Dear Colleagues,
I wanted to share a certain discomfort that I have been experiencing with our current
position. This was reinforced when I ran our conclusions past a number of trans-friendly
colleagues, one of whom is an endocrinologist.
The issue is again focused on the differentiation of gender and sex. As it stands, and
from a human rights/inclusivity stance, there is no argument but that one must
absolutely be able to compete according to one’s preferred gender. When it comes
however to competition, it is hard to discount the potential advantage of
sex/biology. For example the 18 year old fully virilized male, who identifies as female,
who within our current formulation would be eligible to play women’s hockey. It would
be hard to argue that this is a level playing field.
It is true that there are some transfemales who are not bulked up relative to some cisfemales. It is true that some cis-female athletes can compete very favourably with cismales. This however does not eliminate the potential physiological benefits for some of
having developed biologically as male.
We have adopted a position that unopposed male puberty merely represents one of
several competitive advantages that sport has accepted and that individual sports can
regulate themselves in the case of perceived advantages due to stature or other things.
We, as a group, have defined the advantage of growing up male as being
fair/acceptable. I would say that without some very strong scientific evidence, the gut
feeling of the majority will not be dispelled. It will be a stretch for people to equate
socioeconomic and other advantages as being in the same category. One might also be
faced with the argument that sport attempts to minimize unfair advantage by
establishing: weight categories in some circumstances; different competition levels (A,
AA, AAA); sport scholarships. There could be argument addressed at what may be seen
as opposing that strategy by allowing a potential competitive advantage for
transfemales not on hormones.
This prevalent belief regarding male advantage is the concern from which the NCAA
stipulation of one year on hormones derives.
Let’s look at the opportunities for hormonal intervention for transfemales:
1. Early identification as trans might warrant the use of puberty blockers (Lupron)
in early puberty. The result is that puberty is stopped and testosterone levels are
diminished compared to boys experiencing their natural pubertal spurt (20-fold
elevation of testosterone levels) and perhaps even compared to cis-females as
well.
2. Post pubertal identification can lead to initiation of Lupron which for the
biological male will reduce testosterone to prepubertal levels and prevent
further pubertal development. These individuals would have experienced a full
male-sex development up until this point. At 16 years of age that youth is able to
initiate estrogen given that they fulfill the criteria for this intervention. Estrogen
is felt to cause a regression in muscle mass and strength but it does not alter
height or bone structure.
It is possible that the inclusion of a requirement to be taking hormones to be eligible for
competition, may pressure some who were content with a social transition or who for
other reasons did not feel ready to begin hormones. Perhaps an analogy in sport is for
wrestlers who resort to unhealthy practices to classify at a lower weight competition.
They do things they would otherwise not do. The results have in some cases been
catastrophic. A difference is that in the wrestling example, the sole purpose is to
generate competitive advantage. In trans inclusion the intervention would be to gain
eligibility to compete.
The exclusion of any obligation with respect to hormones may result in the youth
themselves, or perhaps due to external pressure from parents, a coach or trainer,
deciding to delay initiation of hormones hoping to benefit from biophysical advantage
There are potential disadvantages of this strategy. It can result in further
masculinization that may very well be detrimental to one’s capacity to pass in one’s
chosen gender. The perceived effectiveness of passing is a risk factor for outcome in the
trans population. We may potentially be introducing discrepant advantage between a
transfemale taking hormones as part of their identity development and a transfemale
who chooses against hormones.
Ryan, I believe, cited TransPulse statistics showing that 4% opted not to embark upon
hormonal transitioning; there were also 7% for whom the question was irrelevant (I am
not certain what that meant.) This means however that the vastly larger majority of
individuals do take hormones as a manifestation of their identities. Statistically speaking
therefore, we would be protecting the needs of a very small number of people – 4-11%
of the already small (based on population prevalence) number of transfemale athletes
who opt against hormones.
My sense was that several around the table alluded to some uneasiness at the very end
of our last meeting. There seemed to be a feeling that, in the interest of being inclusive
and promoting the values of True Sport, we were suppressing what we felt intuitively,
namely that having a male pubertal development could potentially offer unfair
advantage,. Was it Paul that spoke about an elite female athlete who, not wanting to
appear exclusionary or self-serving, publicly communicated an openness that she did
not necessarily feel or believe? Was it a transmale basketball player that while
identifying as male was allowed to play on the female team? Does this not contradict
our premise of participation according to lived gender? The reason he did not
participate on the male team is because he would have been disadvantaged relative to
the other males.
Based on the reactions of the people with whom I spoke, I feel it would be most difficult
to gain substantive support for a position that discounts this bio-male advantage.
By imposing a criterion for someone who is transfemale competing as a woman are we
creating hardship? Or, by establishing a strategy that recognizes and addresses the
potential source of advantage, will there be a greater likelihood of acceptability and
sense of fairness. The absence of any such criteria could potentially alienate a large
number of agencies including perhaps transfemales who have, as part of actualizing
their identities, chosen to use hormones. I believe that TUE’s referring to the
administration of estrogen could be used discretely in exactly the same way that it
would be used for a transmale on testosterone.
I struggle with how to be mindful of those not fitting into the trans binary – i.e.
genderqueer. These are individuals whose identity is more fluid and more difficult to
define or to pigeonhole. Does it make sense that one would be asked to align with
either the male or female gender in the sport of their choice and follow the same
stipulations even though they are fluid in their lived experience? This would avoid Paul’s
raised scenario wherein the choice of where to compete might conceivably be based on
best chance of winning rather than gender affiliation.
The far reaching objective of having genderless definition is hard to anticipate. What will
be the discriminators or category development that will allow people with differing
physical attributes to have a chance to bring home the gold? Would there ever be a
female 100m winner?
I apologize for not raising these concerns more explicitly during the meeting but it took
me some reflection and particularly the reaction of some of my colleagues to
understand what it was that was troubling me. I feel that the objective of creating a
sport environment that upholds the True Sport values may be actualized through a
process that respects confidentiality; provides appropriate accommodations such as
dressing rooms; and, has a sensitive and discrete way of determining eligibility and
addressing challenges.
If we look at the consequences of a hormone requirement policy according to category
we find the following:
Natal male
Natal female
Trans-F using hormones
Trans-F not choosing hormones
Trans-M with hormones
Trans-M w/o hormones
Queer - Natal male
Queer – Natal female
No effect
Expect increased acceptance of trans-F
No incentive to delay
Excluded from competition / coerced to
take hormones
To compete as male
To compete as male (otherwise
contradicts gender based affiliation)
Compete as male or take estrogen and
compete as female
Compete as male or female
(highlighted are the categories that could be negatively affected by a hormone
requirement strategy)
I understand that this communication will have some tearing at their hair but at the
same time I feel, perhaps incorrectly, that there may have been some unspoken
sentiment around the table that was congruent with some of these remarks. If so, it will
be critically important to air these feelings before establishing a consensus statement.
If I in fact have misread that undercurrent of sentiment then once again I apologize and
very much look forward to your frank comments. I would most certainly stand to be
corrected. I do fear the strong backlash that may result and worry about a potential loss
of credibility that could occur if we were to champion so novel a position unless we can
confidently and strongly defend it. For example, we have frequently cited the fact that
over the past 60 years we have not witnessed any overt cheating. For some that will be
an argument to maintain the status quo – ie that the current protocol has been
protective and that attempts at increasing inclusivity may well open the door to false
representation.
Thank you for your consideration of this document.
Steve
Recommendations regarding inclusion of trans-athletes:
Does experiencing a male pubertal development invoke competitive advantages?
1. Structural advantage such as height, bone density
2. Functional advantage such as anaerobic capacity, Hb level, type II fast twitch
muscle fibres, etc
While there is no definitive scientific proof of conferred advantage, face validity derived
by male records being superior to women's records would suggest that such an
advantage did exist.
Whereas SRS does not influence competitive advantage in the least, administration of
feminizing hormones for a period of one year is felt to neutralize any functional
advantage.
Structural advantage, should it exist, could be included with other advantages such as
height, SES, etc.
The expectation of the requirement for hormone use is relevant only where competition
rather than participation is a priority.
Many documents refer to inclusion of the transitioning athlete by which is implied an
athlete who is following a hormonal intervention as part of their gender identification
process.
Proposal:
1. We recognize that until proven otherwise, endogenous testosterone does confirm
potential competitive advantage to trans-females. Things two potential implications:
unfair competitive advantage for those in elite competitive programs; potential for
safety issues where size/muscle mass may be relevant
1. 1 year of cross sex hormones, anti-androgens or puberty blockers will largely
mitigate potential functional advantage
2. Subcategories can be used to mitigate safety issues in sports such as weight
lifting or combat
1. This will exclude the relatively small number of individuals who indenting as
trans but who are not prepared to transition or who have no access to
hormones
2. It will avoid reassuring an athlete to delay transition for competitive
advantage
(This approach recognizes that while there is a potential advantage to the trans female
continuing to benefit from their endogenous testosterone, which would be the priority
belief of the majority of the public, such advantage is less relevant in non-competitive
sport wherein the concept of maximum inclusion is paramount. A greater focus on coed
sport would further promote the broader benefits of sport as outlined by Buzuvis 2010.
Where competition is the penultimate goal within a society where sport has come to
have economic and other power-based dimensions, then a somewhat more rigorous
approach must be adopted.)
2. The principles of confidentiality, establishing an environment that is free of
discrimination, teasing or bullying, full access to appropriate facilities must be strictly
enforced.
3. Any challenges to legitimacy must be addressed through a psychosocial process that
does not include subjection to medical evaluation.
1. The advantage of a trans athlete having somehow registering their trans status
ahead of the competition is that there is no delay in resolving any challenge or
complaint. The criteria for such a submission may be a letter from athlete,
perhaps parent and their medical provider (similar to what may be required for a
gender change or name change on an official document).
2. The advantage of submission only in the context of a challenge may ensure
better protection of confidentiality.
3. Perhaps the choice could be left to the athlete.
4. The use of a TUE is similar to that for athletes requiring hormones like testosterone
for medical reasons. The same advantages and disadvantages apply as per #3. My
uninformed opinion regarding the TUE is that if it were submitted in advance of the
event there would be less likelihood of confusion or breach of confidentiality,
5. As in my previous submission, I struggle with the individual who identifies as gender
queer. The obligation for a biological male to be on transitioning hormones would
potentially exclude biological males who do not endorse a dichotomous gender identity
but who prefer to compete as females. Perhaps in that ours is a gender rather than sexdefined system, they would be asked to compete according to their biological gender or
sex. In a future where sport competition is no longer based on such a divide, this issue
will disappear.
6. What about the trans male (FTM)? If they are on testosterone the TUE policy would
apply. What if they are not using transitioning hormones?
1. If we are being true to a gender-based approach then if they are not using
hormones then they would still participate as a male because they are male. The
more popular approach of allowing their participation as a female further
supports an underlying belief that maleness confers advantage over femaleness.
To avoid this unfair situation these individuals are permitted to compete
according to sex not gender.
2. if we hold to a gender-based approach then FTM who are not on hormones
will likely be excluded from participation. My own bias would be to recognize
and then permit this inconsistency should this be the athlete's preference while
still providing the facilities appropriate to their male identification.
7. Bjorn commented on prepubertal males having a more aggressive approach to sport
than girls - ie these changes preceding the testosterone surge. It would make sense to
allow children to play in accordance with their gender identity. This would mandate a
review of rules and play philosophy to mitigate a socially-inspired style of play - eg
hockey being a martial art. In sports where there is body contact, children might be
grouped according to size or skillset rather than gender. His approach will invariably
promote increased inclusivity, reduced sex-based bias and ultimately move us towards
an acceptance of genderless sport.
As I had previously communicated, this approach is perhaps somewhat limited in scope
but at the same time one that may have a greater chance of gaining acceptance - one
step along the way. A major accomplishment will have been to enshrine a greater, if not
complete, climate of inclusivity. There will be a construct that promotes access,
confidentiality, respect and that promotes the True Sport value system. Specifically this
relates the development of a formula to establish eligibility and to discreetly and expect
fully address challenges.
It is a system than should be reviewed and adjusted at regular intervals to ensure that it
remains synchronous with emerging research. It could also be enshrined within a
broader vision of achieving genderless sport. My understanding of the literature and of
public appetite is that we are not there now but perhaps could be in the future.