I want to preface this by saying that inclusion in sports is not the primary issue that transgender people face. Respondents to the 2015 U.S. Transgender Survey were more than twice as likely as the general U.S. population to say they were in poverty, and three times as likely to say they were unemployed. Nearly a third of respondents had gone homeless at some point, with 12% saying they were homeless in the previous year because they were transgender. 40% of respondents had attempted suicide at some point in their lifetime, and about a quarter said they had been physically attacked because they were transgender. I cannot say that things have significantly improved since 2015. I wish I could, but I can’t.
There are more pressing issues than inclusion in sports. That doesn’t mean we shouldn’t talk about it; just that we need to keep that in mind. I have had several conversations about trans issues interrupted by someone JAQing off with “what about transgender athletes?” When the topic is not transgender athletes, it is, in nearly all instances, better to not bring it up.
Lately, the topic often is transgender athletes, making it worth discussing. Most notably, there have been recent legislative attempts to ban transgender people from K-12 and college sports. Idaho recently banned transgender women from participating in women’s sports teams sponsored by public schools, colleges, or universities, the first among 40 states which have introduced legislation to do so just this year.
It is undeniable that on many metrics, on average, people assigned male at birth (AMAB) are more athletically proficient than people assigned female at birth (AFAB). This fact is sometimes stretched far past its actual utility.
It should be briefly noted that it makes little sense to force transgender children into sports based on their gender assigned at birth. For the vast majority of children, very little in the way of secondary sex characteristics has developed by age 13. It’s hard to imagine a serious motivation for forcing transgender boys into girls’ sports at 13 other than transphobia.
With that out of the way, let’s discuss transgender athletes at higher levels.
Testosterone levels are often used as a proxy for the difference in skill between AMAB and AFAB people. The current Olympic guidelines say that transgender women can compete in women’s sports if their testosterone levels stay below 10 nmol/L for at least a year. Yet, in “Why do endocrine profiles in elite athletes differ between sports?” (Sönksen et al, 2018), they found that a quarter of elite male athletes tested had testosterone levels below 10 nmol/L, and about 5% of elite female athletes had testosterone levels above 10 nmol/L. Most people would instinctively be skeptical of the idea that those elite male athletes with low testosterone are on a level playing field with the elite female athletes. Similarly, if the testosterone level rule was applied to cisgender women as well as transgender women, it would kick 5% of them out of the game, which seems awful unfair.
Similarly, there is debate over if lowering testosterone levels after having a testosterone-driven puberty is sufficient to be on a level playing field. “Transsexual athletes—when is competition fair?” (Ljungqvist & Genel, 2005) in The Lancet gives one example:
The Amsterdam group headed by Louis Gooren has reported that, after 1 year of cross-sexual therapy with androgen deprivation and oestrogen replacement, there was a significant decline in cross-sectional thigh muscle mass in male-to-female transsexuals with the mean muscle area approaching that of pretreatment female-to-male transsexuals. Still, after 1 year of therapy, male-to-female muscle mass remained greater than that observed in the comparison female-to-male group before treatment (though not after testosterone therapy). Although not necessarily correlated with athletic performance, these effects peaked after 1 year of administration.
There are other concerns, like lung capacity and bone structure (Knox et al, 2019). As quote above indicated, though, it’s not entirely clear if these are correlated with athletic performance. In an article in the magazine Men’s Health, Dr. James Barrett, the previous president of the British Association of Gender Identity Specialists and the lead clinician at the London-based Gender Identity Clinic, explains it as follows:
“Lung volume, for example, will remain the same [after hormone therapy], but if you haven’t got the muscles to do the work, does that make any difference? The skeleton doesn't significantly alter, so it will remain heavier – it’s hard to see how that would ever be an advantage.”
I know, I’m not exactly providing many answers so far. What I’ve said up to this point is largely making the topic way more complicated and difficult. Unfortunately, it’s important to know that these proxies—testosterone level, skeleton size, lung volume, etc.—can be boons in some situations and disadvantages in others.
So, how do we handle this, then? Let’s look to the big reviews; what do they say?
Let’s start with “Gender identity and sport: is the playing field level?” (Reeser, 2005). It concludes that regarding athletic performance, there is “inadequate physiological performance related data to allow an unambiguous position to emerge” and “the psychosocial arguments in favour of allowing transsexual participation would appear to be relatively uncomplicated”. Notably, it points out that while the discussion is primarily focused on transgender women, transgender men have their own issues to deal with. Rules which hastily ban transgender men from participating in men’s sports have already led to situations like this, where a transgender boy was forced to compete in girl’s wrestling… and won, twice in a row. And if any exogenous (say, injected) testosterone counts as rule-breaking doping, then transgender men may be barred from participating in gendered sports at all.
“Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies” (Jones et al., 2016) helps clear up the issue further. Analyzing eight research articles and 31 sports policies, it concludes that while “transgender people had a mostly negative experience in competitive sports because of the restrictions the sport’s policy placed on them,” “there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition” and “the majority of transgender competitive sport policies that were reviewed were not evidence based.” The tendency of sports policies, prior to the legislative push to remove transgender people from sports, was already likely too strict.
The question then comes in, what standards should there be? While I won’t dare try to provide specifics (I’m not a professional in sports medicine and they don’t seem quite sure themselves!), there are two primary models that seem viable. The first is to go by some variant of the 2004 Olympic standards. “Transsexual athletes—when is competition fair?” (Ljungqvist & Genel, 2005) argues that those rules “provide a fair and equitable standard.” The 2016 rules, which provided the controversial 10 nmol/L testosterone line, are criticized in “Transwomen in elite sport: scientific and ethical considerations” (Knox et al., 2019) as “an intolerable unfairness.”
However, this falls into the problem noted by “Sport and Transgender People” (Jones et al., 2016) that policies like the 2004 standards were not evidence-based and frequently led to negative experiences by transgender people. An alternative is suggested in “Transwomen in elite sport: scientific and ethical considerations” (Knox et al., 2019). Arguing that the 2016 rules are intolerably unfair to cisgender women but not wanting to exclude transgender women, it suggest thats gender segregation in sports should be replaced with a more nuanced approach. It proposes offsetting natural advantages, such as socioeconomic status or sex, by creating an algorithm to place people into different divisions, akin to weight classes in boxing. While complex, it would make sure that things like sex assigned at birth, socioeconomic status, or the odd advantageous mutation don’t have a deleterious effect on competition. It would help skill be the determining factor of who wins.
Of course, this would take a lot of work to develop. We certainly need far more research on the athletic abilities of transgender women. In the meantime, it seems we need to loosen the restrictions, and not increase them. Most of the new policies are not evidence-based, and restrictions are nearly always driven by transphobia. Consider the case of Rachel McKinnon: She is a transgender woman who lost to a cisgender woman by the name of Jen Wagner-Assali in nearly every race, but when she won once, Wagner-Assali said it was because she was transgender. That is like flipping a coin ten times, and seeing it comes up heads only once, conclude that it must be biased towards heads.
There are a few easy answers. One is that it is nothing short of ridiculous that children younger than 13 are being required by law to compete in the category associated with the sex assigned at birth. Another is that there is a lot of bias against transgender women in sports which shouldn’t be there. Yet another is that transgender men shouldn’t be forgotten about in this discussion.
Past that, it’ll require hard work to come up with a consistently fair and inclusive policy. That hard work will not be achieved by transphobic reductios or an insistence that sports should disregard biological factors altogether. It will be achieved by an honest evaluation of the evidence, including honestly admitting that there is a stunning lack of hard evidence at this moment. But humans are smart. If we want to simultaneously be fair to cisgender women and inclusive of transgender women in sports, we can figure it out.
REFERENCES
Jones, B. A., Arcelus, J., Bouman, W. P., & Haycraft, E. (2017). Sport and transgender people: A systematic review of the literature relating to sport participation and competitive sport policies. Sports Medicine, 47(4), 701-716.
Knox, T., Anderson, L. C., & Heather, A. (2019). Transwomen in elite sport: scientific and ethical considerations. Journal of medical ethics, 45(6), 395-403.
Ljungqvist, A., & Genel, M. (2005). Essay: Transsexual athletes—when is competition fair?. The Lancet, 366, S42-S43.
Reeser, J. C. (2005). Gender identity and sport: is the playing field level?. British Journal of Sports Medicine, 39(10), 695-699.
Sönksen, P. H., Holt, R. I., Böhning, W., Guha, N., Cowan, D. A., Bartlett, C., & Böhning, D. (2018). Why do endocrine profiles in elite athletes differ between sports?. Clinical Diabetes and Endocrinology, 4(1), 1-16.