The science is not settled on trans athlete debate

The decision by swimming’s world governing body, FINA, to restrict the participation of transgender athletes in elite women’s competition has once again set off a debate that has vocal and fervent advocates on all sides.

The new eligibility policy for FINA competitions rules that transgender women are eligible to compete in women’s competitions only if they have had male puberty suppressed by Tanner Stage 2 [the second of five stages of puberty] or before the age of 12. They must also maintain their testosterone levels below a certain limit from that early age. In practice, it will disqualify virtually all transgender women.

The sporting body says the policy was devised by a working group that included athletes, scientists and medical and legal experts. According to FINA, the science group argued that, while it varies by sport, biological sex is a key determinant of athletic performance, which is largely the result of substantially higher levels of testosterone to which males are exposed from puberty onwards.

FINA is hardly the first to use testosterone as a determining factor regarding transgender women, but it has set the toughest restrictions. Cycling’s governing body, the UCI, does not set an age limit but requires transgender women to have had testosterone levels below a certain level for 24 months, and the governing body for athletics, World Athletics (formerly the IAAF), has set similar criteria for track races between 400 metres and one mile.

With this in mind, you would expect the science regarding the causal link between testosterone and athletic performance to be settled, but it is not.

According to Associate Professor Ada Cheung, a leading endocrinologist at Austin Health, no long-term research with adequate comparison groups  has examined the impact of hormone therapy such as testosterone suppressants on strength, fitness or endurance. Cheung is not alone in raising concerns over sporting bodies using testosterone levels as a determining factor in excluding transgender women, but there are many experts who disagree with her.

As The New York Times reported this week, the records for elite adult male swimmers are on average 10 to 12 per cent faster than those held by female swimmers. Dr Michael Joyner, a doctor at the Mayo Clinic who studies the physiology of male and female athletes, says the reason is testosterone. Even those transgender female athletes who have testosterone suppression treatment may have a biological advantage if they went through male puberty.

“There are social aspects to sport, but physiology and biology underpin it,” Joyner told the Times. “Testosterone is the 800-pound gorilla.”

This issue is fraught, involving science, fairness and inclusivity, and too often inflamed by culture wars. Elite sporting bodies are grappling with all of this, and they do not have the same view. In November, while the International Olympic Committee left each sporting governing body to formulate its own policy on transgender athletes, it made clear in a statement of guiding principles, that “any restrictions arising from eligibility criteria should be based on robust and peer reviewed research” and not on “unverified, alleged or perceived unfair competitive advantage”.

FINA has defended its new restrictions by referring to a statement released in January by the International Federation of Sports Medicine and the European Federation of Sports Medicine Associations that says the Olympic committee failed to take proper account of “scientific, biological or medical aspects”, in particular that “high testosterone concentrations … confer a baseline advantage for athletes in certain sports”.

Since the decision by FINA on Monday, the world soccer and athletics governing bodies have stated they are reviewing their transgender eligibility policies in light of the swimming body’s new ruling. Sebastian Coe, president of World Athletics, told the BBC: “We have always believed that biology trumps gender … We will follow the science.”

That might not be as straightforward as it sounds. According to Victoria University researcher Dr Patrice Jones, who is leading an Australian study examining the effects of gender-affirming hormone therapy and investigating sex differences in exercise and epigenetics, “we don’t have enough evidence to make these decisions”.

Among elite athletes and the organisations that govern them, the argument is between two social goods: inclusion of as many people as possible, and fairness of competition. The science, or relative lack of it, makes this a tough call, but it should not be considered transphobic for biologically female athletes to question the fairness of competing against trans women who experienced male puberty.

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