Males and females are divided in sports. Why is this?
There is a dose dependence relationship regarding
circulating testosterone and muscle mass. Men typically have 15-fold higher
concentration than women do at any given age (Handelsman et al., 2018). Larger
muscles generally mean more strength and thus different athletic performance (Handelsman
et al., 2018). Men and women are in different categories due to the physical
and social effects of these physiological differences.
So then what about transgender athletes? Do they participate
in the group they were “assigned” to at birth, or the one they transitioned
into after hormone therapy? In 2018, the International Association of Athletics
Federation (IAAF and now called, “World Athletics”) tried to end the debate. In
their competitions, if an athlete has a “difference of sexual development”,
they must have a blood testosterone level below 5nmol/L. Typically women’s
levels are from 0.12-1.79nmol/L and males after puberty are 7.7-29.4nmol/L
(Worldathletics, 2018). Do you think this is representing the ethical principle
of justice for the other athletes? Does it take the justice away from the
transgender athletes?
After the regulations were released in 2018, the scientific
community began to analyze the cited data collected by the IAAF that they used
in order to declare the new guidelines. Significant scientific flaws were
identified in data collection and analysis (Pielke et al., 2019). Despite backlash,
the IAAF has not acknowledged the criticism.
One study in particular followed multiple transgender men
and women throughout hormonal replacement therapy in order to determine any
physiological differences in these athletes. For reference, a transgender woman
is a woman assigned male at birth and the opposite for transgender men. Muscle
strength, size, and composition were measured throughout 12 months of
gender-affirming treatment (no lifting or training). In transgender men, muscle
volume, area, and density all increased significantly by about 15% in all
tests. In transgender women, the same parameters decreased slightly.
Transgender men increased strength overall while transgender women retained the
same strength levels (Lundberg et al., 2019).
Does this data change your perspective on transgender
participation in sports? Is it necessary to test hormone levels of athletes? At
what ages? What biomedical ethical principles should we hang our hats on with
this?
References:
Anna, W., Lundberg, T. R., Eric, R., Andersson, D. P., Mats,
H., Mirko, M., Thomas, G.
(2019).
Muscle strength, size and composition following 12 months of
gender-affirming
treatment in transgender individuals. The Journal of Clinical
Endocrinology
& Metabolism. doi: 10.1210/clinem/dgz247
Handelsman, D. J., Hirschberg, A. L., & Bermon, S.
(2018). Circulating Testosterone as
the
Hormonal Basis of Sex Differences in Athletic Performance. Endocrine
reviews, 39(5),
803–829. doi:10.1210/er.2018-00020
Pielke Sr, Roger & Tucker, Ross & Boye, Erik.
(2019). Scientific integrity and the
IAAF
testosterone regulations. The
International Sports Law Journal. 10.1007/s40318-019-00143-w.
Worldathletics.org, (2018, April 26). World Athletics: IAAF
introduces new
eligibility
regulations for female classification: News. Retrieved from
https://www.worldathletics.org/news/press-release/eligibility-regulations- for-female-classifica?source
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ReplyDeleteThe topic of gender-affirming hormone therapy (GAHT) was actually on my mind this week after discussing reproductive physiology in class this week. I think that gender dysphoria (not my favorite term as I think it over pathologizes what is experienced by transgender individuals) is still something that we as a society are still trying to get a handle on, and the lens of athletics further complicates the topic. Research by Klaver et al. delved into the physiological changes that individuals experience while on GHAT, reporting that transgender women experienced and increase of 1.8kg body weight, 3kg in body fat, and a loss of 2.4kg in lean body mass. On the other hand, transgender men experienced an increase of 1.7kg in body mass, and 3.9kg in lean body mass, and a loss of 2.6kg in body fat (2016).
ReplyDeleteThis isn't to say that other research will not, and has not shown as some of your sources stated, that individuals undergoing GAHT will not see different results. Analysis into the epigenetic effects of GAHT are still being conducted, so there is still a lot to learn about downstream effects of hormone therapy. It is thought that changes in the hormone profile will strongly affect the transcriptome, epigenome and metabolism in several body tissues throughout various stages of therapy (Nguyen et al., 2018).
I suppose what this boils down to is that we still have a lot to learn about the physiology and epigenetic effects before we can really start applying hard science to the decision of how we include transgender athletes into the sports world. However, I personally do not believe it is just to exclude these individuals from participating in things that bring them happiness, as they have been excluded from most things in our society for so long and still are, and that their decision to move forward with this therapy is in no way related to getting a let up in their sport of choice. If we are to base this decision entirely on the physiological effects of hormone therapy, I think the information provided by Klaver et al. demonstrates that as therapy progresses, transgender individuals are losing the "advantage" given to them by their assigned sex over time and that perhaps this is more of a societal stigma more than it is an issue of competitive fairness.
References:
Klaver M., Dekker M., de Mutsert R., Twisk J.W.R., den Heijer M. Cross-sex hormone therapy in transgender persons affects total body weight, body fat and lean body mass: a meta-analysis. Andrologia. 2017;49(5)
Nguyen, H. B., Chavez, A. M., Lipner, E., Hantsoo, L., Kornfield, S. L., Davies, R. D., & Epperson, C. N. (2018). Gender-Affirming Hormone Use in Transgender Individuals: Impact on Behavioral Health and Cognition. Current psychiatry reports, 20(12), 110. doi:10.1007/s11920-018-0973-0
Wow, Nick, I hadn’t even considered epigenetic effects of GAHT yet. I looked into it a bit and it’s a big concern in fertility preservation practices about how and when to preserve gametes. It’s unclear how the hormone therapy affects that process. I also wonder how things will change as people become more accepting of people transitioning before puberty in terms of the viability of gametes. It seems that fertility preservation is not common at this point but I found little information about why. I suspect that cost is a main factor though I found a paper that cited a desire to adopt in many of the patients they spoke with. All in all it sounds like a new area of research, especially since we haven’t figured out so far what young transgender people even want in terms of having children.
DeleteNahata, L., Tishelman, A. C., Caltabellotta, N. M., & Quinn, G. P. (2017). Low fertility preservation utilization among transgender youth. Journal of Adolescent Health, 61(1), 40-44
Vyas, N., Singer, A., Ter-Barsegyan, A., Kantor, A., Mann, C., Lambrechts, S. I., & Quinn, M. M. (2019). Reproductive life planning and interest in fertility preservation among transgender and gender non-binary individuals. Fertility and Sterility, 112(3), e59-e60.