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

• A declaração responde às regras do COI publicadas em 16 de novembro de 2021, que substituíram a orientação de 2015 do COI sobre atletas trans e mulheres com testosterona natural alta.
• Os autores se opõem à regra de que nenhuma vantagem deve ser presumida. Argumentam que a testosterona em níveis masculinos (cerca de 9 a 32 unidades, nmol/L, no sangue) é a principal razão das diferenças entre os sexos na musculatura e no desempenho esportivo.
• Observam que a Agência Mundial Antidoping proíbe a testosterona como droga para melhorar o desempenho, e argumentam que a vantagem que ela dá deve ser reconhecida e reduzida nos esportes em que importa.
• Apoiam as regras existentes em esportes como atletismo, ciclismo e remo, que exigiam que mulheres trans mantivessem a testosterona no sangue abaixo de 5 unidades (nmol/L) por pelo menos 12 meses. Contestam que o COI chame esse tratamento de 'medicamente desnecessário'.
• Argumentam que o COI coloca sobre o órgão dirigente de cada esporte o ônus de provar uma vantagem 'consistente, injusta e desproporcional', o que a maioria não tem meios nem conhecimento para fazer.
• Alertam para dois extremos: proibir todos os atletas trans ou com DDS (o que, segundo eles, vai contra a Carta Olímpica e é ilegal em muitos países), ou a autoidentificação, que equivale a não ter regras de elegibilidade.
• Pedem que o COI estabeleça padrões claros, baseados na ciência, e financie pesquisas sobre testosterona, desempenho e justiça.

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.