IOC transgender athlete policies and history

Transgender athletes have been competing openly since 1976 [ ] when Renee Richards took the tennis world by storm. Richard was not the only openly transgender athlete of note in 20th century, as American golfer Charlotte Wood [ ] and Thai kick boxer Nong Toom [ ] both caused a stir in their respective sports. Canadian downhill mountain biker Michelle Dumaresq was granted permission by the Union Cycliste Internationale (UCI) to compete against cisgender (or typical) women in 2002 [ ]. Although these individual athletes were pioneers, it was the 2004 decision by the International Olympic Committee (IOC) to allow transgender women to compete in the women’s category of the Olympics [ ] that opened the door for wider participation by trans athletes in sport. The 2004 IOC policy and two sets of guidelines released by the IOC in 2016 and 2021 have been seen by many as documents which legitimized transgender inclusion in sports. To understand the 2004 IOC policy, it is necessary to backtrack a few years and to learn more about Arne Ljungqvist the architect of the so-called Stockholm Consensus.

Arne Ljungqvist was born in suburban Stockholm in 1931 and competed in the high jump in the 1952 Olympics. After retiring as a high jumper, Ljungqvist enrolled in medical school at the Karolinska Institute, one of world’s best educational facilities. His medical expertise and his continued interest in the sport of athletics (track and field to Americans) led him to medical positions in the IOC and in the IAAF, the forerunner to the current World Athletics [ ]. The case of intersex hurdler Maria Jose Martinez-Patino led the IOC and IAAF to convene panels of experts to investigate the question of eligibility for women’s sport in the late 1980s [ ], and Ljungqvist was a central figure in these panels. In the 1990s, these panels were mostly concerned about intersex athletes but in the early years of the 21st century the IOC also decided that they needed a ruling on transgender athletes [ ]. By this time Ljungqvist was the head of the IOC medical commission and he convened a meeting in his hometown. The assembled group of scientists was swayed by the work of Dutch Endocrinologist Louis Gooren who would publish a 2004 paper documenting changes induced by hormone therapy in trans people and suggesting that it was reasonable to allow transgender women to compete in women’s sports [ ]. The resulting IOC policy would allow transgender women into the female category provided they had completed legal changes, gonadectomy, and 2 years of postsurgical hormone therapy [ ].

Although there were many at the time who suggested that allowing transgender women into the women’s category of the Olympics would lead to the death of women’s sports [ ] no openly transgender athletes competed in the 2004, 2008, or 2012 summer games or the 2006, 2010, or 2014 winter games. The transgender athlete who came closest to qualifying for the Olympics in that time span was a trans man named Keelin Godsey who competed in the women’s hammer throw [ ]. Godsey had won NCAA throwing championships while competing for Bates College [ ], competing first under his birth name and later as Keelin. Because Godsey was not taking testosterone at the time, he was allowed to continue competing in the women’s category. By 2011 Godsey was one of the best hammer throwers in the country and he qualified for the US team at the Pan American Games championships that year [ ]. Godsey entered 2012 with a very good chance to qualify for the American Olympic team. He threw a lifetime best of 321′ 3″ to place fifth in the US Olympic trials and fell an agonizing 11″ short of the third and final Olympic qualifying position [ ]. Later in the summer of 2012, Godsey started to take testosterone, ending his eligibility for the female category. He did compete sporadically in the men’s category after his medical transition but not with serious intent [ ].

In 2011, the NCAA [ ] and the IAAF [ ] started to allow transgender women to compete in the women’s category without mandating gonadal surgery. The NCAA regulations stipulated that trans women undertake 1 year of hormone therapy prior to competing in the women’s category while the IAAF rule required trans women to maintain testosterone levels below a certain threshold for 1 year prior to competing in the women’s category. By 2015, it had become apparent that trans women were not taking over sports either in the NCAA or in international athletics. There was also a growing recognition that requiring surgical intervention to compete in sports was not compatible with 21st-century notions of human rights [ ]. Thus, in November 2015 the IOC convened a meeting to devise new guidelines on transgender and intersex athletes. As they had done since the 1980s, the IOC invited a panel of experts to the meeting, but for the first time there was both an intersex and transgender person in the room. Maria Jose Martinez-Patino was a hurdler in the 1980s and after her famous resistance to the chromosome-based eligibility rules of the time, she went on to earn a Ph.D. in physical education [ ]. Joanna Harper is a transgender scientist and distance runner who published an analysis of trans distance runners in 2015 [ ]. The presence of Martinez-Patino and Harper represented an important shift for the IOC, but they were only 2 of 25 decision-makers at the table. It is questionable how much the presence of the two gender variant athletes affected the eventual outcome. The document produced by this working group was published in January 2016 [ ] and removed the requirements for surgery and legal changes, substituting a requirement for 12 months of low testosterone and a statement detailing the desire to compete according to gender identity. The length of hormone therapy required before competing in the female category was reduced from 2 years to 1.

Just as in 2004, the reactions to the 2016 IOC guidelines were mixed. There were some who were thrilled that the surgical and legal requirements were dropped [ ], while there were others who suggested that it would (yet again) mean the end of women’s sports [ ]. There were many international sports federations that were troubled by the elimination of the surgical requirement for trans women and hence the IOC held another meeting in May 2016 to reassure these federations that their sports were not in danger from the new guidelines [ ]. It was at this May 2016 meeting that the seeds for a lower testosterone limit for trans women were sown. This requires some explanation.

When the IAAF chose 10 nmol/L as the lower testosterone limit [ ] (adopted by the IOC in 2015 [ ]) for their hyperandrogenism policy in 2011, they used the bottom of the “normal” men’s testosterone range as determined by immunoassay methods [ ]. A normal range is defined as the 95% confidence level of a distribution [ ], and immunoassay methods were the dominant means of measuring testosterone in 2010. Over the next few years, mass spectrometry methods combined with liquid chromatography (or LC-MS/MS) became the gold standard for measuring testosterone [ ]. The bottom of the men’s testosterone range using LC-MS/MS methodology is approximately 7.7 nmol/L [ ]. Additionally, one should be more concerned about the women’s testosterone range than the men’s testosterone range when determining an upper limit for transgender women in sports. Using LC-MS/MS methods, the top of the “normal” women’s range is approximately 1.7 nmol/L [ ]; however, there is a common condition called polycystic ovary syndrome (PCOS) that afflicts between 5% and 10% of cisgender women and can cause elevated testosterone levels [ ]. Although there are unpleasant effects of PCOS, the elevated testosterone levels lead to overrepresentation of women with PCOS in sports. Data suggest that 99.99% of women with PCOS have testosterone levels below 5 nmol/L [ ]. The advantage gained by women with PCOS is small enough that no one would attempt to regulate PCOS. If one will allow cisgender women with testosterone levels of up to 5 nmol/L to compete in women’s sport, then it is reasonable to allow trans women to compete in women’s sport with the same testosterone limit. Thus, the recommended lower limit for transgender women that eventually resulted from the May 2016 IOC meeting became 5 nmol/L [ ] and was adopted by World Athletics for its 2019 transgender policy [ ]. Regardless of whether sports agencies set their testosterone limit at 5 or 10 nmol/L, more than 90% of trans women (including athletes) maintain testosterone below 2 nmol/L for therapeutic reasons [ ].

Once again, there were no openly transgender athletes in the 2016 summer Olympics or in the 2018 winter Olympics [ ]. However, by 2019, there had become a small cohort of openly transgender athletes who did have the potential to qualify for the Tokyo Olympic Summer Games originally scheduled for 2020. It would be instructive to chronicle their progress.

The first of these athletes is Hannah Mouncey who represented Australia 22 times in men’s handball prior to her transition in 2015 [ ]. There were many who were concerned that the residual size and strength of Mouncey—approximately 6′ 2″ and 220 pounds—would result in her dominating the women’s game. Mouncey first competed internationally in women’s handball at the 2018 Asian championships where she was the third leading scorer for the Australian team that placed fifth in the 10-team tournament [ ]. Although Mouncey was one of the most important players for the Australian team, neither she nor her team dominated play. Moreover, Mouncey was left off the 2019 World championship squad, reportedly because her teammates “ didn’t want to get changed and shower with her” [ ]. The Australian team placed 24th and last in the 2019 tournament and failed to qualify for the Tokyo Olympics [ ].

The next transgender athlete who was considered a candidate for the Tokyo Olympics is Brazilian Volleyball player Tifanny Abreu who played professionally for several men’s teams prior to her 2012 transition [ ]. She resumed playing women’s volleyball in Italy in 2017 and returned to play in the top Brazilian league in 2018 [ ]. The 6′ 4″ outside hitter was a leading scorer in the league for the next few years, but also a defensive liability. Volleyball is the second most popular sport in Brazil and Tifanny—like many Brazilian sports stars she is known by first name only — was one of most polarizing figures in the country from 2018 until 2021. She was not selected for the 2018 or 2019 National team nor for the 2020 Olympic team [ ]. The Brazilian women earned the silver medal in Tokyo.

American BMX freestyle rider Chelsea Wolfe stands 5′ 9″ tall and took up freestyle riding in 2014 after her transition. Once the sport was added to the list of events in the Tokyo Olympics, she got more serious about it [ ]. Wolfe competed internationally for the first time in 2019 and finished 11th in the world championships. Wolfe’s path to the Olympics was made more challenging by the fact that only two American women were allowed to represent the country in the Tokyo games and Wolfe was the third best of the strong national contingent [ ]. Wolfe was named the alternate on the American team for the Tokyo games, allowing her to march in the opening ceremonies but not compete [ ]. The two Americans who did compete in the event in Tokyo, Hannah Roberts and Perris Benegas, finished second and fourth in the games, as Britain’s Charlotte Worthington won gold and Swiss rider Nikita Ducarroz took the bronze [ ].

New Zealand weightlifter Laurel Hubbard set a national junior record of 300 kg [ ]—the total of lifts in the snatch and clean and jerk—in the 105 plus kilogram weight class in 1998. She retired from competition in the men’s category in 2001. Hubbard began her transition in 2012 at age 34 and first competed in the women’s super heavyweight category in 2017. She finished second that year in the World Weightlifting championships with a combined lift of 275 kg, although it should be noted that nine of the World’s top weightlifting nations were banned from the event because of performance drug infringements [ ]. Hubbard competed in the Commonwealth Games in 2018 but ruptured a tendon in her elbow during the snatch and had to retire from the competition [ ]. She did not return to international level competition until 2019, after surgery and rehabilitation. Hubbard placed sixth in the 2019 World championships with a total lift of 285 kg [ ]. She qualified for the Tokyo Olympics at age 43 but failed to record a clean lift in the snatch, placing 14th and last in the competition [ ]. She retired from the sport within days of her Olympic effort [ ].

The most successful transgender athlete at the Tokyo Olympics was the nonbinary Canadian footballer (soccer player to Americans), Quinn, who was assigned female at birth. Quinn played for Duke University from 2013–17 and earned a bronze medal with the Canadian women’s soccer team in 2016 [ ]. Quinn was not out in 2016 and hence there was no publicity around their Olympic participation. Quinn was drafted into the National Women’s Soccer League upon graduation from Duke and has played professionally in the United States, France, and Sweden [ ]. In September 2020 Quinn came out to the world via Instagram [ ], becoming one of the world’s highest profile transgender athletes. Quinn was named to their second Olympic team in June 2021 [ ] and started almost every match in the Olympic tournament. Although the Canadian team had trouble scoring goals throughout the tournament, their stout defense led them to the gold medal. After a 1-1 finish against Sweden in the gold medal game, the Canadian team won on penalty kicks [ ]. Quinn is the first openly trans athlete to win any Olympic medal, let alone a gold medal [ ].

The final openly transgender athlete in Tokyo was nonbinary athlete Alana Smith who competed in the women’s street skateboard event [ ]. Smith was a prodigy in the sport as they won a silver medal in the X Games in Barcelona in 2013 at age 12 [ ]. Unfortunately, there was a dark side to Smith’s early success. Smith grew up in a dysfunctional family and their skateboard success became a way to earn money rather than a passion. Smith ultimately became emancipated from their family and settled in with their partner’s family, but also wound up quitting the sport and suffered through multiple suicide attempts before rejoining the sport in 2019 [ ]. It was during their darkest moments that Smith realized that their love for skateboarding remained intact and their decision to return to competition was rewarded with a birth in the sport’s Olympic debut. Although Smith finished last in qualifying, they came away from the games smiling [ ].

In addition to the nonbinary Olympians, there were three out nonbinary paralympic athletes who competed in Tokyo in 2021 [ ]. This list was headed by Australian Robyn Lambird, who won a bronze medal in the women’s 100 m T34 sprint on the track [ ], but also included track and field athlete Maz Strong and rower Laura Goodkind. And although they did not make the Olympic team, nonbinary middle distance runner Nikki Hiltz did compete for the United States in the 2019 World Athletics Championships [ ] and continues to earn their living as a professional track and field athlete. Layshia Clarendon has played for 8 years in the WNBA and is the only professional basketball player known to have top surgery [ ]. Last, but by no means least, skateboarder Leo Baker, who uses both he/him and they/them pronouns, quit the US Women’s skateboarding team in 2020 to start taking testosterone and have top surgery [ ].

Despite increasing numbers of openly trans and nonbinary athletes, such athletes are still significantly underrepresented at all levels of sport. For instance, there were 5494 women athletes in Tokyo and 5982 men [ ]. Given that transgender people probably make up somewhere between 0.5% and 1.3% of the population [ ] then one would expect that between 27 and 71 of the athletes in the female category would have been transgender and/or nonbinary rather than the three listed above. The levels of underrepresentation are substantially more stunning if one examines grassroots or recreational level sport.

The topic of trans athletes in the Olympics remained hot even after the Tokyo games as the IOC announced a new transgender athlete framework on Tuesday, November 16, 2021 [ ]. The framework relies on 10 principles: inclusion, prevention of harm, nondiscrimination, fairness, no presumption of advantage, evidence-based approach, primacy of health and bodily autonomy, stakeholder-centered approach, right to privacy, and periodic reviews. Rather than rely on a panel of scientific experts for this policy, the IOC adopted a human rights–based approach, and the fact that inclusion, prevention of harm, and nondiscrimination are the first three principles of the new framework reflects this approach. It is appropriate to examine two of the principles more closely. The evidence-based approach principle suggests that restrictions on trans athletes are only appropriate once “robust and peer-reviewed” research specific to trans athletes in a given sport is available. It will be several years and probably decades before such research exists, but it is imperative that sports-governing bodies have existing transgender policies. The second principle that should be examined more closely is the statement that there should be no presumption of advantage held by any trans athlete. It is not presumptive to state that trans women are, on average taller, bigger and stronger than cisgender women, even after hormone therapy [ ]. All three of these attributes are advantageous in many sports. There are sports where being taller or having a larger frame is a disadvantage but it is almost always advantageous to be stronger. However, the advantages that trans women possess have not led to overrepresentation in women’s sport.

The IOC acknowledged in the introduction to this framework that individual sports-governing bodies would have the right to create their own policies [ ]. After the introduction of the IOC framework, both World Aquatics and World Athletics announced that trans women who had undergone male puberty would no longer be allowed to compete in the female category [ ]. Prior to the introduction of the IOC framework, World Rowing banned trans women from the women’s division in international level rugby [ ] and is unlikely to reverse this ban. Given that three major sporting organizations have now enacted bans or virtual bans of trans women from the women’s category in international level competition, it is unclear how many sports-governing bodies will adopt policies that follow the principles laid out by the IOC.

The issues surrounding the participation of trans athletes—and particularly trans women in the women’s category—in the Olympics are sufficiently complex and contentious that the subject is likely to continue to have a high profile for the next several years. Although Laurel Hubbard has retired from sport, she will certainly not be the last trans woman in the games. There will soon be younger trans athletes who will capture the spotlight as the 2024 Paris games approach. Although this chapter has been concerned with Olympic-level athletes, it is important to acknowledge that only a small percentage of all athletes compete in elite sport. Most transgender athletes, like most cisgender athletes, participate in sport at a recreational or grass-roots level. Transgender athletes face substantial barriers to participate in sports [ ] and there should be efforts made to reduce the existing obstacles to participation. Unfortunately, there are organizations including national and state governments [ ] that are dedicated to denying transgender people basic rights including the ability to participate in sports. In addition to removing barriers to participation in recreational level sport, it is also important that organizers reject the notion that all sports need to be divided into male and female divisions. While it is vital to have women’s sport at Olympic and professional levels of sports, these divisions are not universally required in all lower level sports. In a world that is growing increasingly gender diverse and nonbinary, sports organizations should begin to think outside the box when creating categories for sports participation.