1500 words

(See my article on transvestic disorder and gender dysphoria for an intro on my view of transgenderism.)

I have been researching male-to-female (MtF) transgenders (TGs) in sports for the past few months. I, like we all do, have my own biases with what should be done with this problem (not letting them compete with women), however jumping to my initial bias there would not be fair so I’ve undertaken the task of reading as many journal articles on the matter as I possibly can. From my research on the matter, there is no direct consensus in the literature that I could come across. In this article, I will show some of the research I’ve found and how it is inconclusive (as well as interject my own thoughts on the matter, mainly speaking about bone density, somatype, and testosterone). (I will cover female-to-male (FtM) transgenders in a future article.)

One recent article making its way around the news is of a MtF who won a weightlifting competition. He (I will be referring to the people I reference by their biological sex) had a total of 590 pounds, besting the second place winner by 42 pounds. Hubbard (the weightlifter who ‘transitioned’) is 39 and has been ‘transitioning’ since his mid-30s. He has also had previous experience competing. The IOC (International Olympic Committee) has no guidelines that a TG athlete must undergo ‘sex-reassignment surgery’, however, they must be on hormone replacement therapy (HRT) for at least 12 months and demonstrate that they have testosterone levels ‘within acceptable limits’. Well, what are ‘acceptable limits’?

The IOC has a short paper on this matter, writing:

The athlete must demonstrate that her total testosterone level in serum has been below 10 nmol/L for at least 12 months prior to her first competition (with the requirement for any longer period to be based on a confidential case-by-case evaluation, considering whether or not 12 months is a sufficient length of time to minimize any advantage in women’s competition).

The athlete’s total testosterone level in serum must remain below 10 nmol/L throughout the period of desired eligibility to compete in the female category.

Compliance with these conditions may be monitored by testing. In the event of non-compliance, the athlete’s eligibility for female competition will be suspended for 12 months.

So the MtF athlete must have a testosterone level of less than 10 nanomoles and declare that they are ‘female’ for at least four years. The IOC states that the individual must be taking HRT for a year or two—whenever they are able to show that their testosterone levels are below that 10 nanomolar mark, they are then allowed to compete. However, other members of the IOC have stated that 10 nanomoles is too high (which is the lower end for males) while arguing that it should be reduced to 3 nanomoles per liter of blood (3 nanomoles is the upper-end for women).

10 nanomoles per liter of blood converts to about 288 ng/dl (nanograms per deciliter). Going with the lower end suggested by other members of the IOC, 3 nanomoles per deciliter of blood converts to 87 ng/dl. The range for women is 15 to 70 ng/dl. Now, the 10 nmol/l is, as you can see, way too high. However, 10 nmol/l converts to slightly higher than the lower end of the new testosterone guidelines for the average male in America and Europe (which I covered yesterday, the new levels being 264-916 ng/dl). As we can see, even 10 nmol/l is way too high and, in my opinion, will give an unfair advantage to these athletes (I know that there is no consensus on whether or not testosterone does give an inherent advantage to MtFs of to hyperandrogenic women; I provide evidence for that below).

In regards to women and hypoandrogenism, Stanton and Wood (2011) state that “excess production of endogenous testosterone due to inborn disorders of sexual development (DSD) may convey a competitive advantage.” The fact of the matter is, endogenous and exogenous testosterone does convey an advantage. So if having higher levels of testosterone conveys a physical advantage in said sport, then 10 nmol/l is way too high. Therefore, the only way (in the eyes of the IOC, not in my opinion) for MtFs to compete with women is to get ‘sex-reassignment surgery’, as the gonads will be removed and testosterone levels will plummet. But how by how much?

In a new review of the literature, Jones et al (2017) state that “there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.” They further state that, in most instances, testosterone levels in MtFs “[tended] to be lower than average compared with cisgender women.” So they conclude that there is no evidence that MtFs have no inherent advantage since 1) most of them have lower levels of testosterone than ‘cis-gendered women’, and 2) that there is ‘no evidence’ of testosterone conferring an advantage in athletes (I beg to differ there). The review by Jones et al is a great starting point, however, I disagree with them on numerous things (which I will cover in greater depth in an upcoming, exhaustive research article).

Mueller et al (2011) studied a sample of 84 MtFs who were treated with 10 mg of oestradiol every ten days. They were “treated with subcutaneous injections of 3.8 mg goserelin acetate every 4 weeks to suppress endogenous sex hormone secretion completely.” Follow-ups then commenced at 12 and 24 months. It was found that their BMI, fat mass, and lumbar bone mineral density (BMD) had increased. Conversely, they had a significant decrease in lean mass with a concurrent increase in BMI, which would lead to strength decreases and increased range of motion (ROM), and there was no effect on femoral bone density. This is a larger study than most, most studies having ns of ~20, so the results are robust for this research.

Even if MtFs have a decrease in lean mass and gain in fat mass, they still have inherent biological advantages over women. Testosterone, of course, is not the only reason why men are superior to women in most sports (contrary to the literature). Muscle fiber distribution, cross-sectional area, leverages, etc all play a part in why men are better at sports than women (this is covered at length in Man the Athlete). To the best of my knowledge, cross-sectional area, muscle fiber distribution and leverages don’t change. This is another physical advantage that MtFs would have over ‘cis-gendered women’.

Hyperandrogenic women have also been the center of a lot of controversy (if you follow the Olympics, you may have heard about it occurring during the last Games). Hyperandrogenism affects 5-10 percent of women that are of reproductive age. Signs of hyperandrogenism include hirsutism (hairiness in women), androgenic alopecia (Price, 2003), acne, and virilization (the development of male body hair, bulk, and a deep voice, male-typical characteristics) (Yildiz, 2006). After Caster Semenaya’s dominating win in the middle distance run during last year’s Olympics, the IOC revised their regulations on hyperandrogenic women.

However, Karkazis et al (2016) argued against the IOC and IAAF (International Association of Athletics Federation) stating that “The current scientific evidence, however, does not support the notion that endogenous testosterone levels confer athletic advantage in any straightforward or predictable way.” I strongly disagree with the contention, which I will cover at length in the future. (See Cardinale and Stone, 2006; Wood and Stanton, 2012; Vanny and Moon, 2015.) Of course testosterone is not the only biological factor that confers an advantage, but the difference between hyperandrogenic women and normal women is large (hyperandrogenic women have three times the testosterone compared to normal women, so between 45 to 210 ng/dl). So should they be allowed to compete with women with average levels of testosterone?

Men are built differently than women. Even with HRT, MtFs people would still have an advantage over women. The differences are biological, physiological and anatomic in nature and surgery nor HRT will affect certain factors that would confer an advantage due to the sex the person was born as. That part, in my opinion, is the key factor at play. The difference between MtFs and women do not go away due to surgery and HRT (though some do), so since MtFs have certain biological, anatomical and physiological differences, they should not be allowed to compete with women. That is the one main factor in this debate that is being overlooked. And due to these inherent advantages, they should be barred from competing with women.

This then brings up some interesting implications. Should we segregate competitions by race since the races have strengths and weaknesses due to biology and anatomy, such as somatype? It’s an interesting question to consider, but I think we can all agree on one thing: Women should compete with women, and men should compete with men. Thus, transgenders should compete with transgenders. Even the IOC’s regulations are too high, and in my opinion (contra the literature), testosterone does confer an advantage to those who have it in higher levels (i.e. MtFs). Even then, disregarding testosterone, there are a slew of reasons as to why MtFs should not compete with women which will be covered more in the future.