Sport participation policy
Sport participation policies influence who has access to sport and competition, which in turn shapes our idea of who is an athlete. While inclusion policies can be based on age, school attendance, or geography, they are frequently also based on gender. Rules about gender classifications affect access to sport for transgender athletes.
This chapter will
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cover a brief history of athletic participation policy,
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discuss who determines sport participation policies and how they make those decisions,
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discuss some of the common points in the debate over transgender inclusion or exclusion,
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review selected policies at the international, national, state, and sport-specific level.
Gender-based participation policy
While this is not a chapter on the history of cisgender women’s participation in sport, it is helpful to consider the basis for gender-based policy as similar social perceptions affect debates on policy today. Until the late 1800s, women were discouraged from participation in competitive sports. Leisure or performance activities like swimming or horseback riding were appropriate, but it was thought that women were not biologically, mentally, or emotionally strong enough for competitive sport participation. Discouraging intense athletic competition was seen as needed to protect women [ ]. Women’s participation in competitive sports gradually became more common throughout the 1900s. That century also saw the growth of governing bodies like the National Collegiate Athletic Association (NCAA), the International Amateur Athletic Federation (IAAF), and the International Olympic Committee (IOC) that initially focused more on men’s athletics. These larger organizations only sought to include women after competing groups devoted to promotion of women’s athletics like the Commission on Intercollegiate Athletics for Women and Fédération Sportive Fèminine Internationale helped increase to popularity of women’s sports [ , ].
Proving one’s gender in the name of fairness
As women’s sports became more accepted, attempts to assure a person’s sex matched to their professed gender arose in the interest of fairness. The fear that a person of male sex might participate in a sport for women has its basis in beliefs that men are more athletic than women, that women need protection from harm while playing sport, or that men will attempt to cheat by pretending to be women. The myth that cisgender men would participate in women’s sports for glory is still widespread, despite there being no documentation of it happening. Any instances of discovery by verification testing were cisgender women with disorders of sex differentiation (of which they were unaware) [ ] .
In 1950, the IAAF was the first sport governing body to require female participants to prove their sex . Founded in 1912, the IAAF (now known as World Athletics) is the international governing body for track and field. The Olympic Games followed suit in 1968. Verification was based on buccal swabs or blood tests for chromosome verification (later found to be frequently inaccurate) or anatomy inspections (“naked parades”). At the end of the last century, universal testing was abandoned in favor of testing based on suspicion. Antidoping legislation and the athlete’s biological passport also helped make universal screening obsolete because athletes’ genitals were observed during urine testing and testosterone levels were routinely tracked [ ].
Decades of women needing to prove their sex normalized applying this process to transgender athletes. While testing cisgender women rarely revealed any disorders of sex differentiation and never any purposeful misrepresentation of gender, it solidified the use of lab testing as a foundation for fairness. Early policies on transgender athletes focused on proving durable gender identity, verifying testosterone levels, and committing to gender affirming surgery.
Influence of gender on athletic performance
The desire for cisgender women to prove their sex and for transgender women to verify their gender identity and testosterone levels is based on reported athletic performance gaps between men and women. Performance differences in sport are associated with gender , but there are other contributing factors that are associated with gender, such as lifelong opportunities for participation, available coaches, and challenging level of competition [ ]. Performance gaps at the elite level are narrowing with more gender-based differences in performance seen at the nonelite levels. At the elite level for many endurance sports, the performance gap is just under 5% for endurance sports and closer to 18% in power or strength-based sports [ ]. There is scientific basis for performance gaps based on fat-free mass, which is influenced by testosterone but not completely correlated with testosterone levels [ , ]. Endogenous levels of testosterone have not been clearly associated with success in sport. Studies in Elite and Olympic athletes showed that in cisgender men 16.5% had testosterone levels below 8.4 nmol/L (mean 14.6) with lowest values found in track and field, powerlifting, ice hockey, rowing, and bandy ( Fig. 9.1 ). While this study did not correlate testosterone levels with success in their event, all athletes were competing at the international elite level [ , ].
A study attempting to connect success in track and field disciplines with endogenous testosterone levels in cisgender women found only spotty correlations [ ]. The data sets for these studies have since been discredited, making even those possible correlations less likely [ , ]. Early articles on performance changes were helpful to lay the groundwork for this field of scientific inquiry, but most actually assessed nonsport performance physical changes (e.g., muscle size, hemoglobin levels) after gender-affirming hormone therapy in nonathletic transgender participants [ , ]. There is also a selection of articles that use the evidence of effects of endogenous and exogenous testosterone in cisgender athletes to argue against the inclusion of transgender athletes, which is not scientifically sound and is ethically questionable [ , ].
Unfortunately, the body of research on transgender athletes is small [ , ] and does not account for nuances of timing of transition in relation to puberty nor the impact of transition as an elite, amateur, recreational, or nonathlete on subsequent athletic performance. Transition and hormone levels seem to be a small part of athletic success when considered alongside athlete goals, genetics, body type, individual talent, psychology, economic status, opportunities for play, and sociocultural expectations. As such, a global policy on participation is sure to have some outliers on either end of success.
Proinclusion and proexclusion viewpoints
There are vocal advocates for the inclusion and the exclusion of transgender athletes at all levels of sports participation. Both sides invoke themes of fairness from different theoretical foundations.
Advocates for exclusion
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Transgender women retain a physical advantage over cisgender women, creating an unfair environment
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Proexclusion groups will lobby their peers and politicians with anecdotes or research based on the difference in performance between cisgender men and women. They will apply the Straw Man Fallacy by quoting research not on transgender athletes to seem like it applies to transgender athletes. So far the small body of research on transgender athletes shows a leveling of performance in one to three years after transition [ ]. Studies on performance benefits of testosterone in cisgender women or cisgender men cannot be extrapolated to transgender athletes.
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Transgender women were not good male athletes and transitioned for benefit in sport
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There is no evidence of this occurring [ ].
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Transgender males will use supplemental testosterone to gain advantage
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In a sporting world where athletes have had their livelihoods threatened by opponents’ use of performance enhancing drugs, it’s not unreasonable to be concerned that transgender athletes would not be immune to the allure of doping. However, transgender athletes’ testosterone levels are closely monitored, and they are subject to the same testing and monitoring as cisgender athletes.
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Advocates for inclusion
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Participation in athletics and sports has evidence for benefit for all people: physically, intellectually, socially, and emotionally. Sports and athletics have benefit for transgender people specifically.
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Transgender people have lower rates of exercise and participation in organized sports. Hostile environments in some locker rooms and some team cultures decrease physical activity in transgender people, while inclusive environments increase participation [ ].
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High school transgender athletes reported higher grades and emotional well-being than their transgender peers that did not participate in athletics [ , ].
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Transgender students in college who participated in organized sports had less suicidality and high reported emotional well-being than transgender students who did not participate in sports [ ].
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Discrimination is harmful to transgender kids.
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Research that shows that environments that foster stigma and discrimination, like an environment where transgender athletes are not allowed to compete in sport, use bathrooms congruent with their gender, or have access to medical care, are associated with increased risk of suicide attempts, suicide, substance abuse, alcohol abuse, tobacco abuse, depression, and reduced physical activity [ , ].
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Transgender athletes are not outperforming or hurting cisgender athletes.
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In fact, there may be evidence that inclusive policies benefit women’s sports. A review of participation rates in high school athletics from 2011 to 2019 showed stable percentages of young women participating in sports in states with transinclusive policies but declining percentages in states with transgender participations bans or exclusionary policies [ ].
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Most to all transgender women have testosterone levels similar to or below that of cisgender women.
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Studies on nonathletic transgender women show that most achieve levels of testosterone below 130 mg/dL (about 4nMol/L) ( Fig. 9.2 ) [ ].
Figure 9.2
Cisgender male testosterone reference ranges.
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There are many contributions to success in sport: inherent talent, finances of one’s family, genetics, body type, available coaching and competitors, mental health, cultural expectations, etc.
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Past discrimination based on race and gender was inappropriate.
Current sports policy
Who determines sport policy? This is a complex scenario with many groups influencing an athlete’s chance to play. While the IOC has its own policies, it defers to each sport’s international governing body’s standards to determine who can participate in qualifying events. The IOC does not currently have rules about monitoring serum levels of testosterone but some International Federations (IFs) do, and IF policies on participation control who makes it to the Olympics. IFs may find themselves at odds with National Governing Bodies (NBGs), as in the case of World Rugby as described below. Within the United States (US), an NGB may have guidelines, but youth participation is governed by state laws and NCAA expectations. Some states are currently trying to pass laws that are at odds with the NCAA guidelines that govern schools within that state.
IOC: sport is a human right
The Olympic Charter has stated that “the practice of sport is a human right” since 1996 [ ].
2020 Olympic Charter: “The practice of sport is a human right. Every individual must have the possibility of practicing sport, without discrimination of any kind and in the Olympic spirit, which requires mutual understanding with a spirit of friendship, solidarity and fair play. The enjoyment of the rights and freedoms set forth in this Olympic Charter shall be secured without discrimination of any kind, such as race, colour, sex, sexual orientation, language, religion, political or other opinion, national or social origin, property, birth or other status [ ] .
The Olympic Committee’s path to their current transgender athlete policy is covered in detail in an earlier chapter. Their first policy from 2004 required legal gender change, two years of gender-affirming hormone therapy, and surgical transition (gonadectomy) [ , ]. Their revision in 2015 eliminated the legal and surgical requirements, required participation as one’s stated gender for four years, and for transgender women, 12 months of a maximum testosterone level of 10 nmol s/L in transgender women without any restrictions for transgender men [ ]. The current IOC Framework of Fairness, Inclusion and Non-discrimination on the Basis of Gender Identity and Sex Variations ( https://olympics.com/ioc/documents/athletes/ioc-framework-on-fairness-inclusion-and-non-discrimination-on-the-basis-of-gender-identity-and-sex-variations ) is a six-page document offering a “principled approach” to participation without specific hormone level guideline or time of transition. They leave it up to individual sports to decide their inclusion criteria and offer guidelines saying participation policies should focus on inclusion and be based on research on transgender athletes themselves [ ]. While this document gives a human rights-based framework for inclusion policies, it does not take on much of the responsibility of providing medical and scientific guidance for those policies. This leaves open the chance for a wide variety of participation policies that could err on the side of exclusion or no guidance at all [ ]. Examples of sport-specific policies created after the new IOC guidelines close out this chapter.
2021 IOC Framework “Everyone, regardless of their gender identity, expression and/or sex variations should be able to participate in sport safely and without prejudice [ ].”
NCAA
The NCAA developed their first transgender athlete policy in 2010 after seeking “widespread input from the membership and subject-matter experts in science, medicine and inclusion.” [ ] The policy focused on duration of transition without set hormone level parameters and had no surgical requirements. Transgender women needed one year of gender-affirming hormone therapy to compete on a women’s team, but could continue to compete on a men’s team without hormone therapy, during transition, or after transition. Transgender men could no longer compete on a women’s team once they had begun hormone therapy, but could remain on the women’s team if they had only socially transitioned. The nuances of this are exemplified in an early 2022 collegiate swim meet where a transgender man who had only socially transitioned won against a transgender woman who had medically transitioned 3 years prior. The 2010 policy was accompanied by the NCAA Inclusion of Transgender Athletes Handbook (freely available to read online) and in initiation of a yearly Inclusion Forum [ , ]. While the Inclusion Forum focuses on a wider variety of topics than transgender athletes, it serves as a way to assure ongoing dialogue and collaboration on inclusion between leaders in college athletics, including student athletes.
NCAA Inclusion of Transgender Athletes Handbook: The purpose of this resource is to provide guidance to NCAA athletic programs about how to ensure transgender student-athletes fair, respectful, and legal access to collegiate sports teams based on current medical and legal knowledge. It provides best practice and policy recommendations for intercollegiate athletic programs to provide transgender student-athletes with fair and equal opportunities to participate. In addition to specific policy recommendations for college athletics, the resource provides guidance for implementing these policies to ensure the safety, privacy, and dignity of transgender student-athletes as well as their teammates. Specific best practice recommendations are provided for athletic administrators, coaches, student-athletes and the media [ ].
The NCAA sought to revise its transgender athlete policy in 2021, again with input from a broad group of stakeholders and subject-matter experts. Transgender and cisgender student athletes, coaches, parents, representatives from the NCAA, the US Olympic and Paralympic Committee, physicians, psychologists, athletic trainers, and inclusion advocates were among those participating in the revision (a full description of the 2021 Gender Identity and Student-Athlete Participation Summit Final Report is available at the NCAA website) [ ]. The new policy was released in January 2022. It follows the IOC guidance in deferring to each sport’s governing body’s policies, striving for uniform policy within sport while explicitly stating a hope for inclusion. Policy will be determined by each sport’s NGB, or the international federation (IF) if there is no US NGB. Examples of sport-specific polices are reviewed later in this chapter, but some require testosterone suppression to less than 2.5 nmol/L. If the sport does not have an IF or NGB, then athlete participation will be governed by the 2015 IOC guideline. Press releases from the NCAA say that if an athlete is barred from participation from these guidelines, there can be a decision at the Division level to allow play. Athletes will be initially required to provide documentation of hormone levels 4 weeks before competition, and then twice annually as the transition is made to the new policy. NGB policies will be reviewed periodically by the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports over time to assure an environment of inclusion [ ].
Despite seeking input from a broad array of transinclusive experts, the new NCAA guidelines raised some concerns. It was felt that the guidelines should have been more explicitly inclusive to encourage access to sport. While some collegiate athletes strive for the Olympics and would need to meet IF guidelines, most do not compete at the Olympic level. These guidelines increase the chance of all student-athletes facing stricter policies [ ]. Some who were involved during the planning stages were surprised that the policy was released without review or time for comment [ ]. The guidelines result in the need for invasive blood draws for testosterone monitoring that the NCAA previously had not required [ ]. Another issue of concern is that at the same session of the NCAA congress where the new participation policy was announced, members also voted to approve a new constitution that no longer included an antidiscrimination clause (in place since 1993) [ ].
United States: policy and law at the national and state level
Access to sports in the US is affected by the policies of many governing bodies. At the college level, the NCAA makes guidelines, but states can pass laws with different restrictions that supersede the NCAA’s guidance. These laws can be applied to college or to secondary school students. Private or recreational leagues can choose to have their own guidelines outside of restrictions on participation in sports connected to school attendance. However, within each sport, there will also be governance from that sport’s national and international governing body.
Title IX: No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance [ ].
The executive branch of the US government protects against gender discrimination with two landmark documents. Title IV and Title VII of the Department of Justice’s Civil Right Act of 1964 prohibit discrimination on the basis of race, color, religion, sex, or national origin in public schools and public sector and federal employment [ ]; and Title IX of the United States Education Amendments of 1972 prohibits discrimination on the basis of sex in school and other educational programs that receive federal financial assistance [ ].
The Justice Department reaffirmed that gender, including being transgender, was protected under sex-based protections of the 1964 Civil Rights Act with the Supreme Court’s 2021 decision in Bostock versus Clayton County, GA. That case dealt with employment protections but was followed by President Biden signing an executive order early in 2021 on “Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation.” [ ].
Section 1. Policy. Every person should be treated with respect and dignity and should be able to live without fear, no matter who they are or whom they love. Children should be able to learn without worrying about whether they will be denied access to the restroom, the locker room, or school sports. Adults should be able to earn a living and pursue a vocation knowing that they will not be fired, demoted, or mistreated because of whom they go home to or because how they dress does not conform to sex-based stereotypes. People should be able to access healthcare and secure a roof over their heads without being subjected to sex discrimination. All persons should receive equal treatment under the law, no matter their gender identity or sexual orientation.”
Partially in response to President Biden’s Executive Order, many states passed legislation in 2021–23 barring participation of transgender youth in interscholastic sports at any institution receiving government funding. Proponents of antitransgender legislation regarding participation in athletics cite Title IX as justification for the laws, arguing that cisgender girls would be facing discrimination based on their gender if forced to compete against transgender girls. Supporters and the bills themselves use language that does not acknowledge the existence of transgender youth, choosing to use “biological males” and “boys” to refer to transgender women and girls. Sponsors cite fairness and protection of girls as their reasoning, despite there being no evidence of any harm caused by transgender youth participating in sports, and a real need to promote and protect women’s access to sports in other areas.
“Proponents claim that women’s sports require “protection” from transgender athletes, even as they are unable to cite examples of trans athletes competing in their states. Research identifies many significant threats to women and girls in sport — including lack of funding and sponsorship, pay inequities, a decreasing proportion of female coaches and administrators, unequal access to participation, underrepresentation in the media, vulnerability to sexual harassment and abuse, hostile climates, and insufficient implementation of Title IX. Yet the Republican lawmakers now rallying to “save” women’s sports do not appear to be tackling these problems.” ( Elizabeth Sharrow JS, Lindsay Parks Pie per , Anna Baeth, Anne Lieberman States are still trying to ban trans youths from sports. Here’s what you need to know. Washington Post July 26, 2021, 2021) [ ]
There were 75 bills introduced in 36 states in 2021 aiming to limit access of transgender youth to athletics, medical care, or bathrooms congruent with their gender. States that failed to pass bills simply reintroduced them in 2022 and 2023. At time of publishing, 21 states have successfully passed bills banning transgender youth athlete participation in sports. This is in addition to two states whose high school athletic associations require gender affirming surgery prior to participation, four states that require hormone therapy prior to participation, and two that require students to present their birth certificate for verification [ , ]. With no evidence of harm from transgender athletes, these regulations serve mainly to reinforce an environment of discrimination and transphobia, which is associated with higher rates of mental illness and suicide in transgender youth [ ]. Some states require an external and internal exam of a youth athlete’s genitalia along with genetic analysis and blood testosterone levels for athletes who cannot provide their birth certificate or whose gender identity still seems to be incongruent with their birth certificate. These exams will put medical professionals in the ethically questionable position of doing invasive exams on minors, place a financial burden on families, and affect cisgender youth more than transgender youth. At time of publishing, all of these bills are currently being challenged in court ( transathlete.com is an excellent resource for updated information) [ , ]. Legislation introduced on the national level has failed to advance. A 2023 participation ban on transgender girls did pass in the House of Representatives; it is not expected to pass in the Senate or receive presidental approval.
There is variability in state athletic association policies that are not explicitly inclusive. Some leave the decision up to schools, some require athletes to submit a request for participation to verification committees, and some require athletes to either take hormones or to prove they will not have a competitive advantage related to their gender identity ( Fig. 9.3 ).
Sport-specific policies
This section will review the sports-specific policies affecting athletes at the international, national, and now at the collegiate level.
Running: Running is a very popular sport and has participants at many levels like local 5ks, college cross country, international ultramarathons, and track and field events in the Olympics. The policies covering running participation are as varied as the available events. Many local events and discrete major events like the Western States Ultramarathon and the Boston Marathon allow runners to compete in the category of their declared gender without invasive verification or restrictions.
“We take people at their word. We register people as they specify themselves to be. Members of the LGBT community have had a lot to deal with over the years, and we’d rather not add to that burden.”- Boston Athletic Association, 2018 [ ].
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