the man's X chromosome, and partly due to the fact from about age 13 the bodies
of boys are powerfully influenced and "masculinised" by a flood of testosterone from their gonads, while
simultaneously the growth of girls is actually limited and "feminised" in a more delicate direction by the
flood of oestrogens from their ovaries.
According to one US Army manual1:
    •   The average 18-year-old man is 70.2 inches tall, the average woman of the same age is 64.4
        inches tall - a difference of 9%.
    •   The average 18-year-old man weighs 144.8 pounds, the average woman of the same age weighs
        126.6 pounds - a difference of 14%.
    •   The difference in physical size affects the absolute amount of physical work that can be performed
        by men and women.
    •   Men have 50 percent greater total muscle mass, based on weight, than do women.
    •   A woman who is the same size as her male counterpart is generally only 80 percent as strong.
        Therefore, men usually have an advantage in strength, speed, and power over women.
    •   Women carry about 10% points more body fat than do men of the same age.
    •   Because the centre of gravity is lower in women than in men, women must overcome more
        resistance in activities that require movement of the lower body.
    •   Women have less bone mass than men, but their pelvic structure is wider. This difference gives
        men an advantage in running efficiency.
    •   The average woman's heart is 25 percent smaller than the average man's.
    •   For any given work rate, most women will become fatigued sooner than men.
    •   The lung capacity of men is 25 to 30 percent greater than that of women. This gives men an
        advantage in the processing of oxygen and in doing aerobic work such as running.
What the Army study does not really emphasise directly is the fact that the "typical" young untrained male
has an absolute oxygen intake (termed VO2 max) of 3.5 litres/min, while the typical same-age female has
about 2 litres/min - a 43% difference which translates in to reduce performance and increased fatigue.
The difference reduces to 15 to 20% when the difference in body weight is allowed for, but is not
eliminated.
Part of the reason for the V02max difference is that the male sex hormone testosterone promotes the
production of haemoglobin, an oxygen-carrying protein found inside red blood cells, and testosterone also
increases the concentration of red cells in the blood. The female hormone oestrogen has no such effect.
As a result, each litre of male blood contains about 150-160 grams of haemoglobin, compared to only 130-
140 grams for females. The bottom line is that each 'male' litre of blood can carry about 11% more
oxygen than a similar quantity of female blood.
If we compare average body fat in males and females, we find the other part of the answer. Young
untrained women average about 25% body fat compared to 15% in young men. If we factor out body
composition differences by dividing VO2 by lean body mass (bodyweight minus estimated fat weight) the

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difference in maximal O2 consumption decreases to perhaps 7-10% - close enough to 11% difference in
blood carrying capacity just calculated. But this is a theoretical paper exercise as a female athlete cannot
reduce her body fat down to the sub 7% levels often observed in elite males without severe consequences
to her health that would soon rule her out of competition anyway.
The Era of Sex Testing
A man competing as woman in many sports would have an unfair advantage for the reasons described.
Perhaps ever since competitive sports began there have been suspicions and rumours that some female
competitors were not actually women.
Several earlier examples can be quoted such as the Polish sprinter
Stanisllawa Walasiewicz (later Stella Walsh), winner of the 100-meters at the
1932 Olympics (the IOC recovered her medals after learning that she had
male reproductive organs), and the German high jumper Dora Ratjen
(actually Hermann Ratjen) who came fourth in the 1936 games. The IOC
was worried to learn that three other track-and-field champions who
competed as females in the pre-World-War-II games eventually underwent
reconstructive surgery to remove external, male-like reproductive structures.
As sport became increasingly super-power politics by other means, the
masculine physique, deep voices and five o'clock shadow of some formidable
Eastern bloc female competitors was simply impossible to ignore, and sex
tests were introduced after the 1964 Olympic games.
                           Sex testing officially began at the 1966 European Athletics Championships in
                           Budapest. Women competitors were required to disrobe so that medical staff
                           could determine from their genitals whether they were indeed women. Of
                           course, many women found this offensive, but it was also noticeable that
                           several dozen "female" competitors immediately faded from the scene such as
                           the suspiciously masculine Press sisters Tamara and Irina from the Soviet
                           Union who between them won five Olympic titles in the shot-put and hurdles
                           respectively in the early 1960's.
                             However by 1966, sex reassignment surgery had already advanced to stage
                             where “former men” could easily pass this type of "peak and poke" visual test
                             as a woman, therefore at the 1968 Olympics the far more sophisticated
                             polymerase chain reaction (PCR) buccal smear
                             test was introduced to examine the chromosomal
                             picture - if you didn't have XX chromosomes then
you couldn't compete as a woman. Ewa Klubukowska, a 1964 sprint bronze
medallist for Poland, had the dubious honour of being the first woman to fail
the sex test on account of possessing an XXY chromosome pattern,
although she was clearly female in every other way. "I know what I am and
how I feel" she said at the time. After failing her "female" sex test, Ewa
made it a bad joke by getting pregnant and having a baby the next year,
although on the side of the coin Austrian skier Erika Schinegger (Women's
World Downhill Champion in 1966) became Erik after failing her sex test and
later fathered a daughter. Ewa and Erika were in crowded company at the
time, as many other female athletes, including 5 British, failed the new test in
its early days.

Maria Patino, she's now
a reporter and coach
From the start the fairness of this gender verification test was hotly disputed, the vast majority of the
women affected suffered from Complete AIS2 and are legally regarded (and regard themselves) as
women. Things came to head in 1985 when the 24-year old Spanish hurdler Maria Jose Martinez Patino
failed a female sex test because of her AIS before the 1985 World University Games in Kobe, Japan. On
the way to her first race, she was told that she should fake an injury and withdraw - and if she didn’t, her
story would be leaked to the press. She didn’t back down and she won her race, collapsing with physical

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and mental exhaustion after the finish line. The next day, her story was front page news. She returned to
                          Spain to be stripped of her titles and lose her university scholarship and her
                          boyfriend. “I knew I was a woman in the eyes of medicine, God, and, most of
                          all, in my own eyes,” Patino told a reporter. “If I hadn’t been an athlete, my
                          femininity would never have been questioned". Similarly in the 1988 Olympics
                          an unnamed top women's tennis player was prevented from competing when
                          her condition was similarly identified. In the 1992 Barcelona Olympics no less
                          than 5 out of 2,406 women tested as "male", all with some form of AIS. In the
                          1996 Atlanta games 8 women out of 3387 didn't pass as female - 4 with CAIS
                          and 3 with PAIS.
                             Because of pressure from all sources because of the obvious mistakes (so
                             called "false positives") that had potentially ruined the lives and careers of
                             some women exemptions became to be made, starting in 1988 with Maria
Patino herself thanks to efforts of her lawyer.
Between 1972 and 1984, thirteen women "failed" the Olympics' chromosome test and were barred from
competing. Between 1972 and 1990, one in every 504 elite female athletes was found ineligible as a
result of sex chromatin testing yet not one was found to be a "normal male". In the 1992 Barcelona
Olympics, 5 out of 2,406 women tested as "male", all with some form of AIS. In the 1996 Atlanta games 8
women out of 3387 didn't pass as female - 4 with CAIS and 3 with PAIS, but all 8 were allowed to
compete after discussion.
                        By now the whole process of sex test was becoming far more of a hot potato than
                        it was worth as blatant cheats (i.e. a man trying to compete as a woman) which
                        were the real target could be easily picked up by other means, for example when
                        giving a routine anti-doping urine sample which had to be visually observed by an
                        official. Mandatory sex testing for women was finally abandoned for the 2000
                        Sydney Olympics, but unfortunately considerable publicity was still given by the
                        media to two Brazilian women - Judo competitor Edinanci Silva and volleyballer
                        Erika Coimbra - when it was leaked by someone to the press that both were born
                        hermaphrodites, with non-functioning male genitalia which had been surgically
                        removed.
                        MTF Transsexuals Accepted as Women
                        Gender verification test had been dropped before the 2000 Olympics, but there
                        remained a question outstanding about whether sex-reassigned individuals could
                        compete in their new sex.
In February 2004 an IOC advisory group recommended that individuals undergoing sex reassignment
after puberty could compete in the Olympics, but only under certain conditions:
    •   Surgical changes must have been completed, including external genitalia changes and removal of
        gonads.
    •   Legal recognition of their assigned sex must have been conferred by appropriate official
        authorities.
    •   Hormone therapy -- for the assigned sex -- must have been given for long enough to minimize any
        gender-related advantages in sport competitions, a period that must be at least two years after
        gonadectomy.
On Monday, 17 May 17 2004 transsexuals were formally cleared to compete in the Olympics by the IOC
Executive Board. IOC spokeswoman Giselle Davies said the situation of transsexuals competing in high-
level sports was "rare but becoming more common." IOC medical director Patrick Schamasch said no
specific sports had been singled out by the ruling. "Any sport may be touched by this problem," he said.
"Until now, we didn't have any rules or regulations. We needed to establish some sort of policy."
The decision, which covered both male-to-female and female-to-male cases, went into effect starting with
the Athens Olympics in August 2004. The new rules allow the classification as female of men who
underwent the SRS operation before or after their puberty.


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Do Female Transsexuals have an Advantage?
                              There are some valid concerns about the physical advantages that male-to-
                              female transsexuals would have competing against women, particular.
                              Testosterone levels and muscle mass drop considerably after pro-longed
                              hormone therapy and sex-change surgery but the question remains about
                              how much residual advantage the MTF transwoman trains due to her
                              genetic maleness remains and for how long? And although hormone
                              treatments for transgendered athletes certainly diminishes certain
                              differences, skeletal advantages - and possibly lung and heart capacities -
                              are left unchanged. That could give transsexuals, particularly those having
                              SRS after puberty, with a huge advantage competitive in some sports when
                              even a 1% difference can be the difference between first place and eighth.




Physical Advantage           Male                       MTF transsexual            MTF transsexual
                                                        Pre-puberty SRS            Post-Puberty SRS (>2
                                                                                   years)

Height                       Yes                        Reduced                    Yes

Skeletal Structure (pelvis   Yes                        Reduced                    Yes
etc)

Muscle Mass                  Yes                        No                         Reduced

Body Fat Ratio               Yes                        No                         Reduced

Bone                         Yes                        Reduced                    Yes
Mass/Density/Ruggedness

Heart size                   Yes                        Possibly Reduced           Yes

Lung Capacity                Yes                        Possibly Reduced           Yes

Red blood                    Yes                        No                         Reduced → No
cells/Haemoglobin

The table above is rather speculative, but is supported by the limited research available. For example one
study found that androgen deprivation in MTF transsexuals increases the overlap in muscle mass with
women but does not reverse it.
It has been suggested that transsexual women who have SRS after puberty are actually at a disadvantage
in sports compared with other women as they are lugging around the large and heavy skeleton of a man
without the compensations such as big muscles. Alison Carlson:- "A man who's castrated and takes
oestrogen therapy loses a lot of strength advantages. With someone like Renee Richards [see below],
she didn't suddenly become this winning player on the women's circuit. In fact, she didn't do that well,
because although she was tall, she actually had female musculature being carried around on a large male
skeleton. It weakened her." Personally I'm not quite sure that the overall balance and weighting of
advantages and disadvantages agree with this view - although it does depend on the sport.
Complete AIS is sometimes presented as the ultimate form of male-to-female transsexual - the suffer is
genetically male XY but has a completely normal female body (albeit lacking internal reproductive
structures) due to the total inability of their bodies to use the male androgen hormones produced by their
testes in anyway, including for muscle development or VO2max. But a very interesting paper "Complete

                                                                                                             5
Androgen Insensitivity "Syndrome": A Model For Human Performance in Sports" does nothing to support
the suggestion that AIS women, or indirectly male to female transsexuals have no advantage in women
sports.
The Future
Michelle Dumaresq, is perhaps an early example of the future., Since her sex-reassignment, Michelle
claims to have lost bone density, three inches of height [sic], and 30% of her muscle mass along with her
testosterone, but nevertheless she became the Canadian women's downhill cycling champ in 2002.
Michelle also mentions receiving e-mails from three transwomen who were about to qualify for the 2004
Olympics.
There is no doubt that some Olympic events (e.g. running, javelin, pole vault, marshal arts ..) and many
professional, semi-professional women's sports such as tennis, golf, football (soccer), basketball,
bowling, running et al now face a gradual influx of top ranked women who are transsexual, although their
transsexuality may not be public.
Looking backwards for more examples of what can happen, we encounter Dr
Richard Raskind, an American eye surgeon who changed sex and became Renee
Richards. At the age of 44 she reached the quarter-finals of the US Open in 1978.

Renee now sees both sides of the issue regarding whether a transsexual should
be allowed to play a women's event, she believes that it comes down to fairness.
Renee would bar transsexuals from women's sports if they were in their 20s and
still had muscular male physiques that gave them an advantage over other
women:
"That's why we have junior events and senior events, men's events and women's
events, and why 130-pound fighters don't fight against 180-pound fighters. We
have categories in sports to have level playing fields. Tiger Woods or Jimmy
Connors or John McEnroe, if they're 25 years old and they have a sex change and within the next five
years they go out to play against women, of course they have a great advantage. Woods probably isn't
contemplating any changes, and it's unlikely there will be a rush of men with low handicaps switching sex
to clean up on the women's tour. Bagger may be making history of a sort, but she isn't leading a
revolution. She'll play, she'll be somewhere in the middle, she'll do it for a while, and she's going to get a
lot of grief. She'll get some notoriety. She may like it, she may not like it. And then it'll die down. It's not
going to cause a rash of transsexual golfers. Those kind of fears are silly."
But Renee has also warned that the decision by the International Olympic Committee means that
unscrupulous competitors could use the new ruling to change from men to women to give them more
chance of success.
"It's ironic that everyone has tried so hard to keep a level playing field - from corked bats to doping - but
now the IOC has come up with a decision that defies fairness in a similar vein. Sex-reassignment surgery
is based on putting materials into your body."
Putting things in a UK context, the new reality is Tim Henman could become Tina Henman and be a
[female] Wimbledon champion at last. With Henman’s strength and speed, height and muscle density,
added to his skills, it would be a near certainty even after two years of female hormones and aging.
But a counterview to Renee is offered by Kia Siadeski, a transsexual woman whose passion is Barrel-
racing - a women only sport. She says: "I'm 5'5" and weigh 112 pounds - I have no strength advantage,
never did. Not that strength is needed in barrel-racing, anyway - 75% of the sport is about the horse. But
half the women I compete against are bigger and stronger than I am". But when news of her operation got
out, she lost her championship.
If MTF reassignment surgery is performed after adolescence and puberty, Kia (and indeed some sports
organizations such as the Women's Sports Federation) believes that transsexuals should be evaluated on
a case-by-case basis. But there is an implication here that transwomen will have to be below a certain
height, weight or strength before they are allowed to compete as women.
Conclusion
If the question is posed whether male to female transsexuals can compete in all fairness with other

                                                                                                                   6
women, the answer is probably no for most sports, particularly if SRS is conducted after a normal male
puberty. The long term effects of SRS (androgen deprivation) and oestrogen hormone therapy partially
reverse some of previous effects of testosterone on the transwomen's body, for example they become
much closer to women norms in terms of muscle mass - but even in this category not completely so.
However the real question whether transwomen should be allowed to compete as women. The answer
here is a resounding yes, as the IOC and other sporting bodies have finally recognised after decades of
debate. However the scene is set for some controversial cases in the future.




1
    APPENDIX A
PHYSIOLOGICAL DIFFERENCES BETWEEN THE SEXES
Soldiers vary in their physical makeup. Each body reacts differently to varying degrees of physical stress, and no two bodies react
exactly the same way to the same physical stress. For everyone to get the maximum benefit from training, leaders must be aware of
these differences and plan the training to provide maximum benefit for everyone. They must also be aware of the physiological
differences between men and women. While leaders must require equal efforts of men and women during the training period, they
must also realize that women have physiological limitations which generally preclude equal performance. The following paragraphs
describe the most important physical and physiological differences between men and women.
SIZE
The average 18-year-old man is 70.2 inches tall and weighs 144.8 pounds, whereas the average woman of the same age is 64.4
inches tall and weighs 126.6 pounds. This difference in size affects the absolute amount of physical work that can be performed by
men and women.
MUSCLES
Men have 50 percent greater total muscle mass, based on weight, than do women. A woman who is the same size as her male
counterpart is generally only 80 percent as strong. Therefore, men usually have an advantage in strength, speed, and power over
women.
FAT
Women carry about 10 percentage points more body fat than do men of the same age. Men accumulate fat primarily in the back,
chest, and abdomen; women gain fat in the buttocks, arms, and thighs. Also, because the center of gravity is lower in women than in
men, women must overcome more resistance in activities that require movement of the lower body.
BONES
Women have less bone mass than men, but their pelvic structure is wider. This difference gives men an advantage in running
efficiency.
HEART SIZE AND RATE
The average woman's heart is 25 percent smaller than the average man's. Thus, the man's heart can pump more blood with each
beat. The larger heart size contributes to the slower resting heart rate (five to eight beats a minute slower) in males. This lower rate
is evident both at rest and at any given level of submaximal exercise. Thus, for any given work rate, the faster heart rate means that
most women will become fatigued sooner than men.
FLEXIBILITY
Women generally are more flexible than men.
LUNGS
The lung capacity of men is 25 to 30 percent greater than that of women. This gives men still another advantage in the processing of
oxygen and in doing aerobic work such as running.
RESPONSE TO HEAT
woman's response to heat stress differs somewhat from a man's. Women sweat less, lose less heat through evaporation, and reach
higher body temperatures before sweating starts. Nevertheless, women can adapt to heat stress as well as men. Regardless of
gender, soldiers with a higher level of physical fitness generally better tolerate, and adapt more readily to, heat stress than do less fit
soldiers.
OTHER FACTORS
Knowing the physiological differences between men and women is just the first step in planning physical training for a unit. Leaders
need to understand other factors too. Women can exercise during menstruation; it is, in fact, encouraged. However, any unusual
discomfort, cramps, or pains while menstruating should be medically evaluated.



                                                                                                                                          7
Pregnant soldiers cannot be required to exercise without a doctor's approval. Generally, pregnant women may exercise until they are
close to childbirth if they follow their doctors' instructions. The Army agrees with the position of the American College of Obstetricians
and Gynecologists regarding exercise and pregnancy. This guidance is available from medical authorities and the U.S. Army
Physical Fitness School (USAPFS). The safety and health of the mother and fetus are primary concerns when dealing with exercise
programs.
Vigorous activity does not harm women's reproductive organs or cause menstrual problems. Also, physical fitness training need not
damage the breasts. Properly fitted and adjusted bras, however, should be worn to avoid potential injury to unsupported breast
tissue that may result from prolonged jarring during exercise.
Although female soldiers must sometimes be treated differently from males, women can reach high levels of physical performance.
Leaders must use common sense to help both male and female soldiers achieve acceptable levels of fitness. For example, ability-
group running alleviates gender-based differences between men and women. Unit runs, however, do not.


2
    Androgen Insensitivity Syndrome
Important Note: the speculations on this page are my own, and not those of Androgen Insensitivity Syndrome Support Group
(AISSG).
When I established this page in 2000 it soon incorporated feedback from various relevant sources, nevertheless in May/June 2003
several ladies strongly objected to the content and I therefore took it off-line. However I have since had some supportive discussions
and have resurrected this page for information purposes, minus some items. I feel that there are some physiological and legal
relationships between AIS women and transsexual women that make it appropriate for this site. I would love comments from anyone
mentioned on this page, and particularly welcome constructive feedback.


Many thousands of women around the world suffer from a disorder known as Androgen Insensitivity Syndrome (AIS), or Testicular
Feminisation Syndrome. This syndrome is of great interest because it conclusively proves (though perhaps not to some judges and
lawyers!) that women can have XY genes, a fact which has great significance for genetically XY Male-to-Female (MTF) transsexuals.

                       Women with AIS look and feel like typical women, and in every practical, social, legal, and everyday sense
                       they are women, even though congenitally they have testes and XY chromosomes, and can never bear
                       children. The fact that a "woman" has AIS and is genetically a "male" is often not discovered until puberty,
                       when she does not start to menstruate and a gynaecological examination reveals the syndrome.
                       (The above two paragraphs are based on material from the literature of the Androgen Insensitivity Syndrome
                       Support Group (AISSG)).
                       Unlike with MTF transsexual women, no court has ever disputed the right of an AIS woman to legally marry a
                       man and adopt children on the grounds that she's actually genetically XY male. However, an adult AIS
                       woman is physically (internally and externally) almost indistinguishable from a MTF transsexual woman who
                       started surgical and hormonal treatment before puberty, so clearly there is a major issue and injustice here.
                       Medical Background of AIS
                       Every foetus, whether genetically male (XY) or female (XX), starts life with the capacity to develop either a
                       male or female reproductive system. In AIS the child is conceived with male (XY) sex chromosomes and
                       normal embryonic testes (known as the foetal gonads) develop and start to produce masculinising
                       androgens. However with AIS, a rare genetic condition carried on the X chromosome means that the foetus
Jamie Lee Curtis       has no receptors for these male hormones, and his/her body can't "see" or acknowledge them. Lacking the
is                     effect of these androgens, the external genitals develop along female rather than male lines. Unfortunately
 alleged to suffer     however, another hormone produced by the foetal testes simultaneously suppresses the development of
from AIS.              female internal organs (uterus and ovaries).


There are two types of AIS: most (90%) girls have completely normal female type external genitalia, but they lack a uterus or upper
vagina. This is known as Complete AIS (CAIS, technically AIS Grades 7 & 6). The remaining girls have Partial AIS (PAIS), their
outward genital appearance usually lying anywhere from almost completely female (AIS Grade 5) through to almost completely male
(Grade 3).

In PAIS, the foetus showed some response to testosterone (thus the term "partial"). Often girls with partial AIS are born with
ambiguous genitalia, where it is not clear at first if the baby is a boy or a girl. If the clitoris is enlarged, it can resemble a small penis,
and changes in the labia can make it look like a scrotum. Surgery can be performed to reduce the size of the clitoris, although some
experts strongly disagree about when - or even if - the operation should be done. (Clitoral surgery in childhood may interfere with
sexual sensation later in life, having a potentially dramatic impact on the girl's intimate relationships as an adult.)




                                                                                                                                              8
                                       All CIAS and most PAIS babies are reared as female because: they will be infertile as males;
                                       they will have a female type puberty; and they will not be able to function sexually as a man
                                       but they will be able to do so as a woman.
                                       In some types of PAIS (AIS Grades 2 & 1) the male genital deformity is so minimal that a
                                       baby's gender assignment will be male. Excessive breast development is likely to occur (often
                                       unexpectedly!) at puberty, but this can be removed by surgery and the PAIS male may even
                                       prove fertile.
                                       The most accurate figure available for the incidence of CAIS comes from a 1992 analysis of a
                                       Danish patient register, suggesting an incidence of 1 in 20,400 XY births. This includes
                                       hospitalised cases only so true incidence is probably higher. PAIS seems to be only about
                                       1/10 as common as CAIS.
                                       Anne Fausto-Sterling in her excellent new book, Sexing the Body: Gender Politics and the
                                       Construction of Sexuality, suggests that the actual incidence of AIS is about 1 in 10,000 -
                                       which would imply up to 3000 people (male and female) suffer with CAIS or PAIS in the UK
                                       alone. As support groups and surveys have identified only about 500 such people in the UK,
                                       clearly there is still a major hidden problem.

Niamh - a lovely young woman
with AIS. She briefly had a
website in 1999.

Puberty


At puberty girls with AIS experience a female pubertal development because their hidden testes
produce sufficient oestrogen to induce development of the breasts, hips genitalia, etc. (if the
testes have been already removed, larger oestrogen doses will be given at age 12). The body of
an AIS girl not only fails to develop masculinity at puberty, but also develops even further in a
feminine direction, causing the body appearance to simulate an adult XX female.
Shortly after puberty starts, an orchidectomy will often be performed to remove the testes
(primarily to reduce risk of cancer), and Hormone Replacement Therapy begun to substitute for
the oestrogen that the testes were producing.
In appearance the overall body shape typically becomes very decidedly feminine, with a classical
female pattern subcutaneous fat distribution and generous breast development - large breasts
with pale, under-developed, juvenile appearing nipples are one indication of AIS.
                                                                                                        Examples of the physique of
Girls with CAIS will either fail to develop pubic and auxiliary hair (AIS Grade 7), or it remains       AIS woman - warning,
scant (Grade 6).                                                                                        potentially offensive.

Sexual Orientation


Studies have apparently found that most, although certainly not all, women with
complete androgen insensitivity syndrome (CAIS) have no problems with their female
gender identity and unambiguously identify themselves sexually as a woman, often
leading normal sex lives. Statistically their leanings towards heterosexuality,
lesbianism or bisexuality may be no different from females in general.
However it must also be recognised that AIS women have both physical and
psychological factors that might predispose them to suffer sexual dysfunction, e.g.:
shorter than average vaginas, an inability to respond to androgens and anxieties or
concerns about their condition, which could impact on self esteem, body image,
sensuality and sexual function. At least one study found that sexual dysfunction is
common in CAIS, most significantly in the areas of difficulty with vaginal penetration,
infrequency and non-communication.
A rough analysis of biographies and articles published on the Internet by or about AIS         Ilizane Broks (age 16) and sister Xenia
women shows that while many are married or strongly attracted to men, an unusually             (6). Ilizane considers herself "more
large proportion have a lesbian or bisexual orientation. But there may well be a bias in       female than male", while Xenia is much
these results compared with the actual situation. Speculating considerably, a lesbian          more "girlie".
or bisexual orientation may be more prevalent in PAIS (rather than CAIS) women




                                                                                                                                         9
where greater social, physical and biological challenges to their female psychosexual sexual identity have occurred at a young age,
these problems may have made such women more likely to openly state their situation and adopt an activist position than a far more
numerous group of happier and often married heterosexual women who are reluctant to publicise their AIS condition.
Sex


The external genitalia of a CAIS woman are absolutely identical to that of a normal woman, both
in appearance, structure and sensations. Given adequate vaginal depth, there is no reason for a
CAIS woman and her partner not to enjoy sexual intercourse just as much as any other couple.
Things may not be quite so simple for a PAIS woman, but if desired modern feminising
genitoplasty procedures can usually "correct" the external genitalia, again making them
indistinguishable from other women. A short, blind-ending, vagina (averaging 5-6 cm long, about
half normal size - but with great variance) is present in girls with CAIS, but even this is often
lacking in girls with PAIS. Thus before sexual intercourse becomes possible, most girls with AIS
must deepen their vagina. In general the best method involves dilation, in which a doctor or
nurse teaches the young woman how to use an instrument called a dilator to put pressure on the
inside of her vagina. The girl should start dilation only when they feel psychologically ready,
usually between the ages of 15 and 20. Over a few months of daily exercises, the vagina
becomes deeper and wider, making intercourse possible. Surgical procedures can also be used
to lengthen the vagina, but as surgery has more complications than dilation it is avoided if
possible.
Some girls and women with CAIS, and almost all of those with PAIS, are born with a partial
obstruction to the vaginal opening, and an enlarged penis/clitoris. Before dilation can be safely
started they will need a minor surgical procedure to open up the vaginal opening, if this has not
already been done. If desired, it is also possible at this time to reduce the penis/clitoris.
Reproduction and Children
Since women with AIS don't have a uterus, ovaries, or eggs there is unfortunately no possibility
of menstruation and pregnancy .... or her being able to have biological children by any means.
Advanced new fertility treatments are starting to offer AIS women desperately wishing to have
children some hope for the distant future, but currently if a woman with AIS and her husband
                                                                                                     Eden Atwood and her mum.
want to become parents then adoption is probably the main option. Alternatively, some couples
                                                                                                     Eden is an actress and
choose to use in vitro fertilization technology (IVF), fertilizing donated eggs with the husband's
                                                                                                     wonderful jazz singer, with an
sperm and then implanting the embryos into a gestational carrier (surrogate mother).
                                                                                                     amazing life story.


Appearance


Women with AIS present a typically female appearance (technically, they are phenotypic
female). Researchers have noted that their body shape does not deviate much from that of
normal females but that they tend to be larger in all body measurements, although with a
tendency to a slim body. This is thought to be because body shape is controlled by oestrogen
while the "Y" chromosome is mainly responsible for growth (the absent androgens would have
only a small additional effect).
Post-puberty, AIS women are typically tall for a woman, averaging about 5 feet 7½ inches (171.5
cm), this is just over an inch (3 cm) less than the average man but about 3 inches (8 cm) more
than the average woman. However, this average is based on the study of adult women who
generally did not have childhood oestrogen or HRT treatment. Such treatment can accelerate the
completion of growth in the growth plates (the zones of growing cartilage near the ends of
children’s bones) of AIS girls, thus helping prevent excessive adult height. The generation of AIS
girls currently emerging into early adulthood have often benefited from such early supplemental
oestrogen therapy and it's therefore presumed that their average height is somewhat less -
indeed at least one young woman blames her rather short 5ft 2in stature on excessive early HRT.


                                                                                                     AIS beauty Janel Bishop, Miss
                                                                                                     Teen USA 1991




                                                                                                                                  10
I was kindly sent these pictures, a tall but attractive appearance is typical of AIS women.
There will also be some slight masculinisation of the skeleton, with proportionally longer legs and arms, and larger hands and feet
than the average XY woman, and the size of teeth is closer to men than those of women. Due to the lack of androgen affects the girl
will not suffer from acne or temporal balding, and little or no pubic hair and auxiliary body hair will develop.
The overall effect is that AIS women tend to be exceptionally beautiful with above average height (for a woman), long well
proportioned legs, generous breasts, flashing smiles, exceptionally clear skin and luxuriantly thick scalp hair. According to one paper
the AIS woman is "often voluptuously feminine", another report says "some people with the syndrome look like 'mama mia' women",
and even John Money and A. Ehrhardt in their famous book Man and Woman, Boy and Girl noted that AIS girls tend to have a "very
attractive female physique".
Unsurprisingly it's been reported "because they [AIS women] are unusually beautiful, they are usually found in occupations that pay
high salaries for attractive female appearance such as modelling, acting or prostitution".
This is supported by other AIS studies, for example one study found that several top fashion models and two well known [though
unnamed] Hollywood actresses had AIS, an Australian study concluded that "many girls work as models", and another report noted
that one of the girls it had studied was an (unnamed) famous photographic model, two were air stewardesses and one a prostitute.
"In the old West, women with AIS were reportedly popular among the ranks of prostitutes," notes Vikki Huffnagel, a Californian
obstetrician/gynaecologist who treats AIS patients. "They were tall, lean, very attractive, and couldn’t get pregnant."
Despite the above comments, it is certainly an extreme exaggeration to suggest that every AIS woman is a potential supermodel,
nevertheless it seems that the physiological traits associated with at least CAIS are, on average, likely to increase the attractiveness
of a woman with that condition to men.
Famous Woman with AIS
The first historical description of a woman apparently suffering from Androgen Insensitivity Syndrome is in the book Talmud, which
dates back to BC400. Other historical women suspected to have had AIS include: Joan of Arc, Queen Elizabeth I, and Mrs Wallis
Simpson.




                                                                                                                                     11
Joan of Arc (Jeanne d'Arc)               Queen Elizabeth I of England                  Madonna and Child, by Leonardo da
                                                                                       Vinci c. 1482

                                         Sam Berry, Emeritus professor of genetics at University College London, has also
                                         speculated (Daily Telegraph, 21 November 2001) that the Virgin Mary had Androgen
                                         Insensitivity Syndrome, but with differentiation of her sex organs. He claims that it is
                                         possible for a person of this constitution to develop an ovum and uterus, "If this
                                         happened, and if the ovum developed parthenogenetically, and if a back-mutation to
                                         testosterone sensitivity took place, we would have a situation of an apparently normal
                                         woman giving birth without intercourse to a son."




Mrs Wallis Simpson and HRH
the Duke of Windsor on their
wedding day, 3 June 1937

                               In America, the notorious Black Dahlia murder case sadly seems to be AIS related. The Black
                               Dahlia (aka Elizabeth Short ) was a beautiful 22 year-old would-be actress who's body was found
                               horribly mutilated in Los Angeles in 1947. The terrible murder has never been solved, but one
                               theory is that the murderer was a suitor who was totally enraged when he found out that she
                               could not have intercourse due to her underdeveloped vagina. Those who knew her well said
                               that she had never menstruated, but would use a sanitary napkin just the same in order to
                               conceal her condition. All the indications are that she suffered from what is now called AIS.




Elizbeth Short




                                                                                                                                12
                                                                    The beautiful Corr sisters




Linda Evangelista, Bonnie Pfeifer & Cindy Crawford

As already indicated, medical papers frequently mention that various famous but always unnamed (or pseudonym) actresses and
models have AIS, one report even estimating that a very improbable 80% of "supermodels" have this condition"! Perhaps
unfortunately there is enough information from multiple semi-reputable sources (e.g. a link on medhelp.org claims "there are at least
two well-known American movie stars who are XY women, according to researchers in sex differences, although neither of the
actresses wishes her condition to be made public") for what can only be called a "Guessing Game". Also a quiz like "which Oscar-
winning Hollywood superstar’s doctor claims she was born a hermaphrodite, with undescended testes where her ovaries should
have been? (and no, it’s not Jamie Lee Curtis)" doesn't help!

For obvious reasons women with the AIS disorder are very unlikely to admit or confirm that they have
it, while women mistakenly alleged as having AIS are very unlikely to submit to the indignity of
medical examinations and karyotype testing for XY genes in order to convincingly disprove
it. Nevertheless speculation and rumour about possible famous women who have AIS is rife in
popular magazines, newspapers, and particularly on the web - usually backed up with little or no real
evidence other than lack of children. For example, one post I read on a web board suggested that the
ultimate female icon Marilyn Monroe had AIS, another also suggested Katherine Hepburn, while yet
another wondered about the girls of the Irish pop group The Corrs, although the pregnancy of
Caroline Corr and her subsequent birth of a boy in Feb 2003 rather diminished that particular theory!
Despite a miscarriage (apparently just a cover story!) the 5ft 10½in (180cm) tall actress Nicole
Kidman has also become a favourite AIS suggestion since adopting two children,




                                                                                                          Nicole Kidman

Persistent rumours have particularly concerned model Cindy Crawford. These seem to have originated in the mid-1990's from
someone linking her exceptional build, supposed lesbian inclinations and continuing lack of children with AIS and "male genes".
Cindy's physique (like most supermodels) fits the syndrome very well, but her 1999 pregnancy and birth of a son has again
disproved the rumours.
As already hinted, the actress Jamie Lee Curtis is frequently cited as an example of a women with AIS, although this is certainly not
confirmed there does appear to be an unusual amount of "smoke" in this particular instance. Every time a medical study hints that
that unnamed famous actress has AIS, Jamie is always associated. One report [which I can no longer find] stated that she was born
with Partial AIS (Grade 3), in which case she would have required plastic surgery similar to that undergone by MTF transsexuals to
normalise her genitalia as female and create a neo-vagina (Jamie's two children are both adopted).




                                                                                                                                   13
                                   Finally for this section, the stunningly beautiful movie siren of the 1950's and '60's, Kim Novak,
                                   has also been alleged to have AIS. Given her lengthy series of lovers and husbands and the
                                   limited surgical techniques available at that time, if true then she was very probably born with
                                   Complete AIS (Grade 6/7) and adequate vaginal depth for intercourse.




Kim Novak

Sport and AIS Women
Women with AIS do so seem to be either unusually good at sports, or are perhaps more likely to take up sport than other women.
Top female athletes have often been found to have AIS when sex tested, reportedly 1 in 500 women athletes of international
standard suffer from AIS, which is an order of magnitude greater than current estimates of about 1 in 5000 AIS women in the general
female population. There's actually considerable interest in this association, it is being suggested that Complete AIS represents a
valuable model for female performance in sports.
Since before the Second World War questions have been raised (sometimes justifiably) regarding the "femininity" of some highly
successful female competitors. Initially some rather crude methods were introduced to detect male impostors at major sporting
events, but from 1968 these were replaced by various tests that verified female gender (or slightly more correctly, physiological sex)
by not detecting the presence of either a "male" XY chromosomal pattern or a Y gene. Unfortunately these tests identify as male
those athletes who happened to have an XY chromosomal pattern but were otherwise unassailably feminine. AIS women fall in to
this category, although ironically their androgen resistance, whether complete or partial, means that unlike other women they are
naturally resistant to the strength-promoting qualities of testosterone! (Pumping their women athletics full of male hormones was a
common practice by the old Soviet block; it wouldn't work with an AIS woman!). "It’s sheer lunacy to think that an AIS woman has an
advantage in sports," explains Sherri A. Groveman, who helps runs an AIS and intersexed support group "In fact, we’re somewhat at
a disadvantage. I could be taking steroids all day long, and unlike other women I wouldn’t develop increased muscle mass. My
body can’t respond to androgens." If AIS women do have any physical advantage in sports then it probably lies in the fact they often
tend to be tall and their skeleton nearer to male than female in structure, although their musculature and body fat distribution is
always typically female. [Without daring to argue with Ms Groveman, the author of this article does wonder if this skeletal advantage
does explain at least some the exceptional success of AIS women in the sporting field. For example, it appears that the average AIS
woman is in to the top 10% of the overall female population in terms of height, is it only a co-incidence that this matches the over-
success of AIS women in sports.]




                                          Maria Patino, she's now
                                          a reporter and coach




                                                                                             Erika Coimbra, 3 years after the Sydney
                                                                                             Olympics and rather more filled out!




                                                                                                                                        14
In 1985 the 24-year old Spanish hurdler Maria Jose Martinez Patino failed a female sex test because of her AIS at the 1985 World
University Games in Kobe, Japan. On the way to her first race, she was told that she should fake an injury and withdraw - and if she
didn’t, her story would be leaked to the press. She didn’t back down and she won her race, collapsing with physical and mental
exhaustion after the finish line. The next day, her story was front page news. She returned to Spain to lose her university
scholarship and her boyfriend. “I knew I was a woman in the eyes of medicine, God, and, most of all, in my own eyes,” Patino told a
reporter. “If I hadn’t been an athlete, my femininity would never have been questioned". Similarly in the 1988 Olympics an unnamed
top women's tennis player was prevented from competing when her condition was similarly identified. In the 1992 Barcelona
Olympics 5 out of 2,406 women tested as "male", all with some form of AIS. In the 1996 Atlanta games 8 women out of 3387 didn't
pass as female - 4 with CAIS and 3 with PAIS.
However gender authentication (sex testing) for athletes had by now become unsustainable. Clearly the vast majority of failures to
pass the "sex test" were due to AIS, but no one disputed that AIS women were woman - so the results were false positives. Also,
any benefits that an AIS woman may naturally have because of her "male" XY genes are offset by disadvantages, and trivial
compared with the effects of illegal performance enhancing drugs such as steroids on the genetically XX female body. Thus in
February 1999, the Athletes' Commission of the International Olympics Committee urged its parent organization to do away with sex
analysis entirely and rely instead on observed urination during drug testing to pinpoint any obvious male impostors.
Mandatory sex testing for women was thus thankfully abandoned for the 2000 Sydney Olympics, but unfortunately considerable
publicity was still given by the media to two Brazilian women - Judo competitor Edinanci Silva and volleyballer Erika Coimbra - when
it was leaked to the press that both were born hermaphrodites, with non-functioning male genitalia which had been surgically
removed. As they actually suffered from AIS they were not banned from competing under the revised rules, but sadly some of their
opponents made it known that they were unhappy about this fact - the attractive and elf-like Erika (age 20, weight 64kg, height
180cm, with long blond hair) perhaps unsurprisingly receiving much less abuse than the much plainer looking Edinanci (age 24,
weight 71kg, height 175cm), whose opponents disgracefully started to refer to as a "he".
In May 2004 the International Olympic Committee dropped all sex testing for woman's sports starting with Athens Summer Olympics
- with mixed reactions.
Note: For more information or help regarding AIS, the Androgen Insensitivity Syndrome Support Group (AISSG) has an
excellent site at http://www.medhelp.org/www/ais/. Included among the excellent articles is an extract from the book
'Woman - An Intimate Geography' by Natalie Angier, which in part sensitively considers AIS and the life of one AIS woman.


Copyright (c) 2003 Annie Richards
Last updated: 8 July, 2003




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