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30 March 2022

There’s got to be a better way to include transgender women in sport

Testosterone reduction doesn't cancel out the overwhelming advantage of athletes such as Lia Thomas and Emily Bridges being born male.

By Tanya Aldred

Lia Thomas is an excellent swimmer. Sleek and muscular, she won the women’s 500 yards freestyle at the National Collegiate Athletic Association (NCAA) in Atlanta in March, causing an international media maelstrom. Why? Because she was the first transgender woman to win a prestigious college title in the pool, beating a Tokyo Olympics 2020 silver medallist in the process. She is now eyeing up a place at the 2024 Olympics.

She became the topic of discussion this week when, on 29 March, the Labour leader Keir Starmer was asked about her case and whether it is fair that transgender women should be allowed to compete in women’s sport. He said that it is for “sporting bodies to decide for themselves” who can or cannot be included, a fudge that will be increasingly difficult to hold on to as the debate moves closer to home.

For accelerating down the back straight, is the British cyclist Emily Bridges, 21. Bridges had been set to compete in her first race in the women’s category on 2 April until global cycling’s governing body intervened to say that it would have to deliberate on whether she can compete in the category. As a very talented male junior, Bridges won a silver medal at the junior nationals in 2017, broke the junior national 25-mile record, won two silvers in the national track championships in 2018, and was moved onto the GB Olympic pathway.

Bridges came out as trans in October 2020 and, having met British Cycling’s testosterone suppression criteria, was due to race in the National Omnium Championships this weekend in Derby alongside other entrants including the five-time Olympic champion Laura Kenny. Bridges is said to be racing within seconds of Britain’s best women in training.     

Bridges hasn’t disguised her desire to compete again at the highest level, but this time in the women’s category. In an interview with Cycling Weekly she said she felt that having reduced testosterone made her inclusion fair, because it had reduced her maximum oxygen consumption during exertion. “Reduced testosterone has a direct effect on the main determinants of VO2 max — red blood cells, haemoglobin, haematocrit — which drop to female levels within five months,” she said.

This idea is, to put it mildly, disputed by almost all biologists and sports scientists. Ross Tucker, an eminent sports scientist, says: “Endurance performance is the result of, among other things, ability to carry O2, which is affected directly by haemoglobin. But it is also affected by other attributes and the heart, lungs, muscle (enzymes) and even nervous system are part of that.”

Crucially, female bodies are not just mini versions of male ones. Women have smaller arms, smaller hands, wider pelvises, less muscle mass, more body fat, less dense and less fibrous muscles, fewer fast twitch fibres, less connective tissue, smaller hearts, lungs and haemoglobin pools, less dense bones — and that’s just for starters. The biologist Emma Hilton notes “6,500 differences in gene expression between males and females”.

To some, Bridges and Thomas are an inspirational story of the power of sport to fulfil and liberate. To others, they are an example of what happens when slack governance allows inclusion to trump fairness for female athletes. Consider what happens when you crunch the data. When Thomas swam as a man she was ranked 551st in the 200 yards, 65th in the 500 yards and 32nd in the 1650 yards. Now she is ranked first in the women’s 200 yards, first in the 500 yards and sixth in the 1650 yards. Her success may mean many things on a personal or symbolic level, but it is hard to ignore the reality of the advantages her previously male body grants her in the female category.

Sport is all about managing advantage. That is why weightlifting and boxing are divided into weight categories within sex categories, otherwise only the biggest and strongest would ever win. It is why the Paralympics exists, why there are so many disability classifications, why adults are not allowed to compete against children, why doping is banned. And, crucially, it is why women have their own sporting class. Without a female category in sport, women would never win an Olympic medal in most sports, pull on a Manchester City shirt or walk out at Wimbledon. There are approximately 10,000 men with a faster 100m time than the current Olympic female champion, Elaine Thompson-Herah. The only exceptions are skill and precision sports, such as darts and snooker, possibly shooting, or those that involve controlling equipment or animals, such as motor sports and equestrianism.

Male advantage in sports cannot be explained by the long history of women’s sport being ignored, sidelined and patronised, though that has put women’s sport back decades. Nor is it because women haven’t been training smartly enough. “If only Serena Williams believed in herself more and worked harder,” this argument goes, “she’d be able to beat many of the top-ranking men.” In fact, both Serena and her sister Venus were whalloped 6-1 and 6-2 by Karsten Braasch, a man ranked 203rd in the world, who had just come back from a round of golf and a couple of shandies at the “Battle of the Sexes” during the 1998 Australian Open. Male physical advantage, which arrives with a hairy-chested roar alongside male puberty, gives males an 11-13 per cent advantage in running, swimming and rowing, 16-22 per cent in track cycling, 34 per cent in weightlifting, and 162 per cent in punch power.

So where does that leave trans athletes, like Thomas and Bridges, whose gender identity differs from the sex they were born as? The participation of trans men is more straightforward for sporting authorities. If they don’t take testosterone they can keep competing in the women’s category — as Iszac Henig did at the same NCAA championships as Thomas, without controversy. If they do decide to take testosterone they would have to apply for a therapeutic use exemption whichever category they compete in, because testosterone is banned under the anti-doping code.

In 2015 the International Olympic Committee rightly binned its previous medieval rule that had asked male athletes wishing to transition to female categories to undergo a gonadectomy, which understandably kept the number of potential competitors down. The solution most sporting bodies have come up with in an attempt to include trans women, at least at elite level, is to ask them to reduce their testosterone levels. The NCAA required Thomas to reduce levels to 10 nanomoles per litre; Bridges had to reach 5 nmol/l continuously for 12 months to comply with British Cycling policy. The typical level for females is in the range of 0.5 to 2.4 nmol/l.

While these requirements might sound neat, they are proving problematic. The evidence shows that reducing testosterone does not actually significantly reduce male advantage. Two peer-reviewed academic studies of musco-skeletal changes in trans women suppressing testosterone, one by Emma Hilton and Tommy Lundberg, published in Sports Medicine in 2020, the other by Joanna Harper et al, published in the British Journal of Sports Medicine in 2021, came to the same conclusion: there is a little loss of muscle mass and strength, but a strength advantage over natal women remains.

Tucker, who is an expert on testosterone advantage in sport, has no doubts about the conclusion: “Lowering of testosterone is almost completely ineffective in taking away the biological differences between males and females.” This was backed up by a report by the UK’s Sports Council Equality Group published in September 2021, which concluded that it was impossible for sports to balance the inclusion of trans women, fairness and safety, and told sports that they would have to choose which way they fell. The report was heavily criticised by trans advocate groups, and while the physical arguments are well rehearsed in scientific circles, most governing bodies have been swayed by societal arguments.

So if testosterone reduction is not the answer to fair and inclusive sport, what is?    

David Grevemberg, of the Centre for Sport and Human Rights, has suggested staggered starts for the 100m — an eyebrow raising idea which could potentially see a woman crowned “the world’s fastest human” even if her times were slower. Others call for the removal of sex categories altogether on the basis that sex is just another natural human advantage, much as Michael Phelps had a body superbly adapted for swimming. (This idea, of course, ignores the fact that top female swimmers also have freakishly attuned aquatic physiques, but none have ever come close to his times.)

Less fanciful alternatives include having both a female category and an “open” category, which would include men, trans women and trans men who had taken testosterone. This would be beautifully simple but, as the researcher Cathy Devine points out, it would disadvantage trans women who were medically transitioning and trans men. Alternatively, there could be additional categories possibly broken down into trans men not on testosterone, trans men on testosterone, trans women and trans women with reduced testosterone. These categories would be small to start with, and possibly problematic at grassroots levels, but could, as the use of multiple categories in the Paralympics has shown, still bring meaningful competition.

What is in no doubt is that women who speak out in defence of sex-based sport are targeted for abuse. Women with years of athletic experience and hours of volunteering are either sitting reluctantly on the sidelines for fear of losing their livelihood or quietly packing up and doing something else, having been told that their concerns are not valid. Current athletes are bound by contracts with governing bodies and sponsors. Few feel able to discuss the issue.

Mara Yamauchi, the retired British long-distance runner and two-time Olympian, who until recently was the UK’s second-fastest female marathon runner, is among those who have been vocal. She has been called a “hateful, transphobic woman” and had her sources of income targeted because she is vocal in defence of women’s sport. “I don’t think people understand the cascade of exclusion that happens when even a single [biological] male competes in the female category,” she says. “When Lia Thomas won three events at the Ivy League championships, the females who won silver should have won gold, the third-placed females should have won silver, the fourth-placed females were excluded from the medals altogether, in the heats the females who came ninth missed out on places in the A finals, those who came seventeenth were relegated to the C finals, and on it goes.

“People focus on winning, but it is only one tiny part of sport. What is key is the development pathway from beginner to elite: you start off as a nobody, then work your way up. After many years of hard work, some end up as Olympians, some make the national team, some the regional team. Females at all levels deserve fairness. Even at grassroots levels there is fierce competition. I am certain that females will self-exclude if they see women’s sport as unfair and something that is not valued.”

Her conclusion is grim: “Females being excluded from their own sports is seen as acceptable collateral damage.”

There is no denying that sport has an appalling track record when it comes to inclusion. It has traditionally been (especially at elite level) racist, sexist, homophobic and defiantly hyper-masculine. The myriad benefits of sports on a grassroots and elite level should be open to all, particularly marginalised groups like trans men and women.

Yet it is surely not the right answer that female sport, long marginalised itself, has to open its categories in a way that disadvantages the majority of its members. It is almost as if, in an understandable attempt to make good on all the years of prejudice, sports bodies have made rules based on wishful thinking and societal arguments rather than evidence, leaving athletes such as Thomas and Bridges to take the heat for administrators who are too cowardly to admit their inclusion policy is unfair.

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