Dr Antonia Lee

If facts, science and good research no longer matter, I may as well throw these and the hundreds of other books in my sports science, sports medicine and coaching library away.

In February 2019 I explained why I thought the International Olympic Committee’s (IOC) 2015 transgender guidelines (1) were unscientific. To recap: in this current revision, the IOC’s previous requirement for transgender surgery was removed whilst the length of time during which an athlete had to demonstrate testosterone levels within allowable limits was reduced from two years to twelve months. My argument was simple: no evidence was presented, or indeed appeared to exist, to support these guidelines. Furthermore, that anyone could think that a 12-month window of testosterone suppression (for male-to-female athletes) could somehow erase the effects of puberty and a lifetime’s exposure to testosterone, wipe out male muscle memory or change XY cells into ones that are now XX, remains to my mind, simply ludicrous.

In the general preamble, the IOC document states that, “the over-riding sporting objective is and remains the guarantee of fair competition”. This 2015 consensus statement remains live on the IOC’s website (2) and includes the names of all the (then) panel members.

With late transitioning, male-to-female athletes such as New Zealand’s Laurel Hubbard winning gold medals easily in international competition at the age of 41 (3) what do the IOC men and women who created these guidelines now think? Working with two coaching colleagues, we collectively emailed a number of them to find out.

Professor Arne Ljungqvist

In 2016, consensus meeting panel member and former chairman of the IOC Medical Commission, professor Arne Ljungqvist said, “It has become much more of a social issue than in the past. We had to review and look into this from a new angle. We needed to adapt to the modern legislation around the world. We felt we cannot impose a surgery if that is no longer a legal requirement. Those cases are very few, but we had to answer the question. It is an adaptation to a human rights issue. This is an important matter. It’s a trend of being more flexible and more liberal.” (4)

In 2005 and writing in the Lancet (5), Ljungqvist, in a basic review of the literature commented, “…after one year of therapy, male-to-female muscle mass remained greater than that observed in the comparison female-to-male group…”. In other words, he was previously aware of at least one retained physical advantage as shown in one study that had informed the IOC’s former (2004) and more demanding participation guidelines. In the same Lancet piece, Ljungqvist also says, “Ultimately, the number of transsexual athletes who can successfully compete in open international events is likely to be small, in accord with the estimated incidence of gender dysphoria of one in about every 12 000 men and one in about every 30 000 women”.

Perhaps he honestly thought it was never going to be an issue: nobody would take advantage of these now very relaxed, non-surgical transgender (not transsexual) IOC guidelines would they? I’ve commented on this elsewhere (6).

What does he currently say? Nothing, apparently; he simply didn’t respond to the emails.

Dr Richard Budgett

In 2016, Dr Richard Budgett, the IOC’s medical and scientific director said, “This is a scientific consensus paper, not a rule or regulation. It is the advice of the medical and scientific commission and what we consider the best advice.” (4)

Budgett was approached via the IOC’s press office. Neither he, nor they, responded.

For scientific rigour, honesty and transparency, I would suggest that Budgett needs to answer some very important questions. Firstly, if this really is a ‘scientific consensus paper’, where are the references and source documents? There is not a single reference to accompany the published statement. Surely, and from an academic perspective, the source material that was consulted should be made available to other researchers? Do minutes of this meeting — and what must surely have been a lively, lengthy, perhaps even heated exchange of views — exist that can be shared?

As I’ve noted before (1) I find it intriguing that in a short commentary in Current Sports Medicine Reports (November 2016), three of the IOC consensus meeting participants (Pitsiladis, Harper and Martinez-Patino) argued, “Given the paucity of relevant research and the likely impact of decisions relating to transgender and intersex athletes, there is now an urgent need to determine not only what physical advantages transgender women carry after HRT but also what effect these advantages may have on transgender women competing against cisgender women in a variety of different sports. Properly designed intervention studies are required to investigate the effect of the transition (both MTF and FTM transitions) on trainability and performance” (8).

In other words, one year after Budgett claimed that the IOC had produced a ‘scientific consensus paper’, three of his panel colleagues were making a strong case for a very different situation: one of a complete lack of relevant, robust and independent research on the topic.

In addition, it is truly remarkable that the consensus meeting appears not to have considered the important issue of cellular muscle memory, described in a previous article (7). Budgett cannot realistically claim ignorance of myonuclei since his three colleagues include a reference to this in their commentary, and also indicate the likely importance of this interesting aspect of muscle physiology to the subsequent, much-enhanced training response in the formerly athletic, transitioning male who subsequently enters women’s events.

Professor Yiannis Pitsiladis

Writing in the New Scientist, again in 2016 (9), consensus panel member, Professor Yiannis Pitsiladis, references just two studies in his explanation of why transgender athletes, in his opinion, will have no advantage at the Rio Olympics. One is from 2004 and, says Pitsiladis, looked at testosterone and haemoglobin levels in ‘transwomen one-year post-surgery’. This 2004 paper (by Gooren and Bunck) is worth reading (10) since it appears to be the same one reviewed by Ljungqvist. It also includes the statement, “Our data are limited and do not provide insight into all pertinent aspects”. Furthermore, the study participants are not athletes.

Pitsiladis then says, “The only study to directly assess performance was published last year. It looked at race times in eight non-elite transwomen runners”. Yes; Pitsiladis is referencing Joanna Harper. He finishes his piece with the conclusion, “For now, though, we can safely say that the IOC guidance is both inclusive and rooted in the best available scientific evidence”.

Harper’s work, which I’ve considered previously (1) was published in a journal that has what appears to be a novel acceptance and review policy (11). Harper’s study exists, in my opinion, as little more than a collection of anecdotes amid an unfathomable jumble of confounding factors. It appears to rely upon self-reporting and there are years between ‘data’ points. It may reasonably be described, I would suggest, as an observational study that fails to follow established observational research study criteria (12), carried out by an author with an obvious bias (a transgender MtF runner) who is not a sports scientist. It is, I contend, a possible exercise in self-validation. Let me be clear: I do not believe that anyone could seriously consider Harper’s conclusions even vaguely scientifically valid, let alone use these flawed findings on eight hobby joggers to create elite sporting participation guidelines — across all Olympic sports, events and disciplines, not just distance running — that affect half of the world’s population.

Indeed, my personal rule of thumb when reading anything on transgender sport is this: if someone quotes Harper’s work positively, I assume that they either haven’t read it properly, don’t know what they are talking about, or have an agenda other than women’s rights and fair play. For more insight regarding Harper’s study and for an evaluation of the available science generally, I would recommend the transcript of developmental biologist, Emma Hilton’s recent presentation in London as part of the Women’s Place UK/Fair Play for Women conference (13). The blog written by Helen Saxby that reviews a joint seminar by Harper and Pitsiladis in Brighton, England, in 2018 is also essential reading (14). The embedded emails within this blog post (from Ali Ceesay and Stephanie Davies-Arai respectively) are illuminating. Harper will be continuing their work at Loughborough University, England. Looking at the research and social media profiles of Harper’s likely collaborators, I think I know what outcomes to expect.

What does Pitsiladis now say? Again, and just like his colleagues, he failed to respond.

In fact, just one panel member replied. To save them from being attacked by their peers for breaking rank, I’ll preserve their anonymity. No questions were answered. There was just this short statement: “IOC is presently revising the regulations. Please wait and see or contact the IOC directly”.

I’ve yet to meet anyone who understands sport and who reads this 2015 IOC Consensus document who is not left incredulous. Where’s the science? Where’s the critical thinking and reasoning? Where’s the claimed ‘guarantee of fair play’? I’m certainly baffled. It looks to me like — and for whatever reason — an IOC panel comprising 20 people (mainly men) seemed to think that on what appears to be quite nonsensical evidence, they could give away women’s rights to fair competition, thereby ruining sport for 50% of society. After four years of anti-science and anti-intellectual, postmodern relativism invading sport, often fuelled, I would argue, by this IOC document — and with much, much more no doubt to come as the 2020 Olympic Games approach — all kinds of strange and completely unworkable solutions are now being posited (15), all of which complicate what is really quite simple.

My worldview is scientific realism (16). Sex is biological, whilst gender is a social construct. There are two distinct sex classes, with one of them naturally affording considerable physical and sporting advantages over the other. In the interest of fairness, compete in men’s (‘open’) events if born male (XY); compete in women’s events if born female (XX). You remain free to choose and live happily as any gender you like. Your human right to compete in sport — fairly and with respect to fellow athletes— remains intact.

Finally, whenever anyone asks, “How did we get here?”, my opinion is simple: through the actions of Ljungqvist, Budgett, Pitsiladis, Harper and the rest of the panel who created these IOC guidelines. What a legacy.

(With thanks to ‘Big T’ and TB for their email assistance)

References

1. https://medium.com/@Antonia_Lee/the-iocs-transgender-guidelines-are-unscientific-and-pose-a-serious-risk-to-the-health-of-both-5f5f808748e2

2. https://stillmed.olympic.org/Documents/Commissions_PDFfiles/Medical_commission/2015-11_ioc_consensus_meeting_on_sex_reassignment_and_hyperandrogenism-en.pdf

3. https://fijisun.com.fj/2019/07/22/pacific-games-council-to-review-transgender-issue/

4. https://www.theguardian.com/sport/2016/jan/25/ioc-rules-transgender-athletes-can-take-part-in-olympics-without-surgery

5. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2805%2967844-0

6. https://medium.com/@Antonia_Lee/when-gold-is-all-that-matters-2dd0e9a2898d

7. https://medium.com/@Antonia_Lee/myonuclei-the-male-to-female-sporting-advantage-ae205110d4b2

8. https://journals.lww.com/acsm-csmr/Fulltext/2016/11000/Beyond_Fairness___The_Biology_of_Inclusion_for.6.aspx

9. https://www.newscientist.com/article/mg23130854-500-transgender-olympians-in-rio-dont-have-an-unfair-advantage/

10. https://eje.bioscientifica.com/view/journals/eje/151/4/425.xml

11. https://strobe-statement.org/index.php?id=strobe-home

12. https://sportandsociety.com/journal/editors

13. https://fairplayforwomen.com/emma_hilton/

14. https://notthenewsinbriefs.wordpress.com/2019/04/09/who-really-influenced-the-ioc/

15. https://jme.bmj.com/content/45/6/395

16. Kirk, R. (1999) Relativism and reality: a contemporary introduction. London, Routledge.