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Friday, December 01, 2023 — Houston, TX

Letter to the Editor: On fairness and trans-inclusivity in athletics

By Vinay Tummarakota     3/22/22 11:07pm

Editor’s Note: This is a letter to the editor that has been submitted by a member of the Rice community. The views expressed in this opinion are those of the author and do not necessarily represent or reflect the views of the Thresher or its editorial board. Letters to the editor are edited for grammar and spelling by Thresher editors. 

On Feb. 2, 2022, the Thresher published an opinion advocating for Seth Huston to undergo allyship training in response to his comments on trans-women’s participation in women’s sports. While I whole-heartedly endorse several of the authors’ key claims — such as their opposition to House Bill 25 — their interpretation of evidence regarding the effects of hormone therapy on trans-athletes lacks appropriate context, serving as a reminder to critically evaluate evidence in politically fraught discourse.   

For example, the article cites a systematic review published in the British Journal of Sports Medicine to claim that “measures of strength and muscle area [in trans-women] also fall to less than that of cis men” following hormone therapy. However, this claim omits critical context, neglecting to mention that the review also concludes that “values for [muscular] strength, LBM [lean body mass] and muscle area in transwomen remain above those of cisgender women, even after 36 months of hormone therapy.” 

The article then goes on to cite a metastudy of eight research articles which finds “no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage.” However, this metastudy includes just one quantitative cross-sectional study that evaluates the effects of hormone therapy on physiological characteristics. This singular study — which compares the muscle-mass of post-treatment trans-women to pre-treatment trans-men — found a statistically significant difference in muscle mass between the two groups. 

Given these issues with the authors’ interpretation of the literature, one might be tempted to conclude that trans-women must be barred from competing alongside cis-women in athletics. However, there are several arguments in favor of trans-inclusionary policies that must be considered before reaching such a conclusion. 

First, the systematic review notes several limitations of existing research including but not limited to the dearth of prospective studies, small sample sizes, high rates of attrition and study populations composed of untrained individuals as opposed to trained athletes. An additional limitation raised by the cross-sectional study is the lack of height-matched control groups. Given that height is associated with lean body mass and variation in height is viewed as an acceptable natural difference in most sports, studies comparing trans- and cis- athletes ought to stratify comparisons of lean body mass by height. 

Independent of these limitations, however, is the broader philosophical issue of the level of natural variation that is acceptable within a given category of sport. To examine the issue, consider the following two cases: 

Case 1: The internationally-acclaimed volleyball player Flo Hyman was born with Marfan syndrome. Marfan syndrome leads individuals to have a large height and arm-span which are advantageous characteristics in a sport such as volleyball. 

Case 2: An athlete with fully-functioning limbs is barred from competing against A3 athletes in the Paralympics due to the unfair advantages yielded by a full set of limbs. 

Considering these cases in tandem, one might reasonably ask what moral standard permits Hyman’s natural advantages in volleyball while demanding separate divisions for athletes with and without a set of fully-functioning limbs. In my view, the standard to be upheld is that overwhelming advantages - rather than mere relative advantages - constitute grounds to segregate sports. Therefore, to deny trans-women entry into women’s sports, one must demonstrate that trans-women’s athletic advantages are overwhelming such that cis-women would be effectively disenfranchised from the sporting event in question. 

The cross-sectional study highlights the difficulty of making such a determination. Although differences in muscle mass between pre-treatment trans-men and post-treatment trans-women are statistically significant, the range of muscle mass values for both groups is just shy of achieving complete overlap as shown in Figure 1. Furthermore, determinations of overwhelming advantages may vary by sport because different sports rely on hemoglobin levels, muscular strength, and lean body mass to different degrees.  

Lastly, an incidental benefit of trans-inclusion in women’s sports is the greater ability to conduct prospective studies assessing the comparative advantage of trans-athletes relative to cis-athletes. Assuming that trans-athletes are more likely to compete under more inclusive policies, researchers would be better-positioned to conduct studies with larger sample sizes and well-defined controls, leading to a more precise estimation of the relative athletic advantages that trans-women may possess over cis-women. 

Thus, while I take issue with the authors’ interpretation of the literature on the relationship between hormone therapy and athletic ability of trans-women, I believe a much more robust body of research is necessary to determine whether trans-athletes possess overwhelming natural advantages over cis-athletes.

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