The post below originally appeared as commentary in Road Race Management Newsletter, of which I am an associate editor. The question of whether to include transgender women in women’s sport—specifically those who have undergone male puberty—has become caught up in political and culture wars to the neglect of science. Also the kind of language used around it feeds into the political or moralistic narrative.
The Transgender Women Athletes Dilemma
Talking about equality, not fairness, is the way forward, and science indicates cisgender and transgender equality may exist in track and field and road racing in distances of 5000m and over, but not in shorter distances, and not in most team sports.
Since this commentary originally went to press, the International Olympic Committee has taken steps to resolve the transgender women in sport dilemma by turning policy over to the governing body of each sport. Given the current state of science, this may be the best compromise. But just think how a member of the public will get turned off by the complexities of differences between sports. “Oh, is that really a woman? How come it’s a woman in sprinting, but a man in swimming?” Down the road, we need more science, and we need more clarity in the rules.
We need public support to keep our sports thriving! Partly that comes with advances in knowledge, partly that comes from education of athletes, coaches, officials, and the public, and partly that requires dropping the use of “fairness” in favor of “equality.” The term “fairness” creates an unnecessary moral barrier.
Whether transgender women should participate in non-recreational women’s sport is a question now embroiled in social, cultural, religious, and political clashes that evoke strong emotions, and the emotions make a hash of rational discussion.
It’s a bit crazy that the science has been overshadowed by issues irrelevant to sport. Sport itself is not religious or political. People can unify over sport in a way that crosses those boundaries—cheering on the same teams and athletes. Or cheering on excellence even when it’s not on your own team. That’s all good. We should keep it that way. Focusing on the science helps with that.
The language being used—pitting “fairness” against “inclusion”—makes objectivity all the more difficult. In general, fairness is a good. And in general, inclusion is a good. The debate rages about whether the inclusion of transgender women in women’s sport violates fairness in women’s competition. Advocates for abolishing transgender athletes in women’s sport maintain that biological males who have undergone male puberty who self-identify as female have an unfair advantage over biological women where strength and speed are decisive.
Sadly, there’s no middle ground for the athlete in this dilemma. As a transgender woman you are either included in women’s sport—leading to allegations of unfairness to women—or you are excluded.
The Concept of “Fairness” Muddies Rational Debate
The word fairness is loaded with moralistic overtones. The concept of fairness transcends sport: it’s about the fair treatment of all people in society at large. It’s a grim reality that transgender people, both men and women, are under assault in general—discriminated against, smeared, stigmatized, vilified, harassed, bullied emotionally and physically, and even murdered for their choice of identity. They have been called abnormal, unnatural, freakish, and even immoral. They have been accused of cheating in women’s sport. Trans people do not deserve this kind of cruel treatment. It’s manifestly unfair, and it all too often leads to depression and suicide.
Suffering so much unfairness in society at large, trans people resent the charge of unfairness in sport. For many of them, exclusion is unfair in itself. They can say, “who are you to call us unfair? You don’t know the half of unfair.” This view is understandable, coming from a group that is so unfairly mistreated and stigmatized way too often by much too large a segment of our population.
The choice of words and phrasing by the International Olympic Committee concerning transgender participation has sent us down this path. Here are the IOC’s two key statements on the issue:
(1) “It is necessary to ensure insofar as possible that trans athletes are not excluded from the opportunity to participate in sporting competition.”
(2) “The overriding sporting objective is and remains the guarantee of fair competition.”
To resolve the dilemma implied by these two statements, the IOC requires that transgender women maintain “total serum testosterone levels below 10 nmol/liter for at least 12 months prior to and during competition.” Even researchers in the field (see the paper by Emma Hilton and Tommy Lundberg cited below) don’t know the scientific basis for that requirement.
Here we have a number (serum testosterone levels) connected with a subjective concept (fairness) that is open to multiple interpretations. It’s a good example of how a remote bureaucracy makes things unnecessarily difficult for the rest of us.
The IOC Got the Language Wrong. Must We Live with It?
Let’s drop the use of fair and unfair in regard to transgender women in women’s sport. The IOC is not omniscient. Let’s use equal and unequal instead. Equality is easier to define and to measure. Talking about equality has less moralistic baggage and enhances objectivity.
If you’re six feet tall and I’m five-seven and we compete in hurdles, that inequality in height is in your favor—but is it unfair? I may have faster reaction time, more fast-twitch fibers and greater agility, such that differences in training and equipment can offset your height advantage. Everyone understands this is the nature of sport—that there is a mix of genetic and epigenetic differences between individuals, and athletes attempt to overcome their weaknesses and improve on their strengths through diet, training, strategy, and psychology. If someone decides they are too unequal physically to compete, then they can choose not to. In most people’s minds, that makes a sport fair, despite inequalities.
These innate differences and how to deal with them apply to individuals. But when there is an entire class of people who enjoy innate, measurable, and decisive advantages over another class against whom they compete, then inequality should separate their competitive spaces. Featherweight boxers do not compete against heavyweights. Wrestlers are separated into weight divisions. Pro teams do not compete against high school teams. And obviously men do not compete against women.
Such differences are measurable, making it more objective and more meaningful to talk about equality. If we agree that equality is a good, we get closer to grappling with the issue in scientific terms and to finding a way forward that doesn’t push so many emotional buttons.
Inequalities Can Get Complicated. That’s Because They Give Us a Lot of Information. Case in Point: Transgender Women in Endurance Sport.
The question before us is whether transgender women as a class belong in the same division as women in athletics, based on physical equality—or the lack of it.
As shown in the sources you can find at the end of this essay, biological males who have gone through male puberty have several innate physical advantages over biological females: on average they are taller, their hearts and lungs are larger, their bones are longer and stronger. They retain most of these advantages after puberty no matter how much they lower their testosterone afterwards. They are as a class so physically unequal to biological women as a class that they belong in a different division in competition, no matter how they self-identify as women.
This is true in sports where strength, power, and all-out speed matter greatly.
But it’s not quite that simple when it comes to endurance sport, distance running in particular.
In most sports, the “legacy” of puberty enjoyed by transgender women cannot be undone by lowering testosterone. You can narrow the difference, but you cannot reach equality. That’s mostly true, but watch the second (Australian) video below and pay attention to Joanna Harper (34:57 into the video) for an alternative view concerning women’s distance running.
Hemoglobin level is one area where testosterone-lowering regimes bring about rough equality between transgender women and cisgender women. Since hemoglobin is one of the most important elements of success in endurance sport, it’s easy to see how making hemoglobin levels equal would narrow the overall performance difference between transgender and cisgender women. Even so, there’s a counter to that: men have larger hearts, and a larger heart pushes more blood of any hemoglobin level.
However, there are other equalizing factors. Transgender women who have passed through male puberty arrive in women’s sport with stronger bones and muscle in greater quantity and quality. But these come at a cost: weight. Excess weight is a handicap in endurance running. Since men tend to have more muscle in the upper body relative to women, the cost of that extra weight and demand for blood imposes a disproportionate disadvantage.
Yes, it’s complicated. We do not have enough evidence to get to definitive answers.
In general, inclusion for transgender women in athletics must be sacrificed to the principle of equality. The fairness question should be placed in a larger context where it belongs. When it comes to distance running, however, inclusion and equality between transgender and cisgender women may both be achievable.
We Might Get a Win-Win for Transgender and Cisgender Women in Endurance Sport
More research on transgender women in distance running is essential. There are reasons cited above to think that the “legacy” advantage of transgender women given testosterone-lowering hormone therapy drops significantly or vanishes in distance running.
Unfortunately, this is where ambiguity again raises its ugly head: where do you draw the line between “distance running” and “non-distance running?” We tend to place the line somewhere around 2000 meters, where the importance of aerobic capacity of the runner begins to outweigh the anaerobic capacity. In this connection, it seems relevant that when Caster Semenya, who dominated women’s fields at 800m, was compelled by World Athletics to compete at 5000m-plus, her dominance faded away. (Semenya’s situation, although analogous, was developmentally different: in the first video sourced below, Ross Tucker discusses her case.)
Therefore, the science so far indicates that equality and inclusion might be had if we limit a ban on transgender women to distances under 5000 meters, allowing transgender and cisgender women to compete equally at 5000 meters and above. Continued research will show if this holds true.
Don’t Forget Transgender Men
One more thing needs to be said. No one seems to be speaking up on behalf of transgender men (biological women) in men’s sport. Their situation is the converse of transgender women’s: no matter how much they increase their testosterone levels, it still doesn’t bring them up to equality with cisgender men. They probably have a more fair claim to their own division in road races than do self-identifying non-binary individuals. If we seriously want to talk about fairness, then transgender men should be invited to the table.
BELOW: SOURCES WITH ANNOTATIONS
VIDEOS WORTH A DEEP DIVE
- A video presentation by Ross Tucker is a good place to start. Tucker is an exercise physiologist who is unequivocal on the need to exclude transgender women who have undergone male puberty from biological women in most women’s sport. Tucker’s presentation goes methodically step by step from first principles—we divide athletes into classes for a reason—to a fully fleshed-out argument based on current (up to 2022) evidence. An assembly of statistics and charts support what he’s saying. Although he might be wrong, he sets up a clear framework with almost no jargon. Tucker also briefly discusses the Caster Semenya case. Here you go: https://www.youtube.com/watch?v=69WIe-ENDAg.
- Second is a video of a public discussion titled Transgender Athletes conducted in Australia, in which voices from all sides of the issue are heard–some transgender women athletes, some cisgender women athletes, three physiologists, and one ethicist. It’s 52 minutes long, but fascinating if you really want a window into the human and the scientific sides of the story in one place. One particularly significant voice is that of Joanna Harper, who is not only a transgender distance runner but also a medical physicist studying the subject scientifically. She is the leading author on one of the academic papers cited below, and there is also an interview with her that clarifies her position. You can pick Harper up being questioned at 30:57 into the video, up to 34:00. She first talks about an experiment of one (herself) lowering her performance level through hormone therapy to that of women (12% slower than her performances as a man). Then she also describes having similar results with a sample of 200 race times from eight other transgender women. She concedes it was a small sample confined to distance running, but “there was nothing else like it.” Hers may be the strongest scientific case for equality between transgender women and cisgender women in distance running, although she acknowledges the innate superiority of transgender women in women’s sport in general. Here you go: https://www.youtube.com/watch?v=STX1GCxYEIc.
WRITTEN SOURCES
- Emma Hilton and Tommy Lundberg: “Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression” https://link.springer.com/article/10.1007/s40279-020-01389-3
Here, the findings in sport apart from distance running are consistent with Ross Tucker’s video presentation above. Findings for endurance events were outside the scope of research. The conclusion comes down on the side of individual sports federations making their own guidelines: “Thus, we argue against universal guidelines for transgender athletes in sport and instead propose that each individual sports federation evaluate their own conditions for inclusivity, fairness and safety.”
- Joanna Harper, Emma O’Donnell, et al: “How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation.” https://bjsm.bmj.com/content/55/15/865
This is a copious review of academic literature—i.e., a study of studies—much of it in line with the Tucker video and Hilton and Lundberg, above.
- Anna Wiik, Tommy Lundberg et al. Muscle Strength, Size, and Composition Following 12 Months of Gender-affirming Treatment in Transgender Individuals: https://academic.oup.com/jcem/article/105/3/e805/5651219
This study conducted “gender-affirming medical treatment” for a year on 11 untrained transgender women and 12 transgender men with a more complex medical intervention strategy. See the section under “Medical intervention.” The focus was on lower-limb muscle strength and mass. A lot of jargon here. While strength increased among trans men and decreased among trans women with hormone treatment, the strength levels of the trans men came out lower than that of trans women.
- Interview of Joanna Harper in KineSophy: https://kinesophy.com/joanna-harper-on-the-performance-of-transgender-athletes/
- Harper, Martinez-Patino et al.: “Implications of a Third Gender for Elite Sports”: https://journals.lww.com/acsm-csmr/Fulltext/2018/02000/Implications_of_a_Third_Gender_for_Elite_Sports.4.aspx