What is DSD? The condition at the heart of the Olympic boxing controversy and the match with Imane Khelif

Differences in sex development (DSD) have become a central point of controversy at this year’s Olympic Games after ‘biological male’ Algerian boxer Imane Khelif defeated her opponent in the women’s boxing event.

Khelif was previously banned from competing in a women’s tournament after failing a “gender assessment” but was controversially given the green light to compete in this year’s Games.

And when Khelif faced Italian Angela Carini, she won after just two blows. However, her opponent shouted ‘this is unfair’ and the match was stopped.

Khelif has not yet commented on the matter, but speculation is rife that she has DSD, a rare condition that affects only 0.05 to 1 percent of the population.

DSDs are also called ‘intersex’ conditions and can cause individuals who appear female on the outside to have male chromosomes or male anatomy.

The Italian woman staggered after a cross from Algeria’s Imane Khelif (in red), who had previously been banned from the World Cup because she is ‘biologically male’.

Khelif clashed with Carini in a controversial Olympic welterweight bout this morning

DSD is a collective term for more than 40 individual conditions that develop in the womb.

For example, a person may be born with female genitalia but have the XY chromosome combination characteristic of males, as well as hidden internal testicles.

They can provide people with unusual combinations of chromosomes and reproductive organs, which in the context of sports can improve their performance.

For example, an athlete may be born with a female anatomy but have a DSD that increases her testosterone levels, a hormone essential for building muscle and strength.

While many DSDs are discovered at birth, some are not discovered until puberty or as a result of medical surgeries, tests, and even autopsies.

In some cases, athletes only discovered they had DSD during pre-competition medical tests, resulting in disqualification and their dream of representing their country going up in smoke.

One of the most famous examples of DSD in sports is South African runner Caster Semenya.

Semenya, an Olympic gold medalist, has a DSD called 5-alpha-reductase deficiency, which means she has the male XY chromosomes and produces more testosterone than normal in women.

This DSD can occur in people with female reproductive anatomy and genitals, as in Semenya’s case.

She has previously described having male, but internal, testicles, no uterus but a vagina.

Semenya, who dominated women’s running between 2009 and 2019, was diagnosed with DSD at the same time as the rest of the world.

She was forced to take drugs such as the contraceptive pill to lower her testosterone levels, to comply with new regulations that limited the amount of the hormone at women’s events.

Semenya previously said it caused her to have ‘panic attacks’, a lot of stress and made her ‘want to throw up every day’.

The issue of her DSD and whether she was discriminated against by sports organizations are the subject of a long-running legal battle.

And she’s not the only athlete affected by the storm.

Fellow runners Francine Niyonsaba from Burundi, Kenya’s Margaret Nyairera Wambui and Namibians Christine Mboma and Beatrice Masilingi have also been disqualified from competition due to DSDs.

The rules on testosterone limits had already been brought into sharp focus by the very public and famous case of Caster Semenya

Although most people with DSD lead completely normal and healthy lives, some conditions can be serious and require extensive medical care.

Although some DSDs run in families, in most cases the precise cause of their onset during development in the womb is unknown.

According to the Office of the United Nations High Commissioner for Human Rights, up to 1.7 percent of people worldwide have intersex characteristics, about the same percentage as the population that has red hair.

The UK charity DSD Families estimates that around 130 babies born each year in the UK require screening for possible intersex conditions.

People with DSD have sometimes undergone shocking medical treatments in the past, and in some parts of the world this still happens.

For example, so-called ‘corrective surgeries’ are sometimes performed to ‘repair’ the genitals of babies so that they better match one gender, without any medical necessity.

For example, boys born without a penis, a DSD also called aphallia, are sometimes subjected to “feminizing surgery” to create an artificial vagina.

However, such operations only look at the appearance of the genitals and not at the actual structure of a person’s body.

In the example above, this has resulted in people being raised as girls and having facial hair and a deeper voice when male puberty sets in. This can lead to great stress.

DSD charities have also criticised this ‘corrective’ approach, as it is typically based on societal expectations of how a person should look, rather than any medical benefit to the patient.

Semenya (center), an Olympic gold medalist, has a DSD called 5-alpha-reductase deficiency, which means she has the male XY chromosomes and produces higher levels of testosterone than normal for women

The topic of DSDs and the potential benefits women with these conditions may have has been the subject of controversy at this year’s Olympic Games.

At the heart of the storm is Khelif, who was previously banned from an international women’s competition after tests revealed she had “male sex chromosomes,” leading to comments that she is a “biological male.”

At the time, International Boxing Associates president Umar Kremlev claimed that the tests had shown that Khelif had “XY chromosomes,” which indicate that someone is male.

He added that they “unmasked athletes who tried to mislead their colleagues and pretended to be women.”

However, despite the great controversy, she was allowed to participate in the Paris Games.

In a shocking match today against Italy’s Carini, which lasted just 46 seconds, Khelif dominated the match, but the match was stopped after she landed two hard blows.

Sports scientists told MailOnline that pitting a ‘biological male’ against a female opponent is like pitting a 90kg fighter against a 60kg competitor.

Khelif has not yet responded to speculation about her medical history, but previously told Algerian media that she has had high levels of the hormone testosterone since birth.

But ahead of the match, the Algerian Olympic Committee (COA) condemned what it called “unfounded” attacks on Khelif.

“COA strongly condemns the unethical targeted and defamatory statements of our esteemed athlete, Imane Khelif, with unfounded propaganda from certain foreign media,” the spokespersons said.

“Such attacks on her personality and dignity are deeply unfair, especially now that she is preparing for the pinnacle of her career at the Olympic Games. The COA has taken all necessary measures to protect our champion.”