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

• 이 성명은 트랜스 선수와 자연 테스토스테론이 높은 여성에 관한 IOC의 2015년 지침을 대체한 2021년 11월 16일 발표 IOC 규정에 대한 응답입니다.
• 저자들은 이점을 전제하지 않아야 한다는 규칙에 반대합니다. 이들은 남성 수준의 테스토스테론(혈중 약 9~32단위, nmol/L)이 근육과 스포츠 경기력의 성별 차이를 만드는 주된 이유라고 주장합니다.
• 세계반도핑기구가 테스토스테론을 경기력 향상 약물로 금지한다는 점을 지적하며, 테스토스테론이 주는 이점은 그것이 중요한 종목에서 인정되고 줄여져야 한다고 주장합니다.
• 육상, 사이클, 조정 같은 종목에서 트랜스 여성에게 혈중 테스토스테론을 최소 12개월 동안 5단위(nmol/L) 아래로 유지하도록 요구했던 기존 규정을 지지합니다. 그런 치료를 IOC가 ‘의학적으로 불필요하다’고 부르는 것에 이의를 제기합니다.
• IOC가 ‘일관되고 불공정하며 불균형한’ 이점을 증명할 부담을 각 종목의 관리 단체에 지우고 있다고 주장하는데, 대부분은 그럴 수단이나 전문성이 없습니다.
• 두 극단을 경고합니다. 모든 트랜스 또는 DSD 선수를 금지하는 것(올림픽 헌장에 어긋나고 많은 나라에서 불법이라고 말함)과, 사실상 출전 자격 규정이 없는 것이나 마찬가지인 자기 선언입니다.
• IOC에 명확하고 과학에 기반한 기준을 정하고 테스토스테론, 경기력, 공정성에 관한 연구에 재정을 지원하라고 촉구합니다.

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.