By Lynley C. Anderson, Alison Heather, Taryn Knox

In recent years there has been a huge amount of media interest in the inclusion of elite transwomen athletes in the women’s division. Reasoned debate focuses on the delicate balance between the inclusion of transwomen based on “a fundamental human right for everyone to be recognized in the gender in which they identify”, and fairness with regard to how much of a performance advantage an elite transwomen athlete has over elite cis-women athletes (‘cis-women’ meaning athletes that were assigned female at birth and identify as female). Herein lies the dilemma: inclusion of transwomen in all aspects of society, including elite sport, is undoubtedly important, yet fairness is also essential to the integrity of elite sports.

Much of the academic literature on this tension is written either by physiologists, sociologists or ethicists. Our paper is written by academics from physiology and ethics.  Our group of authors have a strong commitment to both accurate science, and the need for an inclusive society.

So what do we offer?

Men dominate world record times in almost all sports. Testosterone and other aspects of male physiology (e.g. longer, increased muscle mass, and larger heart and lungs leading to enhanced aerobic capacity) are the main factors underpinning enhanced male athletic performance. To give women any chance of winning, most elite sports have men’s and women’s divisions. But how does this structure cope with those who wish to move from one category to another (in particular male to female)? While current IOC guidelines require transwomen to have hormone therapy to keep their testosterone levels under 10nmol/L for one year prior to competition, this is still significantly higher than the average level of cis-women. In addition, hormone therapy does not change all elements of male physiology such as bone structure, lung volume or heart size.

There is very little scientific evidence directly concerning the performance advantage of elite transwomen athletes. However, extrapolating from the science of elite male athletes, elite transwomen athletes (specifically those who retain their testes) are likely have a performance advantage over elite cis-women athletes.

Of course, scientific evidence alone does not show that transwomen athletes (with testosterone levels just under 10nmol/L) should not be included in the women’s division. Hence, we discuss six arguments in favour of including transwomen despite their performance advantage. Included in this discussion is whether a transwoman could be considered to have a tolerable advantage similar to the advantage of being tall for sports such as basketball.  Such advantages that arise from the genetic lottery are not standardly deemed to be unfair. It could be argued that the performance advantage held by elite transwomen athletes is similarly tolerable. We offer a counter argument based on the all-purpose benefits provided by testosterone.

The desire to be inclusive is important within society. Nevertheless, a problem exists because the strong push for inclusion does not align with what is currently known about the differences in male and female physiology, especially for elite athletes. Whatever position the IOC holds within our current structure of male and female sport, there will be people who are left unhappy. If transwomen compete with testosterone just below 10nmol/L then many elite cis-women athletes will be unhappy. If transwomen are prevented from competing, they will be unhappy. A new solution must therefore be found. We evaluate solutions offered by others to resolve the tension between fairness and inclusion. We show that all approaches have shortcomings, and therefore suggest that the gender binary in sport is abandoned in favour of a much more nuanced and innovative approach that allows for a solution that is both inclusive and fair to all.

Paper title: Transwomen in elite sport: scientific and ethical considerations

Authors: Taryn Knox*, Lynley C. Anderson*, Alison Heather^

Affiliations:

* Bioethics Centre, University of Otago, Dunedin, New Zealand

^ Department of Physiology, University of Otago, Dunedin, New Zealand

Competing interests: None to declare