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

• 该声明回应2021年11月16日发布的国际奥委会规则，该规则取代了国际奥委会2015年关于跨性别运动员和天然睾酮水平较高的女性的指引。
• 作者反对不应预设优势的规则。他们认为，男性水平的睾酮（血液中约9至32纳摩尔/升）是肌肉和运动表现出现性别差异的主要原因。
• 他们指出，世界反兴奋剂机构将睾酮列为提高成绩的违禁药物，并主张在睾酮重要的运动项目中，必须承认并减少它带来的优势。
• 他们支持田径、自行车和赛艇等运动中已有的规则，即要求跨性别女性至少12个月保持血液睾酮低于5纳摩尔/升。他们不同意国际奥委会把这种治疗称为“医学上不必要”。
• 他们认为，国际奥委会把举证责任交给各项运动的管理机构，要求证明存在“持续的、不公平的、不成比例的”优势，而大多数机构没有这样的手段或专业知识。
• 他们警告了两个极端：禁止所有跨性别或DSD运动员（他们称这违背《奥林匹克宪章》，在许多国家也违法），或自我认定，这等于没有资格规则。
• 他们呼吁国际奥委会制定明确的、以科学为基础的标准，并资助关于睾酮、运动表现和公平性的研究。

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.