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Hamilton B, Brown A, Montagner-Moraes S, Comeras-Chueca C, Bush PG, Guppy FM, Pitsiladis YP. Strength, power and aerobic capacity of transgender athletes: a cross-sectional study. Br J Sports Med 2024; 58:586-597. [PMID: 38599680 PMCID: PMC11137468 DOI: 10.1136/bjsports-2023-108029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The primary objective of this cross-sectional study was to compare standard laboratory performance metrics of transgender athletes to cisgender athletes. METHODS 19 cisgender men (CM) (mean±SD, age: 37±9 years), 12 transgender men (TM) (age: 34±7 years), 23 transgender women (TW) (age: 34±10 years) and 21 cisgender women (CW) (age: 30±9 years) underwent a series of standard laboratory performance tests, including body composition, lung function, cardiopulmonary exercise testing, strength and lower body power. Haemoglobin concentration in capillary blood and testosterone and oestradiol in serum were also measured. RESULTS In this cohort of athletes, TW had similar testosterone concentration (TW 0.7±0.5 nmol/L, CW 0.9±0.4 nmol/), higher oestrogen (TW 742.4±801.9 pmol/L, CW 336.0±266.3 pmol/L, p=0.045), higher absolute handgrip strength (TW 40.7±6.8 kg, CW 34.2±3.7 kg, p=0.01), lower forced expiratory volume in 1 s:forced vital capacity ratio (TW 0.83±0.07, CW 0.88±0.04, p=0.04), lower relative jump height (TW 0.7±0.2 cm/kg; CW 1.0±0.2 cm/kg, p<0.001) and lower relative V̇O2max (TW 45.1±13.3 mL/kg/min/, CW 54.1±6.0 mL/kg/min, p<0.001) compared with CW athletes. TM had similar testosterone concentration (TM 20.5±5.8 nmol/L, CM 24.8±12.3 nmol/L), lower absolute hand grip strength (TM 38.8±7.5 kg, CM 45.7±6.9 kg, p=0.03) and lower absolute V̇O2max (TM 3635±644 mL/min, CM 4467±641 mL/min p=0.002) than CM. CONCLUSION While longitudinal transitioning studies of transgender athletes are urgently needed, these results should caution against precautionary bans and sport eligibility exclusions that are not based on sport-specific (or sport-relevant) research.
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Affiliation(s)
- Blair Hamilton
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
- School of Applied Sciences University, Brighton, UK
| | - Andrew Brown
- School of Applied Sciences University, Brighton, UK
| | | | | | - Peter G Bush
- School of Applied Sciences University, Brighton, UK
| | | | - Yannis P Pitsiladis
- Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Rome, Italy
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, Hong Kong SAR
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Hunter SK, S Angadi S, Bhargava A, Harper J, Hirschberg AL, D Levine B, L Moreau K, J Nokoff N, Stachenfeld NS, Bermon S. The Biological Basis of Sex Differences in Athletic Performance: Consensus Statement for the American College of Sports Medicine. Med Sci Sports Exerc 2023; 55:2328-2360. [PMID: 37772882 DOI: 10.1249/mss.0000000000003300] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
ABSTRACT Biological sex is a primary determinant of athletic performance because of fundamental sex differences in anatomy and physiology dictated by sex chromosomes and sex hormones. Adult men are typically stronger, more powerful, and faster than women of similar age and training status. Thus, for athletic events and sports relying on endurance, muscle strength, speed, and power, males typically outperform females by 10%-30% depending on the requirements of the event. These sex differences in performance emerge with the onset of puberty and coincide with the increase in endogenous sex steroid hormones, in particular testosterone in males, which increases 30-fold by adulthood, but remains low in females. The primary goal of this consensus statement is to provide the latest scientific knowledge and mechanisms for the sex differences in athletic performance. This review highlights the differences in anatomy and physiology between males and females that are primary determinants of the sex differences in athletic performance and in response to exercise training, and the role of sex steroid hormones (particularly testosterone and estradiol). We also identify historical and nonphysiological factors that influence the sex differences in performance. Finally, we identify gaps in the knowledge of sex differences in athletic performance and the underlying mechanisms, providing substantial opportunities for high-impact studies. A major step toward closing the knowledge gap is to include more and equitable numbers of women to that of men in mechanistic studies that determine any of the sex differences in response to an acute bout of exercise, exercise training, and athletic performance.
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Affiliation(s)
- Sandra K Hunter
- Exercise Science Program, Department of Physical Therapy, and Athletic and Human Performance Center, Marquette University, Milwaukee, WI
| | | | - Aditi Bhargava
- Department of Obstetrics and Gynecology, Center for Reproductive Sciences, University of California, San Francisco, CA
| | - Joanna Harper
- Loughborough University, Loughborough, UNITED KINGDOM
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, SWEDEN
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kerrie L Moreau
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, and Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, CO
| | - Natalie J Nokoff
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nina S Stachenfeld
- The John B. Pierce Laboratory and Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Stéphane Bermon
- Health and Science Department, World Athletics, Monaco and the LAMHESS, University Côte d'Azur, Nice, FRANCE
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Martowicz M, Budgett R, Pape M, Mascagni K, Engebretsen L, Dienstbach-Wech L, Pitsiladis YP, Pigozzi F, Erdener U. Position statement: IOC framework on fairness, inclusion and non-discrimination on the basis of gender identity and sex variations. Br J Sports Med 2023; 57:26-32. [PMID: 36526281 DOI: 10.1136/bjsports-2022-106386] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Madeleine Pape
- International Olympic Committee, Lausanne, Switzerland .,Institute of Sports Sciences, University of Lausanne, Lausanne, Switzerland
| | | | - Lars Engebretsen
- International Olympic Committee, Lausanne, Switzerland.,University of Oslo, Oslo, Norway
| | - Lenka Dienstbach-Wech
- Department of Orthopaedics, Spine and Trauma Surgery, Hospital zum Heiligen Geist Frankfurt, Frankfurt, Germany
| | - Yannis P Pitsiladis
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Fabio Pigozzi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Uğur Erdener
- International Olympic Committee, Lausanne, Switzerland.,Department of Opthalmology, Hacettepe University, Ankara, Turkey.,World Archery, Lausanne, Switzerland
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Pigozzi F, Bigard X, Steinacker J, Wolfarth B, Badtieva V, Schneider C, Swart J, Bilzon JLJ, Constantinou D, Dohi M, Di Luigi L, Fossati C, Bachl N, Li G, Papadopoulou T, Casasco M, Janse van Rensburg DC(C, Kaux JF, Rozenstoka S, Casajus JA, Zelenkova I, Ak E, Ulkar B, Arroyo F, Ionescu A, Pedrinelli A, Miller M, Singleton P, Shroff M, Webborn N, Barrett J, Hamilton B, Geistlinger M, Beltrami G, Migliorini S, Dienstbach-Wech L, Bermon S, Pitsiladis YP. Joint position statement of the International Federation of Sports Medicine (FIMS) and European Federation of Sports Medicine Associations (EFSMA) on the IOC framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. BMJ Open Sport Exerc Med 2022; 8:e001273. [PMID: 35127133 PMCID: PMC8739444 DOI: 10.1136/bmjsem-2021-001273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The IOC recently published its framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. This framework is drafted mainly from a human rights perspective, with less consideration for medical/scientific issues. The framework places the onus for gender eligibility and classification entirely on the International Federations (IFs), even though most will not have the capacity to implement the framework. The position of no presumption of advantage is contrary to the 2015 IOC consensus. Implementation of the 2021 framework will be a major challenge for IFs that have already recognised the inclusion of trans and women athletes with differences of sexual development (DSD) using a scientific/medical solution. The potential consequences for sports that need to prioritise fairness or safety could be one of two extremes (1) exclusion of all transgender or DSD athletes on the grounds of advantage or (2) self-identification that essentially equates to no eligibility rules. Exclusion of all transgender or DSD athletes is contrary to the Olympic charter and unlawful in many countries. While having no gender eligibility rules, sport loses its meaning and near-universal support. Athletes should not be under pressure to undergo medical procedures or treatment to meet eligibility criteria. However, if an athlete is fully informed and consents, then it is their free choice to undergo carefully considered or necessary interventions for gender classification for sport to compete fairly and safely in their chosen gender. Free choice is a fundamental human right, but so is the right to fair and safe competition.
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Affiliation(s)
- Fabio Pigozzi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
- Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Xavier Bigard
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Union Cycliste Internationale (UCI), Aigle, Switzerland
| | - Juergen Steinacker
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, Ulm University Hospital, Ulm, Germany
| | - Bernd Wolfarth
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Sports Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
| | - Victoriya Badtieva
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Moscow Research and Practical Center for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation
| | - Christian Schneider
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Orthopaedic Center Theresie, Munich, Germany
| | - Jeroen Swart
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - James Lee John Bilzon
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department for Health, University of Bath, Bath, UK
| | - Demitri Constantinou
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Centre for Exercise Science and Sports Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Michiko Dohi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Sports Medical Center, Japan Institute of Sport Sciences, Tokyo, Japan
| | - Luigi Di Luigi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Chiara Fossati
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
- Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Norbert Bachl
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Institute of Sports Science, University of Vienna, Vienna, Austria
- Austrian Institute of Sports Medicine, Vienna, Austria
| | - Guoping Li
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- National Institute of Sports Medicine, Beijing, China
| | - Theodora Papadopoulou
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
| | - Maurizio Casasco
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- FIMS Collaborating Center of Sports Medicine, Institute of Sports Medicine in Milan (Istituto di Medicina dello Sport di Milano), Milano, Italy
| | - Dina Christina (Christa) Janse van Rensburg
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Medical Board Member, World Netball, Manchester, UK
| | - Jean-François Kaux
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- SportS2, Liège University and University Hospital of Liège, Liège, Belgium
| | - Sandra Rozenstoka
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- FIMS Collaboration Centre of Sports Medicine, Sports laboratory, Riga, Latvia
| | - Jose-Antonio Casajus
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- GENUD research group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Irina Zelenkova
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- GENUD research group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Emre Ak
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- FIMS Collaborating Center of Sports Medicine, Gloria Sports Arena Belek, Antalya, Turkey
| | - Bulent Ulkar
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Sports Medicine Department, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Francisco Arroyo
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- FIMS Collaborating Center of Sports Medicine, Guadalajara, Mexico
| | - Anca Ionescu
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Sports Medicine, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - André Pedrinelli
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Orthopaedics, University of São Paulo Medical School, São Paulo, Brazil
| | - Mike Miller
- World Olympians Association (WOA), Lausanne, Switzerland
| | | | - Malav Shroff
- World Olympians Association (WOA), Lausanne, Switzerland
| | - Nick Webborn
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
- Medical Committee, International Paralympic Committee (IPC), Bonn, Germany
| | - James Barrett
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Blair Hamilton
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
- Centre for Stress and Age-related Disease, University of Brighton, Brighton, UK
| | - Michael Geistlinger
- Department of Public, International and European Law, Unit International Law, University of Salzburg, Salzburg, Austria
| | - Gianfranco Beltrami
- Medical Commission, World Baseball Softball Confederation, Pully, Switzerland
- Faculty of Sport Sciences, University of Parma, Parma, Italy
| | | | - Lenka Dienstbach-Wech
- Department of Orthopaedics, Spine and Trauma Surgery, Hospital zum Heiligen Geist Frankfurt, Frankfurt, Germany
| | - Stéphane Bermon
- World Athletics, Health and Science Department, Monaco
- LAMHESS, Université Côte d’Azur, Nice, France
| | - Yannis P Pitsiladis
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
- Centre for Stress and Age-related Disease, University of Brighton, Brighton, UK
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