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Transsexual Women
and Female Sports


Note: This page assumes that a reasonable definition of sport is a "competitive physical activity". 

Since before the Second World War questions have been raised (sometimes justifiably) regarding the "femininity" of some highly successful female competitors.  Initially rather crude visual methods were used to detect male impostors at major sporting events, but from 1968 these were replaced by various tests that verified female gender (or slightly more correctly, physiological sex) by not detecting the presence of either a "male" XY chromosomal pattern or a Y gene.  Unfortunately these tests identify as male those athletes who happened to have an XY chromosomal pattern but were otherwise unassailably feminine. 

Genetically "XY" men are on average bigger, stronger and faster than genetically "XX" women due to their many physical differences.  As a result men tend to be significantly better than women at sports, as demonstrated by the following 2014 world records:

Event Men's World Record Women's World Record
100m 9.58 seconds 10.49 secs
800m 1 minute 40.91 secs 1min 53.28 secs
10,000m 26 mins 17.53 secs 29 mins 31.78 secs
Marathon 2 hours, 2 mins 57 secs 2 hrs 15 mins 25 secs
Javelin 98.48m 72.28m
Long jump 8.95m 7.52m

These records show that men have about a 11% advantage in running events and more than that others.  Basically millions of men can beat the very best woman in the world in most sporting events. 

Renee Richards
Renée Richards

Sports and Tranwomen
Since the 1970's discrimination against male-to-female (MTF) transsexual women has become increasingly unacceptable - both legally and socially. 

It seems reasonable that if a MTF transsexual is living as woman, is legally a woman, has a passport stating 'sex: female', and is married as a woman - that she should be able to compete in sports as a woman.  But some people - even some transsexual women - have severe reservations about the fairness of allowing this.  For example, if the world record holder of the men's 100 metres race had a sex change and two years later set a new world record as a woman - should that really count?  The closest known example of this happening is when in 1975 a 6 ft 2 inches tall, 40 year old, an American eye surgeon and amateur tennis player called Dr Richard Raskind had SRS and became Renée Richards.  After a legal fight, in 1977 she won the right to compete in women's professional tennis.  In 1978 she reached the women's quarter-finals of the US Open tennis championship and in February 1979 - at the amazing age of 44 - was ranked the 20th best female tennis player in the world.  Even Renée subsequently expressed doubts about the fairness of this.

Mianne Bagger
Transsexual Australian / Danish golfer Mianne Bagger.  The Ladies European tour offers prize money of over €11 million a year, the USA tour about five times that.

Another factor - if rarely openly mentioned - is that women's sport has become financially very lucrative.  Top female competitors in sports such as tennis, golf and athletics can earn more than $1 million a year in prize money and sponsorship deals.  As a result female sporting associations are desperate to develop rules that on the one hand are fair (and legal) in allowing male-to-female transsexuals and genetically 'XY male' intersex individuals to compete as women, but on the other prevent men or transsexuals with excessive physical advantages competing as women.  I.e. they are trying to square the circle!


It's Physical
Experts have been saying that women are rapidly closing the performance gap on men in sports, and some studies even optimistically claim that women could overtake them in the future (e.g. "Will Women Soon Outrun Men?" by Brian Whipp and Susan Ward, Nature, 1992).  But the the brutal reality is most men are still taller, heavier, faster, stronger, bigger, and more powerful than most women, and are likely to remain so.  A controversial study in 1997 by Seiler and Sailer published in Sportscience News found a male-female performance difference of 11-12 percent.  But the table of World Record's given in table at the top of this page has very similar differences.

Upon investigation, the difference in performance is best explainable by the substantial list of physical differences between men and women - even if we only consider factors directly related to sports.

Males typically have greater bone strength and density, greater muscle bulk and broadness in the shoulder area, and greater subcutaneous fat in the upper half of the body.  At maturity, females are generally shorter in height, have more flexibility in their joints, have more delicate ligaments and tendons, have more subcutaneous fat in the hips and lower body regions, have less erythrocyte and haemoglobin mass (which directly affects the ability to of the blood to carry oxygen and get rid of carbon dioxide), and exhibit a greater degree of pelvic tilt and obliquity.  The female elbow offers a greater carrying angle and tendency toward cubitus valgus (i.e. the lower arms stick out more), and the female has smaller lungs, heart, liver, and kidneys than the male.  Female joints are more subject to injury in sports requiring an expulsive effort, sudden stopping, sudden checking of speed and turns, and landing in jumps.  These differences are partly to the man's X chromosome, and partly due to the fact from about age 13 the bodies of boys are powerfully influenced and "masculinised" by a flood of testosterone from their gonads, while simultaneously the growth of girls is actually limited and "feminised" in a more delicate direction by the flood of oestrogen's from their ovaries.

According to one US Army manual:

  • The average 18-year-old man is 70.2 inches tall, the average woman of the same age is 64.4 inches tall - a difference of 9%.

  • The average 18-year-old man weighs 144.8 pounds, the average woman of the same age weighs 126.6 pounds - a difference of 14%.

  • The difference in physical size affects the absolute amount of physical work that can be performed by men and women.

  • Men have 50 percent greater total muscle mass, based on weight, than do women.

  • A woman who is the same size as her male counterpart is generally only 80 percent as strong. Therefore, men usually have an advantage in strength, speed, and power over women.

  • Women carry about 10% points more body fat than do men of the same age.

  • Because the centre of gravity is lower in women than in men, women must overcome more resistance in activities that require movement of the lower body.

  • Women have less bone mass than men, but their pelvic structure is wider. This difference gives men an advantage in running efficiency.

  • The average woman's heart is 25 percent smaller than the average man's.

  • For any given work rate, most women will become fatigued sooner than men.

  • The lung capacity of men is 25 to 30 percent greater than that of women. This gives men an advantage in the processing of oxygen and in doing aerobic work such as running.

What the Army study does not really emphasise directly is the fact that the "typical" young untrained male has an absolute oxygen intake (termed VO2 max) of 3.5 litres/min, while the typical same-age female has about 2 litres/min - a 43% difference which translates in to reduced performance and increased fatigue.  The difference reduces to 15 to 20% when the difference in body weight is allowed for, but is not eliminated. 

Part of the reason for the V02max difference is that the male sex hormone testosterone promotes the production of haemoglobin, an oxygen-carrying protein found inside red blood cells, and testosterone also increases the concentration of red cells in the blood.  The female hormone oestrogen has no such effect.  As a result, each litre of male blood contains about 150-160 grams of haemoglobin, compared to only 130-140 grams for females.  The bottom line is that each 'male' litre of blood can carry about 11% more oxygen than a similar quantity of female blood.

If we compare average body fat in males and females, we find the other part of the answer. Young untrained women average about 25% body fat compared to 15% in young men.  If we factor out body composition differences by dividing VO2 by lean body mass (bodyweight minus estimated fat weight) the difference in maximal O2 consumption decreases to perhaps 7-10% - close enough to 11% difference in blood carrying capacity just calculated.  But this is a theoretical paper exercise as a female athlete cannot reduce her body fat down to the sub 7% levels often observed in elite males without severe consequences to her health that would soon rule her out of competition anyway.

 

Transwomen and Sport

The table below shows the relative advantage that a genetically XY transsexual woman may have in sports over a genetically XX cis-woman.  It is rather speculative, but is supported by the limited research available.  For example one study found that androgen deprivation in MTF transsexuals increases the overlap in muscle mass with women but does not reverse it.

Physical Advantage

Male

MTF transsexual
Pre-puberty SRS

MTF transsexual
Post-Puberty SRS (>2 years)

Height

Yes

Reduced

Yes

Skeletal Structure (pelvis etc)

Yes

Reduced

Yes

Muscle Mass

Yes

Reduced

Reduced

Body Fat Ratio

Yes

Reduced → No

Reduced

Bone Mass/Density/Ruggedness

Yes

Reduced

Yes → Reduced

Heart size

Yes

Possibly Reduced

Yes

Lung Capacity

Yes

Possibly Reduced

Yes

Red blood cells/Haemoglobin

Yes

No

Reduced → No

 

Fallon Fox become a focus of opposition to transwomen competing in women's sports after success as a mixed martial artist.  She is 5 ft 7 in (1.70 m) tall and weighs 144 lb (65 kg)

It has been suggested that transsexual women who have SRS after puberty are actually at a disadvantage in sports compared with other women as they are lugging around the large and heavy skeleton of a man without the compensations such as big muscles.  Alison Carlson:- "A man who's castrated and takes oestrogen therapy loses a lot of strength advantages.  With someone like Renee Richards [see below], she didn't suddenly become this winning player on the women's circuit. In fact, she didn't do that well, because although she was tall, she actually had female musculature being carried around on a large male skeleton.  It weakened her."  Personally I'm not quite sure that the overall balance and weighting of advantages and disadvantages agree with this view - although it does depend on the sport.

Complete AIS is sometimes presented as the ultimate form of male-to-female transsexual - the suffer is genetically male XY but has a completely normal female body (albeit lacking internal reproductive structures) due to the total inability of their bodies to use the male androgen hormones produced by their testes in anyway, including for muscle development or VO2max.   But a very interesting paper "Complete Androgen Insensitivity "Syndrome": A Model For Human Performance in Sports". does nothing to support the suggestion that AIS women, or indirectly male to female transsexuals have no advantage in women sports.

 

Sex Testing
As described above, a man competing as a woman would in many sports have arguably an unfair advantage.   It is possible that ever since competitive sports began there have been suspicions that some of the female competitors were not actually women - but the reality is that female sporting events weren't considered very important until the 20th century. 


Stella Walsh (left) and Dora Ratjen

The potential scale of the men-competing-as-women problem first became apparent after the 1932 and 1936 Olympic Games.  The Polish sprinter Stanisllawa Walasiewicz (later Stella Walsh) was the winner of the 100-meters at the 1932 Olympics, but the IOC recovered her medals after learning that she had male reproductive organs. A post-mortem in 1980 revealed that she had male genitalia as a result of a rare genetic condition called mosaicism.  Even worse, the German high jumper Dora Ratjen came fourth in the 1936 games - in 1938 it emerged that "she" was actually a transvestite man called Hermann Ratjen.  The IOC was further worried to learn that three other track-and-field champions who competed as females in the pre-WW2 games eventually underwent reconstructive surgery to remove external, male-like reproductive structures.

After WW2, sport became increasingly super-power politics by other means.  The masculine physique, deep voices and five o'clock shadow of some formidable Eastern bloc female competitors became impossible to ignore, and after the 1964 Olympic games. it was decided to introduce sex tests.

Sex testing officially began at the 1966 European Athletics Championships in Budapest.  This was a simple visual exercise - women competitors were required to disrobe so that medical staff could from their genitals whether they were indeed women.  Of course, many women found this offensive, but it was also noticeable that several dozen female competitors immediately faded from the scene, most notably the rather masculine Press sisters Tamara and Irina from the Soviet Union - who between them won five Olympic titles in the shot-put and hurdles respectively in the early 1960's.

It was soon realised that Tamara Presssex reassignment surgery had already advanced to stage where a former man could pass a "peak and poke" test as a woman, therefore at the 1968 Olympics the far more sophisticated polymerase chain reaction (PCR) buccal smear test was introduced to examine the competitors chromosomes - with the blunt rule that if they weren't XX she couldn't compete as a woman.  Ewa Klubukowska, a 1964 sprint bronze medalist for Poland, had the dubious honour of being the first woman to fail the sex test on account of possessing an XXY chromosome pattern, although she was clearly female in every other way.  "I know what I am and how I feel" she said at the time.  After failing her "female" sex test, Ewa made it a bad joke by getting pregnant and having a baby the next year, although on the side of the coin Austrian skier Erika Schinegger (Women's World Downhill Champion in 1966) decided to become Erik after failing her sex test - and later fathered a daughter.  Ewa and Erika were in crowded company at the time, as many other female athletes, including five British, failed the new test in its early days. 


In 1983 Maria Patino passed a sex test as female and was given this certificate.
 




Maria Patino in 1985 (top), and 22 years later when working as a reporter and coach.

From the start the fairness of this gender verification test was hotly disputed, the vast majority of the women affected suffered from Complete AIS (CAIS) and are legally regarded (and regard themselves) as women.  Things came to head in with the  Spanish hurdler Maria Jose Martinez Patino She suffered from AIS, i.e. had male XY genes, but in 1983 she mistakenly passed a sex test and was certified as XX female.  However the now 24-year old was retested when she entered the 1985 World University Games in Kobe, Japan.  On the way to her first race, she was told that she was genetically male and should fake an injury and withdraw (apparently a common practice when a sex test was failed) - if she didn’t it would be leaked to the press that she was a man.  She didn’t back down and she won her race, collapsing with physical and mental exhaustion after the finish line.  The next day, her story was front page news.  She returned to Spain to be stripped of her titles and lost her university scholarship and her boyfriend.  Patino told a reporter “I knew I was a woman in the eyes of medicine, God, and, most of all, in my own eyes ... If I hadn’t been an athlete, my femininity would never have been questioned". 

The Olympic Games organising committee started to face huge pressure from all sources because of the obvious mistakes (so called "false positives") that were being made in relation to sex testing, which potentially ruined the lives and careers of some women athletes.  Exemptions began to be made, starting in the 1988 games with Maria Patino herself.

However genetic testing continued, and this still affected many female athletes.  Between 1972 and 1984, thirteen women "failed" the Olympics' chromosome test and were barred from competing.  Like Maria Patina, the vast majority were women that suffered from partial or complete Androgen Insensitivity Syndrome (p/cAIS):

  • In the 1988 Summer Olympics in Seoul an unnamed top women's tennis player was prevented from competing when her AIS condition was identified. 

  • In the 1992 Olympics in Barcelona 5 out of 2,406 women tested as genetically "male", all with some form of AIS. 

  • In the 1996 Olympics in Atlanta 8 women out of 3387 didn't pass as female - 4 with cAIS, 3 with pAIS and 1 with another condition (5-alpha-reductase deficiency).  6 of the 8 had had surgery to remove their gonads.  All were allowed to compete. 

  • In the 2012 Olympics in London  4 women were identified as genetically XY "male", all had some form of AIS and were allowed to compete. 

Between 1972 and 1990, one in every 504 elite female athletes was found ineligible as a result of sex chromatin testing yet not one was found to be a "normal male".  This statistic is still interesting as almost all disqualified athletes had from AIS, but only about 1 in 3500 women suffer from the syndrome, i.e. a genetically XY woman with AIS is roughly seven times more likely to become an elite athlete than an XX cis-woman.

However gender authentication (sex testing) for athletes had by now become unsustainable.  Clearly the vast majority of failures to pass the "sex test" were due to AIS and as no one seriously argued AIS women were not women, the results were effectively false positives.  It was also clear that any benefits that an AIS woman may naturally have because of her "male" XY genes are largely offset by the disadvantages of her condition, and at worst are trivial compared with the effects of illegal performance enhancing drugs such as steroids on the genetically XX female body.  Finally in February 1999, the Athletes' Commission of the International Olympics Committee urged its parent organization to do away with sex analysis entirely and rely instead on observed urination during drug testing to pinpoint any obvious male impostors. 

A New Era
By the early 1990's the whole process of sex testing was becoming far more trouble than it was worth as the most blatant cheats (i.e. a man with out surgery trying to compete as a woman) could be easily picked up by other means, for example when giving a routine anti-doping urine sample which had to be visually observed by an official. 

Erika Coimbra
Erika Coimbra at the Sydney Olympics.

Mandatory sex testing for women was thus thankfully abandoned for the 2000 Sydney Olympics, but unfortunately considerable publicity was still given by the media to two Brazilian women - Judo competitor Edinanci Silva and volleyballer Erika Coimbra - when it was leaked to the press that both were born hermaphrodites, with non-functioning male genitalia which had been surgically removed.  As they actually suffered from AIS they were not banned from competing under the revised rules, but sadly some of their opponents made it known that they were unhappy about this fact - the young, pretty and elf-like Erika (age 20, weight 64kg, height 180cm, with long blond hair) perhaps unsurprisingly receiving much less abuse than the much plainer looking Edinanci (age 24, weight 71kg, height 175cm), whose opponents disgracefully started to refer to as a "he". 

Although "gender verification test was dropped before the the 2000 Olympics, there remained a question outstanding about whether sex-reassigned individuals could compete in their new sex.

In February 2004 an  IOC advisory group recommended that individuals undergoing sex reassignment after puberty could compete in the Olympics, but only under certain conditions:

  • Surgical changes must have been completed, including external genitalia changes and removal of gonads.

  • Legal recognition of their assigned sex must have been conferred by appropriate official authorities.

  • Hormone therapy -- for the assigned sex -- must have been given for long enough to minimize any gender-related advantages in sport competitions, a period that must be at least two years after gonadectomy.

On Monday, 17 May 17 2004 the International Olympic Committee announced  - albeit with some mixed reactions - that it was dropping all sex testing for woman's sports Transsexuals passing the prescribed conditions were also cleared to compete in the Olympics by the IOC Executive Board.  The  IOC spokeswoman Giselle Davies said the situation of transsexuals competing in high-level sports was "rare but becoming more common."  IOC medical director Patrick Schamasch said no specific sports had been singled out by the ruling.  "Any sport may be touched by this problem," he said. "Until now, we didn't have any rules or regulations. We needed to establish some sort of policy."

The decision, which covered both male-to-female and female-to-male cases, went into effect starting with the Athens Olympics in August 2004.  The new rules allowed the classification as female all men who had undergone a SRS operation, regardless of whether this was before or after their puberty.

The decision of the IOC to let transsexual women compete as female athletes, and a similar  decision by the International Athletics Association (IAA) seemed to usher in a new era.  There was no doubt that some Olympic events (e.g. running, javelin, pole vault, marshal arts ...) and many professional, semi-professional women's sports such as tennis, golf, football (soccer), basketball, bowling, running et al seemed to face a gradual influx of top ranked women who were transsexual.

Michelle Dumaresq became an early example of the apparent future.  After her sex-reassignment surgery in 1995 she claims to have lost bone density, three inches of height [which is extremely unlikely], and 30% of her muscle mass along with her testosterone, but nevertheless she still became the Canadian women's downhill cycling champ in 2002 - just a year after entering the sport. 

Renee Richards (who has some regrets about her own transition and SRS) believes that it all comes down to fairness.  Renee would bar transsexuals from women's sports if they were in their 20s and still had muscular male physiques that gave them an advantage over other women:

"That's why we have junior events and senior events, men's events and women's events, and why 130-pound fighters don't fight against 180-pound fighters.  We have categories in sports to have level playing fields.  Tiger Woods or Jimmy Connors or John McEnroe, if they're 25 years old and they have a sex change and within the next five years they go out to play against women, of course they have a great advantage.  Woods probably isn't contemplating any changes, and it's unlikely there will be a rush of men with low handicaps switching sex to clean up on the women's tour.  Bagger may be making history of a sort, but she isn't leading a revolution.  She'll play, she'll be somewhere in the middle, she'll do it for a while, and she's going to get a lot of grief.  She'll get some notoriety. She may like it, she may not like it. And then it'll die down.  It's not going to cause a rash of transsexual golfers.  Those kind of fears are silly."

But Renee has also warned that the decision by the International Olympic Committee means that unscrupulous competitors could use the new rules to change from men to women to give them more chance of success.

"It's ironic that everyone has tried so hard to keep a level playing field - from corked bats to doping - but now the IOC has come up with a decision that defies fairness in a similar vein.  Sex-reassignment surgery is based on putting materials into your body."

Putting things in a UK context, the new reality is Tim Henman could become Tina Henman and be a [female] Wimbledon champion at last.  With Henman’s strength and speed, height and muscle density, added to his skills, it would be a near certainty even after year of female hormones and aging.

A counterview to Renee is offered by Alisha Kia Siadeski (formerly Paul), a trangender 'cowgirl' whose title winning passion is barrel-racing - a minor women-only sport.  She says: "I'm 5'5" and weigh 112 pounds - I have no strength advantage, never did ...  half the women I compete against are bigger and stronger than I am".   

Indeed, Renee herself argues against the theory that desperate athletes will do anything to win the gold, even change their gender. "How hungry for tennis success must you be to have your penis chopped off in pursuit of it?"

Testosterone Concerns

Concerns about men masquerading as women to win medals have been around for almost as long as women have been allowed to play sport.

 In fact, the last case of cheating most people can agree on is German high jumper Dora/Heinrich Ratjen. He nearly won a bronze medal at the 1936 Olympics.

Stella Walsh was the fastest woman in the world in the 1930s, but a postmortem in 1980 revealed she had male genitalia as a result of a rare genetic condition called mosaicism

Sport first cottoned on to this when Spanish hurdler Maria Jose Martinez-Patino was told in 1985 that she was an XY "man", but refused to quit or feign injury (as it is widely believed many had before) and spent the next three years fighting ignorance and ridicule to line up alongside women again.

She got there in the end, proving her Y chromosomes were the product of a rare genetic syndrome. She was also able to show that her condition meant she was insensitive to testosterone: it was in her blood, but it was no good to her.

Sadly, Martinez-Patino's most competitive years were behind her. It is not known what happened to the 13 women who "failed" gender tests at Olympics between 1972 and 1984.

But sport seemed to have learned something, though, mainly that it did not know enough about these complicated issues, and by the end of the 1990s gender verification was shelved, apart from in cases of extreme suspicion.

And then Semenya burst onto the scene.

In 2009 the South African athlete Caster Semenya won the women's 800 metres race at the World Championships.  However her sex was questioned by competitors and observers, and the IAAF asked her to undergo "gender testing".  Whilst Caster's win was eventually confirmed in March 2010, the IAAF and IOC decided to adopt a new sex testing policy looking solely female athletes’ testosterone levels.  Women whose test results fall within the normal male testosterone range would now be be banned from competition unless and until they submit to medical intervention.  Post-SRS transwomen will easily pass this test.

A junior champion in 2008, the muscular teenager took seven seconds off her personal best for 800m over the next nine months, breaking the South African record and setting a world-leading time in the process. The IAAF felt "obliged to investigate", if only to rule out doping.

Hours before the start of the 800m final at the 2009 World Athletics Championships, a race Semenya would win by a huge margin, it was leaked that the sport's governing body had also asked for a gender test. A history of suspicion

Concerns about men masquerading as women to win medals have been around for almost as long as women have been allowed to play sport, which is surprising given how rare it is. In fact, the last case of cheating most people can agree on is German high jumper Dora/Heinrich Ratjen. He nearly won a bronze medal at the 1936 Olympics.

Undeterred by the unlikelihood of a man successfully passing himself off as a woman, the IOC started comprehensive "gender verification" Stella Walsh was the fastest woman in the world in the 1930s, but a postmortem in 1980 revealed she had male genitalia as a result of a rare genetic condition called mosaicism

Initially, this was done by asking female athletes to drop their underwear, but eventually a less humiliating method was found: checking swabs of cheek tissue for chromosomes, women being XX, men XY.

Unfortunately, Mother Nature is not as black-and-white as your typical blazer would like his competitions to be, and it turns out there are a dozen different conditions that would once have been lumped under "hermaphrodite", but are now referred to by the less pejorative term of intersex, or disorders of sexual development.

Sport first cottoned on to this when Spanish hurdler Maria Jose Martinez-Patino was told in 1985 that she was an XY "man", but refused to quit or feign injury (as it is widely believed many had before) and spent the next three years fighting ignorance and ridicule to line up alongside women again.

She got there in the end, proving her Y chromosomes were the product of a rare genetic syndrome. She was also able to show that her condition meant she was insensitive to testosterone: it was in her blood, but it was no good to her.

Sadly, Martinez-Patino's most competitive years were behind her. It is not known what happened to the 13 women who "failed" gender tests at Olympics between 1972 and 1984.

But sport seemed to have learned something, though, mainly that it did not know enough about these complicated issues, and by the end of the 1990s gender verification was shelved, apart from in cases of extreme suspicion.

Moral panic

And then Semenya burst onto the scene.

A junior champion in 2008, the muscular teenager took seven seconds off her personal best for 800m over the next nine months, breaking the South African record and setting a world-leading time in the process. The IAAF felt "obliged to investigate", if only to rule out doping.

Hours before the start of the 800m final at the 2009 World Athletics Championships, a race Semenya would win by a huge margin, it was leaked that the sport's governing body had also asked for a gender test.

Caster Semenya wins the 800m at the 2009 Worlds

After Caster Semenya's crushing win at the 2009 Worlds, a Russian rival sniped: "Just look at her"

After Caster Semenya's crushing win at the 2009 Worlds, a Russian rival sniped, "just look at her"

A young girl with a rare condition, and an even rarer talent, was subjected to a medical examination by media.

Semenya, now 23, returned to racing in 2010, and won silver medals at the 2011 Worlds and 2012 Olympics. But she has never run as fast as she did as an 18-year-old.

Bruce Kidd, the 1962 Commonwealth champion in the imperial version of the 10,000m, the six miles, has spent the last half century as a leading academic in the field of physical and health education. The Canadian is also a self-confessed Olympian "of the old school", a champion of sport's ability to unite.

"What a remarkable story Semenya should have been," said Kidd.

"Wouldn't it have been better if the authorities had raised her hand as a great new champion? Instead they hit the moral panic button.

"There has been a long current in modern sport that there must be something wrong with strong women. In the last 20 years it has become a kind of biological racism."

The hyperandrogenism solution

Semenya's case provoked Olympic levels of hand-wringing.

Ashamed at the leaks and lack of scientific rigour, but stung by the reaction to Semenya's physique from some quarters, the IAAF asked an expert working group to come up with a plan for women with "excessive androgenic hormones", or hyperandrogenism.

India's Santhi Soundarajan at the 2006 Asian Games

India's Santhi Soundarajan was stripped of the 800m silver medal she won at the 2006 Asian Games when she failed a gender test - she tried to kill herself a year later

Androgenic hormones are any natural or synthetic substance that control the development of male characteristics - everything from the formation of testes, to male pattern baldness - with the best known being testosterone.

There is some disagreement over the normal spectrum of testosterone levels for men and women in general, but everybody agrees that typically there is a gap that emerges between the sexes during puberty.

As we have seen, though, there are some women with conditions that give them masculine amounts of testosterone, which the IAAF's working group, in conjunction with the IOC's Medical Commission, decided was anything above the bottom of the male range, 10 nanomoles per litre (nmol/L) of blood.

In April 2011, the new rules came into force. From this moment on, a confidential investigation could be made into any athlete where there were "reasonable grounds". This could be a complaint from a rival, or as a result of an anomaly in a drugs test.

The process would be handled by experts, and "an effective therapeutic strategy" would be offered to any athlete found to have elevated levels of androgen.

Part of this investigation would include finding out if the athlete is benefiting from the testosterone. As was seen in the Martinez-Patino case, androgen insensitivity syndrome (AIS) means those elevated levels of the hormone can give a false picture of what is actually happening.

But while all this is being established, the athletes are ineligible to compete. Sounds reasonable…doesn't it?

The testosterone divide

Peter Sonksen is a professor of endocrinology (the study of hormones) at St Thomas' Hospital in London. It was his research for the IOC that eventually led to the development of an anti-doping test for Human Growth Hormone, but he is far from impressed with its work on testosterone.

"They have got it completely wrong with this idiotic rule," Sonksen told me.

"This rule is unfair, gross and unscientific. It is clear discrimination."

Former German shot putter Andreas Krieger (left) competed as Heidi Krieger (right) before undergoing a sex change

Having been unknowingly given androgens as a teenager, Andreas Krieger (left) had sex reassignment surgery in 1997 - as Heidi (right) he won East Germany a European shot put gold in 1986

Sonksen's main objection to the 10 nmol/L threshold is that the research he did for his HGH study found 16% of his male athletes had lower than expected testosterone, whereas 13% of his female athletes had high levels of testosterone "with complete overlap between the sexes".

In other words, the gap that exists for testosterone between men and women in the general population does not exist among elite athletes.

This research has been leapt upon by a growing body of campaigners who question the premise that testosterone is a significant factor in any discussions about differences between the sexes' athletic performances.

For them, men's greater height, leaner body mass, narrower hips and higher counts of oxygen-carrying red blood cells are all more persuasive than testosterone.

But this is where we enter disputed territory, and a number of experts reacted angrily to what they saw as the misuse of Sonksen's HGH data. For them, there is little doubt of testosterone's impact, although most admit it is part of the mix, as opposed to being the only ingredient.

An arbitrary line

David Epstein is an award-winning writer for the US magazine Sports Illustrated, but he is perhaps better known as the author of "The Sports Gene", a myth-debunking look at "nature versus nurture".

The book details the many physical differences between men and women, including testosterone, which, when you add them all up, explain why unisex sport is a non-starter for most athletic pursuits. As he explains, elite men's running times are about 11% faster than women's, with even bigger differences in jumping and throwing.

 

Do Female Transsexuals have an Advantage?
There are some valid concerns about the physical advantages that male-to-female transsexuals would have competing against women, particular.

Testosterone levels and muscle mass drop considerably after pro-longed hormone therapy and sex-change surgery but the question remains about how much residual advantage the MTF transwoman trains due to her genetic maleness remains and for how long? And although hormone treatments for transgendered athletes certainly diminishes certain differences, skeletal advantages - and possibly lung and heart capacities - are left unchanged.  That could give transsexuals, particularly those having SRS after puberty, with a huge advantage competitive in some sports when even a 1% difference can be the difference between first place and eighth.


The Woman's Tennis Association (WTA) has led other sporting organisations in its acceptance of post-operative male-to-female transsexuals and hermaphrodites born with male genitalia - despite the doubts of some of its members.  Publicised cases include (from left to right) Renee Richards, Andrea Paredes von Roth and Sarah Gronert.


Caster Semenya

Doubts Return

... and then Caster Semenya burst onto the scene.

A junior champion in 2008, the South African teenager took seven seconds off her personal best for 800m over the next nine months, breaking the South African record and setting a world-leading time in the process. The International Association of Athletics Federations (IAAF) felt "obliged to investigate", if only to rule out doping.  Hours before the start of the 800m final at the 2009 World Athletics Championships - a race Semenya would win by a huge margin - it was leaked that the sport's governing body had also asked for a gender test. The findings of the test were never released but she was cleared to compete again in women's athletics, and she was chosen to carry her country's flag during the opening ceremony of the 2012 Summer Olympics in London.

What ever Caster's circumstances, she seems to have triggered increasing reservations at governing bodies such as the IOC as to the extent to which women's sports should be open to transwomen - and other individuals with XY genes. 

These reservations focussed on androgenic hormones - the best known being testosterone.  These are natural or synthetic substances that control the development of male characteristics - everything from the formation of testes, to male pattern baldness.. to strong muscles.  In general, men have higher testosterone levels than women, with gap becoming substantial during puberty.

An IAAF working group, in conjunction with the IOC's Medical Commission, decided that female athletes with more than 10 nanomoles of Testosterone per litre (nmol/L) of blood would be bared from competition unless there were "reasonable grounds" for an exemption.  The AIS condition being an example. 

In April 2011, the new rules came into force. From this moment on, a confidential investigation could be made into any athlete where there were "reasonable grounds". This could be a complaint from a rival, or as a result of an anomaly in a drugs test.

 

Final Thoughts

If MTF reassignment surgery is performed after adolescence and puberty, Renee, Kia and some sports organizations such as the Womens Sports Federation seem to believe (albeit from an interpretation of their different approaches) that transsexuals should be evaluated on a case-by-case basis before being allowed to compete as women. But there is then an implication that transwomen will have to be below a certain age, height, weight or strength before they are allowed to compete as women - and "discrimination" is a word that will inevitably be raised by those that fail the tests.

If the question is posed whether male to female transsexuals can compete in all fairness with other women, the answer is probably "no" for most sports, particularly if SRS is conducted after a normal male puberty. The long term effects of SRS (androgen deprivation) and oestrogen hormone therapy partially reverse some of previous effects of testosterone on the transwomen's body, for example they become much closer to women norms in terms of muscle mass - but even in this category not completely so.

However the real question is whether post-operative transwomen should be allowed to compete as women. The answer here is a resounding yes - as the IOC and other sporting bodies finally recognised after decades of debate.  Slightly surprisingly, three Summer Olympics (2004, 2008, 2012) have since passed without an acknowledged transsexual woman competing. 

Following the IOC's lead, most sporting organisations now allow transwomen to compete in women's sports, indeed they would face legal challenges in many countries if they didn't.  So far no openly transgender woman has reached the very top of her sport, when this happens (and it will) there will undoubtedly be much debate, particularly if the woman in question had previously competed with little success as a man.

 

2016 Update


Former male Olympic decathlon champion Bruce Jenner reappeared as female Caitlyn Jenner in 2015

In January 2016 the International Olympic Committee issued recommendations that transgender athletes should be allowed to compete at the 2016 Rio Olympics without undergoing sex reassignment surgery.  Male-to-female transsexual athletes would only need to prove that their testosterone level had been below a certain cut-off point for at least one year before their first competition.

The new guidelines - which the IOC say have been brought in to adapt to current scientific, social and legal attitudes on transgender issues - are not fixed rules or regulations but are instead designed as recommendations for international sports federations to follow.  

Former IOC medical commission chairman Arne Ljungqvist, who was among the experts involved in drafting the new guidelines, said:

"It has become much more of a social issue than in the past.  We had to review and look into this from a new angle. We needed to adapt to the modern legislation around the world. We felt we cannot impose a surgery if that is no longer a legal requirement."

Under the previous IOC guidelines of 2004, athletes who transitioned from male to female or vice versa were required to have reassignment surgery followed by at least two years of hormone therapy in order to be eligible to compete in their reassigned sex.   However this had not led (as some had feared) to an influx of male-to-female athletes competing in women's sports.   Possibly the lowered thresholds for the determination of sex will again have little actual impact on women's sports.

 


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Last updated: 25 January, 2016