What Is DSD? Rare Biological Condition Behind Imane Khelif’s Olympic Boxing Controversy Explained
Algerian Olympic boxer Imane Khelif, who won the gold medal in the women's 66kg boxing category at the 2024 Paris Olympics, has found herself in the middle of a gender-related debate. Reports accessed by French journalist Djaffar Ait Aoudia, as published in Reduxx, brought to light medical findings about Khelif's biological status, revealing that Khelif has "testicles" and an XY chromosome arrangement, thus confirming as 'biologically male'.
According to this report, Khelif has a medical condition known as 5-alpha reductase deficiency (5-ARD), a rare difference in sex development (DSD). Medical documents, allegedly from collaborations between France’s Kremlin-Bicêtre Hospital and Algeria’s Mohamed Lamine Debaghine Hospital, were reportedly compiled in June 2023. These reports outline that Khelif has internal testes and other characteristics atypical for female development.
An MRI and chromosomal tests confirmed the absence of a uterus and the presence of internal male reproductive organs. Furthermore, her testosterone levels were consistent with typical male ranges.
DSD comprise the group of congenital conditions characterized by lack of typical sex development. In most cases, DSD can be identified in prenatal development due to interactions between complex genetic factors and hormone signals. Sometimes, people use the older term and refer to DSD as "intersex," while at other times they use some precise vocabulary to describe a given condition.
The terms "sex" and "gender" tend to be used almost interchangeably; however, they refer to two different things. "Sex" generally relates to the physical qualities determined by genetics and hormone influence, whereas "gender" refers to a human being's identity and social construction. DSD conditions can usually obscure the distinctions that are typical for sex, making talk around these terms particularly tricky.
Genetic Factors
The genetic factors form the core of DSD conditions. Normally, a human being has 46 chromosomes, two of which decide the sex of the individual-the X and Y chromosomes. In most females, two X chromosomes are found, but in most males, an X and a Y chromosome are found. DSD can cause variations in such chromosomal patterns and hence sometimes lead to incongruity between chromosomal sex and physical attributes.
Sex Hormones
Sex hormones, including androgens in males and estrogens in females, determine body development both in fetal life and at puberty. Such hormones are produced in gonads, which could be either testes in a male or ovaries in a female, as prescribed by the genetic pattern. Hormonal pathways may therefore get affected in DSD such that sexual characteristics might appear in an atypical fashion.
Body Parts of Reproduction
DSD may result in the combination of male and female reproductive structures or in reproductive parts not typical male or female. A few have mixed genitals, but others may have typical genitals yet possess an unusual chromosomal setup that reveals itself at puberty or even later.
DSDs are as diverse as are the individuals affected by them. For example, some can be mentioned to be the following:
- In this case, one finds an individual with an XY chromosome yet having female-like external genitals.
- In other words, one has XX chromosomes but with male-like genitals.
- One can still have both ovarian and testicular tissues, meaning in such a case, you are likely to have genitals which might be a mix of a male and female.
- Some individuals have normal sex organs but an atypical arrangement of chromosomes, meaning changes in physical development over time.
The Cleveland Clinic notes that "intersex" has been the term used for decades in describing DSDs; however, terminology may vary among individuals and cultures. Some people with DSD prefer terms like 'differences' instead of 'disorders', arguing that DSD is just a variation in biological development.
According to a report in The Independent, "If I showed you pictures of my patients without any clothes on, you would say, well, these are females that I'm looking at," said Prof Højbjerg Gravholt, professor of genetic endocrinology in Denmark and works with patients who have differences in sex development.
He mentions that physical characteristics, hormonal profiles, or chromosomes cannot determine a person's sex uniquely. DSD in the lives of many presents the message that sex is not a biological category but rather a spectrum molded by genetic and hormonal diversity.
DSDs are caused by variations in genes that control sexual development or altered response to hormones such as those found in CAH. CAH presents as a result of excess androgen production with the development of male characteristics. Another type of DSD is the AIS where the body system is unable to respond to the presence of androgens thereby modifying physical development.
According to Cleveland Clinic, treatment of DSD is given based on the severity of the symptoms. These can vary from:
-Hormonal therapy for puberty and other conditions that may arise in connection with DSD, including osteoporosis.
-Genital reconstruction or modification surgery. Most of the surgeries are irreversible and thus left until the patient is capable of giving consent. For the very mild cases of DSD, no treatment is necessary and the individual may lead an untreated life.
Currently, DSDs can't be prevented. What is not well understood at present is the complex gene interactions that drive the development of human sex. No method has been developed that can predict or avoid DSDs in future offspring. That unpredictability reflects the normal variation in human biology.
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Your eyes could be giving you clues that your kidneys aren’t working the way they should. While most people associate kidney trouble with tiredness, swelling, or changes in urination, the effects can also show up in your vision. To understand this better, we spoke with Dr Manoj K. Singhal, Principal Director of Nephrology and Kidney Transplantation at Max Super Speciality Hospital, Vaishali.
The kidneys filter toxins and help maintain balance in the body. But when they start to weaken, some of the earliest signs may appear in unexpected places, like your eyes. Some of these symptoms, as per Dr Manoj are:
It’s normal to wake up with puffy eyes, but if the swelling doesn’t fade even after rest, it could point to protein leaking into your urine, a condition called proteinuria, which often signals kidney damage.
Sudden blurriness may be tied to high blood pressure or diabetes—two major causes of kidney problems. These conditions damage small blood vessels in the eyes and can even lead to sudden vision loss.
Many people with chronic kidney disease, especially those on dialysis, experience dryness or irritation in the eyes. This happens when mineral balance in the body is disrupted, leaving the eyes feeling gritty or uncomfortable.
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4. Red or Bloodshot Eyes
Frequent redness can be a warning sign of uncontrolled blood pressure or diabetes. In some rare cases, kidney-related conditions like lupus nephritis can also cause eye problems.
Kidney disease can sometimes affect the optic nerve or retina, making it harder to distinguish certain colours, especially shades of blue and yellow.
Not every eye problem points to kidney disease, but if these symptoms persist or worsen, it’s worth getting both your vision and kidney health checked. Routine eye exams can sometimes reveal early warning signs before bigger problems develop.
If you notice changes in your eyesight alongside other symptoms like fatigue, swelling, or urinary changes, don’t ignore them. Catching kidney issues early can make all the difference for both your eye health and your overall well-being.
How To Protect Your Kidneys and Eyes
While some kidney issues are unavoidable, there are steps you can take to reduce your risk and protect both your kidney and eye health, as suggested by Dr Manoj:
Taking care of your overall health is the best way to safeguard your kidneys. and your eyes from long-term damage.
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Suicides are one of the leading causes of death around the world. While it is easy to say that the person who chose to take their lives did it of their own violation, Harvard psychologist Dr. Matthew Nock, explains the other side. “90% of people who try and kill themselves say, I didn't want to die per se. I wanted to escape from seemingly intolerable.” Speaking on the On Purpose podcast with Jay Shetty, Dr. Nock pointed out that the link between work pressure and suicidal thoughts varies by race and ethnicity.
The concerning rise in suicide cases tied to work pressure has fueled a social media conversation about toxic work culture. What was once considered a normal part of the professional grind is now being openly challenged, as people share personal stories of the anxiety, depression, and isolation caused by unhealthy work environments.
According to Dr. Matthew Nock, certain careers are linked to a higher risk of suicide.
He noted that physicians and police officers are among those at high risk. He mentioned a spike in suicides among New York City police officers, who are predominantly white men, and shared that female police officers, in particular, face a higher risk, even when accounting for factors like age, race, and ethnicity.
According to a 2025 study published in the Police Practice and Research, on average, 21.4 out of every 100,000 officers died by suicide each year.
The study showed that the suicide rate was much higher for male officers (22.7 per 100,000) than for female officers (12.7 per 100,000).
Dr. Nock explained that access to means is a significant factor in these high-risk professions, which helps explain why physicians, police officers, and military members have a much higher risk of suicide compared to others.
Another study published in 2024 The BMJ, showed that the number of suicides among doctors has been going down, female doctors are still at a much higher risk than other people.
When looking at all the data, male doctors were found to have a 5% higher risk of suicide compared to the general population.
In a more recent analysis of the last few years, the overall suicide rate for doctors has decreased, which is good news. But even with this improvement, female doctors still have a 24% higher risk than the general public.
Dr. Nock stresses the importance of openly discussing suicide, particularly in schools. He compared it to fire drills or earthquake preparedness, saying that since 15% of people will experience suicidal thoughts, it's crucial to equip everyone with a safety plan..Dr. Matthew Nock said, "We know that asking about suicide, talking about suicide, does not make people suicidal."
He noted that the people who act on suicidal thoughts often show different signs than those who just have the thoughts. While depression is a strong predictor of having suicidal thoughts, other factors like anxiety, aggressiveness, poor behavioral control, and drug or alcohol use are more closely linked to a person actually attempting suicide.
He believes that a small educational module on suicide in health class could help save lives by teaching people what to do if they or someone they know is struggling.
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While we all know air pollution affects our health, did you know that it was actually driving cancer cases higher? This has led to a big rise in health problems worldwide. Past studies show that air pollution is linked to about seven million premature deaths each year and contributes to over 3% of all years of healthy life lost globally. This revelation was a big concern for public health, and to fix it, many measures were taken.
While some countries like the US showed promising results in bettering public health, a recent study in the International Journal of Public Health showed that this positive trend is not yet showed up in China.
One of the most dangerous types of air pollution is called fine particulate matter, or PM2.5. These tiny particles come from car exhaust, factory smoke, and even from the smoke created by burning solid fuels inside homes. Because they are so incredibly small, they can stay suspended in the air for a long time and, when we breathe them in, they go deep into our lungs.
Once inside the body, PM2.5 can cause inflammation and even change our genes, which increases our risk for many illnesses, especially tracheal, bronchial, and lung (TBL) cancers. A new study looked at how much PM2.5 pollution has affected TBL cancer rates in China, Japan, South Korea, and the United States from 1990 to 2021.
The study, which used data from the Global Burden of Disease (GBD) project, found some important trends:
The good news is that globally, the number of deaths and years of healthy life lost due to TBL cancer linked to PM2.5 pollution are going down. This positive trend was consistent in all the countries studied: China, Japan, South Korea, and the U.S.
Despite this global trend, China faced a much higher death rate from TBL cancer linked to PM2.5 compared to the other three countries. While their rates are decreasing, they still remain significantly higher than the worldwide average.
The research also looked at pollution from burning solid fuels inside homes. The global death rate from TBL cancer linked to this type of pollution has remained stable, but it's actually increasing for women while it's decreasing for men. This highlights a specific danger for women in homes that rely on these fuels.
Looking ahead, researchers predict that the global death rate for TBL cancer caused by PM2.5 will actually increase over the next 29 years. However, the study notes that countries like China, South Korea, and the U.S. are expected to see a significant drop in their rates, while Japan's numbers are expected to stay about the same.
Overall, this study shows that while air pollution is a serious global health risk, the efforts to reduce PM2.5 exposure in many countries are making a real, positive difference.
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