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Transgender people in sports

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The participation of transgender people in competitive sports is a controversial issue, particularly where athletes who have gone through male puberty that are notably successful in women's sport, or represent a significant increased injury risk to female-by-birth competitors.

Resistance to trans women competing in women's sports generally focuses on physiological attributes such as height and weight, or performance metrics such as speed and strength—and whether sustained testosterone suppression can adequately reduce any natural advantages of male body characteristics within a given women's sport.

Access regulations requiring that trans athletes compete against athletes of the same assigned sex at birth and requiring sex verification testing have been used. Proponents of such regulations regard them as necessary to ensure fair competition, while opponents regard them as discriminatory.

History of transgender athletes in competition

Historically sport has been seen as a male domain.[1] The masculine perception of sport was first moderated with the rise of women's sports and further challenged with the gradual acceptance of gay sportsmen.[1] A third departure from tradition occurred with the emergence of trans athletes, many of whom challenge the culturally accepted binary gender norms of male and female.[1]

Renée Richards

Main article: Renée Richards

An early high-profile transgender athlete was tennis player Renée Richards. Already a promising tennis player in the men's circuit, Richards underwent gender reassignment therapy in 1975 and started playing in women's tournaments a year later. Her discovery and the resulting media frenzy sparked protests.[2] After she accepted an invitation to a warm-up tournament for the US Open, the Women’s Tennis Association (WTA) and the United States Tennis Association (USTA) withdrew their support and 25 of the 32 women withdrew.[3]

The USTA and WTA introduced the Barr body test, which identifies a person's sex chromosomes. Richards refused to take the test and was banned from the US Open.[2] She filed a lawsuit in 1977 claiming that her civil rights were violated and that the policy was unfair. The New York Supreme Court ruled in her favor with the judge agreed that the Barr body test as the sole determinant of sex was "grossly unfair" and ruled Richards legally female.[4] She competed in the 1977 US Open at the age of 43, lost in the first round and retired four years later.[2] At the time, the ruling in Richards's case did not lead to major changes outside of tennis.[4]

Olympics

Non-binary Canadian football player Quinn was one of the first transgender athletes in the Olympics and the first to medal and win a gold medal

In 2003, a committee convened by the International Olympic Committee (IOC) Medical Commission drew up new guidelines for participation of athletes who had undergone gender reassignment. The report listed three conditions for participation. First, athletes must have undergone sex reassignment surgery, including changes in the external genitalia and gonadectomy. Second, athletes must show legal recognition of their gender. Third, athletes must have undergone hormone therapy for an appropriate time before participation, with two years being the suggested time.[5]

It was not until 2004 that the IOC allowed transgender athletes to participate in the Olympic Games.[6]

In 2015, the IOC modified these guidelines in recognition that legal recognition of gender could be difficult in countries where gender transition is not legal, and that requiring surgery in otherwise healthy individuals "may be inconsistent with developing legislation and notions of human rights".[7][8] The new guidelines require only that trans woman athletes declare their gender and not change that assertion for four years, as well as demonstrate a testosterone level of less than 10 nanomoles per liter for at least one year prior to competition and throughout the period of eligibility. Athletes who transitioned from female to male were allowed to compete without restriction. These guidelines were in effect for the 2016 Rio Olympics, although no openly transgender athletes competed.[9]

In 2021, the IOC approved Laurel Hubbard, a trans woman, to compete in the 2020 Summer Olympics in weightlifting. Hubbard became the first out trans woman to compete at the Olympics; she did not complete her lifts and won no medals. [10][11] On 21 July 2021, at the same Games, Canadian non-binary soccer player Quinn became the first transgender person to compete at the Olympics, playing for the Canadian women's soccer team.[12][13][14] At the 2020 Summer Olympics, they became the first out, transgender Olympian to medal and win a gold medal.[15][16] Alana Smith, a non-binary skateboarder, represented the United States in the women's skateboarding semifinals of the 2020 Summer Olympics.[17]

World Athletics

In October 2019, World Athletics changed the testosterone limit for transgender competitors, setting it at 5 nmol/L, from the previous 10 nmol/L, in order to bring it in line with the DSD (intersex) regulations.[18] According to regulations from October 2019, in order for a trans woman to compete in the women's category: "3.2.1 she must provide a written and signed declaration, in a form satisfactory to the Medical Manager, that her gender identity is female; 3.2.2 she must demonstrate to the satisfaction of the Expert Panel (on the balance of probabilities), in accordance with clause 4, that the concentration of testosterone in her serum has been less than 5 nmol/L continuously for a period of at least 12 months; and 3.2.3 she must keep her serum testosterone concentration below 5 nmol/L for so long as she wishes to maintain her eligibility to compete in the female category of competition."[19] World Athletics also has rules for intersex/differences of sex development (DSD) athletes. DSD athletes will be subjected to specific rules if they have XY male chromosomes, testes rather than ovaries, have circulating testosterone within the typical male range (7.7 to 29.4 nmol/L), and are androgen-sensitive so that their body makes use of that testosterone. World Athletics requires that any such athlete must reduce their blood testosterone level to 5 nmol/L or lower for a six-month period before becoming eligible for track running events from 400 metres to the mile run in international competition, though World Athletics publicly remains open to extending this to other events based on new scientific study. World Athletics created these rules as a way to ensure fair competition in the women's category.[20]

Other

In 1996 the Iron Ladies, a men's volleyball team made up of gay men and transgender women from Thailand, won the national championship. The Iron Ladies were not allowed to join Thailand's national volleyball team because of the way they dressed.[21]

The first out transgender person to make a US National Team was Chris Mosier, who in 2016 qualified for Team USA in duathlon.[9] Mosier is considered the catalyst for the change[22] in the IOC policy on transgender athletes in 2015, when he challenged the policy after initially being banned from the world championship race. Mosier also became the first known transgender athlete to compete in the Olympic Trials in the gender with which they identify, and the first trans man to make a men's Olympic Trials, when he competed in January 2020 in the US Olympic Team Trials in the 50k Racewalking event.[23]

In 2017 Mack Beggs, a teenager from Texas, was required to wrestle against girls throughout the season of his transition from female to male up through the state championship, despite wanting to wrestle against boys. This was due to state sport regulations requiring athletes to compete alongside athletes of their assigned sex. Some opponents say the testosterone prescribed as part of his transition gives him an unfair advantage and made it unsafe for the other wrestlers. (He finished the regular season at 52–0 and won the state championship.)[24]

In October 2018, Rachel McKinnon won a gold medal at the cycling Masters World Track Championship in Los Angeles.[25]

Testing

Sports organizations have sought a test for sex verification to ensure fairness across all sports. This began in the 1940s with "femininity certificates" provided by a physician. In the 1960s, visual genital inspections were used to confirm gender, followed by chromosomal analysis to detect the presence of the SRY and DYZ1 genes, normally found on the Y chromosome.[26] These tests were all designed to ensure that athletes were only allowed to compete as their sex, but mostly resulted in the exclusion of intersex athletes.[27]

More recently, testosterone levels have become the focus and, at the same time, new guidelines have been sought that would allow successfully-transitioned athletes to compete.[7] Since the proposition in 2003 to use testosterone levels, reputable organizations such as the IOC have adopted strict policies that employ testosterone as a metric to allow successfully transitioned female athletes to compete.[6] More recent guidelines have focused entirely on testosterone levels, such as the IOC’s current guidelines, originally set in November 2015, which set limits on transgender athletes’ testosterone levels for them to be permitted in women’s competition categories.[28] Controversy surrounding the 2020 Tokyo Olympics also centered around testosterone levels, specifically over whether the IOC’s guidelines should be amended to set stricter testosterone limits, although this proposed change has been strongly debated.[28] The testing of testosterone alone as a marker for athleticism has been debated.[29]

The increased visibility of trans women in professional sports has led to debates on the IOC policies.[30] Many scientists criticize the policies because of published papers showing that people who went through male puberty retain significant advantages even after a year of testosterone suppression.[31][32] In July 2021, the IOC's medical and science director, Richard Budgett, stated that the 2015 guidelines were outdated and that new ones would be coming in a few months. He stated that the new guidelines would help each individual sport to balance between safety, fairness, and inclusion.[33]

Testosterone, athletic ability and injury risks

Biological sex differences in humans impact performance in sports.[34][35] Debate over whether and how transgender women should compete in female sports often has to do with whether they have an unfair advantage over cisgender women due to higher testosterone levels and skeletal, muscle and fat distribution differences. Testosterone regulates many different functions in the body, including the maintenance of bone and muscle mass.[36]

A 2021 literature review concluded that for trans women, even with testosterone suppression, "the data show that strength, lean body mass, muscle size and bone density are only trivially affected. The reductions observed in muscle mass, size, and strength are very small compared to the baseline differences between males and females in these variables, and thus, there are major performance and safety implications in sports where these attributes are competitively significant."[34] After 24 months of testosterone suppression, bone mass is generally preserved. The review states that no study has reported muscle loss greater than 12% with testosterone suppression even after three years of hormone therapy.[34] It found that trans women are in the top 10% of females regarding lean body mass and possess a grip 25% stronger than most females.[34] They suggest that instead of universal guidelines, each individual sport federation decide how to "balance between inclusion, safety and fairness" due to differences between sports.[34]

A 2021 systematic review found that significant decreases in measures of strength, lean body mass and muscle area were observed after 12 months of hormone therapy, while the values remained above those observed in cisgender women, even after 36 months, suggesting that trans women "may retain strength advantages over cisgender women." Effects of longer duration therapy were unclear due to scarcity of data.[35]

A 2017 systematic review of literature relating to sport participation and competitive sports policies reported that there is no direct or comprehensive evidence of transgender women having an athletic advantage over their cisgender counterparts at any stage of transition (e.g. cross-sex hormones or sex reassignment surgery), due to the lack of quantitative research on the subject; this made it "difficult to draw any definite conclusions". Only one of the papers in the systematic review took any physical attributes into account.[37] A 2018 extended essay analyzed the current IOC rule set in 2015 (testosterone below 10 nmol/L for trans women) and found that "the advantage to transwomen afforded by the IOC guidelines is an intolerable unfairness", while they propose to abandon male/female categories in favor of a more nuanced division.[38]

A 38-page draft document from World Rugby's transgender working group in 2020 acknowledged that rugby players who are cisgender women, when tackled by a player who has gone through male puberty, are at a significantly greater risk of injury. The working group calculated that increased injury risk for typical players with female characteristics when tackled by a typical player with male characteristics was between 20 and 30%, and potentially reaching "levels twice as large" in extreme cases where the players are unusually small and large, respectively. Consequently, the document proposes that in the absence of persuasive evidence to the contrary, International Olympic Committee (IOC) guidelines regarding a minimum 12-month lowering of testosterone are "not fit for purpose" in the context of rugby.[39] This move was criticized because there were "no examples of transgender women causing serious injuries to cisgender women"[40]

Joanna Harper is a competitive runner, scientist, transgender woman and medical physicist at the Providence Portland Medical Center who advised the IOC.[41] She argues that the use of estrogen supplements and testosterone blockers (or physical castration via sex reassignment surgery) cause a decrease in muscle mass and oxygen-carrying red blood cells, and that this leads to a decrease in strength, speed, and endurance.[42] According to Harper, every athlete has advantages and disadvantages. The greater height that a transgender woman may have gained before transitioning may be an advantage on the basketball court but it is likely to be disadvantageous to a gymnast.[43]

In secondary education

United States

There are no rules federally to regulate inclusion of transgender children.[44] States vary widely on participation of transgender children in sports and which locker room those students should use. Opponents of including transgender athletes emphasize the argument that there may be an unfair advantage of larger size and strength in trans women, and trans athletes could threaten the safety of cisgender children, both in competition and in the locker room.[45] Advocates in favor of allowing transgender children to participate in sports based on their preferred gender point out the known benefits of participating in sports and the psychological well-being of the transgender children.[46] Many states have tried to mimic the NCAA and IOC rules that rely on testosterone level tests to determine when a trans woman can participate in women's sports competitions. These kinds of rules are more difficult to enforce in secondary education because of the lack of resources to test testosterone levels, and medical professionals are often hesitant to prescribe minors hormones.[44] States have individually come up with rules to regulate trans athlete participation through restricting transgender athletes to teams of their assigned sex at birth, matching NCAA/IOC guidelines, allowing school districts to decide, or allowing complete inclusion.[44]

  • In Indiana, schools rely on anatomical sex, requiring gender reassignment surgery for trans athletes to participate in the sport of their identified gender.[47]
  • Nebraska has formed a Gender Identity Eligibility Committee that decides on a case-by-case basis of how each transgender athlete can participate as their self-identified gender.[47]
  • Texas, Alabama, North Carolina, Kentucky,[48] Idaho, and Florida[49] require trans athletes to compete based on their biological sex.[47]
  • In Alaska, Connecticut, Georgia, Kansas, Pennsylvania, and Wisconsin, each school district makes their own decision on how to include transgender athletes.[48]
  • Maine gives approval for students to choose which team they wish to play on, approving based on safety and fairness.[48]
  • New Jersey and New Mexico require that trans athletes provide evidence that they have transitioned or are transitioning.[48]
  • Missouri and Ohio require athletes to undergo hormone treatment. Ohio requires that the athlete must have been on the hormones for at least a year prior to competing.[48]
  • Oregon allows those who identify as male to participate on male teams, and they are then on excluded from girls' competitions. Those transitioning from male to female must be on hormone treatment for at least a year.[48]

Hecox v. Little

In March 2020, Idaho Governor Brad Little signed into law the "Fairness in Women's Sports Act", also known as House Bill 500. This legislation, the first of its kind in the United States, prohibits transgender athletes from competing in sports against athletes of the other biological sex. In April 2020, the ACLU and the Legal Voice filed a lawsuit, Hecox v. Little, arguing that this law violates the US Constitution and Title IX.[50][51][52] ADF Legal Counsel Christiana Holcomb, representing two female athletes, said: "Both of our clients agree: Putting male athletes up against females is simply not fair because it changes the nature and dynamics of sport for young women ... In one year, 275 high school boys ran faster times than the lifetime best of World Champion sprinter Allyson Felix."[53] On August 17, 2020, the United States District Court for the District of Idaho issued a preliminary injunction against the law pending trial, issuing an opinion that the plaintiffs were "likely to succeed in establishing [that] the Act is unconstitutional as currently written".[54] As of May 2021, the case is before the Ninth Circuit Court of Appeals.[55]

Soule v. Connecticut Association of Schools

There was controversy in Connecticut after women's high school competitions were won by a transgender student, Andraya Yearwood.[56][57] This resulted in a civil rights complaint being filed.[58] Christiana Holcomb, ADF Legal Counsel in the case, said that Yearwood and Terry Miller (another transgender student athlete in Connecticut) between them "amassed 15 different state championship titles that were once held by nine different girls across the state."[59] The lawsuit was dismissed in April 2021 by the district court as moot.[60][61]

Australia

In July 2019, Sport Australia published guidelines on making sport more inclusive for transgender and gender-diverse people.[62]

Canada

Provincial governing bodies for high school sports have independent policies on the participation of transgender or non-binary athletes on sex-segregated teams. Organizations such as the Alberta Schools' Athletic Association, the Manitoba High Schools Athletics Association and BC School Sports each have policies that allow the participation of transgender student-athletes in accordance with their gender identity.[63][64][65]

Transgender or non-binary student-athletes looking to compete in a team consistent with their gender identity in British Columbia must submit an application to the BC School Sports Executive Director, and are required to have a written statement from both the student-athlete and the principal of their high school confirming their gender identity.[65]

Post-secondary education

United States

In August 2011, the National Collegiate Athletic Association Office of Inclusion published the NCAA Inclusion of Transgender Student-Athletes resource outlining their best practices and policies for the inclusion for transgender student-athletes.[66] This policy permits transgender athletes who are not using hormone therapy to continue to participate on the team that corresponds to their assigned sex at birth. A trans man student-athlete may participate on either a men's or women's team, unless receiving testosterone, in which case he may only compete on a men's team; athletes receiving doses of testosterone as a part of their transition must apply for a medical exemption through the league, as testosterone is considered a banned substance in the NCAA. A trans woman student-athlete is not permitted to compete on a women’s team until after one year of testosterone suppression treatment.[66] Ongoing monitoring of treatment and written documentation is required for student-athletes undergoing testosterone suppression.[66]

Canada

In September 2018, U Sports, the governing body of intercollegiate and varsity athletics in Canada, released a policy addressing eligibility and best practices for the inclusion of transgender student-athletes at their member institutions.[67] Under this new policy, U Sports student-athletes are able to compete according to their gender identity or sex assigned at birth provided they meet requirements of the Canadian Anti-Doping Program. Transgender student-athletes, like other U Sports athletes, are given five years of eligibility to compete and may only represent one gender of sports team per school year.[67]

Notable trans athletes

Trans men

Trans women

Non-binary athletes

See also

References

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Further reading

Retrieved from ""