Medical Study: Transgender Athletes Have Advantages in Women’s Sports Despite Hormone Therapy

Introduction

Competitive sports have been divided primarily by the concepts of male/female identity. However, these traditional athletic categories do not account for transgender persons who experience incongruence between the gender assigned at birthand their experienced gender identity. The question of when it is fair to permit transgender personsto compete in sport in line with their experienced gender identity is a delicate issuegiven the desire to ensure fair, safeand meaningful competition while at the same time protecting transgender individuals’ rights and autonomy[1–4]. This has been a highly controversial topic, not least after the recent International Association of Athletics Federations(IAAF) regulationson testosterone limits, which was brought about by the rare genetic condition “differences of sex development” (DSD)[5,6].The International Olympic Committee stated in 2016 that Transmen (TM, previously termed female-to-male) are allowed to compete in the male category without restrictions, while Transwomen(TW, previously termed male-to-female) must have a declared gender as female and have testosterone levels below 10 nmol/L for at least 12 months prior to competition[7]. The IAAF in turn states that their expert medical panel shall make a comprehensive review of the athlete’s case and that the athlete is eligible to compete in women’s competition if the paneldetermines that her medical treatment following sex reassignment has been administered in a verifiable manner and for a sufficient length of time to minimize any advantage in women’s competition[8]. The obvious problem is that there isessentiallyno data on how long it takes to negate the athletic advantages of many years of maletestosterone levels, as TWhave experienced prior to commencing gender-affirming treatment. To add further complexity to the issue, the athletic advantage of both endogenous and exogenous testosterone levels is highly debated [9–13].

Is this why The International Olympic Committee (IOC) has pulled back on implementing its new rules for transgender athletes.

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