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

• La declaración responde a las normas del COI publicadas el 16 de noviembre de 2021, que sustituyeron la guía de 2015 del COI sobre atletas trans y mujeres con testosterona natural alta.
• Los autores se oponen a la regla de que no debe presuponerse ninguna ventaja. Sostienen que la testosterona a niveles masculinos (unas 9 a 32 unidades, nmol/L, en sangre) es la razón principal de las diferencias entre sexos en músculo y rendimiento deportivo.
• Señalan que la Agencia Mundial Antidopaje prohíbe la testosterona como fármaco que mejora el rendimiento, y sostienen que la ventaja que otorga debe reconocerse y reducirse en los deportes donde importa.
• Apoyan las normas vigentes en deportes como el atletismo, el ciclismo y el remo, que exigían a las mujeres trans mantener la testosterona en sangre por debajo de 5 unidades (nmol/L) durante al menos 12 meses. Discrepan de que el COI califique ese tratamiento de 'médicamente innecesario'.
• Sostienen que el COI pone la carga sobre el organismo rector de cada deporte de demostrar una ventaja 'sistemática, injusta y desproporcionada', algo para lo que la mayoría carece de medios o de conocimientos.
• Advierten de dos extremos: prohibir a todos los atletas trans o DSD (lo que, según dicen, va contra la Carta Olímpica y es ilegal en muchos países), o la autoidentificación, que equivale a no tener normas de elegibilidad.
• Piden al COI que fije normas claras basadas en la ciencia y que financie investigación sobre testosterona, rendimiento y equidad.

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.