For the past three years I have been working with a family practice doctor who specializes in the treatment of transgender patients. It is a fascinating branch of medicine that I never would have considered studying until I was actively involved in treating that demographic. In recent months there has been an ethical debate regarding the inclusion of transgender women (biological males transitioning to be female) in the female category of sports. The argument that frequently surfaces is that the previous presence of testosterone in transgender women adds an unfair advantage to their athletic performance.
The three hormones used to treat gender dysphoria in male to female patients are estradiol, progesterone, and spironolactone, but the one I will focus on is spironolactone. Spironolactone is used for a variety of medical reasons--in transgender treatment it is used as a testosterone suppressor. Androgens are hormones that contribute to growth and reproduction, in males it is known as testosterone. Spironolactone is used to suppress testosterone because it is an antiandrogen. Physiologically this means that spironolactone binds to the androgen receptors in the body instead of testosterone binding. This means that testosterone can’t bind to the androgen receptors, which leads to a decrease in testosterone because it is no longer being metabolized in the body.
After two years of spironolactone treatment it is expected that a patient’s testosterone level stays within normal female range (2-80 ng/dl) as long as they stay on the regimen. This implies, biologically speaking, they no longer have more testosterone in their body than a cisgendered female athlete. With that being said, if someone has been on hormones for at least 3 years and they have testosterone labs stating their levels are within normal female range, why should they not be allowed to compete? Hilton and Lundberg’s article in The Journal of Sports Medicine argues that the muscle mass and strength one gains during puberty significantly impacts future athletic performance. They found that the performance gap between males and females becomes significant at puberty and often amounts to 10–50% depending on the sport. Therefore, those who transition after puberty do not lose these muscular advantages (Hilton and Lundberg, 2021).
Ultimately, the obvious dilemma becomes whether it is just to allow a subset of athletes with a biological advantage to compete with the gender they identify as. Due to the increased number of transgender athletes this debate has become a hot button topic and warrants further discussion.
Hilton, E. N., & Lundberg, T. R. (2021). Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage. Sports medicine (Auckland, N.Z.), 51(2), 199–214. https://doi.org/10.1007/s40279-020-01389-3
This is a really interesting topic, Jenai. I agree that there are many dilemmas when it comes to transgender athletes and competing against the opposite biological sex. Many argue that there are physical differences between males and females, which could pose problems when a transgender female competes against cisgender females. My group’s independent project is looking at grip strength and there are numerous articles which demonstrate that men and women vary significantly in their grip strength, an argument for transgender physical advantage. On the other hand, Jones et al., concluded that there is no consistent research that transgender athletes have a physical advantage at any stage in their transition. The research is definitely not conclusive. We know that mental states and psychology is crucial in athletic performance, and I think it would be interesting if a study looked at the psychology of cisgender athletes while competing against transgender athletes and seeing if it alters their performance in any way.
ReplyDeleteJones, B. A., Arcelus, J., Bouman, W. P., & Haycraft, E. (2017). Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies. Sports medicine (Auckland, N.Z.), 47(4), 701–716. https://doi.org/10.1007/s40279-016-0621-y.