8 December 2021

Transgender inclusion remains an enigma*

Although the International Olympic Committee’s (IOC) Framework Guidelines on Gender Identity advocate inclusion and harm prevention, sport remains unclear about how it should categorise transgender athletes, speakers at a Sports Resolutions webinar outlined yesterday. The idea of including fully transitioned male to female athletes in the female category was clouded by concerns over the potential for performance advantage due to the action of testosterone on the XY physiology from puberty onwards, and resulting safety concerns. 

The IOC Guidelines outline that there should be no presumption of advantage (click to open)…

Dr. Emma Hilton of the University of Manchester argued that the action of testosterone on Michael Phelps’ XY physiology from puberty onwards has allowed him to develop such an advantage that he would dominate female swimming, were he to transition. Dr. Nicola Williams, of Fair Play for Women, argued that it was “outrageous” that the IOC Guidelines outline that an advantage held by male to female transitioned athletes should not be assumed (see right). 

Both argued that allowing transitioned female to male athletes into female sport affected women irrespective of performance advantage, by denying other women access to female sport. Dr. Williams said she had been approached by junior female cricketers who do not want to play anymore, due to having to compete against XY individuals. This is despite Article 12.2 of the England and Wales Cricket Board’s (ECB) Policy on Trans People Playing Cricket restricting a ‘transgender man’ from competing in a female only competition.

“Trans women do not threaten female sport”, said Joanna Harper of Loughborough University, who argued that any ‘advantage’ held by post transition male to female athletes is not as simple as made out by Hilton and Williams. She pointed to a Study currently being conducted which found that after undergoing hormone therapy, transitioned male to female 100m runners became slower to the point where they were no more competitive in the female category than they had been in the male category. She therefore argued that hormone therapy may ensure “equity of competition” in the 100m.

“The idea that trans women who’ve gone through a medical transition still have male bodies is simply not true”, argued Harper. “The advantage is mitigated by hormone therapy”. She said that there is unpublished evidence suggesting that trans women athletes may lose a greater proportion of their strength than non-athletic trans women.

She argued that the vast majority – but not all – of male to female transitioned people are happy to undergo hormonal therapy, because it makes them happier and healthier. She did acknowledge that some male to female transitioned people can develop health problems due to the reduction of their testosterone levels or as a side-effect of hormone therapy. 

Dr. Williams and Dr. Hilton argued against the idea that the advantage developed by XY athletes who have undergone male puberty can be mitigated. “The evidence is now clear that there is no way to eliminate the male puberty advantage”, said Dr. Williams. “Being born female, I need access to female sport due to my disadvantage”.

Dr. Hilton said that the argument that the advantage of having undergone male puberty is not insurmountable is “sidestepping the issue”. She used the example of Powerlifting, pointing to a 90% difference in performance between men and women, to illustrate the difficulties with deciding how much advantage might be considered too much in a specific sport. 

One of the four athletes who had surgery under World Athletics Rules said she wished she had died…

The panel were divided on whether testosterone suppression, a policy previously adopted by the IOC and World Athletics, is effective in mitigating any advantage held by male to female trans athletes. Whether the IOC and international federations should be held liable for harming1 athletes through medical intervention to reduce testosterone levels was one of many audience questions left unanswered. 

The way forward

Panelists disagreed on how transgender athletes should be categorised. Dr. Williams supported the idea of a ban on the XY physiology being admitted into female categories of sport, unless it could be proven that no advantage exists. She supported the idea of the ‘male’ category being renamed as the ‘open’ category, and welcoming both male to female and female to male transitioned athletes.

Dr. Hilton was critical of the IOC Framework for offering no guidance to international federations about how to categorise transgender athletes. She argued that UK Sport’s Guidance for Transgender Inclusion in Domestic Sport at least offered sporting bodies a framework on how they should approach the issue.

David Grevemberg of the Centre for Sport and Human Rights saw the IOC’s Guidelines as the start of a longer journey towards re-imagining the historical patriarchal origins of sport, placing human rights first. However, panelists disagreed on whether participation in sport is a human right.

Dr. Hilton argued against the idea that participation in sport is a human right. Dr. Williams said that women have a human right to participate in sport without having to compete against XY athletes who hold an advantage due to having undergone male puberty. 

Harper supported allowing male to female transitioned athletes to compete in female sport at the elite level, but only subject to restrictions. She argued that grassroots sport should accept transitioned athletes into both male and female categories without restriction.

All agreed that ‘transgender’ categories make no sense at present, simply because there are not enough transitioned athletes to make competition in such categories meaningful. All agreed that more study is needed on whether male to female transitioned athletes maintain a performance advantage in all sports. 

Back to front complexity

The disagreement between the panelists highlights the complex nature of the debate. Dr. Williams even argued against the idea that it should be a complex debate, as transitioned male to female athletes should be excluded from female sport. On the face of it, her argument that the male category should be renamed as the ‘open’ category appears persuasive.

However, this ignores the fact that many States recognise transitioned male to female people as women. As such, forcing transitioned athletes to compete against XY males is likely to be challenged, irrespective of whether the category is renamed. 

The argument over performance advantage remains a can of worms. XY males outperform XX females in many sports. It is understood that XY athletes can develop this advantage due to the action of testosterone on their XY physiology from puberty onwards. However, the development of this advantage also depends on many other variables, including diet and frequency of exercise over time. 

Given that every XY athlete has the potential to develop this advantage, does this mean that all XY transitioned athletes should be excluded from female sport? Even when hormonal therapy has mitigated that advantage? If so, what level of mitigation is acceptable? Should this apply from the elite down to the grassroots? Who’s going to tell kids undergoing a potentially difficult period in their life that they can’t compete as women? Dr. Williams appears to think that complete exclusion is the only way forward and Dr. Hilton argues that as male puberty advantage cannot be completely nullified, then exclusion shouldn’t be ruled out.

But such an approach ignores the nuances of elite sport, where every athlete plays on their social, physical, and developmental advantages to win. Negating these advantages would render elite sport meaningless. Everybody would finish at the same time. All of the panelists agreed that more work needs to be done in exploring whether XY male to female transitioned athletes retain a performance advantage, and whether that advantage is significant enough to warrant intervention.

This thin line is why World Athletics used the term ‘category defeating’ in its arguments against Caster Semenya’s challenge to its DSD Regulations at the Court of Arbitration for Sport (CAS). In order for exclusion to be viable, sport has to demonstrate that the advantage of having undergone male puberty is so great, it would render competition in the female category meaningless. It managed to do this only in events run between 400m and one mile, however its evidence base in attempting to support its rules was severely criticised2.

Anybody who has read the Semenya Decision3 knows that the DSD Regulations and the Transgender Guidelines regulate the same thing – the participation of XY people in female sport. I urge anyone who thinks differently to read the Semenya Decision entirely.

The IOC Guidelines abandon the concept of reducing endogenous (naturally produced) testosterone to mitigate XY performance advantage in the female category. However the DSD Regulations (click here to download) and World Athletics’ Transgender Guidelines (click here to download) both set a limit of 5nmol/L – for six months prior to competition in the case of the DSD Regulations, and 12 months in the case of the Transgender Guidelines. Given that both regulate the same thing, the reason for the time difference isn’t clear and could present an avenue for challenge.

The reason that the IOC and World Athletics have been forced to chop and change their rules and regulations in this area is because the science in this area has developed since it was first examined over 30 years ago. It is significant that the IOC Guidelines state that an XY advantage should not be assumed. This is a tacit admission that the previous scientific research was inadequate. That is why we have entered this messy stage, and is more research is now being done.

Not assuming performance advantage is also a sensible approach. How could a youth football organisation assess whether a 16 year old boy holds a performance advantage over a 16 year old girl?

“This is an issue that won’t be sorted out in my lifetime”, said Harper. Nor, perhaps, mine. The whole situation presents a microcosm of what happens when sporting bodies are allowed to formulate policy without research. People have been harmed and experts have been polarised. 

It is fair to level criticism at the IOC Guidelines for not providing a clear framework for sport to apply. But perhaps the reason that they don’t is that more scientific research needs to be performed. However, the IOC Guidelines at least prioritise inclusion over exclusion policies that medicate athletes and have been found to harm them. They are a baby step that should have been taken at the start of this journey. They are also perhaps a sidestep in an attempt to avoid liability.


1. ‘IAAF used medically damaged athletes to prop up DSD Regulations
2. ‘PTG2019: Flaws in the IAAF’s response to Semenya presentations
3. ‘SFT rejects Semenya appeal: nothing changes

* This article was amended on 9 December following clarifications from a panelist.

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