Last week, the international governing body for water sports, known as FINA, announced its updated policy for women’s swimming competitions, which effectively bans transgender women from competing in women’s events. This new “gender inclusion policy” only allows swimmers who transitioned before the age of 12, or before the start of male puberty, to compete in women’s events. The argument is that there are “legacy effects” that come from the increase in testosterone levels in men and boys, allegedly giving transgender women performance advantages over cisgender women.
“FINA’s new eligibility criteria for transgender athletes and athletes with intersex variations is deeply discriminatory, harmful, (and) unscientific,” Anne Lieberman, director of policy and programs at Athlete Ally, an organization advocating for LGBTQ athletes, said in a statement. “The eligibility criteria for the women’s category as it is laid out in the policy police the bodies of all women, and will not be enforceable without seriously violating the privacy and human rights of any athlete looking to compete in the women’s category.”
While the FINA policy was informed by the work of specialist groups in athletics, science and medicine, and legal and human rights, there is another argument around the kind of science that should be considered in these kinds of policies. Joanna Harper is a medical physicist and visiting fellow for transgender athletic performance at Loughborough University in England, where she’s part of a program researching the physiology of transgender athletes. She took some time to talk about looking at the science around the performance of transgender athletes versus the science that looks at the differences between male and female athletes; her desire to begin researching this topic after beginning her own transition in 2004 and noticing the changes in her performance as a serious distance runner; and what she typically considers when advising other governing bodies, including the International Olympic Committee, on drafting similar policies. (This interview has been edited for length and clarity. )
Q: You’ve done a considerable amount of work in researching gender and sports — reviewing dozens of studies to review how hormone therapy in transgender women changes body composition, muscle strength and hemoglobin levels — and authoring “Sporting Gender: The History, Science, and Stories of Transgender and Intersex Athletes.” First, can you talk about what initially led you to this specific field of study and research?
A: In 2004, I started my gender transition and I was, and still am, a fairly serious distance runner. Within nine months of starting hormone therapy, I was running 12 percent slower, and that’s the difference between serious male distance runners and serious female distance runners. I’d lost the male advantage within nine months of hormone therapy. I was intrigued as a scientist and I set out to learn more. My background is in medical physics, which is the application of principles of physics to the medical world. I started to learn endocrinology and exercise physiology so I could figure out what happened to me. I also started to gather data. It took a while, but in 2015, I had been asked to publish a paper on transgender athletes. It was a small study and a minor publication, but there was nothing else like it. There were no published data on trans athletes, so I suddenly found myself to be a leading expert. In 2018, Loughborough University decided that they wanted to look at the physiology of trans athletes and they contacted me and asked me if I could help set up a program. I told them that I wasn’t qualified, I didn’t have a Ph.D. They said, “Well, why don’t you come here and get one?” and that’s how I got to be where I am now. We’re doing research into the physiology of trans athletes.
Q: Since FINA’s most recent policy announcement, there’s been a lot of discussion around the topics of science, biology, hormones, inclusion and discrimination. I understand that you’ve previously advised a number of international sports federations, including the International Olympic Committee. What are you typically considering when you do advise agencies on these kinds of policies?
A: The first step would be that trans women should be suppressing testosterone to typical female levels, and I would suggest that that should be a necessary, but not always sufficient, condition of a policy. That was a cornerstone of the 2016 IOC policy that I helped craft and it’s a cornerstone of many other policies, including the now expired FINA policy. I would suggest that the previous FINA policy was probably fairly successful, given that there were no trans women competing at international levels of swimming, so the idea that this wasn’t enough to protect the female category, I don’t think that holds water if you look at the fact that no trans woman has qualified for international level swimming.
Q: And what do you make of this new FINA policy?
A: I think it’s unnecessary. I think it’s overly restrictive.
Q: With this new policy, trans women would only be allowed to compete if they started hormone therapy to reduce testosterone levels before starting the early stages of puberty, or before the age of 12. The reasoning here is that going through male puberty allegedly gives transgender women a lasting and irreversible physical advantage over cisgender women. What has your own work in this area revealed about this understanding of a lasting physical advantage in athletic competition?
A: It’s certainly true that the differences between male athletes and female athletes start with puberty, and when young men go through puberty, they get a surge of testosterone that creates bigger bodies, stronger muscles, higher hemoglobin levels, thicker, denser bones, and several other advantages. Anyone with testes will get the same benefits of going through male puberty, even if they’re transgender. Some of those changes are reversible, some are partially reversible, and some are irreversible. Hemoglobin will go from typical male to typical female values within four months of hormone therapy. Strength will be reduced, but not to female levels, and height won’t be reduced at all.
However, transgender women will also have disadvantages: their larger frames are now being powered by reduced muscle mass and reduced aerobic capacity that can lead to disadvantages, things like quickness of recovery and endurance. Trans women also tend to put on weight and that can be disadvantageous. Trans women also face numerous sociological and psychological disadvantages that can affect athletic performance. Overall, athletic performance is multifactorial, so just focusing on one factor and saying that, while it is true that some of the effects of testosterone that trans women will get with puberty are irreversible, doesn’t mean that the overall performance of transgender women will be out of the realm of norm for all women. We either need to be established or refuted on a sports basis by actually gathering data from trans women.
Q: Athlete Ally, an organization supporting the rights of LGBTQ athletes, has called this new policy, in part, “unscientific.” Do you understand the policy in this way?
A: I don’t think it is unscientific. It is based on science. However, the important science isn’t the science that differentiates male athletes and female athletes, but the science surrounding the performance of transgender athletes, and that science is in its infancy. In the sense that they are diminishing, or perhaps completely ignoring, the lack of science around trans women, I guess you could say it’s unscientific. The science in the performance differences between men and women are well established and the people who wrote this policy are very well aware of that. They’ve used that as the basis of the policy. I don’t think it’s unscientific that I say they may not be looking at the right science, but the science that they’ve looked at, they understand well and they’ve used well.
Q: In the discussion about the physical advantages accompanying the testosterone levels assumed to be found in men and boys, compared to women and girls, among the list of advantages are increased muscle mass, bone density, hemoglobin levels that allow for an increase in speed and endurance. Then, there are examples of cisgender female athletes with naturally higher testosterone levels than some of their competitors. What do most of us misunderstand about hormone levels and how they show up in men and women, and what that means for athletic competition?
A: There’s a huge gulf between the testosterone ranges of men and women. When scientists say ranges, we mean the 95 percentile level, or the level that 95 percent of all people have. The male testosterone level, using the latest measurement techniques, is between, roughly, eight and 25 nanomoles per liter; the female level is under two. So, the bottom of the men’s range is four times as high as the top of the women’s range. That’s a huge gulf. It is important to note, that when we speak of women’s range — by definition, that means 2.5 percent of women will be above the top end of the range — some interesting things happen with that 2.5 percent: there’s a condition called polycystic ovary syndrome, which can lead to elevated testosterone levels; assuming you count intersex women as women, there are some intersex conditions that can also lead to elevated testosterone levels. So, if you’re talking about 95 percent of all women, their testosterone is within a very narrow range, but some of the outliers have some interesting testosterone features.
Q: Overall, what has your own research demonstrated about how we can best understand inclusion for transgender and intersex athletes?
A: My research isn’t really about inclusion, it’s about physiology. Outside of the research, in the policy and public sector areas, a nugget of wisdom I would have is that if someone thinks of trans women as men who think they’re women, or men invading women’s sports, then you will look at this question very differently than if you think of trans women as a subgroup of all women.
If you think trans women are men invading women’s sports, then each successful trans woman is an affront to you. However, if you think of trans women as a subgroup of all women … if we come up with policies that don’t create an overrepresentation of trans women, then those policies could by some standard be considered successful. Rather than looking at simply one or two or a few successful trans women and saying that it’s unfair, I would suggest you should look and see if trans women are overrepresented in women’s sports, and they aren’t. Trans women are hugely underrepresented in that population. That sort of philosophy, from the science that I’ve looked at, I think has a useful way of framing the issue.