Women+ on Wheels 2021: Should we allow transgender women in sport and why?

Preface:
On May 24th, 2021 Vie Cycle and the San Diego County Bicycle Coalition hosted the 2nd Annual Women+ on Wheels webinar and panel discussion. We were joined by four exceptional panelists who shared their knowledge and experiences with the attendees. This blog post is an open ended dissertation provided by one of the panelists.
-Sylvie Froncek

Should we allow transgender women in sport and why?

Since this is a pretty divisive topic the first thing that I will ask from you is respect.
Respect towards others opinions and postures, there is no dialogue if we all think we are right beforehand so the second thing that I will ask from you is to keep an open mind, I won’t tell you what to think or what your personal conclusion should be at the end of this conversation, but I will ask that you give the chance to other points of view to spark at least a little curiosity to encourage a more constructive and positive discussion.

I will also give you a spoiler alert, I personally support Trans women in sports, and you might think that this obvious because I’m a transgender woman and I also practice sports, but you should know that it wasn’t always this way, When I first started my transition in 2010 I was a basketball player.  I was convinced that my days in competitive sports were over and that at 28 Years of age I would never set foot on a basketball court again. (Back then, cycling was only a means of transportation for me.)

 
As of today there are at least 23 states in which trans rights issues have moved to the headers of news sites, newspapers and the forefront of legislative issues, all of this caused by a wave of bills calling for efforts to ban transgender student-athletes from competition and other measures pushing for limiting and even criminalizing gender-affirming health care are on the table. If you, like me, think this is unfair and feel like we need to take a stance, we need to arm ourselves with reasoning and data beyond the argument “transgender women are women.” Sports, after all, are a place for competition, and fairness within fields should be granted to make sports not only fair but enjoyable for everyone participating in them. Therefore we should give space for reasonable doubts regarding those issues.
 
The argument that transgender women have an advantage in sports stems from the belief that men are stronger than women--i.e., ”all men are stronger than all women. If we really ask ourselves, all of us know at least a few women who are stronger than a bunch of men, a reality that debunks this argument right off the bat.

Another common argument surrounds the physical traits, such as strength and size off transgender athletes, (mostly female transgender athletes), that might have developed during puberty before starting hormone blocker. This position is very deceiving; at first glance it seems that it’s only logical to believe that muscular volume, fitness, body mass and size play only in our favor when we compete against cisgender athletes, but with a closer look we can see exactly how this is far from true and varies for every discipline.
 
To give you a short introduction to a very complex and topic I will first give an overview of the IOC rules regarding transgender athletes competing in the Olympics, and then I will discuss three of the main physical factors at play in an individual’s athleticism  -- testosterone, body mass, and fitness.
 
In 2004 the IOC ruled in favor of allowing transgender people in Olympic competitions, after researching, reviewing scientific data and several studies that showed that transgender women not present an imbalanced or advantageous handicap vs cisgender women The rules set at that time are not the exact same that they are today but it is important to understand the past to understand the present.
 
The original rules stated that for transgender women to participate in a women’s field they would have to:

• Have undergone sexual reassignment surgery at least 2 years prior to the event they were competing in
• Present legal documentation from the country they were representing that stated their new identity and gender.

 
At that time, the DSM (Diagnostic and Statistical Manual of Mental Disorders) stated that a doctor performing a sexual reassignment surgery needed the authorization of the mental health professional that supervised the entire transition process of the transgender person to certify that doctors were not performing surgeries on healthy individuals to the detriment of their well being.  
In order to be authorized by the mental health professional you needed to first undergo what is called a test in real life which meant that you would start living your life in the chosen gender but  without any hormones or any other kind of medical assistance. This was designed to deter false claims and spot fetishes and other mental disorders that could potentially motivate an individual to falsely claim gender dysphoria. Months later you would get a prescription for HRT (Hormonal Replacement Therapy) and finally, a few years after that, you would receive authorization to undergo Sexual Reassignment Surgery. The whole process could take between 3 and 5 years and to this day is prohibitively expensive.
 
Throughout the years the IOC has revised its rules on transgender inclusion with more modern standards opening the door forpeople with either no access to or no desire for surgeries and costly medical interventions to take part in competitive sports. The new regulations state that in order for transgender athletes to participate in IOC sanctioned events they must:

• Declare that their gender identity is female, with the declaration unable to be changed for a minimum of four years. 
• Demonstrate that their total testosterone level in serum has been below 10 nanomoles per litre for at least 12 months prior to their first competition - with the requirement for any longer period to be based on a confidential case-by-case evaluation, considering whether or not 12 months is a sufficient length of time to minimize any advantage in women’s competition. 
• Demonstrate that their total testosterone level in serum remains below 10 nmol/L throughout the period of desired eligibility. 
• Compliance with the conditions may be monitored by testing. With non-compliance leading to eligibility to compete in events being suspended for 12 months.

 
It’s very important to understand that we do allow advantages in sport, but what we don’t allow is overwhelming advantages. Fairness has a range, and if we look into the data of competitions in which transgender athletes have been allowed to participate in the past 18 years, there are no statistical deviations pointing towards a clear disadvantage of cisgender VS transgender athletes. This data is consistent with test results performed in labs and scientific studies done both in laboratory environments and on the field.
 
Physical Factors
 
Top performing athletes deviate greatly from the average human in several areas: Most of them have enlarged hearts, higher-than-average blood cell counts, greater number of fatigue-resistant muscle fibers, very low BMI, etc. So when we talk about athleticism we are really talking about a number of characteristics that would make any human male or female stand out from the rest, regardless of discipline. In general the top-performing athletes in the world make up less than 1% of the population, and transgender athletes are so scarce that their chances to make it into that 1% are already pretty slim without considering barriers such as prejudice and difficulty getting into amateur circuits and teams while also having the solvency to pay for sports equipment, competition fees and other expenses related to the sport they’re trying to be a part of.



 

• Testosterone

 
Put simply, testosterone is an anabolic steroid hormone that is responsible for muscular growth, bone density and other secondary sexual characteristics. During the puberty stage in humans this hormone -- which is present in both males and females -- is the main driving factor for different body changes. In average adult males, testosterone levels are at least 8 times greater than in average females, which explains the misconception of “men being stronger than women.”
 
Because this hormone is also a steroid it is easily measurable in regular and mandatory tests performed by sports event organizers. It’s also worth noting that aside from being tested for anabolic and testosterone levels, all athletes are tested for all sorts of ergogenic aids, or performance-enhancing drugs, from painkillers to EPO. 
 
     After a period of about 12 months of undergoing Hormone Replacement Therapy, a transgender person’s testosterone levels will have dropped below 1 nmol/L (nanomole per liter). For comparison, average adult females have between 0.12 and 1.79 nmol/L of testosterone in their blood. So transgender athletes are right in the middle of the range to compete fairly, at least by this measure. This change occurs in combination with a loss of muscular mass and increase in fatty tissue, water deposits, and other mass-increasing body tissues.

• Body Mass

 
    When talking about body mass it is worth noting that while some athletes in some disciplines may benefit from bigger mass and denser bones, such traits might actually be to the detriment of athletes in other disciplines. , Case in point: Compare a road cyclist trying to push 170 pounds of body mass up a 9% gradient with a power output of 250 watts (1.47 lb/wtt) to a 140-pound rider pushing 220 watts (1.57 lb/wtt). On the other hand, body mass has little to no impact on other disciplines, such as weightlifting.. 
However, it is worth noting that the average weight of transgender women tends to increase over the first 6 months of HRT, while strength declines progressively. Weight and strength usually stabilize at around 50% to 70% of the individual’s original values.
 

• Fitness

 
    Fitness is a slippery concept to define, but in this case we will focus on the way the body utilizes its resources to perform an aerobic or anaerobic action. M
    Muscles are formed by two main fibers: slow twitch muscle fibers, which focus on sustained and smaller movements and feed mainly on oxygen, and fast twitch muscle fibers which provide powerful forces for shorter durations and function with almost no oxygen.
    Oxygen is supplied to the muscles via red blood cells, and red blood cell count is something we can quantify and measure and therefore compare between athletes. 
A normal Red Blood Cell count in men is 4.7 to 6.1 million cells per microlitre (cells/mcL) and in women between 4.2 and 5.4 million cells/mcL. The American Association for Clinical Chemistry found in a study that red blood cell counts increased in transgender men and decreased in transgender women after approximately 6 months of HRT, placing their counts right in the normal range for cisgender men and women. 
 
Conclusions:
 
In conclusion; Transgender female athletes compete with a number of embedded disadvantages compared to their cisgender counterparts: reduced oxygen in the blood, atrophied muscles, increased body mass and weight, and reduced testosterone and with it the possibilities for bigger muscle development.
As an example, a transgender female sprinter would have to haul a larger and heavier body than a cisgender athlete. In addition, HRT  blocks the bonding of testosterone, which makes it more challenging to develop muscle compared to cisgender athletes. I can say from personal experience that for every race that I ever won I lost 20 or 30 more, and there are circuits in which I would never have a chance to shine even though I’ve been an athlete trough my entire life, and these are just a few examples. 
 
This investigation that I have presented to you here is by no means complete or in depth, there is a trove of data and research that I haven’t mentioned in order to make this fit the time allocated for me in this space. 
 
The main point that I try to convey to all of you is that because this is a complex subject, we cannot allow ignorance, prejudice, false beliefs, or hatred to determine the faith of transgender people in sports. Furthermore, what we are witnessing right now is nothing short of a human-rights violation; it has the potential to later strip us of the rights that we have fought so hard for decades to obtain, not only as transgender athletes but as transgender humans. 
 
If we allow things like transgender-specific sports categories on an already thin field of female athletes we will only be opening the door to more segregation and discrimination with no scientific basis or support, but only uninformed and biased intolerance.
 
Karl Popper stated in the paradox of tolerance that “if a society is tolerant without limit, its ability to be tolerant is eventually seized or destroyed by the intolerant.” Let’s not allow the intolerant to take over and take a stance against hate, call your representatives and make your voice heard, we need you and the future generations of free children need you even more.

References:

• How do IAAF regulations affect female athletes with high testosterone levels?

    https://globalsportmatters.com/health/2019/11/15/iaaf-regulations-for-female-athletes-with-high-testosterone/
        the IAAF cited research that states “most females (including elite female athletes) have low levels of testosterone circulating naturally in their bodies (0.12 to 1.79  nmol/L in blood), while after puberty the normal male range is much higher (7.7 to 29.4 nmol/L).

• What is testosterone?:
• https://en.wikipedia.org/wiki/Testosterone
  

• Performance-enhancing substances

    https://en.wikipedia.org/wiki/Performance-enhancing_substance

• Muscle fiber composition:
• https://blog.nasm.org/fitness/fast-twitch-vs-slow-twitch
  

• How do muscles get energy:
• https://med.libretexts.org/Courses/Folsom_Lake_College/FLC%3A_Nutri_300_(Giordano)/Text/10%3A_Physical_Fitness/10.5%3A_How_do_my_muscles_get_the_Energy_to_perform_work%3F
  

• How does muscle use glucose and oxygen?:

    https://courses.lumenlearning.com/boundless-ap/chapter/muscle-metabolism/

• Red blood cell counts
•     https://www.nhs.uk/conditions/red-blood-count/

• Impact of Hormone Therapy on Laboratory Values in Transgender Patients (2019)

    https://academic.oup.com/clinchem/article/65/1/170/5607941

• New research paints a more complex picture of transgender sports advantage