Last year, Dr Rachel McKinnon's victory in the sprint event at the UCI Masters Track Cycling World Championships, made her, the self-proclaimed "first transgender woman world champion .... ever". However, her victory wasn't universally welcomed. Breitbart, as you would imagine from Steve Bannon's former ideological pulpit, had a rather different take on things and were quick to label Dr McKinnon as "a biological male claiming to be a transgender woman".
But this statement was more than just invidious clickbait, for in its own crude way it expressed some of the reservations of Dr McKinnon's own competitors. In Twitter remarks, she later rowed back on following a backlash, the bronze medallist, Jennifer Wagner, complained that Dr McKinnon's victory was "unfair". Another competitor, Sarah Fader went so far as to pull out of the final in protest, doing so despite having set the fastest time in qualifying. It is worth noting however that Fader disassociated herself from those dismissing Dr McKinnon as a "cheat", preferring instead to underline that her core issue wasn't that Dr McKinnon participated, or even won, under the overarching regulations, but that the patchiness of the science underpinning those regulations rendered them unfit for purpose. Although Fader's protest stemmed from a seemingly technical rules-based argument, Dr McKinnon nevertheless named Fader alongside Wagner in a complaint she filed under USAC's anti-bullying policy; branding their behaviour as "degrading" and "humiliating" in doing so.
Whatever the merits or otherwise of Fader's and Wagner's respective positions, the fact remains that Dr McKinnon is a far from a dominant figure in her sport. Not only was Fader faster than her in qualifying for the sprint final, but even Wagner had, up until that point, defeated her in 10 of their last 12 races. Moreover, Dr McKinnon's maximum watts per kilogram output (17.05) is markedly inferior to Fader's (21.99) and is consistent with what one would expect from a female sprinter of her size. Altogether, the raw performance data seem to lend credence to what Dr McKinnon describes as a "double bind" facing transgender athletes; victories are attributed to their being transgender, while defeats are roundly ignored.
But that's just the start of it, for the whole overarching issue regarding transgender participation is so tightly knotted that it can be difficult to tell where one argument ends and another begins. That being said, the best place to start is also perhaps the most obvious.
Within the scientific community, there is widespread agreement that, men, on average, enjoy an athletic advantage of between 10-12% over women; although in certain sports the difference can rise as high as 30%. This assertion tallies with what one could call an eyeball assessment of comparative athletic ability, by which it is obvious to even the most casual observer that, for example, Usain Bolt was faster than Flo Jo. The difference between Bolt and Griffith Joyner is one which can be neatly transposed from a common frame of reference - namely the 100m (or 200m) - onto a chart of relative performance. However, in certain sports, a more elaborate non-linear form of transposition can be more appropriate.
Weightlifting is one such sport. At the 2012 Olympics, Zhou Lulu's winning total of 333kg (An Olympic record. The world record is 348kg) in the heaviest female category, 75kg+, only marginally outstripped Kim Un-guk's gold-winning effort of 327kg (admittedly a world record) in the male <62kg category. Moreover, none of the female champions in categories lighter than 75kg+ recorded totals in excess of that achieved by the champion in the lightest male category, 56kg. A one-off you may say. But not so, as the very same pattern repeated itself during the 2016 Olympics.
However, for the simple fact, that male physiology is inclined to accentuate power over endurance, the picture is not quite as clear cut as the aforestated data seem to suggest. While the physiological confluence of, among other traits, a greater number of fast twitch muscles, a higher V02 max, and higher concentrations of haemoglobin undoubtedly confer men with advantages in explosive events, those advantages become significantly less pronounced in ultra-endurance races. Indeed, in such stamina-sapping events, the fact that women's body fat content tends to be 6-11% higher on average is advantageous as it enables women to last longer on less fuel than men.
Nevertheless, the preponderance of evidence resolutely signals that on average men enjoy a competitive advantage over women. That just leaves us to question why such a performance gap persists. In response to this, the body of scientific inquiry has afforded explanatory power to the influence of testosterone. Indeed, a number of studies examining testosterone's influence on transitioning members of the transgender community have provided striking findings.
Following a 12-month period of testosterone treatment, 17 trans men exhibited a 19.2% increase in muscle mass and a 15% increase in red blood cells. Those findings were echoed in a study which charted the effect of administering adult male doses of testosterone to 23 trans-men. Here, in comparison to an age-matched control group, increases in total body muscle size and limb muscle size ranged from 6.5% to 16.6% and by up to 18% with respect to grip strength.
Elsewhere, studies exploring the effect of testosterone manipulation on biological men have also delivered eye-catching results. In one such study, the testosterone levels of 400 men were reduced to female levels over the course of 16 weeks. Thereafter, the participants were divided into 2 cohorts, one of which was administered doses of testosterone sufficient to raise their levels to those of pubescent men. Among this cohort, increases in total muscle mass (2.3%), thigh muscle mass (3%), and leg press strength (5.5%) were recorded. Overall, the clear implication is that the biologically endowed performance gap begins to open at puberty.
In a similar vein, a study charting the effect of genital reassignment surgery on 17 trans women found that marked decreases in total muscle area (-10%) and red blood cells (-14%) persisted 1 year after genital reassignment surgery was conducted. Again, the finger was pointed squarely at testosterone, as over the course of the reassignment process average levels of the hormone had plummeted from 21 nanomoles per litre (nM/L) to 1nM/L.
As a whole, the weight of such evidence has been of sufficient credibility to convince the IOC to frame its trans-female policy largely in terms of testosterone levels. As it currently stands for a trans-women to qualify as eligible for competition, she first must declare her gender identity to be female and do so in the knowledge that this declaration cannot be reversed for a minimum of 4 years. And now for the key part. She must also be able to demonstrate that her total level of testosterone in serum falls within the IOC's threshold of 10 nM/L - though this upper limit is set to be reduced to 5 nM/L in time for Tokyo 2020. Incidentally, there are no restrictions limiting the participation of trans-men in male competition.
Everything at this point may seem pretty straightforward, but there are a number of contentious issues which make it anything but. First up, there are some, among them Dr McKinnon, who question the legitimacy of imposing any form of testosterone limit on trans-women. At the core of their argument is the contention that there is no substantiated relationship which has been proven to tie endogenous testosterone levels (testosterone produced by the body) to performance. Indeed, their claims seem to be corroborated by a study which found that 1/6 elite male track runners had lower endogenous testosterone than the average female range. While one should have some reservations over conclusions drawn from a single study, one also has to concede that it does raise questions about the scientific orthodoxy underpinning the IOC's policy.
Dr McKinnon goes further and believes that the results deal a devastating blow to testosterone's preeminence as a gender arbiter of sorts. Indeed, she contends that the observable performance gap is not, at root, a product of underlying biological differences, but rather a sociological phenomenon. Societal expectations, she contends, shape experiences, which in turn shape expertise. In essence, the gender performance gap is reframed as a practice gap, or as nurture superseding nature. What is more, the lifelong athletic effect may be most pronounced among the transgender community due to, what has been dubbed, "the changing room problem". For transgender people, the act of choosing a dressing room can narrow into a cognitive bottleneck which tapers to exclusion as expectation and identity crowd one another out.
Another question mark hanging over testosterone is what opponents consider the arbitrary nature of the 10 nM/L threshold itself. The established figure stands at 5 standard deviations from the female average, at a level which, as some have pointed out, places it somewhat conveniently at the bottom of the typical male range. It is also problematic from the standpoint that women with polycystic ovary syndrome or hyperandrogenism both report testosterone levels well in excess of the female average. That said the origins of the 10 nM/L threshold can be traced back to a study, first commissioned by the IAAF to shape policy regarding hyper-androgenous female athletes. Critically, however, that study has subsequently been largely discredited due to numerous methodological shortcomings.
In truth, the debate surrounding the arbitrariness or otherwise of the 10 nM/L threshold is of decidedly peripheral significance when compared to the overarching ethical imperative; do trans-women have an advantage over biological women? Once again, in the absence of an unequivocal answer, controversy abounds. A study by Joanna Harper, herself a trans-woman, purports to evidence that the process of transitioning from male to female is sufficient in and of itself to neutralise athletic advantage.
Explicitly, the data indicate that race times for a cohort of 8 transitioning female athletes slowed to a level which put them in a female age range bracket commensurate with their past performance as males; so if as a 28-year-old male a participant's performance ranked in the 88th percentile, their performance as a 33-year-old women would rank similarly. While the study has been heralded as "groundbreaking" in some quarters, there are others who suggest that Harper's methodology suffers from significant shortcomings. Chief among the reservations are the small sample size, the self-reported nature of the data and the fact information pertaining to numerous relevant factors such as training history and overall health are not included.
Further concerns surrounding fairness have been prompted by evidence which suggests the existence of a putative latent testosterone effect. Explicitly, the argument contends that muscles developed under the influence of testosterone will be easier to build in the future even in the absence of testosterone. So, if correct, a trans-woman who transitioned after puberty would retain a muscle-building advantage over women, or critically, over other trans-women who transitioned before the onset of puberty. The effect has been attributed to dormant myonuclei and labelled, perhaps prematurely, as "male muscle memory".
Similarly, while it can be accepted that a reduction in testosterone levels will precipitate fall offs in muscle size and red blood cell levels, the fact remains that many other physical attributes accrued through pubertal testosterone exposure will remain resilient to any underlying hormonal changes. Lowering testosterone levels won't elicit dramatic changes in someone's height, organ size, or limb length for example. The counterargument questions whether the source of an advantage actually matters. Should sport really concern itself with why a biological female netball player is tall or with why a trans-woman netball player is tall? At the end of the day isn't height, height?
More broadly, this argument can be considered as an extension of what could be called the "no level playing field" position, which maintains that advantageous characteristics are naturally occurring, and should not, therefore, be legislated for. While, in the main, it should be noted that they are not, the volume of scientific evidence identifying testosterone as critical to the development of many advantageous traits underwrites why it is singled out as an exceptional case. But, as ever with this debate, there is a counterpoint to the counterpoint. The contention that testosterone is something of a gender barometer is to grossly oversimplify what differentiates male from female. Indeed, it may be fanciful, given that biology is better conceived of as individual than dimorphic, to consider the issue as anything other than irreducibly complex.
A frequently overlooked aspect of the transgender fairness debate relates to trans-men competing against cisgendered males. As we have already seen, the IOC sees no need to impose restrictions on their participation, but is this a legitimate stance? It may seem somewhat peculiar to even pose the question, but there are a number of reasons why it deserves to attract greater scrutiny. Firstly, women are more sensitive to testosterone, and secondly, exogenous testosterone (produced outside of the body) delivers a greater bang for its buck than does endogenous testosterone. Consequently, it has been hypothesised that the result of adding a more potent version of testosterone to a biological system, which is itself more susceptible to the effects of testosterone, would be to completely overhaul the natural advantages of cisgendered males. Furthermore, proponents of this viewpoint fear that "XX supermen" will come to dominate. Although that may be the view held by some, it is somewhat inevitably not universally accepted and the counterargument championed by sceptics maintains that while receiving exogenous testosterone is undoubtedly advantageous, it is not so advantageous as to compensate for the full spectrum of female athletic disadvantage.
A literature review conducted by academics from Loughborough University concluded that there is no clear evidence to support the claim that transgender people enjoy an athletic advantage over their cisgendered competitors. A conclusion which led the researchers to call for the widespread adoption of inclusive transgender sporting policies, which enable trans-men and women to compete, and this is critical, irrespective of their hormonal levels. Interestingly, though such a recommendation chimes with Dr McKinnon's stance, it does not necessarily represent the views of the entire transgender community.
Jillian Bearden, like Dr McKinnon, is also a trans-woman cyclist. However, far from calling for a laissez-faire approach, she insists that it is only by abiding by regulations, such as those imposed by the IOC, that transgender athletes can hope to win wider acceptance. Joanna Harper goes one step further and advocates that since 99% of women have testosterone levels of less than 3 nM/L, a stricter testosterone threshold should be imposed to regulate participation.
However, the preoccupation with regulating testosterone levels may prove dangerously blinkered if the case of Kirsti Miller is anything to go by. When Miller underwent sex reassignment surgery, she lost her capacity to produce testosterone naturally, and since overarching sporting regulations expressly ban athletes from taking testosterone, her body has begun to prematurely age as a consequence of the emergent testosterone deficit. The upshot is that a one-time elite athlete now often finds herself unable "to get out of bed" and can exercise only very occasionally. She fears that if Dr McKinnon continues to take androgen blockers it will inevitably lead to similar complications and, more pointedly, to a precipitous decline in her overall health. Miller's profoundly distressing life experience has led her to caution against the widespread adoption of a one-size-fits-all policy.
At the heart of Miller's position is a recognition of the fact that transgender athletes do not form a homogenous group. Unfortunately, nor is their heterogeneity as straightforwardly complex as to be neatly encapsulated by individual biological differences, for on top of that one also has to consider the unpredictable range of effects elicited by direct intervention. For example, the lifelong physiological implications of undergoing hormone treatment either prior to, or after, puberty are significantly different. Ultimately, in many ways, at the core of the convoluted debate surrounding biological factors is a surprisingly simple question; can you turn a man into a woman? Dr Eric Vilain, a geneticist at The George Washington University, may, on one hand, be unequivocal in thinking not, but on the other, he dismisses the question as being based on an outmoded idea that the transgender debate needs "to move past".
One neat way to do just that is to appeal to the universality of Human Rights, which coincidentally is a tactic that Dr McKinnon herself champions. Indeed, The International Olympic Committee explicitly describe participation in sport as a human right. The problem for proponents of Dr McKinnon's stance comes from how precisely to interpret a clause which pointedly requires "no discrimination of any kind". With scientific research on the transgender question having so far failed to reach anything even vaguely resembling a consensus, the clause can only be considered as ambiguous. Whether this is ambiguity by design, or otherwise, is by the by, as in terms of extending the right to participation to transgender athletes it is unmistakably equivocal.
The rights-based language, enshrined within the United Nations' various covenants and declarations, is similarly ambiguous in this respect. Here, although it is notable that there is no express "right to sport" per se, reference is made to a right to "physical and mental health". Once again, however, this is a contestable phrase of little elucidatory value with respect to the practicalities of transgender inclusion. One legal framework which does offer clarity is the UK's Equality Act, under which it is permissible to exclude persons of reassigned gender from single-sex sport in the name of preserving safety and fair competition. Nevertheless, overall the prevailing equivocation which, in general, plagues rights-based arguments only serves to reaffirm that the debate surrounding transgender participation in sport is one which offers no easy solutions.
Irrespective of that, a flow of proposals have attempted to transform the transgender question into a navigable space. One such proposal, recommends introducing a Paralympics style model wherein competitors would be grouped with respect to their ability. Such a proposal fails to surmount numerous shortcomings. How do you define ability? Isn't it antithetical to the competitive nature of sport to even try? How do you prevent the type category abuse that is rife at the Paralympics? How do you compensate for diluting the prestige, undisputed status, public recognition, and commercial worth which accompanies anointing a single identifiable champion?
Another proposal is to convert the male category into a revamped "open" category. While equitable in a competitive sense, it may serve to inadvertently reinforce a societal stigma which refuses to consider trans-women as anything other than men. Essentially, therefore the idea of an "open" category fails to satisfactorily reconcile the issue of matching trans-identity with a congruous category. A similar empathy gap undermines the proposal to introduce separate transgender categories. A shortcoming which would only be exacerbated by a probable lack of competitiveness, given how few transgender athletes are presently active, and by the insidious threat of bigoted violence which could manifest as a result.
Notwithstanding the limitations which hamper proposals to resolve the issue, it remains imperative that a compromise, and it will have to be a compromise, is reached. Otherwise, the high farce which surrounds a 2-time Texas state girls 110-pound wrestling champion will be replayed over and over again on an interminable loop of bureaucratic intransigence.
The wrestler in question is Mack Beggs, assigned as female at birth, he is currently undergoing hormone treatment to transition to male. As his birth certificate lists Beggs as a girl, he is required by the rules governing in-state competition to compete as a female. This despite the fact, incidentally, that he has petitioned to compete as a boy - appeals which have fallen on deaf ears. To compound matters, whereas his use of testosterone, within the female category, is permissible under state rules, due to the fact that it has been prescribed, this is not the case when Beggs fights under USA Wrestling's rules. Therefore, if one adds these two incongruous regulatory frameworks together what results is a ludicrous scenario wherein Beggs is forced to hop across gender lines, between male and female, at the behest of administrative bodies.
On top of that, bear in mind the boos that greet his victories, bear in mind the fact that transgender persons exhibit higher rates of suicidal ideation, and bear in mind that this is a kid in high school. Now, with all that in mind, surely from some primeval well of humanity the powers that be can draw just enough compassion to codify rules which are at least consistent.
Sadly, in many ways Beggs' story could be considered as a metaphor for the overarching controversy; a complicated question, which became more complicated still in the asking, now seems almost impossible to answer. Admittedly, scientific research continues undeterred, with new studies branching out to examine the relationship between hormone levels and physiological measures. But, while such efforts are laudable, they may ultimately prove futile. To my mind, on this issue, scientists are paddling upstream against a problem which, in meandering between biology and sociology, traces the unpredictable path of culture.
As such, while I can appreciate the argument, posited by, among others, Nicola Williams of Fair Play for Women, that further scientific evidence should be a prerequisite for transgender participation in female sport, it is not a point of view that I personally can share. Since, fundamentally, this is a position which can be reiterated ad infinitum - how much science is enough science? - it smacks to me a little of kicking the can down the road and of trying to wish a future solution into existence. Yes, undoubtedly our current scientific understanding is patchy at best, but by the same measure, any future understanding will be imperfect also. Don't get me wrong, absolutely, research should continue, but at the same time raising expectations that a clear-cut scientific answer is lurking in a test tube somewhere seems disingenuous - at least in the short to medium term. Ultimately, pressing pause on a live issue today only creates a backlog of issues tomorrow.
That said, neither do I agree with Dr McKinnon's position that trans-women should have unfettered access to compete as females. While part of me is uneasy about the notion of imposing hormonal thresholds, particularly if strict adherence is proven to precipitate a deterioration in health, I can see no practical alternative which can promise to safeguard the sanctity of the female category to the same degree. Although Dr McKinnon's attribution of the gender performance gap to sociological factors should not be entirely dismissed, it seems manifestly evident that biological factors do indeed constitute the majority of the difference. Moreover, as Jillian Bearden and Joanna Harper, steadfastly maintain, with compliance comes credibility and with credibility comes the prospect of more widespread acceptance. Additionally, it should also be noted that the presence of a hormone threshold may serve as a deterrent to cisgender males who may otherwise be tempted to impersonate trans-women.
Obviously, my own argument is eminently disputable - one could very legitimately argue, hell even part of me argues, that introducing regulation without the requisite scientific research is myopic and that it prioritises short-term expediency ahead of long term stability. Manifestly, this is a compromise then, but, particularly in highly emotive cases such as this, compromise doesn't always have to be a shabby byword for selling one's principles short. Indeed quite the opposite. Compromise is often the place where one's idealism comes closest to becoming everyone's reality.
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