Key Findings

• The 2021 IOC framework on gender identity and sex variations is criticized for prioritizing human rights perspectives over medical and scientific evidence, particularly its stance of 'no presumption of advantage' regarding testosterone levels.
• Testosterone is well-established as a performance-enhancing hormone that increases muscle mass and athletic ability, and the authors argue that high testosterone concentrations confer a baseline competitive advantage that must be recognized and mitigated.
• The framework places full responsibility for gender eligibility rules on International Federations (IFs), most of which lack the capacity, resources, and expertise to implement it effectively.
• The authors warn that implementation could lead to two undesirable extremes: either total exclusion of transgender and DSD athletes from competition, or self-identification policies that effectively eliminate meaningful eligibility rules and fair competition.
• The position statement calls for the IOC to provide clear, evidence-based standards for all sports to follow, rather than leaving individual federations to navigate this complex issue alone.

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.

Summary

This joint position statement from FIMS and EFSMA critiques the IOC's 2021 framework on gender identity and sex variations, arguing that its human rights-focused approach inadequately addresses medical and scientific evidence regarding testosterone's performance advantages. The authors contend that placing full responsibility on International Federations without clear standards risks creating an unworkable system that could lead to either exclusion of transgender and DSD athletes or elimination of meaningful eligibility rules altogether, undermining fair and safe competition for women in sports.

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.