Trans women retain athletic advantage after one year of hormone therapy

By Dan Avery - NBC News

A new study suggests that transgender women maintain an athletic advantage over their cisgender peers even after a year of hormone therapy.

The results, published last month in the British Journal of Sports Medicine, could mean that the current one-year waiting period for Olympians who are in transition is not long enough.

"For the Olympic level, the elite level, I would say two years is probably more realistic than one year,"

says study lead author Dr. Timothy Roberts, a pediatrician and director of the Children's Mercy adolescent medicine training program. Hospital in Kansas City, Missouri.

"After a year, trans women still tend to have an advantage over cis women," she says, referring to cisgender or non-transgender women.

Roberts began investigating the athletic endeavor of transgender men and women while in the Air Force, working with Lt. Col. Joshua Smalley, a physician and study co-author, at a clinic that coordinates care for Airmen beginning or continuing their transition. of genre.

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Active duty service members are required to take a physical readiness test every six to 12 months.

Roberts, Smalley and another co-author, Dr. Dale Ahrendt, found that they had access to robust data on service members before, during, and after starting hormone replacement therapy.

The three physicians conducted a retrospective review of the medical records and physical fitness tests of 29 transgender men and 46 transgender women from 2013 to 2018. The Air Force's physical fitness assessment includes the number of push-ups and sit-ups performed in a minute and the time needed to run 1.5 miles (2.4 kilometers).

They also obtained records on when the subjects began being treated with testosterone or estrogen, the type of hormone used, and the number of days from when the treatment began until their hormone levels reached the normal adult range for a cisgender person.

New Zealand transgender athlete Laurel Hubbard during the women's weightlifting final at the 2018 Commonwealth Games in Gold Coast, Australia on Monday, April 9, 2018.AP Photo / Mark Schiefelbein

During the first two years after starting hormones, trans women were able to do 10% more push-ups and 6% more sit-ups than their cisgender female counterparts.

After two years, Roberts claimed "they were quite equivalent to cisgender women."

Their speed times also decreased, but two years later, trans women were still 12% faster in the 1.5-mile run than their cisgender peers.

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Unsurprisingly, testosterone affected the fitness numbers of the transgender men they reviewed: Before starting hormones, they performed fewer push-ups and had slower run times than cisgender men in the control group.

However, after one year of treatment, these differences disappeared.

With abs, trans men were comparable to cisgender men before treatment and outperformed them after one year on testosterone.

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The longest follow-up of any participant was two and a half years, according to Roberts.

The doctor clarified that he is not suggesting that being in the army is the same as being an elite athlete, but added that "it

is a comparable situation", someone tries their best "to maintain or improve their skills

.

"

Joanna Harper, a medical physicist from Portland, Oregon, has done research on the effect of testosterone blockers on transgender runners like her.

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In 2015, she published her first study on transgender women and athletic performance and found that trans women ran at least 10% slower after starting hormones.

And, relatively speaking, they fared no better against cisgender runners than they had previously against cisgender men.

Harper noted that Roberts' methodology is robust, but he sees some limitations in the study.

In an assessment shared with NBC News, he questioned the lack of data on the individual training habits of the participants.

He also noted that there was no coordination between when the subjects started taking hormones and when they took their annual fitness test.

"The tests were arranged in three blocks," Harper explained.

“One of the tests that took place in the first year after the start of hormone therapy, one of the tests that took place between one and two years of hormone therapy and a third that took place between two and two and a half years after the start of hormone therapy, "he added.

Pooling the data could blur the changes that happened over a 12-month period "and could significantly distort the results," he said.

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The fact that trans women were even faster after two years could be due to differences in training intensity, he speculated.

But push-up and sit-up tests involve muscle strength, technique, muscular endurance, and cardiovascular, and "are probably good indicators of success in many team sports."

Increased scrutiny of trans athletes

As the transgender community has become more visible, its place in sports competitions has come under increased scrutiny.

In October, the World Rugby League became the first international sports body to ban transgender women from playing in the women's division, citing "risks to the well-being of female players."

Two months later, a group of 200 elite athletes, including Billie Jean King, Megan Rapinoe, and Candace Parker, signed a document supporting the rights of trans women and girls to participate in women's sports.

Transsexual soccer player Mara Gómez, from Villa San Carlos, controls the ball during a match of the Argentine professional women's soccer league against Lanús in La Plata, Argentina, on Monday, December 7, 2020.AP Photo / Natacha Pisarenko / AP

The brief was filed with the US Court of Appeals for the Ninth Circuit in response to the Idaho Women's Sports Fairness Act, signed by Republican Governor Brad Little in March.

The law prohibits transgender athletes from competing in school sports based on their gender identity, regardless of when they transitioned.

The case is before the Ninth Circuit after a lower court prevented it from taking effect in August.

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"There is no place in any sport for discrimination of any kind," King said in a statement.

"I am proud to support all transgender athletes who simply want access and the opportunity to compete in the sport they love."

"Actually, there was not much data available when the International Olympic Committee (IOC) published its guidelines,"

added Roberts, "Now we have a little more information," he recalled.

Harper, who was a consultant for the current IOC recommendations, said the true conclusion of Roberts' study is that transgender women finally achieve parity with cis women as athletes. 

However, she doesn't think Roberts' findings mean that sports organizations should require two years of testosterone suppression before trans women can compete against cisgender women.

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"It is not necessary to eliminate all the advantages," he said.

"All that is needed is for trans women to behave more like cisgender women than cisgender men," she said.

A "totally level" playing field

Roberts stated that there is no way to eliminate all the advantages of an athlete, regardless of their gender identity.

“People who received testosterone at puberty tend to have narrower hips.

If you're taller and have narrower hips, that gives you an advantage that probably won't change with testosterone blockers or estrogen, ”he explained.

"On the other hand, we have a lot of elite athletes who tend to be tall and thin with slim hips, and we are not censoring them," he added.

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Roberts also noted that physical advantages are not the only advantages some athletes have over others.

“LeBron James kids have access to the best coaches and the best facilities with the best equipment.

They are going to have an advantage

.

And all those people are still in the same competition, "he said.

The IOC last revised the regulations for transgender competitors in 2016, removing a requirement for gender confirmation surgery and reducing the minimum requirement for hormone replacement therapy for trans women from two years to one.

Currently, transgender men can compete in men's events without any restrictions.

The guidelines, which are used by most sports federations, also stated that female trans athletes must keep testosterone levels below 10 nanomoles per liter.

That's on the low end for most cisgender men, but higher than average for cisgender women, whose testosterone is generally between 0.3 and 2.4 nanomoles per liter.

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But, Roberts notes, cisgender women with PCOS and some other conditions can have levels three times higher, or even higher.

Almost a third of elite adolescent female athletes have relatively high testosterone levels, compared to just 2% to 12% of the general female population.

Female Olympians also tend to have higher levels than controls of the same age.

"The playing field has never been completely level,"

concluded Roberts.

The IOC announced that it is working on new guidelines to be published in 2021 after the rescheduled Tokyo Summer Games.

"This work is based on an extended consultation to consider not only the medical, scientific and legal perspectives, but also that of human rights, with an emphasis on the vision and experiences of affected athletes," explains an IOC spokesperson in a email.

"Overall, the discussions to date have confirmed a considerable tension between the notions of fairness and inclusion, and the desire and need to protect the category of women, all of which will need to be reconciled," he adds.