Comment on Dr. Rachel McKinnons youtube video "Including Trans Athletes in Sport: Analyzing Principles and Policies of Fairness in Competition"

Firstly – the video in question. You have to watch it for this blog post to make any sense. Secondly, my position in the whole "trans/intersex/high testosterone female athlete" debate after having seen Rachel's video is more or less the same as it has been since I wrote a blog post about the topic two years ago. This position is a middle position of sorts, similar to the one espoused by "scientist first, athlete second, transgender third" Joanna Harper, whose opinions on the matter are stated here, and a more personal account of her experience as a trans athlete on hormone replacement therapy is something can be read about here.

Having gotten that out of the way, although I understand that singling out (only) testosterone as something to determine female eligibility in sports is problematic (since women come in all shapes and sizes, etc), I still think that this makes the most sense taking all things into account. Rachel asks (rhetorically) why it should be considered fair to permit other large competitive advantages based on natural physical characteristics like height where the advantages are greater than the 10-12% which male athletes have over female ones (supposedly mostly due to their testosterone levels), but ban levels of endogenous free testosterone (fT) in female athletes that although comparatively high, confer a much smaller advantage than that. What needs unpacking here before answering the question is the alleged "endogenous testosterone that confers a smaller advantage", and the research that this conclusion is based on. Sure, high fT levels in female Olympic athletes might account for a “mere” ~3% difference in performance, but this is only so when using a very specific tool to measure and define what would constitute“high levels of fT”.

(I'm jesting – it's not really that bad)

As Roger Pielke writes in his review of the IAAF study (Bermon and Garnier, 2017), the paper has some significant methodological issues, the most notable according to him being the inclusion of female athletes known to have been doping, with those who have naturally high levels of fT. I myself see the usage of tertiles to divide female athletes and their athletic performance as it relates to high fT levels as more problematic. Don't get me wrong; the study as presented does give us valuable information, but I don't really know what to do with it for my purposes, because I'm mostly interested in the outliers – i.e. the freaks – and their relative performance to the other 99% which although not by any stretch are necessarily “normal”, definitely are so relative to the super (in more than one sense) deviations. Why? Because the question of female eligibility has always been actualized in relation to the outliers, rather than a third of the elite athletes. The fact that there is an on average 3% difference in athletic results between the top and bottom tertiles isn't surprising, nor am I sure that it should matter to anyone if this data isn't supplemented by data concerning the aforementioned 1% (unless one deems 3% to make all the difference in the world of elite sports and thus feels satisfied with the data we already have because any more would be "more of the same"). As Joanna Harper writes: "The difference in the T levels between the two groups of women in the Bermon/Garnier study was not nearly as large as the difference between most women and those with hyperandrogenism. And it is this massive testosterone-based advantage held by many intersex women that was the foundation for the now-suspended IAAF rules".

In the Bermon/Garnier study, twenty-four female athletes showed a T concentration >3.08 nmol/L, a number which according to Pielke has been calculated to represent the 99th percentile in a previous normative study in elite female athletes. What this means is that those women have exceptionally high fT levels, yet still have 3-10 times lower levels than the average man does. The argument could be made that although hyperandrogenism in general (among elite, Olympian athletes, that is*) doesn't seem to confer a competitive advantage larger than ~3% across the board, some cases of hyperandrogenism might. One might also thus argue that some cases of "transgenderism" have even bigger potential for conferring competitive advantages in female athletes – especially if allowing trans women who haven't gone through hormone replacement therapy be eligible for female competition, which is Rachel's opinion.

My own opinions in the matter are a conglomerate view that I've arrived at after considering the available research, female sports as a whole, the transgender issue, the social justice aspects, etc. I still think that although there is no clear answer here, and there are inconsistencies in all the conclusions which seem possibly correct to me and touches base with all of the point of interests and areas of contention mentioned above, I believe the best way to go from here is to classify people by default as men or women as dictated by their legal gender, and then permit sport organizations to measure athlete's fT levels and deny people who have a higher concentration than say 8 nmol/L to compete in the female category. It might be wise to add some corollary qualifiers following this, such as a time-span in which the athlete must have such and such (low) fT levels, or that the legal gender of the athlete wanting to compete in the female category should also be female. And although my focus lies on the "eligible vs ineligible female regulation" part of it all, I do believe that gender verification by legal documents rather than self-definition would help the cause here to get trans women more accepted the coming 10-20 years as women, and as female athletes, which is very important to me – more so than opening up the playing field for all kinds of trans(feminine) people.

In the interest of fairness, and given the disparities concerning transgender care and acceptance across countries, one could argue that self-definition is the more just option for “deciding gender”, but I'm hoping that the problems for specific individuals (even if seen in the light of class and/or race) following a stricter admittance policy would be small enough not to justify to give up "the needs of the many", whom I deem would be better served by having eligibility requirements. I believe that the needs of the many are likewise best served by not allowing fT levels higher than 8nmol/l to compete in the female category simply because I don't believe it would be that much of a problem for a clear majority of intersex and transgender athletes due to my assumptions that 1) not many women with hyperandrogenism have testosterone levels in the male range, and 2) very few trans women would want to, while also serving as a sort of check for both public outcry, and controversy.

As such, just as Rachel, I am using a proportionality test as a condition for justifying prima facie discrimination, only reaching different conclusions than she does. Are the social benefits of the discriminatory policy outweighing the cost to those discriminated against? When it comes to not allowing transgender women compete as women, the answer is emphatically no, but my answer right now is unequivocally negative only when there are corresponding modifiers and "prima facie discrimination practices" applied which expressly regulate and use fT levels as the central eligibility criteria for participation. Such are the conditions under which I believe the most goodness can be expressed and achieved, and although that statement might sound unambiguously utilitarian, I consider my belief to be more nuanced than so, in that I approach the matter (but perhaps don’t disclose this process well enough) also from other vantage points, for example pragmatism and virtue ethics.

All of sports and it’s idea of “fairness” is, to be honest, as much make-believe as the rules which govern the different sports, but in order for the pretense to be kept up, rule changes of any kind have to be grounded in some sort of “natural virtue” as much as people’s idea of fairness, and their intuitions concerning these. There’s nothing God-given in the whole male/female division, but as long as our intuitions concerning sex and gender are the way they are, and are so strong that it’s one of the intuitions we organize our society after the most, the rules which govern sports will, and should, be an expression of that fact – given that we value that institution as a bearer of and a vessel for our moral values. Times they are a’ changin’, sure enough, and so do the rules which follow the times, but they do so gradually, and I see little value in full-on revolution when things are going in the right direction already.

We might imagine a future Olympic Games that has done away with the idea of crowning a champion that is the best there is in a given category and/or sport, and instead concentrates on creating an event that is radically different to what we might imagine today. Where every event that takes place is more centered around people and their training process, reality-show style, than performance. Where the people selected for the venue have been done so by lottery tickets – a different sorts of “veil of ignorance”. They might even make the Olympics about something else than competition altogether, focusing instead on play, and fun. The question comes down to what sort of bodies and events we, right now; want to watch perform athletic feats; what kind of athletes inspire us; and what rules make us aspire to become better athletes, competitors, and people, on the whole, and as a whole – as a people. Paradoxically, as with all aspirations of unity (even unity in diversity), someone has to draw the short straw, and it’s not fair, but it can be appropriate and right nonetheless. 

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* A 3% advantage performance at the Olympic level is very much given that it can basically be the difference between competing for a medal and not qualifying at all, but one must remember that this is after having added together all of the other advantages that the Olympians have over the general population, such as physical markers (height, weight), genetic variables, other hormonal markers,, accessibility to good coaching, etc. People who compete in the Olympic Games are the cream of the crop, meaning that they already have a significant amount of the competitive advantages that are possible to have, making high fT just one of many variables which are more or less “maxed out” in the athletes in question, which, depending on how you look at it (and depending on how much empiric data, besides “clinical experience”, we actually might have on the matter), makes high fT levels even more essential for competition at an elite level, or, in fact, less.