The chequered biology of sports: Reviewing the conflict between sex-segregation & trans inclusion

Sports, despite its efforts at reducing the gender gap, ableism and toxic masculinity, remains largely exclusive, entirely binary and devoid of trans participation. A recent study found that less than 20% of the transgender population play sport, and even fewer participate in organised formal team-based sports, at least openly as a trans person. More than a third identified bullying and harassment but the primary issues limiting their participation in sport pertain to systemic policy and procedural inequity. 

This makes it especially difficult for trans sportspersons to participate in elite sporting events. Despite being the most contentious debate in the world of sports, the norms surrounding segregation are so vague that it makes conversation impossible beyond a certain point. In my opinion, there’s just too much mystification and too little scientific evidence, with no crusader taking the cultural and legal aspects of the dialogue forward.

At the risk of digression, Hugh Herr who presented Oscar Pistorius’s case in the Court of Arbitration for Sport in 2011 – and succeeded in reversing the ban which the International Association of Athletics Federations (IAAF) imposed – maintains that there is no peer-reviewed scientific evidence to prove that the South African double amputee has an unfair advantage by running on his prosthetic Cheetah ‘blades’.

Yet when gender and body politics in the sporting context come under scrutiny, even those of us prepared to defend masculine women Caster Semenya and Dutee Chand, give ourselves pause when articles claim that transgender equality is the death of women’s sports.

ICYMI: Caster Semenya and masculine women: The double standards behind mandate on female athletes to suppress hormones

The science behind the debate

In 2003, the International Olympic Committee permitted transgender athletes to compete in the Olympic Games under the gender with which they identify, without a doctor’s note or undergoing the humiliating sex-testing procedure. According to their 2015 guidelines, transgender women don’t need legal recognition of their gender, but must continue to limit their testosterone levels.

Drastic changes in policy have made it possible for soccer player Jaiyah Saelua to become the first transgender woman to play in the World Cup. Last year, Dr. Rachel McKinnon became the first trans cyclist to win a world title. It has also paved the way for Andraya Yearwood, a sophomore sprinter in Connecticut, where athletes are allowed to compete with the gender with which they identify.

But such developments have raised many eyebrows, primarily from elite female athletes like Paula Radcliffe and Dame Kelly Holmes. Even puzzled bystanders at the Pussy-Hats march have asked: What if transgender women, who lower their testosterone levels as required by current policy, continue to have performance advantages over cisgender women, in sporting events that benefit from higher testosterone? Is the genetic edge removed by reducing T-levels?

In other words, the male-vs-female performance difference which stands at 10% implies that a male, who is 7% slower than the best in his category (i.e., a sub-elite player) and loses 3 to 4% after gender reassignment, would still be better than most females and as good as elite females.

If some advantage remains even after lowering testosterone, then it would have massive implications for women’s sport, because it would theoretically allow a sub-elite male to compete as an elite female.

In effect, it would ‘flood’ the female sports division with new arrivals, who enter the group by virtue of a physiological advantage that is unavailable to those already in the group, claims those in vehement opposition to the idea of trans sportswomen competing against women.

In trans athlete Joanna Harper’s personal study (of her own lap records with that her cis compatriots’) at least, that wasn’t found to be the case. Writing for the Washington Post she asks, “Do transgender athletes have an edge? I sure don’t.”

An MTF athlete, under the existing rules, is allowed to compete only if they show that they’ve kept their T levels below a certain point (10 nmol/L currently, perhaps 5 nmol/L in future) for the last one year at least. This is aimed, in theory, at taking away the advantage enjoyed by biological males.

To clarify, this rule extends to participants born with an intersex variation; maybe because they’re transgender and they’ve altered parts of their biology through surgery or hormones or maybe because they’re neither intersex nor transgender but they have different biology for different reasons; a woman who’s had a hysterectomy, an older man with unusually low testosterone levels.

Dr. Richie Gupta, Director of Plastic and Reconstructive surgery at Fortis Hospital, Shalimar Bagh, highlights how precarious and delicate the process of gender reassignment is. Explaining how hormone therapy is commenced only after gender dysphoria is alleviated, he tells Qrius that an MTF candidate is administered estrogens for the development of secondary sexual characteristics like breasts, modification of the hairline among others.

On asked if being legally required to control T-levels can cause physiological complications in transgender sportswomen, Dr. Gupta tells me, “Subjecting such a person to further androgen blockers must take place only after thorough medical check-up including liver function test, etc., in the presence of an endocrinologist.” And even then, the practice is frowned upon in the medical trans-solidarity network.

Testosterone does not dictate better athletic performance

Studies on this account remain largely inadequate, and further undercuts the citation of T-levels as the primary determinant of one’s gender.

What about the biological sex characteristics you are born with, the gender you identify with, or your gender presentation and performance? Shouldn’t it also vary according to the sport that you’re involved in, the level of competition that you’re talking about, and your legal compliance obligations?

Yannis Pitsiladis, Professor of Sport and Exercise Science at the University of Brighton, tells BBC: “We need the evidence to be able to say that having transgender females competing against cisgender females is fair – or at least, we can make the argument that it’s fair.”

For example, while the connection between higher testosterone and greater muscle mass is common knowledge, there is no proof that once hormone therapy during gender reassignment is complete, the muscle retains its capacity to grow to its former size owing to muscle memory.

One key study was carried out in 2004 by Louis Gooren and Mathijs Bunck of VU University Medical Center Amsterdam, and looked at physical changes over the course of the transition. They found a significant overlap in muscle mass between transgender and cisgender women and concluded that the two groups could reasonably compete. However, the participants in the study were not athletes, and none of the physical changes studied directly measured athleticism.

The rule of thirds

Moreover, do you disclose everything including potentially completely irrelevant highly personal information about their medical, surgical and hormonal status? Is that information the sports association is entitled to have, or do you disclose nothing and run a risk of being found out or worse – accused of cheating?

That’s precisely what happened with Mary Gregory, transgender heavy lifter from Charlottesville whose honours were rescinded after she revealed her gender with pride and the records she set for her age and class, in an Instagram post celebrating her victory. The 100% Raw Powerlifting Federation explained in a statement that the competition recognises “physiological classification rather than identification.”

So first, there is no scientific evidence that hormones play a significant role in athletic performance, as much as conservative sports scientists would love to claim. It further poses an ethical question if suppressants should be administered to trans athletes at all (especially when some seem to think reduction isn’t enough) and on hyperandrogenic women by consequent logic.

More importantly, why don’t we hear similar complaints about trans-men who participate in men’s sport?

Trans rights activists seem to think this is indicative of a very important but completely unspoken assumption— that all men are better at all sport than all women. (Evidence cited includes that the average man has greater aerobic capacity and greater muscle strength than the average woman but they ignore the equally true fact that not all men have greater aerobic capacity and muscle strength than all women).

It seems the rules are so designed to allow for control over a person’s T-levels, because doing the same for cardiovascular, metabolic, biochemical, anthropometric, respiratory, neurological and musculoskeletal differences wouldn’t be legal, even though they are equally important factors in all sports at all level of competition that determine performance.

On this note, Peter Hyndal (of Tran-formation Solutions) has the perfect comeback for people who often refer to international world records where men routinely run faster and jump higher and throw further than women. At a conference on the subject last year, he said that at a non-elite level, the differences between men’s and women’s performances are usually far less.

He advocates for the relaxation of these rules at least in the non-elite levels, as majority of people participating in sport are motivated to do so for completely different reasons, and the factors that influence their performance are also far more varied and complex.

But perhaps it’s time we finally put to rest what accounts for gender in sports instead of asking trans women to defend their identity. While we tend to assume it’s completely self-evident if someone should compete in women’s or men’s competitions, we’re not very clear ourselves, about which criteria we should rely upon in order to make that assessment. 

Chromosomes, hormones, genitalia, identity or performance?

To unpack the question of transgender inclusion in sport, especially with respect to MTF transgender athletes, Qrius spoke to former WISDEN India editor in chief Dileep Premachandran.

He acknowledged the popular perception that trans women athletes enjoy certain benefits by virtue of training as a man for most part of their lives, and sympathises with women like Martina Navratilova who faced backlash this year for airing her argument against allowing trans women to compete with cis women because it amounts to “cheating”. While higher T-levels can’t make you a world beater, Premachandran says the muscle mass you’re born with allows you to train harder for longer, which is certainly a big advantage in preparing for certain events.

Premachandran takes the example of Bruce Jenner who won a decathlon gold in 1976, saying it would have been extremely unfair had he undergone transition in the 80’s and participated in the women’s category. “Women competing against her wouldn’t have had a hope in hell,” he tells me.

At the same time, he calls out Navratilova for framing her angst and fear of trans athletes in such a disturbing, upsetting, and deeply transphobic manner. Citing the abuse of anabolic steroids by the doping racket of the 1980’s, he claims that the current hysteria over testosterone is “a direct result of those ‘dirty’ decades and the trauma felt by those who felt so cheated back then.”

But there is no science or medical professional that would advocate taking blockers to lower natural levels. “Yes, a higher T level may give an advantage to someone already athletically gifted. But if it’s naturally occurring and not ingested through steroids and such, what can you do?”

“You don’t penalise Zion Williamson for being 2.01m tall and 120-odd kilos at 18.”

He also acknowledges the gaps in medical science and legal infrastructure that go into affixing T-levels are the primary index. “The idea that 5.01ml of testosterone makes you a male, and 4.99 is a female is just ludicrous,” he says. The system needs “a far more nuanced understanding of sexuality and gender that is obviously not binary and easily to fit into neat little boxes.” “Yet, the rule-making shows only the level of understanding that we had in 1988.”

The fact that you’re born with the gift and with you put in a lot of hard work go into the making of a good athlete. In fact, “there will be women out there more ‘masculine’ than Caster, who wouldn’t be able to run 800m in four minutes,” he says, to illustrate why T-levels should be phased out as the key driver of male/female differences.

Our very limited understanding of gender and its complexities makes exclusionary politics in sport a statement on social behaviour, he says, and the need for a cultural breakthrough seems intuitively obvious. Perhaps doing away with these hang-ups at the non-elite level would eventually make for more egalitarian sport that is independent of chromosomes or cortisones, I say and he agrees.

He also seems on the board with the idea that a separate tournament would offer trans sportswomen the space and representation they are denied elsewhere, even if it counterproductively introduces further segregation. [Notably, other single-sex spaces like prisons are also open to the idea of a separate unit for trans prisoners today.]

Intersectionality and sports: A can of worms

When asked the burning question — why inclusion in sports isn’t nearing its resolution as it seems to be in every other field — Premachandran quotes Vince Lombardi’s oft-cited apothegm, “Winning isn’t everything [in sports], it’s the only thing.”

He then refers to another quote by the father of American Super Bowl: “It takes a special person to love something unattractive, someone unknown. That is the test of love.”

“Trans athletes are the ‘someone unknown,’” he says. People think they know but they don’t have a clue,” Premachandran tells Qrius, proving my point about the need to demystify gender. Let us also not forget that a major part of the bias and bigotry stems from how different trans athletes look.

ICYMI: Finally, being transgender not a mental illness: What WHO said

Evolutionary psychology which deals with the origin of sex differences indicates that the dissimilarity forms biologically, as humans become familiarised with the changes in their biosocial environment. Social constructionists (Wood and Eagly, 2002) also acknowledge that sex differences take particular form because they are embedded in specific social contexts like physical labour, giving birth and other gender roles, and would differ considerably with variation in societal arrangements.

The point here is not that we should do away with sex-segregated sport but to foreground opportunity and access over winning and losing. The point is also that when we choose to make a particular competition sex-segregated, we need to be really clear about why and we need to be really clear exactly what it is we mean by those words in that context.

The issue is clearly not as black and white as it looks on paper, because when it comes to sports, we cannot expect women to deny their lived experience and accept the irrelevancy of biology. But we cannot continue to posit a biological criterion as the key to superior athleticism, as Katrina Karkazis passionately argues, either; let alone define eligibility solely on the basis of testosterone.

Policing testosterone levels of transgender athletes is a violation of their human rights, McKinnon contended after her win last year, adding that “focusing on performance advantage is largely irrelevant because this is a rights issue.”

Several policymakers, sports scientists and organisations have called for more research into the existence or extent of inherent athletic advantages but the research needs to be directed at the changing athletic performance over the course of transitioning.

As transsexual participation remains a sore point between trans rights activists and feminists, we owe it to ourselves to take the dialogue forward and figure out how best to integrate in a way that is also fair on cisgender athletes – the future of intersectional sports depends on it.


Prarthana Mitra is a Staff Writer at Qrius