Summary

In November 2021 the International Olympic Committee (IOC) replaced its 2015 testosterone-based guidance with new rules. These say athletes should not be assumed to have an advantage because they are trans or have differences of sex development, and leave eligibility to each sport. In this joint statement, two sports medicine federations argue the new rules focus on human rights and sideline biology. They say male-level testosterone is the main reason men have more muscle and perform better, and most sports bodies lack the means to produce the evidence the IOC now wants. They warn of two bad outcomes: banning all such athletes, or self-identification with no real rules. They favour testosterone limits. It is expert opinion, not a review, with little direct evidence on trans athletes after lowering testosterone, and many authors are tied to sports bodies whose rules are at stake.

Key findings

• Становището отговаря на правилата на МОК, публикувани на 16 ноември 2021 г., които заменят насоките на МОК от 2015 г. за транс спортисти и жени с високи естествени нива на тестостерон.
• Авторите възразяват срещу правилото, че не трябва да се предполага предимство. Те твърдят, че тестостеронът на мъжко ниво (около 9 до 32 единици, nmol/L, в кръвта) е основната причина за половите различия в мускулите и спортното представяне.
• Те отбелязват, че Световната антидопингова агенция забранява тестостерона като средство за подобряване на представянето, и твърдят, че предимството, което той дава, трябва да бъде признато и намалено в спортовете, в които има значение.
• Те подкрепят съществуващите правила в спортове като лека атлетика, колоездене и гребане, които изискват транс жените да поддържат тестостерона в кръвта под 5 единици (nmol/L) поне 12 месеца. Те оспорват това, че МОК нарича такова лечение „медицински ненужно“.
• Те твърдят, че МОК поставя тежестта върху управляващия орган на всеки спорт да докаже „последователно, нечестно, непропорционално“ предимство, което повечето нямат средствата или експертизата да направят.
• Те предупреждават за две крайности: забрана на всички транс или DSD спортисти (което според тях противоречи на Олимпийската харта и е незаконно в много страни) или самоопределяне, което се равнява на липса на правила за допустимост.
• Те призовават МОК да определи ясни, основани на науката стандарти и да финансира изследвания на тестостерона, представянето и справедливостта.

Abstract

The IOC recently published its framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. This framework is drafted mainly from a human rights perspective, with less consideration for medical/scientific issues. The framework places the onus for gender eligibility and classification entirely on the International Federations (IFs), even though most will not have the capacity to implement the framework. The position of no presumption of advantage is contrary to the 2015 IOC consensus. Implementation of the 2021 framework will be a major challenge for IFs that have already recognised the inclusion of trans and women athletes with differences of sexual development (DSD) using a scientific/medical solution. The potential consequences for sports that need to prioritise fairness or safety could be one of two extremes (1) exclusion of all transgender or DSD athletes on the grounds of advantage or (2) self-identification that essentially equates to no eligibility rules. Exclusion of all transgender or DSD athletes is contrary to the Olympic charter and unlawful in many countries. While having no gender eligibility rules, sport loses its meaning and near-universal support. Athletes should not be under pressure to undergo medical procedures or treatment to meet eligibility criteria. However, if an athlete is fully informed and consents, then it is their free choice to undergo carefully considered or necessary interventions for gender classification for sport to compete fairly and safely in their chosen gender. Free choice is a fundamental human right, but so is the right to fair and safe competition.

Conclusion

The new IOC framework leaves all responsibilities to the IFs, whereas the authors believe the IOC should provide direction to the IFs. The IOC framework only deals with this important issue from a particular human rights perspective, yet this must be seen in a more rounded human rights perspective and is also a medical and scientific matter. The authors would like to see further discussion and consultation with all stakeholders leading to a balanced framework that protects the rights of all athletes and gives IFs the tools they need to ensure inclusion and fairness.