What Is A Woman

Transgenders In Women's Sports

The inability of a black, female US Supreme Court Justice candidate at a congressional hearing last year to define a woman was astounding, to say the least, to most Americans.  However, this should be understood in the context of controversial gender identities. The Woke movement has been lamenting about the discriminatory and bad treatment of transgender and gay people.  World sports organizations, including the International Olympics Committee, has allowed transgender women to compete against women born as female who identify as women (cisgender women) largely based on testosterone hormone levels, but has changed the criteria several times in the past decade.  Eighteen states in the US have now banned transgender women from competing against girls and women in sanctioned educational and women’s sports.  That ban was challenged recently in a West Virginia court with a federal judge deciding that a person who goes through puberty as a male has innate physical advantages over cisgender women in competitive sports, regardless of hormone supplements.

Physical Variants By Gender

The goal of fair competition in athletics is long standing, including the recognition that biological males, on average, have superior physical strength and other advantages over biological women.  During puberty males develop longer and denser bones, more muscle mass, strength, speed, height and lung capacity than females.   The typical biologic male has a circulating testosterone level ranging from 7.7 to 29.4 nmol/L.  Typical adult testosterone levels for women born as females is 0.12 to 1.79 nmol/L.

Gender differences in muscle mass depends on many factors, including height, ethnicity and fitness level, so is more complex to measure.   Muscle mass includes skeletal, smooth and cardiac muscles and is considered part of lean body mass.   Skeletal muscle is important for mobility, balance and strength and is a sign of physical performance and health.  Depending on body composition, a person can have low or high muscle mass with low or high body fat. Muscle mass is naturally lost with aging and changes in hormonal levels.  Exercise and good nutrition help to preserve muscle mass with aging, which generally has positive health effects.  Typically, the more muscle mass a person has, the less vulnerable they are to injury, chronic disease and early death. 

A 2000 study published in the Journal of Applied Physiology measured the muscle mass percentages of 468 men and women and is probably the most accurate study using magnetic resonance imaging for precise and reliable measurements (Journals.physiology.org).  The study employed a whole body MRI protocol to determine skeletal muscle (SM) mass and distribution.  The subjects were healthy adults (men = 268; women  = 200) and none were taking hormone replacement therapy. Subjects were recruited from hospital employees, students at local universities, and the general public through fliers and local media.  Sixty-seven percent of the subjects were Caucasian, 17% were African-American, 8% were Asian and 7% were Hispanic.

Men had significantly more SM in comparison to women in both absolute terms (33 kg vs 21 kg) and relative to body mass (38.4 vs 30.6%).  The gender differences were greater in the upper (40%) than lower (33%) body. Weight and height explained around 50% of the variance in SM mass between men and women.  Age related decreases in SM mass was primarily attributed to a decrease in lower body SM.

The median SM mass findings for men:

Age         Total kg    Relative %    Lower Body   Upper

18-29        33.7           42.3                18.5            14.3                      

30-39        34.0            39.1                18.7            14.7

40-49        33.5            37.1                18.3            14.1

50-59        31.4            35.1                17.3            13.5

60-69        30.2            33.8                16.7            12.8

70+           27.8            36.0                13.8            13.5

All men     33.0            38.4                18.1            14.1

The median SM mass findings for women:

18-29         21.8             34.1                12.5            8.7

30-39         21.6             30.6                12.7            8.5

40-49         21.4             29.2                12.7            8.4

50-59         20.9             29.1                12.0            8.3

60-69         18.4             27.3                10.5            7.5

Women 21.0            30.6                12.2            8.4     

 

Several transgender women who competed athletically in sports before and after taking hormone therapy have reported that their timed scores or weights lifted decreased some after taking testosterone reducing hormones.  This claim has been used to justify full and fair rights to compete against cisgender women athletes.  However, their relative ratings when competing against men were much lower than against women, indicating a clear advantage.  Studies have documented some lessening of strength as testosterone levels drop, but not to the level of cisgender women athletes.

The average circulating level of female Olympic athletes is around 3 nmol, according to the International Association of Athletes Foundation (IAAF).  All competitors are tested for testosterone levels for the objective of protecting women’s sports.   A couple of cisgender women who had not taken any hormone treatment tested too high and were excluded from competing until they took hormone reducing drugs.  This highlights some of the variability and range of natural born sex organs. 

For example, around 1.7 percent of the population is biologically intersex.  Intersex is a term describing naturally born anatomies that are not strictly male or female binary.  It results from a wide variety of situations including XXY chromosomes instead of XX for female and XY for males.  Other intersex people may have both ovarian and testicular tissues, both male and female external genitals or a male/female combination of internal organs. 

Doctors and parents notice immediately if a newborn’s genitals look different.  They decide what sex the infant shall be recorded as having and sometimes do corrective surgery.    Surgical procedures to modify the sex organs are not considered as necessary for a medical problem however since it is a natural variant.   They may also be given hormones to make them fit into a male or female category as they go through puberty.   Other times the intersex condition is unknown until puberty and does not necessarily match the sexual identity assigned at birth.    With current trends of sexual identity activism, there are growing numbers of people who believe that no medical interventions should be done until the intersex person is old enough to decide for themselves if they want treatment or surgery.

Historical Accommodations For Transgender People In Sports

People are born with a huge range of positive attributes, but gender so consistently gives certain physical advantages in athletics, that men and women’s sports have been divided since ancient times. Women’s sports have not traditionally been funded at the same rate as that of boys and men, so there has long been a sense of need to protect it.  And now in the past two decades, women’s sports is again in jeopardy by the entry of transgender people who were born and went through puberty as male but now identify as women.  Opponents of that argue that transgender women have an unfair advantage and even may endanger cisgender women in team sports due to differences in human physiology, even if hormone therapies are taken. 

Supporters of transgender athletes argue that puberty blockers and estrogen suppress testosterone levels and muscle mass of transgender women.  Supporters argue that sports, particularly for youth, is also about belonging, well-being and socialization of young people.  They claim that being excluded can harm the emotional health of transgender people.

The controversy and debates have resulted in the need to verify sex by physical examination, sex chromosome testing and sex hormone levels.  These regulations are made in the attempt to ensure fair competition and women’s safety.  But opponents of regulations claim discrimination against transgender and intersex women, disproportionately affecting women of color and violating medical ethics.  These are brave athletes who should be praised for openly coming out.   They are emotionally vulnerable minorities who deserve protection and inclusion.  They describe the use of sex regulations as overstretching  binary policies and suppression of diversity .  And in reality, all athletics tends to favor people with the certain physical attributes anyway.

One of the earliest well-known transgender athletes was tennis player Renee Richards.  Already a promising player in men’s tennis, Richards underwent gender reassignment therapy in 1975 and began playing in women’s tournaments a year later.  After accepting an invitation to play in 3 major American tournaments, 25 of 32 women withdrew.   Litigation followed  her being required to test for sex chromosomes, which she won as a violation of her civil rights. Later she competed in the 1977 US Open and reached the doubles final.

The International Olympic Committee (IOC) first allowed transgender athletes to participate in 2004 under three conditions.  Athletes must have undergone sex reassignment surgery including external genitalia and gonadectomy, have legal recognition of their changed gender, and have taken hormone therapy for at least two years prior to participation.  IOC modified the guidelines in 2015, requiring only that trans women declare their gender for 4 years, and demonstrate a testosterone level of less than 10 nanomoles per liter for at least one year prior to competition.   This level is significantly higher than the typical 3.0 testosterone level of cisgender women.   Athletes who transitioned from female to male were allowed to compete without restriction.

At the 2020 Summer Olympics in weightlifting, Laurel Hubbard, a trans woman, became the first out (open disclosure of status)  trans woman to compete at the Olympics.  She did not complete her lifts or win any medals.  At the same games, Canadian soccer player Quinn was the first out transgender to win a gold medal.  The first out transgender person to make a US national team was Chris Mosier, who qualified for Team USA in duathlon in 2016.   He also competed in January 2020 in the US Olympic Team Trials in the 50K Racewalking event

In October 2019, World Athletics changed the testosterone limit for transgender competitors from 10 nmol/L to 5 nmol/L  to align with  their intersex regulations  for at least 12 months prior to participation.  World Athletics has regulations for differences of sex development (DSD) athletes if they have XY male chromosomes, testes rather than ovaries, have circulating testosterone in the typical male range of 7.7 to 29.4 nmol/L, and are androgen sensitive.   They must reduce their testosterone to 5 nmol/L or lower in order to compete.

University of Pennsylvania student Lia Thomas swam for the men’s team in 2018-2019 and for the women’s team in 2021.  She has become the face of the debate on transgender women in sports.  In March 2022 she won the NCAA Division I national championship in the 500-yard freestyle event.  Her time for the 500 freestyle is around 15 seconds slower than her personal best before medically transitioning.    In other races, Thomas has been beaten by multiple cisgender women as well as by Iszac Henig, a transgender man not on hormones.  According to Swimming World, her rank had moved from 65th on the men’s team to 1st on the women’s team in the 500-yard freestyle and from 554th on the men’s team to 5th on the women’s team in the 200-yard freestyle.

In June 2022, the International Swimming Federation (FINA) bared all transgender  athletes from competing in  professional women’s swimming except for those who could demonstrate that they have not experienced any part of male puberty beyond Tanner Stage 2 or before the age of 12, whichever is later.

Recent Litigation

On January 10, 2022 federal Judge Joseph R. Goodwin of the Southern District of West Virginia upheld a  state law that prohibits biological male student athletes who identify as female from playing on girl’s school sports teams.  He ruled that HB 3293, the Save Women’s Sports Bill, which defines girl and woman as biologically females for the purpose of secondary school sports is constitutional.   He wrote that ,” I recognize that being transgender is natural and is not a choice.  But one’s sex is also natural, and it dictates physical characteristics that are relevant to athletics.

 Judge Goodwin also wrote that, “while some females may be able to outperform some males, it is generally accepted that, on average, males outperform females athletically because of inherent physical differences between the sexes.”   And he wrote, “ The fact is, however, that a transgender girl is biologically male and barring medical intervention, would undergo male puberty like other biological males.  And biological males generally outperform females athletically.”   He did not agree that the law violates Title IX because transgender girls are not entirely excluded from school sports.  He also pointed out that some transgender people may only transition socially, not medically and physically.

The law is one of several recent bills introduced by Republican-controlled state legislatures to bar transgender students from competing against girls in 18 states.  The American Civil Liberties Union (ACLU) defended a middle school student named Becky Pepper-Jackson, who wanted to join the girls’ cross-country team.  The ACLU filed the lawsuit in 2021, arguing that the law violated the 14th Amendment’s Equal Protection clause and federal Title IX, a statute that prohibits sex-based discrimination.  Enforcement of the law has been on hold since July 2021, but now will be enforced.

The decision was welcomed by West Virginia Attorney General Patrick Morrisey, who defended the law in court.  He said, “This is not only about simple biology, but fairness for women’s sports, plain and simple.  Opportunities for girls and women on the field are precious and we must safeguard that future.  Protecting thee opportunities is important, because when biological males compete in a woman’s event, women and girls lose their opportunity to shine.”

Conclusion

Debates over whether transgender women should compete in women’s sports focuses on unfair advantages over cisgender women, opportunity, and safety.  Sport organizations largely use testosterone levels as a measurable determinate because it regulates bone and muscle mass, but only to a minimal degree.  And testosterone is only one of multiple variables that could cause a competition to be less than fair.  American has numerous anti-discrimination laws on the books, but this debate also involves the moral do no harm rule.  Liberty and freedom are not absolute and total.  One person’s liberty and rights are justified only so long as they don’t constrict the rights of someone else. 

Judge Goodwin’s ruling about school sports will probably be seen as a setback for transgender advocates and the Woke movement, so this is likely not the final debate.  Novel solutions must be found to accommodate transgender people that are not at the expense of biologic women.  One solution that has been suggested is to create a third sex category, where transgender people could compete against each other.   Another solution might be to limit transgender women from contact sports such as basketball rugby or boxing, where smaller women are at risk for injury by larger and denser bodies.  Solutions might include separate scoring handicaps in sports where athletes compete individually, such as swimming or weight lifting.  A solution does need to be agreed upon because these issues have arisen in almost every sport and will continue to do so.   For example, women have different tee boxes in golf, different basketball arcs, different hurdle heights in track and different net height in volleyball to accommodate the differences from generally taller men.