Transgender Athletes Could Be At A Physical Disadvantage, New Research Shows

Transgender athletes could be at a physical disadvantage compared to their cisgender counterparts, challenging claims that serve to exclude transgender athletes from participation in sport spaces that coincide with their gender identity, a new report suggests. A recent cross-sectional study examined the athletic capabilities and potential differences among trans and cisgender athletes. This investigation was the first to be funded by the International Olympic Committee (IOC) on the subject and marks the first analysis on athletes who have undergone gender-affirming hormone therapy.

The study, which was published earlier this month in the British Journal of Sports Medicine, a leading peer-reviewed journal in sports medicine, examined the athletic capabilities of 35 transgender athletes compared to 40 cisgender athletes. The study assessed cardiovascular performance, strength, and lower-body power among 23 transgender women, 12 transgender men, 21 cisgender women, and 19 cisgender men. All transgender participants had undergone hormone therapy for over a year, and both cisgender and transgender participants were actively engaged in competitive sports or underwent physical training at least three times weekly.

Significant Findings:

• Transgender women performed worse than cisgender women in tests measuring lower-body strength.
• Transgender women performed worse than cisgender women in tests measuring lung function.
• Transgender women had a higher percentage of fat mass, lower fat-free mass, and weaker handgrip strength compared to cisgender men.
• Transgender women’s bone density was found to be equivalent to that of cisgender women, which is linked to muscle strength.
• There were no meaningful differences found between the two groups’ hemoglobin profiles. Hemoglobin (Hb) plays a crucial role in athletic performance by facilitating improved oxygen delivery to muscles. Elite endurance athletes may exhibit up to a 40% higher level of Hb compared to untrained individuals. Moreover, heightened levels of Hb typically correlate with enhanced aerobic performance.

Similar findings have been echoed in previous reporting. According to a recent report that generated an in-depth review of all English-language scientific literature (published between 2011-2021) about transgender (trans) women athlete participation in elite sport, several key conclusions coincide with findings from the IOC funded study, including:

• Biomedical factors such as lung size, bone density, and hip-to-knee joint angle (q-angle) are not indicative of athletic prowess.
• Testosterone levels do not predict athletic performance or overall athleticism.
• Conversely, social elements such as nutrition, training regimen, and equipment accessibility significantly influence an athlete's performance, but are frequently disregarded in policy formulation.
• It's imperative to integrate both biomedical and social scientific insights into policy-making processes. However, there's a tendency to prioritize biomedical research excessively, which can compromise the overall well-being of athletes.

According to Anna Baeth, director of research with Athlete Ally, “The science is murky when it comes to specific hormones like testosterone and trans women athletes — primarily because no study, until this one, have examined trained athletes who identify as transgender. What does remain clear is that there are hundreds of factors that impact athletic performance, especially social ones. If governing bodies are serious about creating better and more opportunities for women, their focus should be on the numerous, proven research which consistently finds unequal treatment of women’s sports in participation opportunities, funding and resources, access to facilities and infrastructure, and media coverage.”

Transgender athletes frequently encounter a range of barriers to inclusion and participation in athletic activities. A notable challenge to inclusion is the absence of comprehensive policies and regulations that facilitate the involvement of transgender athletes in competitive sports. As a result, the research team, among them a member of the IOC’s Medical and Scientific Commission, concluded that sporting federations should refrain from hastily banning transgender women from competing in the women’s category, advocating for additional research tailored to each sport and additional longitudinal investigations. You can read the full open-access publication in the British Journal of Sports Medicine here.