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 déclaration répond aux règles du CIO publiées le 16 novembre 2021, qui ont remplacé les recommandations du CIO de 2015 sur les athlètes trans et les femmes ayant une testostérone naturelle élevée.
• Les auteurs contestent la règle selon laquelle aucun avantage ne doit être présumé. Ils soutiennent que la testostérone à des niveaux masculins (environ 9 à 32 unités, nmol/L, dans le sang) est la principale raison des différences entre les sexes pour la masse musculaire et la performance sportive.
• Ils notent que l'Agence mondiale antidopage interdit la testostérone comme produit améliorant la performance, et soutiennent que l'avantage qu'elle procure doit être reconnu et réduit dans les sports où il compte.
• Ils soutiennent les règles existantes dans des sports comme l'athlétisme, le cyclisme et l'aviron, qui exigeaient des femmes trans de maintenir leur testostérone sanguine sous 5 unités (nmol/L) pendant au moins 12 mois. Ils contestent que le CIO qualifie ce traitement de « médicalement inutile ».
• Ils soutiennent que le CIO fait peser sur l'instance dirigeante de chaque sport la charge de prouver un avantage « constant, injuste et disproportionné », ce que la plupart n'ont ni les moyens ni l'expertise de faire.
• Ils mettent en garde contre deux extrêmes : interdire tous les athlètes trans ou DSD (ce qui, selon eux, va à l'encontre de la Charte olympique et est illégal dans de nombreux pays), ou l'autodéclaration, qui équivaut à l'absence de règles d'éligibilité.
• Ils appellent le CIO à établir des normes claires fondées sur la science et à financer la recherche sur la testostérone, la performance et l'équité.

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.