The Uncertain Olympic Future for Trans and Intersex Athletes
The participation of trans and intersex athletes in elite sporting competitions has been controversial for decades, and the debate is centered around testosterone.
Illustration by Grace Wilson
There has never been an out transgender competitor in the Olympic Games. Until 2003, trans people weren't eligible to compete; that year, the International Olympics Committee (IOC) held a meeting in Stockholm, Sweden, to address what was considered a growing controversy at the time. The result of that meeting—called the "Stockholm Consensus on Sex Reassignment in Sports"—provided a framework for allowing trans people to compete in the Olympics for the first time. The rules were restrictive and discriminatory by today's standards—they included requiring hormone replacement therapy for at least two years before competition, legal recognition of the individual's new gender, and mandatory genital reconstructive surgery—but overall the change was lauded as a progressive step forward.
But critics still descended on the decision with disgust and outrage, which particularly focused on male-to-female trans athletes. One former female Olympian lamented the new policy, explaining that women athletes had fought hard for their right to compete in the Olympics; she said trans women—who were essentially men, as she saw it—would spoil these efforts, since trans women must have a natural athletic advantage due to having undergone male puberty. "There's an essential difference between men and women," she said. "Any dummy on the street knows the difference."
Both trans and intersex athletes have historically been forced to undergo pharmaceutical or surgical intervention in order to qualify for the Olympics, and for the last several decades—but particularly in the last ten years—their presence has been a source of controversy: over the effect of hormones on athletes, fair and equal opportunity in sports, athletic advantage, and the dubious prescription of unwanted medical treatment for otherwise healthy people by athletics organizations. As such, IOC officials and medical experts, whose expertise ranged from genetics to sport science and women's and transgender health, took part in another IOC meeting in November of 2015, when the IOC reduced the existing eligibility requirements for both transgender and intersex athletes in advance of the 2016 Olympics now under way in Rio de Janiero. The policy changes that resulted allow transgender men and women to compete in international sporting competitions, including the Olympic Games, with fewer restrictions than ever before; now, trans women athletes are allowed to compete after 12 months of hormone replacement therapy and passing hormone tests, and transgender men have no restrictions at all. Neither is required to undergo genital reconstructive surgery.
Thanks to the decreased IOC restrictions, more trans and intersex athletes were eligible for competition at the 2016 Olympic Games. At an IOC meeting in May, two anonymous trans women athletes were reported be competing in Rio this year. Reports noted that the two were considering coming out prior to the start of the games, but as of now they remain unknown. According to the Daily Mail, the athletes are so distressed by the prospect of their gender history becoming public that they would "probably drop back" if they actually won a medal. (It is unclear whether that means they would plan to intentionally underperform or throw the competition.)
The stigma that drives beliefs like those is perhaps part of the reason that Olympian Caitlyn Jenner is the most prominent face of trans athletics, even though she had not yet transitioned when she won her gold medal in the decathlon in 1976. Slowly, some advocates are trying to change this. Team USA member Chris Mosier is an international competitor in the duathlon, a running and cycling competition that is not currently considered an Olympic sport, and the first out trans man in the United States to make a national sports team. In an interview with Broadly, Mosier outlined the risks that trans athletes take by coming out. "Trans people in general are subject to higher rates of discrimination and violence; in many places it is not safe for trans folks to be out," he said. Though Mosier could have competed professionally without publicly disclosing the fact he is transgender, he has chosen to make his gender history known and in the process become an outspoken leader for trans athletes. He founded the resource site transathlete.com and serves as the executive director of GO! Athletes, a national network of current and former LGBTQ student athletes.
The stakes for trans athletes are high. By competing, Mosier says, they wager "acceptance from their teammates and coaches, sponsorship money, the ability to participate given the rules in their particular sport, and the criticism and scrutiny they will be subjected to simply because they will be the first." When he says, "the first," Mosier is pointing out the historical lack of resources, visibility, and precedent for trans athletes. The political movement for transgender equality has made great achievements in recent years, including the updated IOC guidelines, but before this there has been little support, if any, for trans people embarking on athletic careers.
Chloe is a college athlete in her early 20s and a trans woman. In an interview with Broadly, she explained that, though she would love to eventually qualify for the Olympics someday, she fears that she'll never get that far in her career because of the myriad difficulties facing trans people in sports. In addition to the taxing process of transition, Chloe has faced the discrimination that Mosier mentioned. "I've had those experiences when trying out for college teams," she said. "Bringing up being trans was an instant deal breaker to many of the coaches."
She relates this to the cultural prejudice against trans women, which exists in all aspects of society but is pronounced in athletics in very particular ways. Earlier this year, the Obama administration instructed schools to treat trans students according to their identified gender, allowing them to access facilities like bathrooms and participate in activities like sports programs. But while states like California have passed trans-inclusive policies for athletes, trans students across the US are still fighting for their right to play sports. In May, Fusion reported that Texas recently passed an amendment defining gender in schools—and schools' athletic programs—by one's birth certificate, and that the state, along with ten others, planned to sue Obama over his trans-inclusivity directive.
Photo via Wikimedia Commons
The IOC is a non-profit governing body that calls itself the "supreme authority to the Olympics movement." In addition to protecting athletes against things like discrimination, this authority seeks to "promote Olympism," a merging of sports with cultural and ethical values that they describe as being a "way of life."
The removal of the surgery requirement for trans athletes is a strong example of these values finally moving in the right direction when it comes to trans issues. After the IOC's first meeting regarding the participation of trans athletes in professional sports in 2003, the only trans athletes who could compete without restriction in the years between 2003 and 2016 were those who had sex reassignment surgery before puberty. If a trans athlete was seeking to compete and had undergone puberty, then they were required to have genital reconstructive surgery in addition to hormonal and legal alterations to their gender. They were also required to wait two years after their genital surgery before they would be eligible to compete.
Chloe told me that while she believes hormonal requirements for transgender competitors are logical, surgical requirements are obviously unnecessary and point to cultural phobias around trans bodies rather than to any scientific facts about the relative sportiness of genitals. "The notion that a woman can't be a woman without 'female anatomy' and a man can't be a man without 'male anatomy' is completely ridiculous and only puts transgender individuals in danger," Chloe said. "I feel as time progresses there will be more universal consensus on guidelines that are fair and beneficial to all participants. Slowly, more and more associations and committees seem to be adopting the 'one year on hormone replacement therapy' rule."
Bringing up being trans was an instant deal breaker to many of the coaches.
The new IOC guidelines no longer place any restrictions at all on female-to-male athletes, and the restrictions placed on trans women have been reduced. The concern that trans women will retain masculine athletic advantage as women may contribute to this distinction, but the issue ultimately falls on the purported advantageous effects of testosterone. Without controlling participation based on testosterone levels, experts worry that trans women would have an unfair advantage.
According to the new IOC guidelines, athletes seeking to compete in women's events must have testosterone levels below 10 nmol/L for at least 12 months. (According to a study of elite female athletes conducted in 2014, 99 percent have testosterone levels below 3 nmol/L. If a trans woman has had surgery, her testosterone levels will likely be lower than that; if she is undergoing hormone replacement therapy but has not had surgery, her testosterone levels will be similar to that of a cisgender woman.) Trans women are also required to declare their gender as female and not change their mind "for sporting reasons" for four years.
Joanna Harper is the chief medical physicist at Providence Portland Medical Center, a trans woman, and an athlete. Harper was at the IOC meeting that produced the updated guidelines for trans and intersex players. In an interview with Broadly, she explained that there are actually disadvantages to being a trans woman in sports. In addition to her medical expertise, she knows this from personal experience; within one year of male-to-female hormone replacement therapy (HRT), Harper began running 12 percent slower than she had before. (She says that men run, on average, about 12 percent faster than women over long distances.)
There's an essential difference between men and women. Any dummy on the street knows the difference.
Other features, like height, don't change on HRT, so trans women are most likely going to be taller than the women they're competing against—but that's not necessarily an advantage, either. Harper pointed out that height is a disadvantage in some sports, like gymnastics or bodybuilding. Trans women also lose a great deal of muscle mass on HRT, Harper said, but they do retain some, meaning they're likely to have more muscle than many other women. Though having more muscle is an athletic advantage, Harper says that because many trans women have larger mass than cis women, but typically have testosterone levels even lower than cis women, they could be at a disadvantage as well. She likens women, trans and cis, to cars. "The small car with the small engine can, in many ways, outrun the large car with the small engine," Harper says.
It could also be argued that being trans is a major disadvantage simply because of the incredible amount of discrimination that trans athletes have to deal with. "At games I've been laughed at and made fun of," Chloe said, explaining that both the audience and other players will mock her on the field while she's trying to focus on the game. Chloe's use of the female locker room is protected by law in California, where she lives, and her teammates are all incredibly supportive, so her critics have little power to stop her from participating like any other athlete. But it's still an additional weight to shoulder.
These issues reveal how fraught an attempt at comparison is—not only is it creepy to attempt to outline the pros and cons of being trans, any potential advantage or disadvantage would have to depend on the specific sport and the particular athlete attempting to compete in it.
There has been controversy surrounding the purported advantages of trans athletes for decades, stretching back to 1976, when a trans woman and tennis player named Renee Richards was forbidden from competing in the US Open. In 2013, trans Mixed Martial Arts (MMA) fighter Fallon Fox came out and became the target of critics who were outraged at the prospect of a "man" beating a woman in the ring. MMA fighter and fringe celebrity Ronda Rousey has been one of Fox's most vocal critics, infamously decrying Fox's presumed advantage: "[Fallon Fox] can try hormones, chop her pecker off, but it's still the same bone structure a man has."
As evidenced by the IOC panel that convened last November, and a study released in 2015, which found trans female runners have no advantage over cisgender female runners, medical experts agree that trans women who have hormonally transitioned do not posses an unfair advantage over other female athletes. The critiques around unfair advantage may not be backed up by science, but even if trans women do have advantages here and there, many argue that those advantages are no different than the advantage that someone like Michael Phelps, whose long wingspan has been credited with some of his success, has. All athletes benefit from biological advantages, or suffer from biological disadvantages, in their respective sports.
Trans women aren't the only athletes whose sex has become contested in high stakes sports. Intersex competitors will be the most controversial participants in this year's Olympic games, Harper believes. "There is a very well known intersex athlete named Caster Semenya who is probably going to win the 800 meters [in Rio this year]," she said. Semenya is a runner from South Africa whose sex became scrutinized seven years ago during the world championships, where she first won the 800-meter challenge. Tests ordered by the International Association of Athletics Federations (IAAF) determined that Semenya was intersex, a broad term that encompasses many different iterations of human sex that do not conform to the standard biological gender binary. Intersex people sometimes have genitalia that outwardly reflects their condition, but other times they do not, and only testing will show that there are internal differences in sex characteristics, such as chromosomes or sex organs. The tests on Semenya revealed that she has undescended testes, lacks a womb, and produces high levels of testosterone. She likely has hyperandrogenism, a condition that produces higher than average levels of testosterone in the body. The headlines said Semenya was both a woman and a man; some called her a "hermaphrodite." Her body became sensational news.
In order to compete, Semenya likely began taking medication that would suppress her hormone levels; reporters speculated that this is why her performance dropped. But in 2013, the then-17-year-old Indian athlete Dutee Chand became similarly scrutinized; she was banned from competing against women and was tested for and diagnosed with hyperandrogenism. But she refused to lower her testosterone levels. As reported by USA Today, Chand challenged the IAAF in the Court of Arbitration for Sport (CAS).
Chand claimed that the IAAF restrictions on women with hyperandrogenism "discriminate unlawfully against female athletes," and that the guidelines are "based on flawed factual assumptions about the relationship between testosterone and athletic performance."
Sex testing in sports has a long, sad history. According to an in-depth report by the New York Times Magazine, the practice began in the 1960s, when all international female competitors were briefly required to undergo mandatory genital checks that sometimes involved a "nude parade" before a panel of doctors. It went through several iterations, from physical exams to chromosome testing, until it eventually stopped being standard practice.
When she was first tested, Chand was in residence at the National Institute of Sports, which is controlled by the Sports Authority of India (SAI). There, Chand claims that she was tricked into undergoing sex testing she didn't consent to. She says that Dr. Arun Mendiratta, a member of the medical commission of the Athletics Federation of India (AFI), told Chand that the AFI wanted to create a "high-performance profile" of her, which involved a blood test and checking for diseases. Chand says then that she was told that the nurse who performs the blood tests was unavailable, so they would be doing an ultrasound instead. The AFI denied this in court, claiming Chand had an ultrasound because she had complained of abdominal pains. According to the CAS report, Mediratta has stated that other athletes had made complaints about Chand's appearance, but he insists that the AFI was not intentionally submitting Chand to sex testing. In June of 2014, after the ultrasound Chand was given, the AFI sent a letter to the SAI warning them of "doubts regarding the gender" of Chand, and urging the SAI to conduct further testing prior to Chand's upcoming competitions.
The SAI then subjected Chand to more procedures, including blood tests, another ultrasound, clinical gynecological tests, and an MRI exam. Chand was then banned from competing in the Commonwealth Games. News of her condition went public, making her body a spectacle of national embarrassment, and her life and career media fodder.
Testosterone-based rules should apply to all women.
None of this stopped Chand. She achieved temporary success in court, and the rules requiring medical intervention on intersex athletes have been put on hold as the CAS has ordered the IAAF to "provide evidence to show there was a clear difference between male and female testosterone levels, and how big an advantage the extra testosterone gave hyperandrogenic women," USA Today reported. The IOC's updated guidelines for trans athletes include mention of the Chand ruling, and state that "rules should be in place for the protection of women in sport," encouraging the IAAF to bring sufficient evidence back to CAS "to support the reinstatement of hyperandrogenism rules." In other words, the supreme authority over the Olympic games wants the IAAF to produce scientific proof that intersex female athletes have an athletic advantage over non-intersex women athletes before the regulations requiring the suppression of testosterone in intersex athletes can be reinstated. (They also suggest in their updated guidelines that athletes who register at testosterone levels too high for female competition should be allowed to compete against men.) Dutee Chand is scheduled to compete in the Olympic games in Rio this Friday.
The introduction of this case creates a difficult problem for inclusion: It is ethically dubious to force intersex people to alter their bodies in order to conform to gender standards that they're not otherwise interested in, yet many—including advocates—feel that intersex athletes should be held to the same hormonal standards that both cisgender and trans women athletes are held to.
"If your primary concern is for the human rights of intersex people, then [the CAS] decision [on behalf of Dutee Chand] was a very good thing," Harper told me. She is worried, however, that this decision, while supportive of the rights of intersex people, may also undermine the work that sporting organizations have done to provide fair opportunities for the general population of female athletes. "If your concern is to try to create appropriate sporting categories for women so that potential female athletes have the ability to compete and succeed at the highest levels, then this is a very bad decision," she said.
"Testosterone-based rules should apply to all women," Harper continued. "If you consider the vast majority of female athletes, plus the rights of those of us who are different, both transgender and intersex, I think that [the current testosterone level limit of 10 nmol/L] is a reasonable compromise."
Others suggest that any advantage that intersex athletes may have are irrelevant. On Wednesday, Newsweek argued on behalf of Semenya and Chand, stating that their hypothetical advantages "would not be unfair. This is because setting a limit on hyperandrogenism and singling it out from other biological variations that may confer an advantage is—at best—an inconsistent policy. There are plenty of other variations—biological and genetic alike—that are not regulated by the IAAF and, even though advantageous for athletic performance, are not considered unfair for competition."
The Chand case won't be closed for awhile, Harper pointed out. Until then, this issue is still incredibly controversial, especially because intersex athletes are now competing in the Olympic Games in Rio without being required to suppress their naturally high levels of testosterone. Caster Semenya is scheduled to run on August 17, and critics are already saying she will "easily win," hypothesizing that since she doesn't have to take medication anymore and her testosterone levels are subsequently going to register higher than both transgender and cis female athletes, who are required to have levels below 10nmol/L.
Like Harper, Chloe believes that any woman with irregular hormone levels who is participating in "binary" sports should be required to undergo hormone replacement therapy in order to suppress their testosterone level. She points out a potential solution, though it seems unlikely to happen in our lifetimes. "Perhaps more non-binary sports teams will be formed in the future and we can have more categories than just 'men and women,'" Chloe said. "Not everyone considers themselves to be a man or woman, and they too should have an opportunity to participate in sports."