essay about transgender athletes

All the Arguments You Need: To Prove It’s Fair for Trans, Intersex Athletes to Compete in Consistence With Their Gender Identity

Bodies and gender identities aren’t binary, so why are sporting competitions?

Nowhere is the struggle between maintaining the traditional status quo of the gender binary, and moving forward toward greater inclusivity, more pronounced than in competitive sports, due to the differences in male and female physiology. But, there is enough science and data out there to suggest these differences aren’t nearly as stark as we’ve been led to believe — which means any argument against allowing trans and intersex people and people with differences in sex development (DSD) to compete against ciswomen is queerphobic at best. Here are all the arguments you need to fight for greater gender inclusivity in sport.

“Biological males have physical advantages over women such as more stamina, larger bones, and more muscle, so it’s unfair for trans women to compete with ciswomen.”

The science on what women’s bodies can do is flimsy at best. But consider what the female body can do better than a male body: “Women’s bodies have a lower center of gravity and therefore better balance; they tend to be more flexible, and their bodies more efficiently convert calories into energy giving them greater endurance,” Liesl Goeker writes for The Swaddle , while arguing for equal pay in sports. This gives women the upper hand in ultra-endurance running and gymnastics — just as male bodies have the upper hand when it comes to sports such as the shotput and 100m sprint that require speed and brute strength. But zero trans women who are gymnasts are complaining about the advantage cis women have, or saying they want to compete in the men’s category for endurance running or gymnastics — because they just want to participate in the sports category congruent with their gender identity.

Besides, sports isn’t ‘fair.’ It never was. Genetics isn’t either. Many elite athletes are genetically blessed in a way the average person isn’t. Basketball players have the advantage of height, and Michel Phelps’s very peculiar anatomy gives him the upper handin swimming. Privilege isn’t fair either — athletes of color are at a disadvantage when it comes to exposure, opportunities, and resources to even begin pursuing sports competitively, compared to Caucasian athletes. So, what is this “level playing field” argument but a myth spun by those allowed to play and win in the field, to maintain the status quo?

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“Biological males have the advantage of testosterone that enhances performance so it’s unfair for trans women to compete with ciswomen.”

The science on physiological advantages male athletes have over female athletes is in a nascent stage. It’s important to preface this argument by pointing out that very little research and conversation is around, say, the advantages of estrogen (the hormone responsible for many physical characteristics of a typical female) or prolactin (the breastfeeding hormone) on athletic ability. The obsession is entirely with testosterone (T) — the hormone responsible for many glorified physical characteristics of a typical male — and the absurd question of at what level of testosterone does a female athlete become too good to be a woman.

For every credible study and statement out there that proves greater testosterone is linked to greater athletic ability in men and women, there are equally credible studies that prove testosterone is just one of the many factors that affect sporting ability — sometimes even negatively. Take the International Association for Athletics Federation’s data on elite women athletes. Its initial analysis of two world championships showed that women with higher T levels performed better in only five out of 21 events.

After an independent group of researchers took an issue with the research methodology to reach even this finding, the sports body was forced to issue a correction. In the corrected results, in three of 11 running events, the group with the lowest levels of T did better. Across all events, the association between T and performance was the strongest (and the most surprising) in the 100m sprint: athletes with lower T ran 5.4% faster than those with the highest levels of T. The independent group of researchers who objected to the results earlier concluded it’s “impossible” to discern the real relationship, if any, between T and performance. Clearly, though, neither this study nor the broader sports science literature supports the IAAF’s claim that targeted trans, intersex athletes  “have the same advantages over [other] women as men do over women.”

Then there’s the stuff outside of the binary that science is nowhere close to explaining clearly, like Chand’s and Semenya’s hyperandrogenism (a medical condition where a typical female body produces higher testosterone than usual). Or, as Faryal Mirza, a clinical endocrinologist at the University of Connecticut Medical Center, tells Scientific American , sometimes high T simply means that a person isn’t very efficient at using T: the body is producing more precisely to arrive at “typical” function of someone producing T in the “typical range.”

IAAF’s Caster Semenya Decision Arbitrarily Dictates What Is Female

A review of 31 national and international transgender sporting policies, including those of the International Olympic Committee, the Football Association, Rugby Football Union and the Lawn Tennis Association by researchers at the Scool of Sports Exercise and Health Sciences, Loughborough University concluded : “After considering the very limited and indirect physiological research that has explored athletic advantage in transgender people, we concluded that the majority of these policies were unfairly discriminating against transgender people, especially transgender females” by overinterpreting the “unsubstantiated belief” that testosterone improves athletic performance.

Thousands of trans athletes have been competing at national and international competitions who you just don’t hear about simply because they don’t all win or qualify for the Olympics even with all their apparent unfair advantages. This also proves the non-cisgender athletes who do go ahead and win medals owe their success more to their training, skill, perseverance, resilience, and a host of other reasons apart from their gender or sex, and especially from the myth of testosterone.

“Letting trans and intersex women compete in women’s sports will lead to many male athletes pretending to be women just so they can easily win.”

Yikes. Are we really suggesting there are numerous male athletes who will declare they identify as women, go through exhausting transition processes such as hormone replacement, gather the required medical and psychological proof of their fake gender dysmorphia (prolonged distress caused a mismatch between their biological sex and gender identity), go through their entire lives living under the pretense of being female, all while facing prejudice that trans people face on a daily basis — only for a few gold medals and some cash? Notwithstanding the paranoia (looking at you Martina Navratilova ), this argument is the literal definition of transphobia . This idea — that we should ban all innocent and real trans and intersex women based solely on the fantastic hypothetical of the fraudulent cis man — has roots in an irrational fear of the other (in this case, non-cisgender people) based on prejudice or ignorance.

Laws and rules can always be misused, irrespective of gender. But, we can’t deny people’s rights simply because a few could, in theory, game the system. Look at it this way: are some people falsely framed for murder? Yes. Does that mean we don’t have any rules to punish the crime? Of course not.

This debate doesn’t even have to be esoteric; there is actual data to prove male athletes aren’t queuing up to declare a new gender identity. In 2003, the International Olympic Committee adopted the Stockholm Consensus (SC) allowing the inclusion of trans athletes who had undergone sex reassignment, making it possible for trans athletes to compete in the Olympics from 2004. The IOC modified these guidelines in 2015 to put a cap on testosterone levels for trans womenathletes. And yet, despite the fact that more than 50,000 athletes have participated in the Olympics since 2004, no trans athlete has ever been a part of the Olympics until now, real or fake. So, clearly including trans athletes in sports won’t make the sky fall.

Explaining the Vocabulary of the Gender Spectrum

“If not men’s and women’s sports categories, then how do we organize sports fairly?”

Creating a third, mixed category for trans, non-binary, cis men and women to compete against each other can be an earnest, motivating place to start making sports more inclusive. Mixed-gender sports teams are a widely debated topic and have been for many years, just not in relation to opportunities for transgender people. But, introducing more mixed-gender sports teams would also facilitate accessibility for transgender people. The IOC did well, when in June 2017, it added mixed-sex events in athletics, swimming, table tennis, and triathlon to the upcoming Summer Olympics schedule in Tokyo 2020 , in addition to the traditional categories. This not only allows trans and intersex athletes to compete in the sports category congruent with their gender identity based on their athletic ability alone, Tokyo 2020’s milestone mixed-sex events are a concrete step towards ungendering sports. (It is important here to note this will all be moot unless the IOC allows trans and intersex athletes to compete — in these mixed events at least — without having to meet any criteria other than being a human adult who’s good enough to qualify.)

Another way to organize sports, as suggested by Alison Heather, a physiologist at the University of Otago in New Zealand, and her colleagues in an essay  published in the Journal of Medical Ethics , would be to create a system that uses an algorithm to account for physiological factors such as testosterone, height, and endurance, and social factors like gender identity and socioeconomic status. Sure it’s a Herculean task, but international sports bodies have enough money to at least begin research into the idea if it means a more inclusive world.

Apart from this, sports can also be organized on the basis of other factors such as weight class, professional/amateur status, and size. The idea is that through a mixture of formats, we redesign sports to make them more inclusive.

It’s going to take fresh thinking and self-awareness that what we believe to be facts about sex and gender are not unquestionable. But every individual must have the possibility of practicing sport, without discrimination of any kind, and in the spirit which requires mutual understanding, with a spirit of friendship, solidarity and fair play. Those are not my words, that’s the Olympic charter.

Pallavi Prasad is The Swaddle's Features Editor. When she isn't fighting for gender justice and being righteous, you can find her dabbling in street and sports photography, reading philosophy, drowning in green tea, and procrastinating on doing the dishes.

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Striking a balance between fairness in competition and the rights of transgender athletes

Professor of Ethics, Strategy, and Public Policy, University of New Orleans

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Chris W. Surprenant does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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In a majority of U.S. states , bills aiming to restrict who can compete in women’s sports at public institutions have either been signed into law or are working their way through state legislatures.

Caught up in this political point-scoring are real people – both trans athletes who want to participate in competitive sports and those competing against them.

As a professor of ethics and public policy , I spend much of my time thinking about the role of the law in protecting the rights of individuals, especially when the rights of some people appear to conflict with the rights of others.

How to accommodate transgender athletes in competitive sports – or whether they should be accommodated at all – has become one of these conflicts.

On one side are transgender athletes who want to compete in the gender division with which they identify. On the other are political activists and athletes – especially biologically female athletes – who believe that allowing trans athletes to compete in women’s divisions is inherently unfair .

So why is this issue so fraught? What’s so special about women’s sports? Why do women’s divisions even exist? And is it possible to protect women’s sports while still finding a way to allow transgender athletes to compete in a meaningful way?

Winners elicit outcry

Let’s be clear: Few Americans would care about how to best accommodate transgender athletes if they were not winning events.

But that’s exactly what has happened. In 2017 and 2018, Terry Miller, a trans woman, won the Connecticut women’s high school track championships in the 55-meter, 100-meter, 200-meter and 300-meter events. Her closest and only real competitor those two years was Andraya Yearwood , who is also a trans woman.

In 2017 and 2018, Mack Beggs, a trans man, dominated the Texas 6A 110-pound girls wrestling division, capturing two state championships while compiling a record of 89 wins and 0 losses. Unlike in Connecticut, where athletes may compete as they identify , athletes in Texas must compete in the gender listed on their birth certificate .

While Miller, Yearwood, Beggs and others have triumphed in their respective sports, the number of transgender high school athletes is very low . Nor is there any evidence that athletes have transitioned for the purpose of gaining a competitive advantage.

Yet some legislators have latched onto these examples, using them as a basis for bills that ban all transgender teens from participating in gendered divisions that differ from their birth sex. But these bills don’t solve the competitive imbalances that can occur with athletes like Beggs. Worse, they might prevent transgender teens from competing altogether.

Sports matter – with meaningful participation

Since studies have shown that kids who participate meaningfully in athletics have better mental and physical health than their peers who don’t – and teens who identify as transgender are at a significantly greater mental health risk than their peers – it’s a worthy goal to try to accommodate their desire to compete.

The phrase “participate meaningfully” is important. Someone who, for example, is nominally on a team but does not take the sport seriously does not participate meaningfully in competitive sports. Similarly, someone who takes a sport seriously but easily dominates all competition also does not participate meaningfully in competition.

Youth sports organizations exist because we don’t believe kids should compete against adults, and kids are further separated by age because age, for children, is a reasonably good proxy for skill and ability. Organizations like the Special Olympics and Paralympics exist to provide opportunities for people with physical and mental disabilities to participate meaningfully and compete against people with similar skill sets.

Male and female athletes are separated for the same reason.

[ The Conversation’s science, health and technology editors pick their favorite stories. Weekly on Wednesdays .]

The rise of women’s sports

In 1972, the U.S. Congress extended Title IX of the Educational Amendments to the 1964 Civil Rights Act to prohibit discrimination in all federally funded education programs, including their associated athletics programs .

Title IX’s impact on athletics for women and girls – and, as a result, U.S. culture – has been nothing short of dramatic . In 1970, fewer than 5% of U.S. girls participated in high school sports. Now 43% of high school girls participate in competitive sports.

Separating athletes by biological sex is necessary because the gap between the best male and female athletes – at all levels – is dramatic.

Serena Williams is not only one of the best female tennis players in history, she’s one of the best female athletes in history. In 1998, both Serena and her sister Venus famously claimed that no male ranked outside of the ATP Top 200 could beat them. Karsten Braasch, the 203rd-ranked player ATP player at the time, challenged each to a set. Braasch beat Serena 6-1 and Venus 6-2.

“I didn’t know it would be that difficult,” Serena said after the match . “I played shots that would have been winners on the women’s circuit, and he got to them very easily.”

At the 2019 New Balance Nationals Outdoor, the national track championship for U.S. high school students, Joseph Fahnbulleh of Minnesota won the men’s 100-meter with a time of 10.35 seconds . That same year, Olympic Gold Medal winner Shelly-Ann Fraser-Pryce ran the fastest 100-meter time of any female in the world – 10.71 seconds . Her time would have tied for 19th at that U.S. boys high school event.

One more example that’s a bit different: In 2012, Keeling Pilaro , a 4-foot-8, 80-pound seventh grade boy, petitioned the New York State Public High School Athletic Association to play field hockey on his school’s all-female team. It approved his petition.

As a seventh grader, Pilaro made the school’s JV team. As an eighth grader, he made the varsity team. But players and coaches from other schools argued he had a significant advantage because he was a boy. During the summer before his ninth grade year, the league agreed. It ruled Pilaro could no longer participate because his “advanced field hockey skills” had “adversely affected the opportunities of females.”

I point to these examples because, put together, they show that no fitness regimen, no amount of practice, and no reallocation of financial resources could allow the best female athletes at any level to compete against the best male athletes at that same level.

This advantage isn’t simply a difference in degree – it’s not just that male athletes are bigger, faster and stronger – but it’s a difference in kind. Pound for pound, male bodies are more athletic .

Evaluating trans athletes on a case-by-case basis

So, how can we allow trans athletes to compete without giving them an unfair advantage over their competitors?

One proposed solution, as if taken from the pages of novelist Kurt Vonnegut’s “ Harrison Bergeron ,” is testosterone-based handicapping for events . Competitors would have their testosterone levels measured and then algorithms would determine their advantage. Then, competitors would be fitted with weighted clothes, compete on a different track or otherwise receive an appropriate handicap before competing.

But having a higher level of testosterone does not automatically make you a better athlete . Beyond this, while handicapping may be fine for a golf outing with friends, it isn’t appropriate for serious athletic contests. The point of athletic competitions is to determine who is actually the best, not who is the best relative to handicaps.

Another proposed solution entails replacing gender divisions entirely with ability-level divisions . Yet this could hinder women’s participation in sports. In a world with no female-only divisions, Serena Williams would still win some tennis tournaments, but they likely wouldn’t be tournaments you’ve heard of.

So what’s the most viable solution to this debate?

Since there is no typical transgender athlete, broad rules for transgender athletes don’t seem appropriate.

Instead, language similar to the Equal Employment Opportunity Commission’s disability accommodation policy could be used for transgender athletes: “ The decision as to the appropriate accommodation must be based on the particular facts of each case .”

“Men’s” divisions could be eliminated and replaced with “open” divisions. Any athlete could be allowed to compete in that division.

Then, transgender athletes could be evaluated on a case-by-case basis. Based on their athletic ability, a tournament organizer could determine which division is most fair for them to compete in, “women’s” or “open.”

For trans women athletes, at issue is their athletic ability, not their womanhood. If a tournament organizer determines that a trans woman athlete is too good to compete against other women because of her biological advantage, requiring her to compete in an “open” division does not undermine her humanity.

Instead, this acknowledges – and takes seriously – that she identifies as a woman, but that respect for the principles of fair competition requires that she not be allowed to compete in the women’s division.

While whatever decision is made is unlikely to make all competitors happy, this approach seems to be the most fair and feasible given the relatively small number of transgender athletes and the unique circumstances of each athlete.

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Four Myths About Trans Athletes, Debunked

For years state lawmakers have pushed legislation attempting to shut trans people out of public spaces. In 2020, lawmakers zeroed in on sports and introduced 20 bills seeking to ban trans people from participating in athletics. These statewide efforts have been supported through a coordinated campaign led by anti-LGBTQ groups that have long worked to attack our communities.

Before the COVID-19 pandemic shut down most state legislatures, Idaho became the first state to pass a sweeping ban on trans people’s participation in athletics from kindergarten through college. We, along with our partners, immediately sued . Advocates across the country are gearing up to continue the fight against these harmful bills in legislatures when they reconvene. In Connecticut, the ACLU is defending the rights of transgender athletes in a lawsuit brought by cisgender athletes seeking to strike down the state’s inclusive policy.

Though we are fighting every day in the courts and in legislatures, upholding trans rights will take more than judicial and legislative action. It will require rooting out the inaccurate and harmful beliefs underlying these policies. Below, we debunk four myths about trans athletes using the expertise of doctors, academics, and sports psychologists serving as experts in our litigation in Idaho .

FACT: Including trans athletes will benefit everyone.

Myth: the participation of trans athletes hurts cis women..

Many who oppose the inclusion of trans athletes erroneously claim that allowing trans athletes to compete will harm cisgender women. This divide and conquer tactic gets it exactly wrong. Excluding women who are trans hurts all women. It invites gender policing that could subject any woman to invasive tests or accusations of being “too masculine” or “too good” at their sport to be a “real” woman. In Idaho, the ACLU represents two young women, one trans and one cis, both of whom are hurt by the law that was passed targeting trans athletes.

Further, this myth reinforces stereotypes that women are weak and in need of protection. Politicians have used the “protection” trope time and time again, including in 2016 when they tried banning trans people from public restrooms by creating the debunked “bathroom predator” myth. The real motive is never about protection — it’s about excluding trans people from yet another public space. The arena of sports is no different.

On the other hand, including trans athletes will promote values of non-discrimination and inclusion among all student athletes. As longtime coach and sports policy expert Helen Carroll explains, efforts to exclude subsets of girls from sports, “can undermine team unity and also encourage divisiveness by policing who is ‘really’ a girl.” Dr. Mary Fry adds that youth derive the most benefits from athletics when they are exposed to caring environments where teammates are supported by each other and by coaches. Banning some girls from athletics because they are transgender undermines this cohesion and compromises the wide-ranging benefits that youth get from sports.

FACT: Trans athletes do not have an unfair advantage in sports.

Myth: trans athletes’ physiological characteristics provide an unfair advantage over cis athletes..

Women and girls who are trans face discrimination and violence that makes it difficult to even stay in school. According to the U.S. Trans Survey , 22 percent of trans women who were perceived as trans in school were harassed so badly they had to leave school because of it. Another 10 percent were kicked out of school. The idea that women and girls have an advantage because they are trans ignores the actual conditions of their lives.

Trans athletes vary in athletic ability just like cisgender athletes. “One high jumper could be taller and have longer legs than another, but the other could have perfect form, and then do better,” explains Andraya Yearwood , a student track athlete and ACLU client . “One sprinter could have parents who spend so much money on personal training for their child, which in turn, would cause that child to run faster," she adds. In Connecticut, where cisgender girl runners have tried to block Andraya from participating in the sport she loves, the very same cis girls who have claimed that trans athletes have an “unfair” advantage have consistently performed as well as or better than transgender competitors.

"A person’s genetic make-up and internal and external reproductive anatomy are not useful indicators of athletic performance,”according to Dr. Joshua D. Safer. “For a trans woman athlete who meets NCAA standards , “there is no inherent reason why her physiological characteristics related to athletic performance should be treated differently from the physiological characteristics of a non-transgender woman.”

FACT: Trans girls are girls.

Myth: sex is binary, apparent at birth, and identifiable through singular biological characteristics. .

Girls who are trans are told repeatedly that they are not “real” girls and boys who are trans are told they are not “real” boys. Non-binary people are told that their gender is not real and that they must be either boys or girls. None of these statements are true. Trans people are exactly who we say we are.

There is no one way for women’s bodies to be. Women, including women who are transgender, intersex, or disabled, have a range of different physical characteristics.

“A person’s sex is made up of multiple biological characteristics and they may not all align as typically male or female in a given person,” says Dr. Safer. Further, many people who are not trans can have hormones levels outside of the range considered typical of a cis person of their assigned sex.

When a person does not identify with the sex they were assigned at birth, they must be able to transition socially — and that includes participating in sports consistent with their gender identity. According to Dr. Deanna Adkins, excluding trans athletes can be deeply harmful and disruptive to treatment. “I know from experience with my patients that it can be extremely harmful for a transgender young person to be excluded from the team consistent with their gender identity.”

FACT: Trans people belong on the same teams as other students.

Myth: trans students need separate teams..

Trans people have the same right to play sports as anybody else. “For the past nine years,” explains Carroll , “transgender athletes have been able to compete on teams at NCAA member collegiates and universities consistent with their gender identity like all other student-athletes with no disruption to women’s collegiate sports.”

Excluding trans people from any space or activity is harmful, particularly for trans youth. A trans high school student, for example, may experience detrimental effects to their physical and emotional wellbeing when they are pushed out of affirming spaces and communities. As Lindsay Hecox says, “I just want to run.”

According to Dr. Adkins, “When a school or athletic organization denies transgender students the ability to participate equally in athletics because they are transgender, that condones, reinforces, and affirms the transgender students’ social status as outsiders or misfits who deserve the hostility they experience from peers.”

Believing and perpetuating myths and misconceptions about trans athletes is harmful. Denying trans people the right to participate is discrimination and it doesn’t just hurt trans people, it hurts all of us.

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• Transgender People and Discrimination
• Transgender Rights

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I’m a Trans Runner Struggling to Compete Fairly

Trans athletes are trapped in a culture war. I’m not a cheater but I may have an unfair advantage.

Supported by

I’m a Trans Runner, and You Might Not Like What I Have to Say

Featuring Andie Taylor

Video by Lindsay Crouse Taige Jensen and Adam Wolffbrandt

In the highly politicized debate over whether transgender women should be allowed to play women’s sports, opinions tend to divide into two starkly opposing camps.

There are those people — including lawmakers in dozens of states — who argue that the integrity of girls’ and women’s sports needs to be safeguarded against people assigned male at birth and the physical advantages they may possess. The other side argues that by the very fact of their gender transition, trans girls and women have earned the right to compete as their chosen gender.

But Andie Taylor, a 48-year-old trans woman and competitive runner who has much to gain or lose in this debate, finds herself staking out a more nuanced position, somewhere in the apolitical middle ground.

In the Opinion video above, Ms. Taylor describes how she is eager to compete among women and yearns for inclusion — but only if the scientific research unequivocally shows that her years living as a male did not give her an advantage.

There is little research regarding the performance of transgender athletes, in part because their numbers are so small. Some evidence suggests that trans women retain some athletic advantages after a year of undergoing testosterone suppression. Researchers have also found that those advantages, with time, largely fall away .

As research advances, Ms. Taylor is imploring all sides in the debate to refrain from using the issue for political gain.

“I want to win,” she says, “but I only want to win if I know it’s fair.”

Andie Taylor is a distance runner and transgender woman from St. Paul, Minn.

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Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies

Bethany alice jones.

1 Nottingham Centre for Gender Dysphoria, 3 Oxford Street, Nottingham, NG1 5BH UK

2 School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK

Jon Arcelus

3 Division of Psychiatry and Applied Psychology, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK

Walter Pierre Bouman

Emma haycraft.

Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation.

To the authors’ knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature.

Eight research articles and 31 sport policies were reviewed.

In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport’s policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based.

Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.

Introduction

Transgender people are those who experience incongruence between the gender that they were assigned at birth (based on the appearance of their genitals) and their gender identity/experienced gender. Gender identity, or experienced gender, can be defined as a person’s internal sense of gender, whether this be male, female, neither or somewhere along the gender continuum. Some transgender people, but not all, will choose to affirm their gender identity by socially transitioning (i.e. living as their experienced gender socially, at work or at an educational institution, with friends and family, outside the home) and some, in addition, will choose to medically transition with cross-sex hormones and gender-confirming surgeries [ 1 , 2 ]. Although over time various different terms have been used, the term ‘transgender female individual’ will be used to describe individuals assigned male at birth, based on their genital appearance, but who later identify as female. ‘Transgender male individual’ will be used to describe people who are assigned female at birth, based on their genital appearance, but later identify as male. ‘Cisgender’ will be used to describe people who do not experience incongruence between their gender assigned at birth and their gender identity.

Recent reports indicate that the number of transgender individuals who attend transgender health services has increased substantially over the years in many European countries [ 3 – 5 ]. There has also been a significant increase in the number of people who self-identify as transgender and do not necessarily attend transgender health services [ 6 ]. For example, Kuyper and Wijsen [ 6 ] found that 4.6 % of people who were assigned male at birth and 3.2 % of people who were assigned female at birth in their Dutch population sample reported an ambivalent gender identity (equal identification with the other gender as with the gender they were assigned at birth). The authors also reported that 1.1 % of the people who were assigned male at birth and 0.8 % of the people who were assigned female at birth identified as transgender. It remains unknown how many of these people will seek treatment through a transgender health service. The increase in people who identify as transgender may be at least partly explained by the increase in visibility of transgender people within Western society [ 4 , 5 ]. For example, Caitlin Jenner, a former athlete and current television personality, recently came out as transgender during a television interview that was viewed all over the world [ 7 ]. Increases in visibility may have prompted some people to reflect and question their gender identity [ 8 ].

Some transgender people experience stigma, transphobia, prejudice, discrimination and violence as a consequence of their gender identity [ 9 – 11 ]. Ellis et al. [ 12 ] found that transgender people were more likely to avoid situations when they were afraid of being harassed, identified as transgender or ‘outed’, such as in clothes shops, public toilets and gyms. Gyms are a popular outlet to engage in sport-related physical activities (i.e. gym fitness exercises) and therefore it is important to create an inclusive environment given the established mental and physical health benefits of physical activity and sport [ 13 , 14 ]. This is particularly important for transgender people as they have been found to report a high prevalence of depression and anxiety [ 15 , 16 ], which could be managed with physical activity. Furthermore, physical activity and sport can also contribute towards maintaining the appropriate weight necessary to undergo gender-confirming surgery, acknowledging that not every transgender person will wish to do so [ 1 , 2 , 17 ].

The premise of competitive sport is fairness (i.e. inclusion in the absence of advantage) and, owing to fears surrounding the perceived athletic advantage of transgender people, the question of whether transgender people should be permitted to compete in accordance with their gender identity has been raised and greatly contested within the literature, among sport organisations, fellow competitors and spectators. It is a commonly held belief that androgenic hormones (especially testosterone) confer an athletic advantage in competitive sport. Therefore transgender female individuals, because of high endogenous testosterone levels, are perceived to hold an advantage in sport (when testosterone has not been blocked to a cisgender female level). Transgender men are not thought to possess an athletic advantage, despite being injected with testosterone if they chose to medically transition with cross-sex hormones. However, there has been a paucity of research that has directly explored how androgenic hormone levels are associated with athletic competence in both cisgender and transgender populations (e.g. running time).

To facilitate the inclusion of transgender competitors, in 2004, the International Olympic Committee (IOC) [ 18 ] announced that transgender people could participate in all future Olympic games providing they had fully medically transitioned (i.e. had been prescribed cross-sex hormone treatment for 2 years and undergone gender-confirming surgery). Although the requirements of this policy appear to concur with the commonly held belief that transgender people hold an athletic advantage, they have been criticised for not being underpinned by an evidence-based rationale [ 19 ]. The IOC [ 20 ] has recently updated its policy to be more inclusive of transgender athletes (i.e. fewer restrictions); however, the 2004 policy has been extremely influential on other sport organisations’ policy development. The new (2016) IOC policy will be considered in Sect. 3 .

In an attempt to draw a consensus as to whether transgender people should be able to compete in accordance with their gender identity, in 2005 Reeser [ 21 ] conducted a review of the literature pertaining to gender identity issues in competitive (elite) sport. Reeser paid particular attention to the evolution of gender verification in competitive sport and whether current competitive sport policies for transgender people are fair. He concluded that, while gender verification has made significant advances, there is a lack of physiological performance-related data in transgender people. This is preventing an overall consensus from being made as to whether transgender sport policies are fair or not (i.e. fairness in the absence of advantage). Reeser’s review, although important, has some limitations. He did not adopt a systematic methodology and therefore did not include the majority of transgender sport policies. Additionally, Reeser only considered the implications of such policies in relation to elite competitive sport and did not consider the experiences of transgender people who engage in sport or sport-related physical activity for leisure or fitness (e.g. gym fitness activities, jogging).

With the intention of addressing the limitations of the previous literature review, this systematic review has two aims. First, to systematically analyse and critically review the available literature regarding transgender people’s experiences in relation to competitive sport (elite and recreational) and sport-related physical activity participation (e.g. jogging, gym fitness activities). Second, to systematically review the available transgender competitive sport policies with regard to their fairness (i.e. competition in the absence of advantage). It is hoped that this systematic review will further enhance the understanding of sport participation and competition amongst transgender people. It may be expected that as more people define themselves as transgender, the issues that transgender people experience in competitive sport and sport-related physical activity will become more pronounced. It is therefore important that those who work to facilitate and promote sport and develop policies for their own sport organisations (e.g. sport medicine specialists, sport policymakers) are informed about the issues that this vulnerable population face. This will allow for a non-discriminatory atmosphere in sport, whilst ensuring a fair system for all participants and competitors (regardless of their gender identity).

Search Strategy

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to undertake this systematic review [ 22 ]. To obtain relevant peer-reviewed articles, an electronic search of literature published between January 1966 and August 2015 was conducted using the following search engines: ScienceDirect, Web of Science, Scopus and PubMed. Within each search engine, the following search terms were entered: gender dysphoria, gender identity disorder, trans people, trans individual, transgender and transsexual. These terms were combined with three terms relating to sport (physical activity, exercise and sport) using the “AND” operator. The reference lists of eligible papers were searched for potentially relevant publications. Sport policies were obtained through a Google search using the above search terms with the addition of “policy” at the end of all sport-related terms.

Inclusion and Exclusion Criteria

To address the first aim, articles that were selected were concerned with the experiences and issues surrounding physical activity and sport participation for transgender people. This systematic review only considered articles eligible if they were research articles, as opposed to discussion papers. Case studies were also considered eligible, as research articles were limited. Peer-reviewed articles that were written in English only were included. For the second aim, all available national and international policies on competitive sport in transgender people were selected and reviewed.

Study Selection

Thirty-one research articles were considered potentially relevant to the remit of this review. The search also identified 31 competitive sport policies for transgender people. After screening the abstracts, ten research articles were excluded as six were concerned with lesbian, gay, bisexual and transgender sport, one was a Scottish non-academic survey, one was a book chapter, one was concerned with an irrelevant topic and another focused on cisgender participants. The remaining 21 articles were downloaded for full-text review and 13 papers were excluded as they were discussion papers, as opposed to research articles. Therefore, eight research articles fulfilled the inclusion criteria and were consequently included within this systematic review (Fig.  1 ). All 31 competitive sport policies for transgender people were reviewed and included within this systematic review.

Process of identifying eligible research articles. LGBT : lesbian, gay, bisexual, transgender

This section presents the findings from the research articles and sport policies included within this systematic review. First, the findings from the research articles that explored participation in sports (both elite and recreational standards) and sport-related physical activities (i.e. gym fitness activities, jogging) are provided. Second, findings from the reviewed competitive sport policies relating to transgender inclusion are given.

Transgender People and Sport Participation

Characteristics of the eligible research studies.

The oldest research article included was published in 2004 [ 23 ] and the most recent publication was from 2015 [ 24 ]. The majority of the studies were qualitative in nature, all of which employed interviews [ 24 – 29 ]. The remaining two research articles included an experimental study [ 23 ] and a cross-sectional survey [ 30 ]. Most of the studies were concerned with transgender people who participated in sport competitively, at an elite or recreational level [ 21 , 23 , 25 – 29 ]. Some authors focused on a specific sport; ice hockey, netball and softball [ 26 , 28 , 29 ] while others were concerned with transgender people engaging in any sport [ 25 , 27 , 29 ]. Broadly, across all sports, Gooren and Bunck [ 23 ] explored whether transgender athletes have a physiological advantage in competitive sport. One study explored participation in competitive sports and sport-related physical activity [ 24 ] and another study discussed participation in sport-related physical activity only [ 30 ]. Details of all of the research articles included within this systematic review can be found in Table  1 .

Table 1

Study characteristics of research articles included within the review

Review of Transgender People and Competitive Sport Participation (Elite and Recreational): Research Articles

The same data were extracted from all research articles reviewed (Table  1 ). Below, we provide the most prominent findings in relation to competitive sport participation from each of these articles. Six research articles were concerned with competitive sport participation within this systematic review [ 23 , 25 – 29 ]. The only experimental study was by Gooren and Bunck [ 23 ] who aimed to explore whether transgender people taking cross-sex hormone treatment can fairly compete in sport. The authors measured transgender people’s muscle mass (via magnetic resonance imaging) and hormone levels (via urine and blood analyses) before and 1 year after cross-sex hormone treatment. They found that 1 year after transgender male individuals had been administered cross-sex hormone treatment, testosterone levels significantly increased and these levels were within a cisgender male range. They also found that 1 year after cross-sex hormone treatment, transgender male individuals’ muscle mass had increased and was within the same range as transgender female individuals (assigned male at birth) who had not been prescribed cross-sex hormone treatment. In relation to transgender female individuals, Gooren and Bunck found testosterone levels had significantly reduced to castration levels after 1 year of cross-sex hormone treatment. Muscle mass had also reduced after 1 year of cross-sex hormone treatment. However, muscle mass remained significantly greater than in transgender male individuals (assigned female at birth) who had not been prescribed cross-sex hormone treatment.

Therefore, Gooren and Bunck concluded that transgender male individuals are likely to be able to compete without an athletic advantage 1-year post-cross-sex hormone treatment. To a certain extent this also applies to transgender female individuals; however, there still remains a level of uncertainty owing to a large muscle mass 1-year post-cross-sex hormones. While this study was the first to explore, experimentally, whether transgender people can compete fairly, the sample size was relatively small ( n  = 36). Additionally, they did not explore the role of testosterone blockers and did not directly measure the effect cross-sex hormones had on athletic performance (e.g. running time). Many, but not all, transgender female individuals are prescribed testosterone blockers to help them to reach cisgender female testosterone levels, when administration of oestrogen alone is not enough to reduce testosterone levels. This is particularly important if the person aims to undergo gender-confirming surgery, as 6 months of testosterone suppression is a requirement for such procedures. However, if a transgender woman does not wish to undergo surgery or does not wish to have their testosterone blocked to cisgender female levels (e.g. as they wish to use their penis), their testosterone levels will be above cisgender female levels. Differentiating not only between those taking cross-sex hormones and not taking cross-sex hormones, but also transgender female individuals taking testosterone blockers, may be necessary when discussing an athletic advantage.

The remaining studies considered within this section are qualitative, and although they have provided insight into the experiences of transgender people participating in competitive sport, the findings cannot be generalised. Semerjian and Cohen’s [ 27 ] narrative account provides a good overview of how diverse and individual the issues and experiences of transgender people participating in competitive sport can be. Some participants felt anxious when engaging in sport because they felt their genitals may be revealed (e.g. when changing). In contrast, one participant used sport as a safe space to escape from the harassment he received at school. It must be considered though, that participants within the study engaged in different sports and their experiences could therefore be associated with the specific sport (i.e. some sports could be more inclusive then others).

Three qualitative studies described the implications that sport policies had on the experiences of transgender people who engaged in sport [ 26 , 28 , 29 ]. Cohen and Semerjian [ 26 ] published a case study about a transgender woman (pre-gender-confirming surgery) who was playing in the women’s national ice hockey tournament, but who was eventually banned from playing in the tournament because it was felt she had an athletic advantage. She described how she felt under constant surveillance when she was playing and at times felt ambivalent about what gendered team she should play on. It was apparent that although teammates were supportive, the issues she experienced in relation to inclusion in the tournament were primarily related to constraints put in place by competitive sport policies. Similarly, the discussions held by two former New Zealand transgender female netball players in Tagg’s [ 28 ] study gave the impression that although transgender sport policies were supposedly implemented to increase the inclusivity of transgender people, this was not always the case. They discussed how policy would allow a pre-gender-confirming surgery transgender woman to compete in a male or mixed-gender netball team only and they must obey male dress codes. However, the participants in this study were former netball players and therefore their discussions may not have been based on the current state of netball in relation to transgender participation. In contrast to the previously mentioned studies, the majority of participants ( n  = 12) in Travers and Deri’s [ 29 ] study discussed the positive experiences they had in relation to transgender participation in competitive sport. However, some of the transgender men did discuss how they had hostile experiences (e.g. incorrect pronoun use). Several of the participants in this study also felt that testosterone gave transgender women (endogenous) and men (when injected) an athletic advantage.

For the two young transgender male individuals in Caudwell’s [ 25 ] study, the stage of transition appeared to be instrumental in disengagement from participation in competitive sport. The discussion held by the participants highlighted how accessing sport during their transitional period was difficult as they would not be accepted or feel comfortable on either a male or female team during this period. However, this study again discussed sport very broadly and therefore it is unknown whether the participants’ experiences were associated with specific sports or whether they are generalisable across other sports.

In summary, there is limited research from which to draw any conclusion about whether transgender people have an athletic advantage in competitive sport or not. The limited physiological research conducted to date has informed the development of transgender sport policies that are implemented by sporting organisations all over the world. It is these sport policies that appear to be instrumental in transgender people’s experiences with competitive sport, most of which are negative.

Review of Transgender People and Sport-Related Physical Activities: Research Articles

Within this systematic review, only two studies explored sport-related physical activities [ 24 , 30 ]. Muchicko et al. [ 30 ] set out to quantitatively explore the relationship between gender identity and physical activity. They compared levels of physical activity between cisgender and transgender people. The study found that self-identified transgender participants ( n  = 33) reported engaging in less physical activity than cisgender participants ( n  = 47). Social support and self-perception were found to mediate the relationship between gender identity and physical activity. The authors suggested that their study highlights how leisure centres need to be more inclusive, and transgender people need to be given more social support to encourage physical activity. However, this study was limited by the sampling methods employed. The cisgender participants were recruited from a university campus where they potentially had more opportunity to walk around campus, and opportunity for discounted gym memberships, whereas the transgender participants were recruited from a support group for transgender people and were not associated with the university.

As with transgender people who engage in sport at a competitive level, transgender people who engage in sport-related physical activity also appear to experience a range of different barriers. Hargie et al. [ 24 ] found in their qualitative study that transgender people prefer to engage in individual, as opposed to group, sport-related physical activities. This was reportedly owing to their fear of being ‘outed’. Regardless of whether sport-related physical activities are engaged in individually or in a group, changing rooms appeared to be a significant barrier. Being excluded from sport-related physical activities was distressing for participants, as they could not maintain physical fitness, which they felt was important in preparation for gender-confirming surgery. Despite these interesting findings, the study is limited by the lack of sociodemographic information provided about participants. Within qualitative research, because of the small sample size, it is often desirable to provide a large amount of sociodemographic detail about participants so that the findings can be interpreted in relation to this information. For instance, in the context of sport-related physical activities, the stage of transition may be an important factor when interpreting the individuals’ current experiences of sport-related physical activities.

The limited research studies concerned with sport-related physical activities suggest that inclusive environments are not created for transgender people engaging in such activities, which may deter engagement.

Transgender-Inclusive Sport Policies

Characteristics of the eligible sport policies.

Of the 31 transgender inclusive policies reviewed, 13 were from the USA [ 31 – 43 ]. Ten of the policies reviewed were from the UK [ 44 – 53 ]. One policy was from Australia [ 54 ]. The rest of the policies ( n  = 7) were international [ 18 , 20 , 55 – 59 ]. Details of all of the sport policies included within this review can be found in Table  2 .

Table 2

Transgender-inclusive sport policies included within this systematic review

GCS gender-confirming surgery, CHT cross-sex hormone therapy, IOC International Olympic Committee, TUE therapeutic use exemption, n.d. no date

a Gender dysphoria is the diagnostic name included within the Diagnostic and Statistical Manual for Mental Disorders , Fifth Edition, for people who experience an incongruence between their gender assigned at birth and gender identity [ 60 ]

Review of the Sport Policies

Policies within this section were systematically reviewed in relation to their inclusiveness of transgender competitors (i.e. maintaining fairness in the absence of advantage for all competitors). The fairness of the policy requirements was judged against the available physiological research that has explored athletic advantage. The time restrictions associated with each requirement were also reviewed (e.g. cross-sex hormones must have been administered for at least 2 years prior to competition). The requirements from each policy are summarised within Table  2 and the most salient points of these policies are then presented in the section that follows.

In 2004, the IOC [ 18 ] announced that transgender people who transition after puberty are permitted to compete in sport in line with their experienced gender identity providing they have had gender-confirming surgery, can provide legal recognition of their gender, have been prescribed cross-sex hormone treatment for at least 2 years and have lived in their experienced gender for the same amount of time [ 18 ]. Additionally, transgender people who had undergone gender-confirming surgery pre-puberty are eligible to compete in sport in line with their experienced gender identity [ 18 ]. This is an international policy and has been adopted by sport organisations all over the world.

While the 2004 IOC [ 18 ] policy has been praised for its efforts to address the inclusion of transgender athletes [ 61 ], several flaws have been identified [ 61 ]. First, the policy excludes transgender people who choose not to have gender-confirming surgery owing to a lack of genital dysphoria (distress), medical reasons, fears about risk during operations, and/or because of other personal reasons [ 28 , 62 , 63 ]. The 2004 IOC [ 18 ] policy also excludes transgender people who are in the process of transitioning. For instance, a transgender athlete may be prescribed cross-sex hormone treatment, but be yet to undergo gender-confirming surgery. The 2004 IOC policy [ 18 ] therefore adopts a very narrow definition and excludes a large proportion of transgender people [ 19 ]. In addition to this, the policy appears to have been developed with only transgender female individuals in mind, possibly as transgender male individuals are not thought to possess athletic advantages in the majority of sports, and therefore the policy discriminates against transgender male individuals [ 21 ]. Moreover, the 2004 IOC [ 18 ] policy fails to take into consideration the regional, national and international differences in accessing cross-sex hormone treatment and gender-confirming surgery [ 18 , 63 – 65 ]. Within this policy, there also appears a lack of an evidence-based rationale as to why a period of 2 years was chosen as the length of time cross-sex hormone treatment must be administered prior to sport competition and why individual differences in blood hormone levels are not considered [ 66 ]. As mentioned previously, the role of testosterone blockers in transgender women is also not considered. Although the rationale for the 2-year time period is not made explicit, it may be related to the fact that this time period was imposed by the IOC in 2004, when banning athletes from competitive sport to discipline them for doping violations. The evidence-based rationale for gender-confirming surgery is also not clear [ 61 ]; whether an athlete has a penis or vagina appears irrelevant, as this will not change the physiology of the body or the physiological advantage of the person [ 63 ].

Approximately 200 days before the 2016 Rio Olympic Games, the IOC announced changes to their competitive sport policy for transgender people. The new 2016 IOC [ 20 ] policy suggests that transgender male athletes are able to compete in a male category without any restrictions. Transgender female athletes may compete in a female category if they have declared their gender as female for at least 4 years and their blood testosterone levels are below 10 nmol/L for at least 12 months prior to competition. However, the latter requirement is a general guideline, and each case will be reviewed individually to determine whether 12 months is a sufficient amount of time to suppress testosterone levels to an appropriate level. If transgender female athletes do not meet these requirements, they will be able to compete in a male category. This is a great improvement in sport policy, which considers gender assigned at birth and individual difference in relation to bloody hormone levels and moves away from the requirement of surgery to compete in their experienced gender category. However, we could not find any evidence to support the requirement for testosterone levels to be below 10 nmol/L for at least 12 months.

Despite its flaws, the 2004 IOC policy [ 18 ] has been adopted by several other sport organisations. Within this systematic review, 11 sport organisations adopted the policy outlined by the IOC in 2004 [ 33 , 36 , 38 – 40 , 45 , 46 , 48 , 49 , 51 , 57 ]. All but one (the International Tennis Federation) of these sport organisation policies are employed at a national level. Not only is it problematic that other sport organisations adopted the 2004 IOC policy, but elements of the 2004 IOC policy concerning children pre-puberty are not applicable to sport organisations in the UK and many other countries. Within the UK (and many other countries), children presenting with gender incongruence cannot undergo gender-confirming surgery before the age of 18 years, by which time puberty has usually started.

Three policies stated that it is only necessary to provide legal recognition of gender and to be prescribed cross-sex hormone treatment for a ‘sufficient amount of time’ (international policy) [ 56 ] or so that hormone blood levels are within cisgender female or male ranges (national policy) [ 44 , 52 ]. Policies from the National Collegiate Athletic Association [ 32 ] and British Rowing [ 50 ] also state that only cross-sex hormone treatment is required; however, the specifics of this requirement differ for both transgender male and female individuals. With both of these policies, transgender female individuals have to provide more evidence of cross-sex hormone treatment and their blood hormone levels in comparison to transgender male individuals. Similarly, the Association of Boxing Commissions [ 31 ] in its national policy has different cross-sex hormone treatment requirements depending on gender assigned at birth and how the athlete identifies themselves (transgender or transsexual). The language used within the Association of Boxing Commissions’ policy [ 31 ] may be seen as offensive by some transgender people and the difference between “transsexuals” and “transgender” people remains unclear. Policies held by the Ladies Professional Golf Association (international policy) [ 43 ] and the International Association of Athletics Federations [ 55 ] differ dramatically in relation to gender and gender-confirming surgery as a requirement. In both cases, it is necessary for transgender female individuals to have undergone this procedure, but not for transgender male individuals. Although some of the requirements of these policies are unreasonable and not evidence based (e.g. gender-confirming surgery), the gender difference in relation to the amount of evidence that is required about their gender change seems acceptable considering that only transgender female individuals (and not transgender male individuals) are currently seen to potentially have an athletic advantage [ 23 ].

The more inclusive sport policies reviewed here only required legal or medical recognition or do not ask for any evidence of gender; thus they encourage competition in line with the experienced gender (five were national policies and two were international) [ 34 , 35 , 41 , 42 , 53 , 54 , 59 ]. The Fédération Internationale de Volleyball [ 58 ] had the most invasive policy considered within this systematic review; they ask players to provide a birth certificate to verify gender. Additionally, female players may be asked to provide a gender certificate or submit themselves to a medical examination if the medical evidence is not sufficient. Both British Universities & Colleges Sport [ 47 ] and USA Triathlon [ 37 ] do not have their own policies, but suggest the adoption of other policies (i.e. those relevant to the sport in question or guidelines of the US Anti-Doping Agency, respectively).

Currently, the majority of sport policies unfairly exclude transgender people from competitive sport, as the requirements they place on them are not underpinned by evidence-based medicine. Until (and if) there is consistent and direct evidence to demonstrate transgender people have an athletic advantage, it seems unreasonable to exclude them on any basis.

The first aim of this systematic review was to explore the experiences of transgender people in relation to competitive sport participation (elite and recreational) and sport-related physical activity. The majority of the studies within this body of literature are qualitative in nature, which may be at least partly a reflection of the low numbers of transgender people in the general population. It is therefore difficult to draw any definite conclusions because of the lack of quantitative research. By its very nature, the findings from qualitative research cannot be generalised but the findings can be used to form a platform from which generalisations can be made. The research articles reviewed here described a generally negative experience of sport participation and sport-related physical activity for transgender individuals. It was evident from these studies that transgender people are facing barriers when engaging in competitive sport and sport-related physical activity. In relation to sport-related physical activity, lack of accessibility to an inclusive and comfortable environment appeared to be the primary barrier to participation. Charities and support organisations working with transgender people should consider developing campaigns to raise awareness about different gender identities. Leisure centres should also be made more aware of potential gender differences (i.e. via training and greater information provision) and be given advice on how to make such environments more inclusive of transgender people (e.g. gender neutral changing facilities with cubicles). In relation to competitive sport participation, the findings from this systematic review suggest that the requirements that transgender competitive sport policies place on competitors were instrumental in transgender athletes’ negative experiences.

While a distinction needs to be made between the issues and experiences transgender people have with regard to participation in sport and competitive sport, it also needs to be acknowledged that there is an overlap. Transgender male and female individuals have anecdotally discussed that access to sport participation (such as becoming part of the local football team) is restricted as even community and local sport organisations who play at a recreational level implement transgender competitive sport policies.

The second aim was to review the available sport policies regarding the fairness for transgender people in competitive sport (i.e. fairness in the absence of advantage). Owing to overinterpretation and fear of the athletic advantage in transgender athletes, the majority of the policies reviewed were discriminatory against transgender people, especially transgender male individuals (i.e. exclusion in the absence of advantage). Although the updated IOC policy may be perceived as more inclusive then the 2004 version, there are still flaws. The requirement for a transgender female individual to have declared their gender as female for at least 4 years is excessive. In the UK and many other countries, once a transgender person has accessed a transgender health service, it is likely to be less than 4 years before a person legally changes their name, undergoes irreversible treatments and, hence, fully commits to their experienced gender. There appears to be a lack of rationale regarding the 4-year time period for transgender athletes, although this time restriction is consistent with the current disciplinary action for cisgender athletes when a doping incident occurs [ 67 ]. The 2016 IOC policy [ 20 ] also states that to avoid discrimination against transgender female individuals, they are allowed to complete in a male category if they do not meet the requirements for transgender female athletes. For most transgender female individuals, competing in a male category, when their experienced gender is female, would be distressing and may deter engagement in competitive sport altogether. This particular requirement may be promoting exclusion of transgender female individuals in competitive sport, rather than avoiding discrimination.

Several sport policies, including the recently updated IOC 2016 [ 20 ] policy, have based their requirements for transgender competitors on indirect, inconsistent and unambiguous evidence. Physiological research involving cisgender people has shown that testosterone deficiency in young men is associated with a decrease in muscle strength [ 68 ] and testosterone injections in cisgender men are associated with an increase in some aspects of muscle strength [ 69 ]. However, this research did not determine whether these decreases and increases in muscle mass are within ranges for cisgender female and male individuals and the time required to reach cisgender male or female levels. Elbers et al. [ 70 ] expanded on this research by exploring the effects of oestrogen supplements and androgen deprivation on fat distribution and thigh muscle mass (by using magnetic resonance imaging) in 20 transgender female individuals. They found that 12 months after cross-sex hormone treatment, transgender female individuals had a more feminine pattern of adiposity and their thigh muscles had decreased. Other research has found that transgender female athletes who have hormonally and surgically transitioned have reported feeling weaker and their testosterone levels tend to be lower than average compared with cisgender women [ 19 , 71 ]. However, this research does not tell us anything about the relationship between androgenic hormones and athletic ability.

To date, Harper’s study [ 72 ] is the only one to directly explore androgenic hormones and athletic ability. The aim of the study was to explore the long-distance (5–42 km) running times of eight transgender female individuals pre- and post-testosterone suppression. It was found that post-testosterone suppression running times were significantly slower in comparison to pre-testosterone suppression. Harper stated that owing to reductions in testosterone and haemoglobin, transgender female individuals post-transition would have the same endurance capabilities as a cisgender female individual. However, the sample size was very small ( n  = 8) and participants were asked to self-report their race times, which might have been subject to recall or social desirability bias.

On average, men perform better than women in sport; however, no empirical research has identified the specific reason(s) why. Based mainly on indirect research with cisgender people, it is commonly believed that androgenic hormones (specifically high testosterone levels) confer an advantage in competitive sports (i.e. enhance endurance, increase muscle mass) and, while this belief has informed several sporting policies, testosterone may not be the primary, or even a helpful, marker in determining athletic advantage [ 73 ]. Karkazis et al. [ 73 ] have argued that there is no evidence to suggest that endogenous testosterone levels are predictive of athletic performance (apart from doping), as there is variation in how bodies make and respond to the hormone. Testosterone is only one part of a person’s physiology and there are other important factors (both biological and environmental) that should be considered if fairness (the absence of advantage) is the aim in competitive sport. For instance, having large hands is key for manipulation in some sports (e.g. basketball), but this is not seen as an unfair advantage. Establishing what an athletic advantage is in competitive sport would facilitate inclusion of all athletes (regardless of their gender identity) on the premise of fairness.

The Canadian Centre for Ethics in Sport [ 74 ] recently released a document offering guidance to sport organisations on how to develop inclusive competitive sport policies for transgender people. An expert panel maintained the viewpoint that everyone has the right to compete in accordance with their gender identity at a recreational and elite level. Cross-sex hormones and gender-confirming surgeries should not be a requirement at any level of sport. If any sport organisation requires transgender competitors to take cross-sex hormones for a specified time, they will have to provide evidence to support that this is reasonable. The panel suggests that when sporting organisations are concerned about safety, based on the size or strength of competitors, such organisations should develop skill and size categories, such as in wrestling.

The issues and challenges that transgender people experience when engaging in competitive sport and sport-related physical activity will undoubtedly become more prominent as the visibility and prevalence of transgender people become more pronounced. Consequently, health professionals working in sport will need to become more familiar with the specific issues and challenges that a transgender person may experience when engaging in sport. By doing this, these professionals will be able to ensure transgender people can start or continue to engage in sport in a safe and inclusive manner. The most common question of people working within the sport domain will likely be: When it is safe and fair to permit a transgender person to compete in sport in line with their experienced gender? At the current time, this is a difficult issue to address considering that there is a lack of direct and consistent physiological performance-related data with transgender people, which is preventing a consensus from being made as to whether transgender people (especially transgender female individuals) do or do not have an athletic advantage. It may be sensible to suggest that until there are direct and consistent scientific data to suggest that transgender competitors have an advantage, transgender people should be allowed to compete in accordance with their gender identity with no restrictions (e.g. no requirement to have cross-sex hormones, gender-confirming surgery). The athletic advantage transgender female individuals are perceived to have (based on indirect and ambiguous evidence) may be no greater than widely accepted physiological (e.g. large hands) and financial (e.g. training opportunities) advantages that some cisgender people possess in competitive sport. Sport organisations wanting to exclude a transgender person from competing in their experienced gender category would need to demonstrate that the sport is gender affected and that exclusion is necessary for fair and safe competition [ 74 , 75 ]. At the current time, this would be difficult considering there is no evidence to suggest that androgenic hormone levels consistently confer a competitive advantage [ 74 , 75 ].

Limitations of the Area and Directions for Future Research

Within the area of sport, physical activity and transgender individuals, research is limited and mainly qualitative. More quantitative research needs to be conducted to increase the applicability and generalisability of the research findings and so that conclusions about transgender people and sport can be drawn. At a medical level, more physiological research is needed with the transgender population to accurately determine whether transgender people have an advantage in competitive sport or not. Future studies should investigate when a person can be considered physiologically as their experienced gender. This in turn should aid more inclusive (i.e. inclusion in the absence of advantage) sport policies for transgender individuals and a fair system for all. To date, the few studies exploring the experiences of transgender people have mainly been concerned with exploring experiences in relation to competitive sport. This research now needs to be extended to those who participate in sport-related physical activity for leisure and fitness. It is also important to understand transgender people’s experiences in the context of different sports. The barriers to, and facilitators of, football participation, for example, may greatly differ to those experienced when engaging in gymnastics, athletics, swimming or aquatic activities. For the latter four sports, clothing may be revealing and an indication of one’s gender. For example, feeling comfortable in swimwear may be an issue for transgender people, especially when they are in the process of transitioning, as the body is often more exposed than in other sportswear (e.g. a football kit) and swimwear is heavily gendered (i.e. swimming trunks are worn by male individuals and swimming costumes by female individuals). In light of this, it would be interesting to explore the experiences of transgender people who have previously participated, or are currently participating, in aquatic activates, gymnastics and/or athletics.

Overall, it appears that the majority of transgender people have a negative experience of competitive sport and sport-related physical activities. Accessibility to sport-related physical activity needs to be improved. Within competitive sport, the athletic advantage transgender athletes are perceived to have appears to have been overinterpreted by many sport organisations around the world, which has had a negative effect on the experiences of this population. When the indirect and ambiguous physiological evidence is dissected, it is only transgender female individuals who are perceived to potentially have an advantage as a result of androgenic hormones. Within the literature, it has been questioned as to whether androgenic hormones should be the only marker of athletic advantage or, indeed, if they are even a useful marker of athletic advantage. Given the established mental and physical health benefits of engaging in physical activity and sport [ 13 , 14 ], the barriers transgender people experience are a significant limitation to the promotion of healthy behaviours in transgender individuals. There are several areas of future research required to significantly improve our knowledge of transgender people’s experiences in sport, inform the development of more inclusive sport policies, and most importantly, enhance the lives of transgender people, both physically and psychosocially.

Acknowledgments

We sincerely thank Prof. Barrie Houlihan for his helpful advice and feedback on an early draft of this systematic review.

Compliance with Ethical Standards

Bethany Jones was supported by a PhD studentship co-funded by Leicestershire Partnership NHS Trust and Loughborough University. No other sources of funding were used to assist in the preparation of this article.

Bethany Jones, Jon Arcelus, Walter Bouman and Emma Haycraft declare that they have no conflicts of interest relevant to the content of this review.

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A Researcher Is Trying To Settle The Transgender Athlete Debate — Using Science

Tom Goldman

The debate on whether transgender females should be allowed to play women's sports has become increasingly politicized. One transgender athlete and researcher is forging a middle ground with science.

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