Fact or Crap? Transgender Athletes And Sports

By Dirk Smith, MSc, SDL (He/Him). 

There has been increased discussion lately regarding the eligibility of transgender athletes and their participation in sporting competitions. Many proponents on both sides have been in heated discussions including several prominent athletes speaking out as well as various national and international sports organizations adopting trans-inclusive or transphobic policies

The reason for all this discussion and controversy is that there is simply a lot of misinformation and overall lack of information regarding what constitutes fair play over an unfair advantage. With questions and claims being thrown around that are based on little research or willful ignorance with little regard of the fact that we’re just talking about human beings who simply want to participate in sports. With such various information out there as well as inconsistent policy. It is easy to get lost in the sea of it all and end up even more confused than before.
 
So, before we move on, let’s clarify a few definitions
 
Transgender Male/Female/Person- An adjective to describe someone who does not fully identify with the sex they were assigned at birth. These terms are often used as umbrella terms for more specific terms that people within trans communities use to describe themselves (and sometimes a person may use several to describe themselves).
Biological Male/Female - The sex (typically M or F) that is assigned to a person based on external genitalia at birth.
Cisgender Male/Female- Someone whose gender identity corresponds with expectations based on the sex they were assigned at birth. For example, a person who was assigned female at birth and identifies as a woman is regarded as cisgender or as a cisgender woman.
Intersex- A general term used for a variety of conditions in which a person is born with a physical characteristics (e.g., gonads, chromosomal makeup, external genitalia, internal reproductive or urinary organs) that do not fit typical medical or social definitions of female or male. Some people use the term DSD (Disorders of Sex Development) to describe intersex people, but this is not seen as affirming by intersex communities.
 
Transgender Females
One of the more common arguments revolves around the eligibility of transgender females (male to female) who participate in the female division of their sport. Specifically, with question in regard to the amount of testosterone within their bodies, muscle mass, bone density, general strength and power that leads to questions over unfair advantages on their prior physiological development and training. An example of an athlete is Fallon Fox, who is the first transgender athlete to compete in MMA on the professional level.
 
Fact or Crap? Transgender females have an unfair advantage in strength and power compared to cisgender females.
 
One of the most common arguments against the inclusion of female transgender athletes in sports is that they retain the physiological advantages that they gained as a male, including increased muscle mass, general size, bone density, and even lung capacity. In a 2009 study by T’Sjoen et al. 50 Male to Female Transgender Participants were examined through the course of transition over a three-year period while on anti-androgen (testosterone blockers) and estrogen hormone therapy. The study reported an increase of fat mass, decrease in overall muscle mass and decrease in bone mineral density.
 
Muscular strength and power is strongly correlated with Cross Sectional Area (CSA) which measures the overall size of the muscle tissue and is the main contributor to the differences in strength between male and female athletes. Testosterone is well attributed to contribute to muscular hypertrophy which increases the CSA of muscular tissue. As the 2009 study as well as follow up by Harper et al., once testosterone levels are significantly reduced after an extended time, the muscular CSA is also reduced. This is reflected within the 2015 International Olympic Committee guidelines that require female transgender athletes to maintain a serum testosterone level under 10 nmol/L for at least 12 months before their first competition.
 
Ruling- Crap! However, there haven’t been any studies yet that examine the effects of transition on overall performance in elite athletes, so more research and discussion is needed.
 
Fact or Crap? Men will just wear women’s clothes and declare they are female to compete in the women’s division
 
This argument is common during discussions that undermine the whole discussion and work to dehumanize transgender people. Most notably, a rapper named Zuby tried to claim that he identified as female to break the women’s world record for the deadlift. The whole thing was a publicity stunt to try to discredit the entire discussion, despite the actual deadlift not taking part in any kind of sanctioned competition nor governed by any official rules or policies. Both the IOC and NCAA policies regarding Male to Female Transgender Athletes require the athletes to undergo at least one full year of testosterone suppression therapy hormone therapy or one year post-surgical intervention before they are eligible to compete in the women’s division. Once the athlete competes in the women’s division, they are not allowed to return to the men’s division for at least 4 years (NCAA) or not at all (IOC).
 
Unlike Zuby, they can’t just suddenly walk up and “identify as female” just for the competition and then go home as a male again. In addition, it is important to note that there is no documented case in which this has actually occurred on the elite or professional level since the founding of the modern Olympic movement. In addition, it is likely not to occur given the gender pay gap between male and female athletes is considerable that female professional athletes are paid considerably less than their male counterparts. In fact, of the Forbes 100 top paid athletes in 2018, none of them are female. So, there is no real financial incentive for a male athlete to masquerade as female for a sports competition.

Ruling- Crap! Just like Zuby.
 
Fact or Crap? If transgender females compete in sports, there is no level playing field.
 
This is where things get to be a bit sticky and ultimately the biggest point of discussion. A “level playing field” is very subjective, especially among female athletes. What is a “level playing field?” Well, if you ask coaches, athletes, managers, and fans, cisgender and transgender alike, you’ll get a lot of different answers. If a playing field were truly level, then it would be assumed that all the athletes have the exact same physical and mental characteristics that go into their games, the same training, the same equipment and would more or less be like a game of foosball. But the fact is, that’s not what sports is about. Cisgender female athletes like Serena Williams, Lindsey Vonn, Simone Manuel, and Katie Ledecky all have advantages that help them be the best female athletes in their sports.
 
This concept of the “level playing field” is further examined in a report by Dr. Rachel McKinnon who is a transgender academic and athlete in which the concept of “burden of proof” is also examined as neither side has yet to conclude what constitutes an “advantage” that a transgender athlete might have over a cisgender athlete and whether or not it is considered significant (p<.05).
 
Ruling- Jury is still deliberating.

Transgender Males
On the other side of the spectrum, the discussion continues with the eligibility of transgender males to participate in the male division of their sport. Again, with the role of testosterone coming to play here. But in this perspective, it is considered a form of doping or as a Performance Enhancing Substance. For transgender males, transition also involves the use of hormone therapy in the context of suppression of the production of estrogen and progesterone hormones while taking testosterone therapy. An example of a Transgender Male athlete is Chris Mosier, who is the first transgender athlete to be selected for the U.S. National Team.

All biological females produce testosterone, which is an anabolic sex hormone that aids in the development of lean muscle tissue and regulates sex drive. However, it is not produced at nearly the quantity of biological males due to the lack of male genitalia. Instead, biological females produce large amounts of estrogen and progesterone, which are sex hormones that play a significant role in the biological female reproductive system in addition to the regulation of bone density. As we learned above, testosterone plays a role in the development of lean muscle tissue and mass through the optimization of protein muscle synthesis. Thus, the more testosterone a person has, the easier it is for them to increase their Cross Sectional Area (CSA) Remember, Cross Sectional Area is correlated with developing muscular strength and power output even though it is not necessarily causal. It is possible to look like a balloon animal and also have the strength of one too, but that’s a different conversation altogether.
 
Fact or Crap? Transgender males use of the anabolic hormone testosterone is doping and should be considered cheating.
 
Part of the process of transition for Transgender Males involves the use of estrogen blockers or surgery, while taking testosterone supplements to give them more characteristics and functions of biological males. This has led to discussions and controversy over the role of these supplements as it pertains to the use of Performance Enhancing Substances and Blood Doping in sports. Is it a loophole around the current doping guidelines for transgender males to use anabolic steroids in sports? Well, not quite. The IOC and NCAA policies as well as the World Anti-Doping Agency which is the independent authority regulating doping on all levels of professional sport instated policies regulating the use of anabolic steroids specifically for Transgender Males. The IOC and NCAA policy states that transgender males are permitted to compete in the male division of their sport without restriction, however like all athletes. Transgender males are required to adhere to all the same guidelines in regard to the WADA policies concerning the use of anabolic steroids. The WADA policy is one based on each individual who must apply for a Therapeutic Use Exemption (TUE) and even still, the among of testosterone in each individual’s system must be consistent with that of biological male athletes.
 
Ruling? Crap! After receiving a Therapeutic Use Exemption, transgender males are still required by the World Anti-Doping Agency to adhere to the same policy regulating acceptable levels of testosterone in the body as any biological male competing in the male division.

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Fact or Crap? Transgender athletes can just switch back and forth between gender divisions.
 
For both Transgender Males and Transgender Females, according to the IOC and NCAA guidelines, once the athlete has declared their status as transgender to the administrators for their sport, they are no longer eligible to compete in the other division. For example, once a transgender male competes in the male division, they are no longer eligible to compete in the female division of their sport. This policy is in place, again, to prevent cheaters from taking advantage of these inclusive policies.
 
Ruling? Crap. It is quite a substantial process for a transgender person to be eligible to compete in the division of their selected gender. Once they are eligible, they are not permitted to return to the previous division they competed.
 
Sex and Gender Verification in sport has a long, unethical and complicated history. While the current guidelines are still in the process of being accepted in the worldwide sports community, they are a step in the right direction toward building inclusion for transgender individuals to participate in all sports at any level. It will continue to take time, social, and scientific research to fully understand this issue more and to adopt more widespread and consistent policy. It is important to recognize that, again, on an anatomical and physiological level; with respect to each person as an individual. Transgender athletes still face significant barriers that make sports a harsh, intimidating and discriminatory environment. There are no fundamental biological, physical, or physiological reasons why transgender athletes cannot participate on an equal playing field with their cisgender counterparts.

By Dirk Smith