A recent article published in the Journal of Medical Ethics (read HERE) attempts to clarify some of the concerns raised following the controversy that erupted after the publication of an earlier paper in the same journal. The paper in question concerned the conflict created by the attempt of male athletes (biologically male) who have transitioned to the female gender (“transwomen”) to be admitted into elite sporting competitions like other biologically female women (cisgender), an issue we have already addressed in our Observatory (see HERE). The dispute stems from the evidence that the hormone treatment that these men have undergone to feminize them has only partly succeeded in conferring them with female physical characteristics, with many inherently male phenotypic traits linked to their body structure, metabolism, endocrine system, brain, etc. remaining. This would give them an advantage over genetically female women that would introduce an unfair gap in elite sport.

Trans athlete controversy

Physiological futures remain, scientific says

Trans athlete controversy

The mere exposure of this comparative disadvantage between women and men who have transitioned to the feminine gender (“transwomen”) has sparked intense controversy among readers, both those who refuse to allow trans women to compete on equal terms with other female athletes and those who claim it is discriminatory not to allow trans women to compete in elite sports alongside other women.

The study cited in the first place attempted to find a middle ground between the two positions, proposing to replace the gender binary in elite sport (male and female competitions) with a different approach, based on an algorithm that would be applied to all elite athletes (cisgender and transgender); this would include a number of physiological factors (including testosterone levels, among others), as well as their gender identity. This tool would also be proposed for female athletes who have transitioned to the male gender.

Scientific aspects of trans athlete features

In the aforementioned cases, the differences that would separate biologically male athletes from women who have transitioned to the male gender are also evident and would mean a disadvantage for them, unlike in the previous case.

Even if, through hormone therapy, the testosterone level of a “transman” (biologically female but with transition to the male gender) reached that of an elite biologically male athlete, part of their previous female physiology is unlikely to change (e.g. bone structure and lung size), which means that, in this respect, they would remain at a disadvantage.

The article also reported how female athletes in East Germany, even when subjected to the highest levels of doping, failed to achieve the world records set by male athletes (read HERE entire study).

Similar cases of conflict with clinical studies of transgender people

A similar problem arose when all the red flags were raised about the inclusion in clinical studies of transgender people, who asked to be considered according to their new gender. As a result, the statistical validity of study results was compromised, with the introduction of major biases depending on the condition of biological sex in the individuals recruited for such studies, implying openly different phenotypic characteristics between sexes that remain —albeit disguised — after hormonal gender transition treatments (SEGARRA, Ignacio, et al. Sex-divergent clinical outcomes and precision medicine: an important new role for institutional review boards and research ethics committees. Frontiers in Pharmacology, 2017, vol. 8, p. 488.) (PRAGER, Eric. Addressing sex as a biological variable. Journal of Neuroscience Research, 2017, vol. 95, no 1-2.).

Behavioral – gender versus biological – sex, confusion

This type of controversy will continue as long as behavioral aspects (gender) are confused with biological aspects (sex), which are not interchangeable, as some would claim, in many of their associated characteristics.

Julio Tudela Pharm PhD

Bioethics Observatory – Institute of Life Sciences