By Lynley Anderson, Taryn Knox and Alison Heather

International media has reported on Laurel Hubbard, a 39 year old trans-woman weightlifter who has been named in the New Zealand Commonwealth Games team to compete in Australia in 2018. Hubbard is the first New Zealand weightlifter to medal at any world championships and is the first transgender athlete to represent New Zealand at the Commonwealth Games. The CEO of the Australian Weightlifting Federation, Mike Keelan, called for Hubbard to be banned from the Commonwealth Games. This is despite Hubbard meeting the criteria of the Commonwealth Games Federation and the International Olympic Committee (IOC) to compete in the female division.

Mack Beggs, an 18 year old trans-male wrestler, recently won the Texas girls class 6A 110 lbs division. After winning, Beggs was subjected to cheering and booing from the crowd. Beggs is transitioning to male and taking testosterone. Beggs asked to compete in the boys division, but the relevant rules forbade this – high school athletes must compete under the gender on their birth certificate (University Interscholastic League, 2017). As Beggs will have higher testosterone levels than his cis-female competitors (i.e. those competitors who were both born female and identify as female), it is possible that he will have a physiological advantage over them. If so, it raises the question of whether this competition was fair.

Is allowing Hubbard to compete in the female division fair?

One might argue that Laurel Hubbard’s testosterone levels and the residual effects of a previous life with a male physiology means she has an advantage over her competitors. The IOC requires those competing in the female division to have testosterone levels < 10nmol/L. This is below the younger male range (less than forty years old) of 10.4-41.6 nmol/L (Boyce et. al., 2004). However, the levels for acceptable testosterone to compete in the female division are perhaps set too high, especially given the standard testosterone range for cis-women is between 0.3-2.1 nmol/L (Braunstein et. al., 2011).

Inclusion and fairness

Two principles involved in these cases are those of inclusion and fairness. Regarding trans-athletes, the principle of inclusion allows athletes to compete in the division that aligns with their gender identity, rather than their biological sex. The principle of fairness seeks to provide a playing field that is as level as possible so that athletes with the most skill are competing, and this skill has been honed by persistent training, not by other means (this is known as the ‘skill thesis’. See Carr in Bianchi, 2017, 233.) It would be thought unfair for an athlete to win because he or she has used an ergogenic aid such as a performance enhancing drug or a bike with a hidden electric motor. Hubbard and Beggs’ cases highlight the tension between the principles of fairness and inclusion. Which of the two principles should take precedence in sport?  And could it be that the balance between inclusion and fairness might differ depending on the sport and/or the level of competitiveness?

Drilling deeper – what role does testosterone play?

While there is very little evidence concerning whether testosterone provides elite trans-women athletes with a physiological advantage over cis-women athletes, testosterone is performance enhancing. Testosterone increases muscle mass, bone strength and oxygen carrying capacity in a linear fashion (Bhasin et. al. 2001; 1996). Some might argue that we are overplaying the role of testosterone, as it is not the sole driver of the difference between male and female athletic performance. However, it is a major factor in performance in almost all sports. Elite trans-women athletes who take hormone therapy and/or have gender reassignment surgery to lower their testosterone to IOC-acceptable levels are likely to retain some of the male physiological advantages prior to transitioning, such as skeletal structure, and heart and lung size. Equally, trans-men who take testosterone, might have a physiological advantage over cis-women, but they would be disadvantaged when competing against cis-men as trans-men have not had the benefits of a lifetime of a higher testosterone level. Is allowing trans-women and trans-men to compete against cis-women fair? The benefits of high levels of testosterone mean that trans-women and trans-men are not on a level playing field with cis-women.

Can the playing field be truly level?

It could be argued that any attempt to level the playing field is futile. For example, tall people have an advantage over short people in many sports. This variation in height is part of the genetic lottery, and we do not seem overly concerned by such variations. By extension, it could be argued that the high testosterone trans-women have is similar to those variations arising from the genetic lottery, especially when some women have naturally high testosterone levels in the range of 2.1-5.1 nmol/L (Kindi et.al., 2012). This argument would lead to the conclusion that trans-women should be allowed to compete against cis-women i.e. that the advantage that trans-women have over cis-women is no different from the advantage a very tall person might have when playing basketball. This is a strong argument. However, a material distinction between the two is that as a population, cis-women’s range of height overlaps with the male population, but levels of testosterone do not. This allows cis-women to select their chosen sport based on their individual physiological parameters e.g. height, but testosterone is a physiological parameter not available to cis-women.

There is a range of possible responses to account for the tension between fairness and inclusion. One is to ban elite trans-athletes from competition. This is inconsistent with the principle of inclusion – there should be room for transgendered athletes to compete in elite sport. The second option is to allow elite trans-athletes to compete in the gender which with they identify. While consistent with the principle of inclusion, this option is unlikely to satisfy the principle of fairness. These two options suggest that the principles of inclusion and fairness are incompatible if the male/female binary is retained. We are in favour of a third option, namely, having new categories of competition based on a) social parameters including gender identity, and b) physiological parameters including testosterone.

Doing so will facilitate both fairness and inclusion, and cater to the needs of all athletes. Just as we should not boo Beggs, we should also accept Hubbard’s participation in the female division at the Commonwealth Games as she complies with the current rules of her sport and the IOC. Where concerns about fairness exist, these should be addressed to relevant organisations, not individual athletes.

References

Al Kindi, M. K., Al Essry, F. S., Al Essry, F. S., & Mula-Abed, W. A. S. (2012) ‘Validity of serum testosterone, free androgen index, and calculated free testosterone in women with suspected hyperandrogenism’ Oman medical journal, 27(6), 471.

Bhasin, S., Storer, T. W., Berman, N., Callegari, C., Clevenger, B., Phillips, J., & Casaburi, R. (1996) ‘The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men’ New England Journal of Medicine, 335(1), 1-7.

Bhasin, S., Woodhouse, L., Casaburi, R., Singh, A. B., Bhasin, D., Berman, N., & Dzekov, J. (2001) ‘Testosterone dose-response relationships in healthy young men’ American Journal of Physiology-Endocrinology And Metabolism, 281(6), E1172-E1181.

Bianchi, A. (2017) ‘Transgender women in sport’ Journal of the Philosophy of Sport, 44(2), 229-242.

Boyce, M. J., Baisley, K. J., Clark, E. V., & Warrington, S. J. (2004) ‘Are published normal ranges of serum testosterone too high? Results of a cross‐sectional survey of serum testosterone and luteinizing hormone in healthy men’ BJU international, 94(6), 881-885.

Braunstein, G. D., Reitz, R. E., Buch, A., Schnell, D., & Caulfield, M. P. (2011) ‘Testosterone reference ranges in normally cycling healthy premenopausal women’ The journal of sexual medicine, 8(10), 2924-2934.