Transgender people in sports

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

Contents

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

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 challenging that policy, and the New York Supreme Court ruled in her favor. 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

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]

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. [10] 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." [11] 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. [12]

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. [13]

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 [14] 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. [15]

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.) [16]

In October 2018, Rachel McKinnon won a gold medal at the cycling Masters World Track Championship in Los Angeles. [17] At the time, she was the youngest in the 35–44 age bracket.

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. [18] 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. [19]

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. [20] 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. [20] The testing of testosterone alone as a marker for athleticism has been debated. [21] There are many other androgens which affect characteristics related to athleticism.

The increased visibility of trans women in professional sports has led to debates on the IOC policies. [22]

Testosterone, athletic ability and injury risks

There is ongoing debate over the impact of biological sex differences in humans on sports abilities. People who oppose transgender women competing in women's sports say that they are given an unfair advantage over cisgender women due to higher testosterone levels and different muscle and fat distribution. Testosterone regulates many different functions in the body, including the maintenance of bone and muscle mass. [23] It is also argued that athletes who transition to a woman after puberty will have a greater muscle-to-fat ratio compared to female athletes. [6] A September 2019 study from the Karolinska Institutet in Stockholm found that a year of hormone therapy decreased muscle mass in transgender women only modestly. [24]

Even after 24 months of testosterone suppression, bone mass may be preserved over 12 years. [25] Further, no study has reported muscle loss greater than 12% with testosterones suppression even after 3 years of hormone therapy. Males have approximately 40% greater muscle mass than females, so even with testosterone suppression, transgender women athletes have a muscle mass advantage over females. This is evidenced by transgender women being in the top 10% of females regarding lean body mass and possessing a grip 25% stronger than most females. [25]

A 38-page draft document from World Rugby's transgender working group in 2020 acknowledged that cisgender female rugby players, when tackled by a player who has gone through male puberty, are at a significantly greater risk of injury. The document cites recent peer-reviewed or preprint [lower-alpha 1] [26] research showing that trans women, after taking medication to lower their testosterone, retain "significant" physical advantages over cisgender women "with only small reductions in strength and no loss in bone mass or muscle volume or size after testosterone suppression”. 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 20-30%, 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 guidelines regarding a minimum 12-month lowering of testosterone are "not fit for purpose" in the context of rugby. [27]

The British Journal of Sports Medicine has proposed that the 12-month treatments for transwomen that were proposed by World Athletics and the International Olympics Committee were not sufficient due to transwomen still being 12% faster than biological women after two years of treatment. [28]

Joanna Harper is a competitive runner, scientist, transgender woman and medical physicist at the Providence Portland Medical Center who advised the International Olympic Committee (IOC). [29] 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. [30] 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. [31] Eric Vilain, a professor of human genetics at UCLA and a consultant to the IOC medical commission, stated: "There is 10 to 12% difference between male and female athletic performance. We need to categorize with criteria that are relevant to performance. It is a very difficult situation with no easy solution." [32]

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 making it "difficult to draw any definite conclusions". Only one of the papers in the systematic review took any physical attributes into account. [33] This study measured the physical changes of transitioning. The main finding of the study found that "androgen deprivation in transgender female individuals increases the overlap in muscle mass with [cis] women but does not reverse it." [34] 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. [35] A 2019 study found that the one year lowering of testosterone as required by the IOC rules resulted in only "modest changes in [transgender women]". Where transgender women "generally maintained their strength levels" over the assessment period despite a 4-5% loss in muscle volume. [36]

In secondary education

United States

There are no rules federally to regulate inclusion of transgender children. [37] 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. [38] 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. [39] 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. [37] 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. [37]

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. [42] [43] [44] ADF Legal Counsel Christiana Holcomb, representing two female athletes in Hecox v. Little, 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.” [45] 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". [46]

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. [47] [48] This resulted in a civil rights complaint being filed. [49] 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.” [50]

Australia

In July 2019, Sport Australia published guidelines on making sport more inclusive for transgender and gender-diverse people. [51]

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. [52] [53] [54]

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. [54]

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. [55] 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. [55] Ongoing monitoring of treatment and written documentation is required for student-athletes undergoing testosterone suppression. [55]

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. [56] 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 5 years of eligibility to compete and may only represent one gender of sports team per school year. [56]

Notable trans athletes

See also

Notes

  1. As of 2020-10-11 the Hilton and Lundberg paper is in preprint and has not yet been peer-reviewed.

Related Research Articles

Gender dysphoria (GD) is the distress a person feels due to a mismatch between their gender identity and their sex assigned at birth. The diagnostic label gender identity disorder (GID) was used until 2013 with the release of the DSM-5. The condition was renamed to remove the stigma associated with the term disorder.

Sex reassignment surgery (SRS), also known as gender reassignment surgery (GRS) and several other names, is a surgical procedure by which a transgender person's physical appearance and function of their existing sexual characteristics are altered to resemble those socially associated with their identified gender. It is part of a treatment for gender dysphoria in transgender people.

Sex reassignment therapy is the medical aspect of gender transitioning, that is, modifying one's sex characteristics to better suit one's gender identity. It can consist of hormone therapy to modify secondary sex characteristics, sex reassignment surgery to alter primary sex characteristics, and other procedures altering appearance, including permanent hair removal for trans women.

Mianne Bagger Professional golfer

Mianne Bagger is a professional golfer from Denmark. In 2004, by playing in the Women's Australian Open, she became the first openly transitioned woman to play in a professional golf tournament. She also became the first trans woman to qualify for the Ladies European Tour in 2004, and the first high-profile transitioned woman to qualify for a professional sports tour since Renee Richards joined the Women's Tennis Association tour during the 1970s.

A trans man is a man who was assigned female at birth. The label of transgender man is not always interchangeable with that of transsexual man, although the two labels are often used in this way. Transgender is an umbrella term that includes different types of gender variant people. Many trans men choose to undergo surgical or hormonal transition, or both, to alter their appearance in a way that aligns with their gender identity or alleviates gender dysphoria.

Sex reassignment surgery for male-to-female involves reshaping the male genitals into a form with the appearance of, and as far as possible, the function of female genitalia. Before any surgery, patients usually undergo feminizing hormone therapy, though this is not a requirement. There are associated surgeries patients may elect to undergo, including vaginoplasty, facial hair removal, facial feminization surgery, breast augmentation and various other procedures. There is debate among trans people and activists regarding what terms are preferable to use, some arguing gender confirmation surgery or gender affirmation surgery are preferable terms, while other trans people maintain use of the term sex reassignment surgery.

Sex verification in sports

Sex verification in sports occurs because eligibility of athletes to compete is restricted whenever sporting events are limited to a single sex, which is generally the case, as well as when events are limited to mixed-sex teams of defined composition. Practice has varied tremendously over time, across borders and by competitive level. Issues have arisen multiple times in the Olympic games and other high-profile sporting competitions, for example allegations that certain male athletes attempted to compete as women or that certain female athletes had intersex conditions that gave unfair advantage.

Michelle Dumaresq is a Canadian professional downhill mountain bike competitor and post-operative trans woman. She competes with other professional female downhill mountain bike racers. She entered the sport in 2001, six years after completing gender reassignment surgery, when she was discovered riding on Vancouver's North Shore by several top women mountain bikers. Dumaresq is quite open about gender identity.

Sexuality in transgender individuals encompasses all the issues of sexuality of other groups, including establishing a sexual identity, learning to deal with one's sexual needs, and finding a partner, but may be complicated by issues of gender dysphoria, side effects of surgery, physiological and emotional effects of hormone replacement therapy, psychological aspects of expressing sexuality after medical transition, or social aspects of expressing their gender.

Masculinizing hormone therapy, also known as transmasculine hormone therapy, or female-to-male hormone therapy, is a form of hormone therapy and gender affirming therapy which is used to change the secondary sexual characteristics of transgender people from feminine or androgynous to masculine. It is a common type of transgender hormone therapy, and is predominantly used to treat transgender men and other transmasculine individuals. Some intersex people also receive this form of therapy, either starting in childhood to confirm the assigned sex or later if the assignment proves to be incorrect.

Transsexual People experiencing a gender identity inconsistent with their assigned sex

Transsexual people experience a gender identity that is inconsistent with their assigned sex and desire to permanently transition to the sex or gender with which they identify, usually seeking medical assistance to help them align their body with their identified sex or gender.

A trans woman is a woman who was assigned male at birth. Trans women may experience gender dysphoria and may transition; this process commonly includes hormone replacement therapy and sometimes sex reassignment surgery, which can bring relief and resolve feelings of gender dysphoria. Trans women may be heterosexual, bisexual, homosexual, asexual, or identify with other terms.

Chris Mosier American triathlete (born 1980)

Chris Mosier is an American transgender advocate and triathlete. He started his athletic career before transitioning, started his transition in 2010, and in 2015 earned a spot on the Team USA sprint duathlon men's team for the 2016 World Championship, making him the first known out trans athlete to join a U.S. national team different from his sex at birth.

Transgender hormone therapy, also sometimes called cross-sex hormone therapy, is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is feminization or masculinization:

Fallon Fox American MMA fighter

Fallon Fox is an American retired MMA fighter. She is the first openly transgender athlete in MMA history.

Hannah Mouncey is an Australian national squad handball player who also plays Australian rules football. Mouncey represented Australia in men's handball before transitioning. She has been the subject of controversy over her eligibility to participate in women's competitions. Mouncey debuted with the Australia women's national handball team at the 2018 Asian Women's Handball Championship.

Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions, as well as sex reassignment therapies, for transgender individuals. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks, and access to healthcare for trans people in different countries around the world.

CeCé Telfer is a Jamaican-American athlete who, in 2019, became the first openly transgender woman to win an NCAA title. While a student athlete at Franklin Pierce University, Telfer first competed in the men's division from 2016 to 2017 but after coming out and beginning her transition, she was allowed to compete in the women's division. She eventually took first place in the 400-meter hurdles event in June 2019.

Recent regulations governing eligibility for women's athletics have moved away from a policy aimed at sex verification to one that imposes restrictions on testosterone levels, which an affected athlete must reduce by medical means in order to be allowed to compete. The most recent rules, set by the World Athletics, the international governing body for the sport of athletics apply only to athletes with certain XY disorders of sexual development, and set a 5nmol/L testosterone limit.

The participation of transgender people in ice hockey is an ongoing issue in the place of LGBT+ rights and diversity in ice hockey. Only a small handful of professional players have come out as openly trans, and systemic transphobia presents many barriers to the inclusion of trans people in the sport.

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Further reading