3rd August 2021

Imagining fair sport that doesn’t harm people

Even before the New Zealand Olympic Committee officially announced that Laurel Hubbard would represent her country in weightlifting at the Tokyo Games, media from around the world were reaching out to me to speak about it. The issue of transgender athletes’ participation in sport has been in the news for months due to a series of discriminatory bills seeking to ban or limit such participation, introduced in state legislatures across America. 

Public discussion around the topic was – and remains, unfortunately – both passionate and heavily polarised. So, even just the possibility that Laurel could become the first athlete to compete in an Olympic Games in a category other than her gender assigned at birth was enough of a talking point to generate interest and flood my inbox. When she stamped her ticket officially, that flood turned to a tsunami — a crush that continues beyond her competing on August 2.

That I am being asked to comment comes as no surprise to me. Like Laurel, I am a fully transitioned XY female. Though I never got the chance to participate at an Olympic Games, I was a Waterskier and Cyclist who competed for Canada at the international level both during and after my transition. I am now, among other things, a leading international spokesperson for health, safety and prevention within sport – particularly around issues of gender diversity, health and wellbeing through the lens of design. 

I am also one of the world’s foremost experts in the science behind what actually happens to an athlete’s body during and after transition. Because it happened to me.

In short, I am uniquely qualified to talk about Laurel’s historic accomplishment. It is historic because Laurel has qualified for the Olympics despite the impact that transition has on an XY female’s physiology.

Apples and oranges

In the public discussion about transgender and intersex athletes, there is an obsession with the idea that XY females have developed an ‘unfair competitive advantage’ within sport. It is exclusively applied to female athletes – like me, like Laurel, like Caster Semenya – by people opposed to our opportunity to compete. Though it’s usually phrased in cruder terms, the argument basically boils down to the belief and singular homogenised view that the higher natural testosterone levels produced by XY individuals from puberty onwards allow their bodies to become stronger, leading them to become inherently better athletes than XX individuals.

There has never been scientific evidence to support that claim. There is only ‘one science’. Testosterone alone is useless as a measure of athletic prowess. Like so many of the drums people bang in the name of ‘protecting’ women it is deeply misogynistic – predicated on the idea that women are, by default and without exception, inferior athletes. It is a policing tactic exclusively applied to female athletes. And it completely disregards the physical experience of going through transition — let alone competing in elite-level sport after the fact.

The XX and XY physiologies utilise and synthesise androgens differently. You cannot compare the two. You would be comparing ‘apples to oranges’.

In the XY karyotype, the endocrine system is driven by testosterone, which is produced by the testicles. In the XX karyotype, it is driven by oestrogen and progesterone in addition to testosterone. The XY endocrine system collapses without testosterone, whereas the XX endocrine system doesn’t.

Sex reassignment surgery involves the complete removal of the testicles (castration), the organ responsible for the primary production of testosterone in XY bodies. Losing the ability to produce the body’s primary hormone results in a complete disruption of the endocrine system, disabling the brain’s ability to communicate with vital body organs and carry out vital internal communications that ensures many of the body’s glands and organs work collectively and properly to ensure an athletes health, recovery and performance on the ‘field of play’. Removing testosterone from that system severs the links between those organs and glands, throwing the body into a state of complete androgen deprivation.

Androgen deprivation is an extremely dangerous medical condition, which is well medically researched. Its common symptoms include, but are not limited to, cessation of cell synthesis due to the removal of the organ which provides the primary stimulus for testosterone production; loss of sexual and mental health; cardio vascular issues; respiratory and metabolic impact; joint instability; complete muscle atrophy; increased subcutaneous fat levels; accelerated bone loss; premature ageing; increased vulnerability to coronary heart disease and joint injuries; elevated core body temperature during exercise; reduced stamina; fatigue; delayed recovery; and diabetes. 

Not exactly how you want to be feeling heading into your first Olympics. Yet the IOC required transgender athletes to undergo this as a prerequisite for competing in female competition from 2003 until 2016.

Outside of women’s sport androgen deprivation, which is unique to the XY karyotype and is known medically as hypogonadism, is treated with testosterone supplements and intervention to elevate blood levels to increase health and wellness. But within the sporting structures governed by IOC policy, access to testosterone is heavily regulated. XY individuals need their testosterone levels to be T>14nmol/L or higher to be healthy. Yet the IOC requires that XY females competing without a therapeutic use exemption (TUE) – like Laurel – to maintain testosterone levels at below 10nmol/L, where XY athletes who have undergone sex reassignment are at 0.5nmol/L, as the only remaining source for their primary hormone, testosterone, is the adrenal glands.

Transitioned testosterone levels – impact on the human physiology over time. Click to open.

This process does take time. But Laurel Hubbard transitioned in 2012. To be clear: because of the impact of transition on her physiology, she is at a distinct disadvantage to all her female competitors.

Laurel Hubbard is not at the Olympics because she was born in an XY body. Given the almost insurmountable bureaucratic barriers placed in her way, she is there despite that fact, and due to her raw determination and her love for her sport as an athlete.

Athlete health risks

I am also uniquely qualified to share my concerns about Laurel’s safe participation on the ‘field of play’ in Tokyo. When Laurel lifts in Tokyo, she will be exposing herself to tremendous and unnecessary personal risk – in every sense.

From personal experience, I can tell you that it is next to impossible to continue competing at the international level in most sports, let alone safely, while abiding by the IOC Policy – which is also used to set the policies of sport-specific, national and regional governing bodies as signatories to the Olympic Movement, worldwide. Beyond competing in sport, it is impossible to maintain your basic health as a transitioned XY female competitor without therapeutic support and the necessary infrastructure and understanding. 

Multiple athletes have lost their careers to these policies. I am one of them, and I personally know of close to two dozen other voices.

That tremendous human cost has been ‘justified’ by the IOC and others as a necessity for maintaining the ideological view of fairness of sport, within a framework of sport designed in 1896 by Pierre de Coubertin through a lens designed by men, for men and to entertain men. That basic framework still remains and beyond this, would always be about accommodating anybody that doesn’t fit – for example, women. 

The IOC is tasked with a herculean effort in accommodating the evolutional changes in society through a framework that was never designed to accommodate them, and is unable to respond to these changes effectively. In 1896, Pierre de Coubertin could never have envisioned these societal changes. As we enter the second week of the Tokyo 2020 Olympic Games, the ‘splintering’ that is occurring is due to the IOC still using this framework in a modern context. This has impacted the mental, physical, and social health of several athletes, as we have seen during the first week of the Games. 

These occurrences are reflective of the IOC using the framework designed by Pierre de Coubertin to respond to modern issues. And as Laurel competes in Tokyo – still without any infrastructure to support her physical health and wellbeing to ensure she can do so safely – the  potential risk that she will be injured or suffer some other lasting harm is yet another apparently acceptable part of this cost.

Given my experience, what we are seeing at Tokyo 2020 represents déjà vu. Athletes are being impacted by this very same framework, and being put at risk through an insecure, unhealthy, and unsafe environment in which to ensure an athlete’s success. 

Annet Negesa lost her sporting career due to sport’s policies in this area making her unwell…

Though my experience is unique in many ways, many other women were no afforded mechanisms of support and their bodies failed them. They had to leave sport, as there was no infrastructure to support their health and physical longevity. There was a complete unwillingness to support them, and the focus was always on defence. If the scientific work had been done originally, these women would still be healthy and participating.

Every athlete should be assured their optimal health, to ensure the best possible outcome on the ‘field of play’, while enjoying the life changing opportunity of becoming an Olympian in their sport. And the idea that it has anything to do with ‘fairness’ is so tragic, because the IOC’s Policy around hormone levels in XY female athletes has never had scientific backing. These incredibly harmful restrictions are completely arbitrary – something I have proven in court in 2016, where the IOC – on its own initiative – removed ‘sex reassignment’ from its Policy to answer a human rights question, recognising the catastrophic long-term impact on the XY physiology.

Worley succeeded in holding sport to account for her treatment…

In addition to losing my cycling career and Olympic opportunities as a result of these policies, I was also the first athlete to be ‘gender tested’ under measures implemented in the IOC’s 2003 Stockholm Consensus – a humiliating and invasive medical examination that amounted to a sanctioned sexual and psychological trauma. In 2016, I sued several of sport’s governing bodies – including the IOC, the World Anti-Doping Agency, the International Cycling Union, Cycling Canada and Ontario Cycling – for violating my human rights. They only wanted to hit the survivor with a bigger hammer. 

Worley’s book details her journey…

This process, and my story, is told in much more detail in my autobiography Woman Enough, but the short version is I brought them before the Ontario Human Rights Tribunal outside the Court of Arbitration for Sport (CAS) in Switzerland. The decision affirmed, among other things, that sport’s policies created long-term trauma and made me a survivor, and that they had no basis in science, as now recognised by the International Olympic Committee.

Do no harm

As awed as I am by Laurel’s accomplishments, her strength and her ability to endure, and her kindness, as I am now recognised by the International Olympic Committee as a survivor I can confidently say that sport and this particular Olympic Games isn’t ready yet, and is unable to create an environment that ensures her health, wellbeing, success and safety on the field of play. But I can also say that a future in which athletes – such as Laurel and myself, sure, but also every other athlete that has been down this path – are properly protected is closer than it may seem, and I believe we are on the right path.

At a news conference in Tokyo in mid-July, IOC president Thomas Bach told those assembled that the IOC is in a ‘inquiry phase’ as it reviews its rules governing trans athletes. He stressed that the Guidelines that eventually result from that review process, “cannot be rules, because this is a question where there is no one-size-fits-all solution”.

To me, that one sentiment signals the first informed response from the IOC on this issue since 2003. It gave me hope that the Olympic Movement can adapt to a human centred design approach through the design lens of do-no-harm, health, wellbeing and connecting people to the ecosystem, one in which I wouldn’t be so scared to see Laurel compete, moreover one which can be applied to every person who has access to sport at any level to play and participate anywhere in the world.

It is possible to reimagine the design of sport with an emphasis on prevention, and athlete health wellbeing and safety. That reimagining would pre-empt the endless circular ‘debates’ about ‘fairness’ that dehumanise the very people that compete. It may also elevate people to a better understanding of human diversity, which we should be cherishing for what their efforts and accomplishments teach us about being human. It would shift the focus to them as athletes and people.

Last November, the IOC adopted the UN Guiding Principles on Business and Human Rights through the framework introduced by Shift Project Co-founder and Vice-President Rachel Davis and Zeid Hussein. This is the first step and beginning of a much deeper dive and pivot for the IOC. The IOC leadership and Olympic Movement have recognised we cannot continue the ‘business as usual’ approach using the current Games framework. 

The IOC has recognised that as a steward of sport, it must operate under the ‘do no harm’ principle. It must elevate sport and invest in communities, playing a modern role in health and wellbeing that extends beyond the field of elite sport. Its current Policy regarding transgender athletes doesn’t fit this new perception.

We have now made it possible to reimagine sport. Though in its infancy, what does sport look like through this new lens? What will the role of the modern-day Olympics and Olympic Movement be?

That’s the conversation I want to be having. Call me when you’re ready.

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