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

• 這份聲明回應 2021 年 11 月 16 日發布的 IOC 規定，該規定取代了 IOC 2015 年針對跨性別運動員和天然睪固酮偏高女性的指引。
• 作者反對不應預設有優勢的規則。他們主張，男性程度的睪固酮（血液中約 9 至 32 單位，nmol/L）是肌肉和運動表現出現性別差異的主要原因。
• 他們指出世界反禁藥機構禁止睪固酮作為提升表現的藥物，並主張在睪固酮有影響的運動項目中，必須承認並降低它所帶來的優勢。
• 他們支持田徑、自行車和划船等運動現行的規定，要求跨性別女性至少 12 個月內血液睪固酮維持在 5 單位（nmol/L）以下。他們反對 IOC 將此類治療稱為「醫療上不必要」。
• 他們主張，IOC 把負擔放在各項運動的管理機構身上，要求它們證明存在「一致、不公平、不成比例」的優勢，而大多數機構沒有能力或專業知識做到這點。
• 他們警告兩種極端：禁止所有跨性別或 DSD 運動員（他們認為這違背奧林匹克憲章，在許多國家也違法），或自我認定而等於沒有任何資格規則。
• 他們呼籲 IOC 制定明確、以科學為基礎的標準，並資助關於睪固酮、表現與公平性的研究。

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.