by Sarah Kingsley
OVERVIEW
There is considerable disjunction in the attitudes of various organisations to the essential question of whether biological sex confers significant difference in performance between male and female athletes: and if there are such differences, whether hormone treatments are sufficient to create the required level playing field.
At the beginning it was usually thought that hormone treatments focused on testosterone, with a view to reducing a male’s testosterone levels to that of women, were all that was required. Many organisations based their policies on this belief. These groups stipulated hormone levels in their guidelines.
Further scientific research has shown that regulation of testosterone levels of itself does not adequately negate the inherent performance advantages of males. It is now understood that male puberty confers physical changes to the entire body. A post-puberty male has a larger heart, stronger bones, longer reach for height, greater stamina, more powerful musculature, greater upper body strength, etc than females. Hormone treatments make some, but not a great deal of, difference to these features. Post-puberty males are still taller, heavier, faster and stronger than females of the same age, height and weight.
These findings have influenced sports organisations in forming their policies, and lie behind the recent moves by a number of bodies to revise their rules to entirely ban trans athletes from women’s competitions. However, many organisations, including those which adopt a case-by-case approach, are still basing their policies on measuring hormone levels. This is an expression of the fundamental fault line in the policies of the different bodies: it mirrors the extent to which the organisation prioritises either trans inclusivity, or the provision of a level playing field.
There has been considerable change in the last two years. In general, analysis of the position of a range of sports governing bodies suggests that they are increasingly abandoning policies based on testosterone levels and, following recent scientific studies, are banning trans athletes from women’s competitions altogether. A number of world bodies have taken this position over the last two years. National and local bodies have been slower to follow suit. The fact that the world bodies determine the participation rules for elite athletes has created a two-tier system in many sports/countries/states, between elite and sub-elite competitions which align to the world body’s rules, and community sport (amateur, local, etc) with much broader rules.
Physical difference: Balance Challenge
A simple balance challenge reveals how intractable sex-based anatomical differences that affect performance are. In the challenge, women kneel and lean forward with their hands behind their backs. Men are unable to do this and fall forward. The reason is that due to their larger pelvises, women’s centre of gravity is lower. Men’s centre of gravity is around the sternum, due to their smaller pelvis and greater upper body mass. It is a compelling demonstration of the inherent differences in performance that male and female anatomy produce, regardless of other factors such as size, age, fitness or training.
This difference is so significant that in some sports there are activities that are only open to men or to women because the other sex is unable to perform them adequately. In gymnastics, for instance, rings work is only performed by men, with their greater upper body strength, while beam work is restricted to women, since it relies more on a low centre of gravity and does not require upper body strength.
COMPLICATING FACTORS
The whole situation with sporting governing bodies’ attitude to transgender athletes is very complex. The most complicating factor is that none of these bodies, sports or categories exists in isolation.
Children and adults
For instance, most bodies differentiate between child and adult athletes, which in itself is an admission that puberty makes a difference. Most bodies have different rules for youth and adults. This clearly recognises that puberty makes a difference to the athlete’s body and capabilities. The fact that the distinction is based on puberty is implicit in the age stipulated. Some organisations such as British Fencing are explicit: Biological males under 16 may compete in the women/girls/ category “subject to an individual case by case assessment undertaken by BF’s Medical Officer which may include confirmation of their stage of pubertal development.”
But children do not remain children forever and the child participating in amateur competitions will go on to be an adult participating in adult competitions. It’s obvious that a male to female trans athlete, for example, at the age of 14 or 15, who has been permitted to play in their local women’s team despite being a biological male, on reaching puberty or the age designated by the sport (usually 16), may suddenly have to transfer to the men’s teams. This is clearly unsatisfactory both for the child and for the sport in general.
Then there is the undoubted fact that children reach puberty at different ages and have very varied stages of physical development. A school sports team for pupils aged, say, 14-16, may have in it boys who seem hardly to have developed past the age of 12, who are relatively slight in build and short, who have not yet experienced anything but the earliest stages of male puberty. It may also have boys who have fully experienced male puberty, who are 6 foot tall, muscular, with a long reach. If these boys have been playing much sport, or have been working out at all, they may have a level of muscular development comparable to that of an adult male.
In girls the effects of puberty have a less dramatic effect on physical capabilities. However, the same applies to a somewhat lesser extent. Considering these large variations in a small age group, which are bound to have a dramatic effect on capabilities, to combine the sexes, which at this age already have different capabilities, seems to be creating intrenched inequality. It is also important to note the potential for serious injury due to the very varied capabilities of the participants.
- Differing views of the importance of pubertal changes in athletic performance
It is unsatisfactory for everyone that there is so much discrepancy between views of the physical facts of male versus female performance. The wide variety of eligibility criteria testifies to the struggle in this transitional era, to grapple with the conflicting demands of inclusivity and fairness. Many organisations do not believe that there is any such conflict.
In the past, fairness was the only issue. Things have become far more complicated. A great deal of quality research has now been done, and continues, into the exact nature of the effect of puberty on male performance, and the extent to which medical treatments can mitigate advantage so that biological males can fairly compete with women. These considerations are being taken more and more seriously and scientists, paediatricians and sports physicians are increasingly publishing research which supports the importance of biology rather than gender identification as the determining factor.
“In this chapter, the physical attributes and normal patterns of growth of young children and adolescents are discussed. Variability in the tempo and timing of normal growth and development is addressed, and its relevance to participation in youth sport is discussed. This is pertinent in today’s context of sport specialization at relatively young ages and the increase in the occurrence of injury. Regular physical training is only one of many factors that could affect child growth; however, distinguishing influences of training programs on growth from those associated with normal growth and development is problematic. The alignment of young athletes by biological rather than chronological age is an important consideration to reduce sport injuries”.
Baxter-Jones, A.D.G. (2022). Growth and Development. In: Canata, G.L., D’Hooghe, P., Hunt, K.J., M. M. J. Kerkhoffs, G., Longo, U.G. (eds) “Management of Track and Field Injuries”. Springer, Cham. https://doi.org/10.1007/978-3-030-60216-1_32
- Examples of different views
World Archery
“because of the significant advantages in size, strength and power enjoyed (on average) by athletes assigned male at birth (AMAB) over athletes assigned female at birth (AFAB) from puberty onwards, due in large part to much higher levels of androgenic hormones and the impact that such advantages can have on sporting performance, it is necessary to have separate competition categories for males and females in order to preserve the safety, fairness and integrity of the sport.”
World Triathlon:
“1.2.1.2. Most relevantly for present purposes, because of the significant advantages in size, strength and power enjoyed (on average) by Athletes Assigned Male at birth (AMAB) over Athletes Assigned Female at Birth (AFAB) from puberty onwards, due in large part to much higher levels of androgenic hormones and the impact that such advantages can have on sporting performance, it is necessary to have separate competition categories for males and females in order to preserve the safety, fairness TRI Eligibility Regulations Transgender Athletes 3 and integrity of the sport, for the benefit of all of its participants and stakeholders.”
World Boxing Council:
“The WBC is committed to its value of fair competition. A combat sport bout should occur between two equally matched competitors. At present there is no consensus whether a bout between a transgender woman against a cisgender (biological) woman is a fair bout between two equally matched competitors. Metrics such as testosterone level less than 10 nanomoles per liter (achieved by using testosterone suppression medication in the transgender woman), in isolation, are inadequate to ensure fairness at the time off the bout. It can be argued that by the time a transgender woman combatant launches her professional career she has already gone through male puberty thus conferring her with the musculature and bony structure of a male. So, a transgender woman combatant may have an unfair advantage over her cisgender woman combatant.”
Rugby Football Union (UK):
“evidence that there are physical differences between those people whose sex originally recorded as male and those as female at birth, and advantages in strength, stamina and physique brought about by testosterone and male puberty are significant and retained even after testosterone suppression.”
FIFA (Soccer) (World)
“FIFA competitions are defined for specific groups determined by age and sex in order to ensure a level playing field for all players. Androgenic hormones have performance-enhancing effects, particularly on strength, power and speed, which may provide an advantage in football and could influence the outcome of the game. With respect to the integrity of football, it must be guaranteed that players fulfill the respective criteria for participation. It is a major responsibility of member associations and team physicians to ensure correct gender of their players.”
Athletics Australia
“1.3. Athletics Australia acknowledges that: 1.3.1. strength, stamina and physique of Athletes* is relevant in all forms of athletic competition and that this is also recognised under Australian law.” (* Sports involving the ‘strength, stamina or physique of competitors’ is the major exemption provided in the SDA).
It goes on to state explicitly that it adheres to the World Athletics rules on trans participation.
However, Sport Australia and the Australian Sports Commission are pro trans inclusion and downplay the legislative exemption in the SDA (see above*) in their guidelines.
- Australian Sport and the Sex Discrimination Act
There is widespread misunderstanding of the SDA. This Act is Australia’s lead legislation on discrimination. Sports have always had, and still have, single-sex categories. This does not equate to ‘discrimination’. It is a question of eligibility. Many sports’ organising bodies have detailed eligibility requirements for various classes and competitions, based on physical, biological parameters. This is the norm among sporting organisations. It is not intended to be discriminatory, nor is it regarded as such by athletes.
The SDA states:
“Article 18: It is unlawful for an authority or body that is empowered to confer, renew, extend, revoke or withdraw an authorization or qualification that is needed for or facilitates the practice of a profession, the carrying on of a trade or the engaging in of an occupation to discriminate against a person on the ground of the person’s sex, sexual orientation, gender identity, intersex status, marital or relationship status, pregnancy or potential pregnancy, breastfeeding or family responsibilities”
However, among the list of exemptions is this, specifically for Sport:
“Article 42: (1) Nothing in Division 1 or 2 renders it unlawful to discriminate on the ground of sex, gender identity or intersex status by excluding persons from participation in any competitive sporting activity in which the strength, stamina or physique of competitors is relevant.
Clearly, the Government intended that single-sex sports would be able lawfully to exclude athletes on the grounds of sex, gender identity etc, IF strength etc were at issue, since that is the exact meaning of the wording of the exemption and must be the reason for its inclusion in the Act.
- Conflicting approaches:
Gymnastics Australia
Guidelines
“For all community gymnastics competitions (i.e. non representative competitions delivered and managed by local clubs, regions or state associations) an individual can participate in the competition which best reflects their gender identity. This is in accordance with the Sex Discrimination Act 1984 (Cth), which explains that it is unlawful to discriminate against a person on the basis of sexual orientation, gender identity and intersex status.”
This statement shows misunderstanding of the SDA, and seems unaware of the exemption provided in that Act.
Australian Football League
Guidelines
“The AFL and Australian Football leagues more generally are also legally obliged to not discriminate against people because of their
gender identity (i.e. if they are trans or non-binary) save for where the exception in sport arises, that is where relevant issues of strength, stamina or physique arise and have an appreciable effect on the ability of a trans woman or non-binary player to compete (as compared to cisgender players”
The AFL’s position is in marked contrast to that of Gymnastics Australia and far better reflects the law according to the SDA.
Amateur and professional
Distinctions are also commonly drawn between amateur and professional competitions and even between professional and elite competitions. There is a commonly a degree of latitude which is applied to ‘community’ (youth, amateur, local, nonprofessional, non-elite) sport, in which inclusivity is emphasised and which takes the form of permitting anyone to play in any team or competition, as opposed to much stricter rules for ‘elite’ sports.
While on the face of it this may seem sensible, allowing ordinary people as well as budding athletes to enjoy participation in sport, in practice it has an inherent flaw. This is because community sports are typically the earliest stage of the development of professional/elite athletes. An Olympian will have at some stage been involved in sport at a local, school, or amateur level for several years. It is unsatisfactory for trans people to have been permitted to play in their local club or competition, but on their attaining a level of prowess they find themselves excluded from the category in which they have been competing. Typically sports clubs, coaches etc. look for promising athletes among the ranks of amateur and local competitions, and having identified them, encourage and coach and develop them through the various stages of competition and professionalism until they are ready to compete on the state, then national, then international stage. So, the distinction between local/amateur sport and professional/elite sport is more apparent than real. This is a very serious issue especially in the USA, where college sports are the traditional pathway for ambitious athletes to international competitions. Some sports bodies have tried to overcome this by designating ‘elite pathway’ categories for youth.
Which sport?
Then there is the question of different rules for different sports. Is it fair or helpful for, for instance, for a woman to be assured of competing only against biological women in say, tennis, but not in squash or volleyball? In rugby but not soccer or AFL? Should trans athletes have to pick and choose not only among clubs but among sports? To be able to play in their gender choice in one sport or district or league, but not in another? It seems evident that such disparities will ultimately result in some sports, competitions and leagues being entirely dominated by single-sex athletes and others by trans athletes, meaning that players lose the opportunity to participate in the sport of their choice. And how many trans players can a single-sex team accommodate? If a netball team, for instance, consists entirely of biological males, is it still a women’s team? At what point does it stop being a women’s team and become a trans team?
Some sports have begun to move to providing ‘open’ categories. It seems likely that these will become more common and may perhaps be very successful at community level. However, the issue of progression to elite sports remains.
The ultimate effect is not helpful for the sport itself or for specific competitions. That is because such competitions are themselves the ladder by which individuals, localities and states ascend in the game. An example is the developing boycott (2024) by several women’s teams in the American college volleyball league against a team which fields a trans player. Increasingly, college teams are forfeiting matches rather than play against this team. It may be said that that is merely a matter of choice for those teams, but it is clearly a matter for the league itself, as widespread forfeits skew the entire competition. They throw out the roster, and if enough teams refuse to play in the roster, it becomes no longer representative or comprehensive. Then, since position in that roster dictates which teams will move up to semi-finals and finals, it skews those levels of competition, resulting eventually in the winners being the winners of a partial competition only. It is instructive to observe the extent to which a single transidentifying male is disrupting the entire college league. Nothing could demonstrate more clearly the inter-connectedness and sequential nature of sports competitions at all levels.
Recent reviews
- Sports Councils’ Equality Group (SCEG) (UK)
Sport England, Sport Scotland, Sport Northern Ireland, Sport Wales and UK Sport conducted an 18-month consultation and review (2021) of the existing research, involving respondents from 54 sports and 175 organisations, to investigate inclusion of trans people in sport. It produced Guidelines explaining the review’s findings and recommendations, covering the main areas. The review recommended:
“As a result of what the review found, the Guidance concludes that the inclusion of transgender people into female sport cannot be balanced regarding transgender inclusion, fairness and safety in gender-affected sport where there is meaningful competition. This is due to retained differences in strength, stamina and physique between the average woman compared with the average transgender woman or non-binary person assigned male at birth, with or without testosterone suppression. Sports, however, are incredibly diverse and there can be no ‘one-size fits all’ approach. This review has concluded therefore that, for many sports, there may not be a common single competition model which will meet the needs of full transgender inclusion while retaining competitive fairness, particularly in female sport.”
Recommendations included:
“Categorisation within the sex binary is and remains the most useful and functional division relative to sporting performance.”
“Competitive fairness cannot be reconciled with self-identification into the female category in gender affected sport.”
“Based upon current evidence, testosterone suppression is unlikely to guarantee fairness between transgender women and natal females in gender-affected sports”
“Case-by-case’ assessment is unlikely to be practical nor verifiable for entry into gender-affected sports.”
Silent issues: the elephants in the room
* Issue: Ethnic youth. One of the elephants in the room, never mentioned, in relation to youth participation is how ethnicity affects physical development. Youth from some ethnic backgrounds may routinely lag their age cohort, or race ahead. This will advantage or disadvantage those individuals, and attempts to regulate participation on a case-by-case basis may actually create what is in practice racial profiling.
* Issue: Facilities. Another ignored issue is what might be described as the off-field environment. Participation in a sport at almost any level involves sharing of facilities. These are typically toilets, showers and change rooms. In all of these participants are normally semi-clothed or naked for at least some of the time. They (especially women and girls) may need to engage in private, intimate procedures. This has traditionally been recognised by the provision of single-sex facilities. The inclusion of trans athletes in sports has raised issues in the off-field area. Girls and women have found transidentifying male athletes are appearing naked in these facilities and mingling with naked or partly-clothed girls and women. Female athletes have also been required on occasion to share bedrooms with transidentifying male athletes. A court case is current in the US in which a woman is suing her college, which placed her in a shared bedroom with an athlete who she was unaware was biologically male.
It is important to note that this is exacerbated by self-ID provisions. Today, transidentifying people are not normally required to have undergone particular, or any, medical treatment to claim gender identification. Male to female transgender have very rarely (about 3%) undergone gonadectomy, so biologically are intact males. A substantial %, especially at amateur level, are also not on hormone treatment.
* Issue: Religion/culture. While in the West there is generally a fairly relaxed attitude to women and men mingling socially, that is not universally true and is not the case in many cultures. In those, strict separation between males and females is observed and in some, the two do not touch and women may not appear unveiled before non-related males. Some cultures also do not recognise the existence of transgender people. Clearly, trans participation in sport is a potential problem for athletes from these cultures. This is rarely mentioned. It is important, however, not to downplay or dismiss the seriousness of this matter for people of such backgrounds. A female athlete would consider it out of the question to share any facilities with a biological male or even to be on the same team, which might involve touching or other forbidden behaviour. In countries with anti-discrimination laws, it is frequently not recognised that inclusion of trans players in women’s teams automatically excludes athletes of such cultures, and is therefore a form of discrimination – indirect discrimination. All the same, it is discrimination, which prevents such women from engaging in sport and as such, a breach of both international human rights and of local anti-discrimination laws. As with sharing of facilities, brushing aside cultural/religious differences may well result in what amounts to racial profiling.
*Issue: Women’s rights The topic of trans participation in sport is debated under all sorts of headings. Very frequently the importance of inclusion is featured, and the right of all individuals to participate in sport is brought forward. This right is listed in the Universal Declaration of Human Rights and included in various national legislation. It is a fundamental human right. What is less commonly mentioned is the right of women to participate in sport.
The fact is that, due to the strength advantage of men, trans inclusion affects only women’s sport. Also, many sports, such as various football codes, have only recently become open to women, after many years of strenuous lobbying. Women athletes have traditionally occupied a subordinate place and are still generally paid less and have fewer opportunities than males. There is understandable deep concern in women’s sports bodies at anything that may be perceived to erode this hard-won current level of recognition and participation.
Inclusion of trans athletes in sport has the effect of making women’s competitions actually mixed, or open events. Where trans athletes are included, there is no longer a Women’s competition. There is only Men’s and Open. The Women’s category has disappeared.
Discussion of inclusion centres around relative physical prowess, of the capabilities of women versus transidentifying men. Official Guidelines state the importance of inclusion at length. The question is almost never raised: will inclusion of one group mean exclusion of another? why cannot women have a single-sex category of their own, as men do, in every sport, regardless of strength or prowess? why must inclusion be at the cost of deleting the entire category of women’s sport? This can hardly be fair, and it is not fair. And this glaring unfairness, although rarely explicitly mentioned, is a factor, along with others, in the move by some organisations to blanket bans on trans athletes in women’s competitions. As Sebastian Coe said in announcing World Athletics’ new policy, “It is absolutely vital that we protect, we defend, we preserve the female category.”
*Issue: Exploiting intersex. Intersex people – men and women born with disorders of sexual development – are not transgender. They are a completely separate group. However, they are affected by the debate and regulations around transgender athletes because they, too, are entering competitions which do not accord with their biological sex. At the Rio Olympics in 2016, for instance, the women’s 800m podium was filled entirely with biological males.
There has been an influx of African runners from various countries including Kenya, Namibia and Burundi who have been barred due to abnormally high testosterone levels. World Athletics has pointed out that “We have a lot of athletes with this kind of condition. It is not just the one or two people you hear about in the media. In elite female athletics the number of intersex athletes is 140 times more than what you might find in the normal female population.”
There is no evidence that African people have an unusual predisposition to intersex. So what’s causing this extraordinary situation? “Living in this ambiguous state in countries like South Africa or Algeria with rigid gender roles and violent homophobia is a tough fate. Such people have found refuge in women’s sport where, unsurprisingly, they have excelled. African coaches began deliberately scouting for DSD males to train for high-level female competition, since after 2000 they even had a shot at Olympic gold” (“A simple cheek swab can protect female boxers”Janice TurnerThe Times August 2 2024). Kenya’s Intersex Persons Implementation Coordination Committee is identifying talented intersex people, including those in schools, to support their growth in sports.
On the face of it, there is no issue with encouraging intersex people to excel at sports. However, there is something very problematic about specifically scouting for intersex children. It is highly reminiscent of the policy in Communist China that had Party officials canvassing schools to find talented children whom they then removed to special training institutes, as happened to ballet dancer Li Cunxin. In both cases the government wants nationals who can excel on the international stage. There is considerable danger that these practices exploit children without reference to their wishes or welfare. It seems that intersex is being commodified in Africa, following the abandonment of genetic testing by the IOC as well as crackdowns on doping. And this is not individual athletes happening to be intersex: it is a deliberate plan to insert biological men into women’s sport.
Resources
- Transgender Athletes in International Sports Federations – detailed legal analysis, history, case studies
by Pierre Bydzovsky (2023). First published in The International Sports Law Journal.
- Resources consulted by World Archery in forming its policy:
1.3.1. The IOC Consensus Meeting on Sex Reassignment and Hyperandrogenism (2015).
1.3.2. IOC Framework on Fairness, Inclusion And Non Discrimination Based On Gender Identity and Sex Variations (2021).
1.3.3. “Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition”: the FIMS Consensus Statement Sport Medicine (2021).
1.3.4. Joint position statement of the International Federation of Sport Medicine (FIMS) and European Federation of Sport Medicine Association (EFSMA) on the IOC framework on fairness, inclusion and non-discrimination based on gender identity and sex variations BMJ Open Sp Ex Med 2022.
1.3.5. “Integrating transwomen athletes into elite competition: the case of elite archery and shooting”. European Journal of Sport Science 6/2021.
1.3.6. “The current knowledge on effects of gender-affirming treatment on markers of performance in transgender female cyclists”. Xavier Bigard, June 2022. UCI documents.
1.3.7. World Athletics Eligibility Regulations for Transgender athletes. October 2019.
1.3.8. World Triathlon Eligibility Regulations for Transgender athletes. November 2022.
1.3.9. The subsequent discussions and exchanges between the World Archery executive board and medical experts, sports physicians, legal counsel, human rights experts and transgender representatives.
- Detailed critique of the IOC’s framework on inclusion by international team of physicians.
“The International Olympic Committee framework on fairness, inclusion and non-discrimination on the basis of gender identity and sex variations does not protect fairness for female athletes” Tommy R. Lundberg Scandinavian Journal of Medicine and Science in Sports Vol 34 Issue 3, 21 March 2024
https://onlinelibrary.wiley.com/doi/10.1111/sms.14581
- Medical explanation of physical changes at puberty:
TABLE: POLICIES OF SPORTS GOVERNING BODIES ON INCLUSION OF TRANSGENDER ATHLETES