Gender identity and sport: is the playing field level?

World Athletics regulations unfairly affect female athletes with differences in sex development

World Athletics have introduced regulations preventing female athletes with certain differences in sex development from competing in the female category. We argue these regulations are not justified and should be removed. Firstly, we examine the reasoning and evidence underlying the position that these athletes have a substantial mean difference in performance from other female athletes such that it constitutes an advantage, and argue it is not sufficient. Secondly, if an advantage does exist, it needs to be demonstrated it is unfair. We argue the advantage would not be unfair because to say otherwise relies on a presupposition about whether these athletes are female, which involves contradictory and inconsistent definitions of sex. Thirdly, we contend that even if it is established that there is an advantage and it is unfair, the response of requiring athletes to take testosterone-suppressing medication is not appropriate and is unfair.

How is the Topic of Intersex Athletes in Elite Sports Positioned in Academic Literature Between January 2000 and July 2022? A Systematic Review

BACKGROUND

Within the topic of intersex athletes in elite sports, science has become a decisive factor in decision- and policy-making. However, in the academic literature approaches to this topic vary. An overview of these approaches is proposed to provide better insight into relevant aspects and underlying values and may serve as a starting point on the path toward a solid solution of the question of categorization of intersex athletes in elite sporting competition.

OBJECTIVE

This systematic review aims to discover how the topic of intersex elite athletes is positioned in the academic literature from January 2000 to July 2022 from a neutral perspective.

METHODS

A comprehensive search in eleven databases using the search terms [intersex* and sport*] yielded 87 articles. A qualitative content analysis was conducted to find all authors' statements including perspectives on intersex athletes and proposals for solutions. Underlying values were extracted and connected to each other during axial coding.

RESULTS

The results provide an overview of the sometimes-contradictory perspectives toward intersex elite athletes and proposals for solutions. Three core values were distilled: social justice for intersex elite athletes, competition fairness, and evidence-based practice. The authors' statements disclose an interaction/conflict between social justice and competition fairness.

CONCLUSIONS

The results raise an important discussion on the role of science within the topic of intersex elite athletes. A multidisciplinary approach including scientists and other experts is suggested to find an appropriate solution. Additionally, more awareness on intersex variations is needed for a better overall understanding and to ensure a respectful approach for everyone involved.

Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage

Males enjoy physical performance advantages over females within competitive sport. The sex-based segregation into male and female sporting categories does not account for transgender persons who experience incongruence between their biological sex and their experienced gender identity. Accordingly, the International Olympic Committee (IOC) determined criteria by which a transgender woman may be eligible to compete in the female category, requiring total serum testosterone levels to be suppressed below 10 nmol/L for at least 12 months prior to and during competition. Whether this regulation removes the male performance advantage has not been scrutinized. Here, we review how differences in biological characteristics between biological males and females affect sporting performance and assess whether evidence exists to support the assumption that testosterone suppression in transgender women removes the male performance advantage and thus delivers fair and safe competition. We report that the performance gap between males and females becomes significant at puberty and often amounts to 10-50% depending on sport. The performance gap is more pronounced in sporting activities relying on muscle mass and explosive strength, particularly in the upper body. Longitudinal studies examining the effects of testosterone suppression on muscle mass and strength in transgender women consistently show very modest changes, where the loss of lean body mass, muscle area and strength typically amounts to approximately 5% after 12 months of treatment. Thus, the muscular advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed. Sports organizations should consider this evidence when reassessing current policies regarding participation of transgender women in the female category of sport.

Unwarranted and Invasive Scrutiny: Caster Semenya, Sex-Gender Testing and the Production of Woman In ‘Women’s’ Track and Field

This article discusses the imbrication of racialising and sexualising scientific practices of gender testing and verification in elite athletics competition, and their intersection with social politics, using as a theoretical frame the feminist, anti-racist work of Hortense Spillers (2003), Judith Butler (1990, 1993a, 1993b, 2004) and Anne Fausto-Sterling (2000), among others. It traces the practice of sex-gender testing of ‘women’ at sanctioned International Association of Athletics Federations (IAAF) and International Olympic Committee (IOC) track and field competitions in order to contextualise South African middle-distance runner Caster Semenya’s experiences at the 2009 Berlin World Championships and the subsequent spectacularisation of her body through the discursive practices of representation.

Something’s Got to Give: Reconsidering the Justification for a Gender Divide in Sport

The question of whether transgender athletes should be permitted to compete in accordance with their gender identity is an evolving debate. Most competitive sports have male and female categories. One of the primary challenges with this categorization system, however, is that some transgender athletes (and especially transgender women) may be prevented from competing in accordance with their gender identity. The reason for this restriction is because of the idea that transgender women have an unfair advantage over their cisgender counterparts; this is seen as a problem since sports are typically guided a principle called ‘the skill thesis’, which suggests that sports are supposed to determine who is most skillful by maintaining a fair starting point. In this paper, I argue that if the skill thesis ought to be maintained and there continues to exist no conclusive evidence in support of unfair advantages possessed by trans women, then we may want to re-consider the gender binary in sport. Rather than having male/female categories, it may make more sense to categorize athletes based other sport-specific factors (e.g., height, weight, etc.). This may help to maintain the skill thesis while at the same time removing potentially unfair and discriminatory barriers against transgender athletes.

Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies

Background

Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation.

Objective

To the authors’ knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature.

Method

Eight research articles and 31 sport policies were reviewed.

Results

In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport’s policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based.

Conclusion

Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.

Awakening to the politics of food: Politicized diet as social identity

In this qualitative study, the process of developing a politicized identity around diet was explored through a social psychological lens. Applying one of the most influencial models of group identity development proposed by Cross (1978) in which an "encounter" experience spurs an awakening into a politicized identity, we asked 36 participants who followed alternative diets due to political reasons to describe their unique encounter experiences that brought them to their politicized awakening. Their self-identified diets included pescetarian, vegetarian, vegan, raw, non-GMO/organic, and reduced meat consumption. Participants described the rationale for their diets, their "encounter" or awakening to their politicized diets, and whether they viewed their diet as a part of their identity. Using thematic analysis, we identified four key types of encounters that sparked their politicization: a series of integrated events, exposure to educational materials, a direct visceral emotional experience, and guidance from a role model. We discuss the results with regard to the politics of food, the nature of the politicized dieter's identity as part of a minority food culture, and the difficulties of engaging in political action through one's diet. The underexplored benefits of applying social psychological theories of identity to research on dietary subcultures is also discussed.

Natural selection for genetic variants in sport: the role of Y chromosome genes in elite female athletes with 46,XY DSD

At present, it is widely assumed that hyperandrogenism in female athletes confers an unfair competitive advantage. This view is perpetuated in current regulations governing eligibility of female athletes with hyperandrogenism to compete, which identify testosterone levels in the male range as the critical factor. Detailed evidence is presented here for the first time that genes for stature (and possibly other genes) on the Y chromosome are responsible for the increased frequency of 46,XY disorder of sex development (46,XY DSD) among elite female athletes identified by eligibility tests. In many cases, androgens are non-functional or, alternatively, absent and therefore testosterone cannot be responsible for their athletic success. Genetic variation has a major role in the selection of individuals for training and success in competition; however, this variation is not grounds for determining who should compete in athletic events. There is no convincing evidence to support the view that hyperandrogenism is associated with performance advantage in female athletes. Current time-consuming regulations may lead to the unwelcome resurgence of innuendo in the media and coercion of female athletes into accepting gonadectomy and other treatments to which they might otherwise not have been subjected. These regulations should be withdrawn on the grounds that they are not supported scientifically, are discriminatory towards women and place some female athletes at risk of unnecessary and potentially harmful investigations. Improved understanding about genetic factors that lead to selection in sport should offer reassurance that women with hyperandrogenism possess no physical attribute relevant to athletic performance that is neither attainable, nor present in other women.

Policing the boundaries of sex: a critical examination of gender verification and the Caster Semenya controversy

On August 19, 2009, Caster Semenya, South African track star, won a gold medal in the women's 800-meter event. According to media reports, on the same day, the International Association of Athletics Federations (IAAF) ordered Semenya to undergo gender verification testing. This article critically assesses the main concepts and claims that undergird international sport organizations' policies regarding "gender verification" or "sex testing." We examine the ways in which these policies operate through several highly contested assumptions, including that (a) sex exists as a binary; (b) sport is a level playing field for competitors; and (c) some intersex athletes have an unfair advantage over women who are not intersex and, as such, they should be banned from competition to ensure that sport is a level playing field. To conclude, we make three recommendations that are consistent with the attainment of sex and gender justice in sport, which include acknowledging that myriad physical advantages are accepted in sport, recognizing that sport as a level playing field is a myth, and eliminating sex testing in sport.

Testosterone and sport: current perspectives

Testosterone and other anabolic-androgenic steroids enhance athletic performance in men and women. As a result, exogenous androgen is banned from most competitive sports. However, due to variability in endogenous secretion, and similarities with exogenous testosterone, it has been challenging to establish allowable limits for testosterone in competition. Endogenous androgen production is dynamically regulated by both exercise and winning in competition. Furthermore, testosterone may promote athletic performance, not only through its long-term anabolic actions, but also through rapid effects on behavior. In women, excess production of endogenous testosterone due to inborn disorders of sexual development (DSD) may convey a competitive advantage. For many years, female competitors have been subject to tests of sexual genotype and phenotype known as gender verification. Although gender verification has not identified any normal man competing as a woman, this process has identified women athletes with DSD. As understanding of DSD has expanded in recent years, women with DSD are increasingly able to continue athletic competition.

Gender verification: a term whose time has come and gone

The process of testing to determine gender in putatively female athletes was developed in order to prevent cheating, but has devolved instead into a clumsy mechanism for detecting disorders of sexual development (DSD's). In over thirty years of compulsory testing, individuals with DSD's have been stigmatized and some have been denied the right to compete, although frequently their condition provided no competitive advantage. More recent guidelines require testing only on a case-by-case basis; the South African runner Caster Semenya was the first major test of this policy, and her experience points to the need for a more sensitive and confidential process. In addition, her case dramatizes the inadequacy of the term "gender verification." Gender identity is a complex entity and resists simple classification. Sports authorities may set guidelines for who can compete, but they should refrain from taking on themselves the authority to decide who is and who is not a female.

Beyond the Caster Semenya controversy: the case of the use of genetics for gender testing in sport

Caster Semenya won the eight-hundred-meter title in the Berlin World Athletics Championships in 2009. Few hours after, Caster was at the center of a harsh contestation on gender. The International Association of Athletics Federations started an investigation, which was not respectful of her privacy. Caster's case highlights the need for an improvement in the awareness of genetic counseling principles amongst professionals, the public and various stakeholders. We critically examine the historical steps of gender verification in the Olympics, the violation of genetic counseling principles in Caster's case and outline some reflections on the complexity of the genetics of Disorders of sex development (DSD). Variability in both genotypes and phenotypes in DSD may not allow any etiological or functional classification at this point in time that could permit uncontroversial gender verification for fairer sport participation. We strongly suggest revisiting the pertinence of gender verification, and the process whereby this is done.

The science of sex verification and athletic performance

The division of athletes into male and female categories for competition is a widely accepted practice and is ordinarily straightforward, requiring no intervention from authorities. However, for reasons ranging from deliberate cheating to complex medical conditions resulting in ambiguous development of sex organs, the controversy of sex verification in athletic events has existed for 70 years. Testing procedures, initially implemented to prevent cheating by men masquerading as women, have produced humiliating outcomes for women athletes who were often for the first time confronted with the possibility that they have one of the disorders of sex development. Sporting authorities have and continue to formulate position stands for the management of such cases. An important missing component in this debate is the sound scientific evidence to determine (a) whether a performance advantage actually exists and (b) how large it might be. The division of competition into separate categories and the large difference in sporting performance between male and female necessitate that sport-governing bodies define the boundaries between the sexes in a just and fair manner for all participating athletes. This review will therefore provide the historical context of the debate and aim to discuss relevant physiological and performance aspects of the sex verification process.