New APA Blog Series: Including Trans Athletes in Competitive Sport

An issue increasingly on people’s minds and in the public eye is whether—and how—transgender women should be allowed to compete in sport in women’s categories. Is it fair? Do trans women have an unfair competitive advantage? Various sports organizations are wrestling with this issue.

My work with Dr. Aryn Conrad explores these issues. In a series of APA Blog posts, we’ll cover some of the arguments in favor of including trans athletes without restriction. You can find a short version of our presentation online here.

In 2015 the International Olympic Committee (IOC) updated their hyperandrogenism (high endogenous testosterone) and transgender policy. Previously, trans women were required to undergo invasive, expensive, and often undesired genital surgery, and then wait two years before being able to compete as women. The new policy removes that requirement and, in its place, requires trans women to be able to demonstrate that their endogenous testosterone levels are below 10nmol/L for 12 months—and at all times thereafter. That value represents the bottom of the ‘average’ male range, but still falls above the top of the ‘normal’ female range. However, there are cisgender women who have testosterone values above 10nmol/L, it’s just uncommon.

As it stands under IOC policy, any woman who has endogenous testosterone >10nmol/L would run afoul of the policy, and would require some sort of medical intervention (such as medication) to lower her testosterone. If she didn’t, she would be deemed ineligible for competition. IOC sports recognize only two gender categories: ‘male’ and ‘female.’ An ineligible female, therefore, may not compete in male sports categories, since she’s female.

Moreover, IOC sports no longer engage in sex-verification or sex-testing; instead, sports must accept an athlete’s legally recognized gender. This was explicitly stated in the 2015 Court of Arbitration for Sport (CAS) decision in the Dutee Chand vs International Association of Athletics Federations (IAAF), which involved whether the IAAF’s hyperandrogenism regulations constituted unethical discrimination. CAS ruled that the policy did, and the regulations were struck down in an interim decision.

But what of that 10nmol/L value? Is it well supported by science? Is there good evidence that hyperandrogenic women enjoy a large competitive advantage, and one large enough to justify a limit on endogenous testosterone? This was at the center of two lawsuits: the aforementioned Dutee Chand CAS case, and the very recently settled human rights case in Canada, brought by Kristen Worley against the IOC, UCI, and Cycling Canada. As it happens, high endogenous testosterone has, at best, been shown to provide a 2-3% competitive advantage. (In a future post, we will analyze the data demonstrating this.) That’s not much. But is it unfair? What is fairness in sport?

Most people immediately respond, “A level playing field.” But what does that mean? Literally speaking, the phrase refers to a soccer pitch: the field should be level so that the conditions of play do not grant one team an unfair advantage over another. More broadly, it means that everyone must abide by the same rules–that’s what ‘fairness’ means. But that’s not really what most people mean when they invoke the level playing field. Instead, they mean something like “No competitor has a competitive advantage over another.”

We hope that it’s very quickly obvious that this is not a good definition of ‘fairness.’ If no competitor had any advantage over another, sport would turn into games of chance, like flipping coins or rolling dice. But athletes try to train harder than their competition, train smarter, have better tactics, better equipment, more time, more money, better facilities, and so on. Sport is rather explicitly about unleveling the playing field in this sense. The issue is when we consider an advantage due to a natural physical trait ‘unfair.’

It’s important to note that the only natural physical trait that sport will deem a woman ineligible to compete is high endogenous testosterone: height, mitochondrial mutations, lung capacity, and so on are not regulated. Only testosterone.

Consider two 30 year old cyclists. Alice is 6’0”, 170lbs, with a functional threshold power—the power she can maintain for 60 minutes, a key cycling metric—of 4watts/kg of bodyweight, and a peak sprint power of 1300w. Bonnie is 5’3”, 115lbs, with a threshold power of 5.1w/kg, and a peak sprint of 850w. Who is the better cyclist? Who would likely win in a race?

Someone familiar enough with cycling would answer that “It depends.” It depends heavily on the race course profile: are there significant climbs, where the race will be decided? Is it relatively flat, where we expect it to finish in a sprint? If the former, then Bonnie is the clear favorite: she has a large competitive advantage by being smaller and having a higher w/kg threshold power. Alice might even be ‘dropped’ from the main pack and finish near the back. If the latter, then Alice is favored: she has a large competitive advantage due to her impressive sprint, and Bonnie may struggle to crack the top 20. And each rider’s ‘advantage’ in courses that favor them is far more than the 2-3% we’re worried about with endogenous testosterone.

But now suppose that Alice is transgender. Is it “unfair” for her to compete? Trans women come in all shapes and sizes. They’re not ‘men in dresses.’ Some are 5’3” and not athletic at all, some are short and athletic. Some are 5’9” and overweight. Some are 6’2” and very thin. Rachel has an Olympic gold medalist friend, a cis woman, who is 6’4”. Trans women come in all shapes and sizes, just like cis women. If we’re interested in the science of trans women athletes, one recent (albeit small) study found that through the medical transition process, trans women did not retain any significant competitive advantage (Joanna Harper 2015).

If someone is a top 20% runner pre-transition running in the men’s categories, she remained a top 20% runner post-transition running in the women’s categories: she didn’t magically go from a top 20% runner to top 5%. We have some evidence that trans women do not have a significant competitive advantage, and what evidence we do have of an advantage places it in the 2-3% range, which is much smaller than other natural physical trait differences we consider ‘fair’ such as height.

In our next blog post, we’ll focus on the human rights argument for including trans athletes in competitive sport without restriction.