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The Fluidity of Gender and Implications for the Biology of Inclusion for Transgender and Intersex Athletes

Harper, Joanna, MS1; Lima, Giscard, BPhEd, MSc2; Kolliari-Turner, Alexander, BA3; Malinsky, Fernanda Rossell, PhD3; Wang, Guan, PhD3; Martinez-Patino, Maria Jose4; Angadi, Siddhartha S., PhD5; Papadopoulou, Theodora, MD, PhD6,7; Pigozzi, Fabio, MD, PhD2,7,8; Seal, Leighton9; Barrett, James9; Pitsiladis, Yannis P., MMedSci, PhD2,3,7

doi: 10.1249/JSR.0000000000000543
International Federation of Sports Medicine: Section Articles

One of the most contentious issues in modern day sport arises when sports are divided into male and female categories. The International Association of Athletics Federations’ (IAAF) previous policy regulating intersex athletes was suspended by the Court of Arbitration for Sport (CAS), resulting in a new policy. The challenge faced by the governing body of athletics is to formulate a policy that upholds both international law and the Olympic charter that stipulates athletes compete without discrimination of any kind. Implementation of the policy has been delayed until after a verdict, expected no later than March 26, 2019, in the Semenya versus IAAF trial in the Court of Arbitration for Sport. If the policy is enacted, it will restrict athletes from competing in the female athletics category with specific differences of sex development (DSD) in races from 400 m up to the mile in international level competitions unless they lower their natural testosterone (T) levels below 5 nmol·L−1. To thoroughly assess this new IAAF policy, one needs to appreciate its legal, sociological, and scientific underpinnings but also the history of previous policies attempting to define precisely how athletes should be divided into male and female categories. We previously proposed a system to deal with gender variant athletes that relied on a determination of an “athlete/athletic gender.” The concept of “athlete gender” was presented to multiple audiences, and the resulting survey is included. A large majority of participants (71% of 153) who answered the survey agreed with the idea of an athlete gender. This position also was accompanied by the request for more studies (20% of those who agreed) and concern over the process of hormone monitoring (32% of those who agreed) to avoid doping misuse. The primary argument of those participating in the survey that disagreed with the position (23% of 153) was that biological differences between males and females remained even after the transition (47% of opposing comments). Mixed gender/sex competitions provide unique opportunities for athletes to compete against one another outside of the traditional male/female divide and pave the way for a more flexible approach for dealing with gender variant athletes.

1Providence Portland Medical Center, Portland, OR;

2Department of Movement, Human and Health Sciences, University of Rome “Foro Italico,” Rome, ITALY;

3Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UNITED KINGDOM;

4Faculty of Educational Sciences and Sports, University of Vigo, Vigo, Galicia, SPAIN;

5College of Health Solutions, Arizona State University, Phoenix, AZ;

6Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, UNITED KINGDOM;

7International Federation of Sports Medicine (FIMS), Lausanne, SWITZERLAND;

8Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, ITALY; and

9The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UNITED KINGDOM

Address for correspondence: Yannis P. Pitsiladis, MMedSci, Ph.D., International Federation of Sports Medicine (FIMS), Lausanne, Switzerland; E-mail:

Copyright © 2018 by the American College of Sports Medicine.