The Atlantic has waded into perilous waters by publishing what turns out to be quite a good article about transgender women competing in athletics against biological women. The fact that this liberal and prestigious magazine even writes about the issue is, to me, a good sign: a sign that the issue needs discussing.  And I’m glad to see that the author, staff writer Helen Lewis, concludes with a solution that is virtually identical to mine.

To read her piece, click below, or find it archived here.

Lewis begins by citing recent controversies involving transgender women competing—and winning—against biological women. They include the now well-known story of Lia Thomas, who will swim no more against women, as well as the San Jose State women’s volleyball team, which included what seemed to be a trans woman (they won’t publicly admit it, but most team members do). This story isn’t as well known:

In September, the San Jose State co-captain Brooke Slusser and the associate coach Melissa Batie-Smoose went public with their concerns about their own team’s trans player. “Safety is being taken away from women,” Batie-Smoose later told Fox News. “Fair play is taken away from women.” Both women told Quillette that they believed players and coaches were being pressured not to make a fuss. The next month, Liilii told me, she and her Nevada teammates voted, 16–1, to boycott their next match against San Jose State. The Nevada players were not alone: Teams from Boise State, the University of Wyoming, Southern Utah, and Utah State also forfeited games rather than face the trans player.

 

San Jose State kept competing despite all that—and despite a lawsuit aimed at barring the school from the Mountain West Conference postseason tournament in Las Vegas in November. (The lawsuit failed, and the team finished second in the finals.) The season ended in acrimony. “I will not sugarcoat our reality for the last two months,” San Jose State’s head coach, Todd Kress, said in a statement after the tournament. “Each forfeiture announcement unleashed appalling, hateful messages individuals chose to send directly to our student-athletes, our coaching staff, and many associated with our program.” Afterward, seven of the team’s athletes requested to enter the transfer portal. The disputed player, who is a senior, will not compete again.

The problem is, as the references below show, trans women who go through male puberty retain substantial athletic advantages over biological women, even if testosterone suppressors are used to try to equalize the categories.  But the suppressors don’t do that, for somebody who goes through male puberty develops the musculature, bone density, grip strength, and other indices of athletic success that give them pronounced advantages over natal women (equestrian sports may be an exception).  And this advantage appears to last for years—perhaps forever.

Well, why not allow trans women to compete who have transitioned before puberty? The problem is that there are almost none of these, for male puberty occurs some time between ages 9 and 14, and that is simply too young for adolescent males to decide to take hormones and/or have surgery to develop something closer to a woman’s body. If future research shows that transitioning at a very young age makes females athletically equal on average to natal females, then we can reassess. But existing data show that trans women, or some with disorders of sex determination, have an innate athletic advantage over women, and thus shouldn’t be competing in women’s sports.

Republicans have made hay of this, of course, and if you polled Democrats versus Republicans over whether trans women should compete against natal women in sports, Republicans would say “no” at a higher rate. But just because this view is more pervasive in the GOP doesn’t mean it’s wrong. In fact, Democrats themselves are starting to realize that such competition is unfair:

Greater awareness of Thomas and other trans athletes in women’s sports did not translate into greater approval. If anything, the opposite occurred: In 2021, 55 percent of Democrats supported transgender athletes competing in the team of their chosen gender, according to Gallup. Two years later, however, that number had fallen to 47 percent. Overall, nearly seven out of 10 Americans now think athletes should compete in the category of their birth sex.

Nevertheless, the Biden Administration’s early executive order prohibiting discrimination on the basis of gender identity implied that this would also hold for sports participation. Now, as Lewis notes, Biden has backed off on this construal of the order, perhaps because the wokeness of Harris and Biden (the subject of GOP attack ads) may have played a role in their November defeat.

Regardless, as I’ve learned in the past week or so, those who say that “trans women are women” will accept no exceptions to that mantra: trans women are to have every perquisite of natal women, including sports participation.  But, unlike gay rights, trans rights conflict with the rights of other groups far more often (I can’t think of any case in which gay rights conflict with other people’s rights, except for those cases of religious people asked to make cakes for gay weddings). The last sentence in Lewis’s paragraph below is telling (I’ve bolded it):

“People like to say that it’s a complicated issue, and I don’t actually think it is … It all boils down to: Do you actually think that trans women and intersex women are real women—and are really female or not?” the transgender cyclist Veronica Ivy told The Daily Show’s Trevor Noah in 2022. “It’s an extreme indignity to say, ‘I believe you’re a woman, except for sport.’” She added that the enforcement of traditional categories was about “protecting the fragile, weak cis white woman from the rest of us.” Noah’s studio audience in New York heartily applauded Ivy’s words. Sports was only one part of a seamless whole: If you believed, as good liberals did, that trans women were women, no carve-outs were justifiable.

Many women and men think otherwise, as do I. But the carve-outs, as I see them, are very few. Still, if you’re a extremist gender ideologue, they are impermissible.

Democrat Seth Moulton’s breaking ranks from the Biden-ish gender ideology may have been a telling moment, as it made it acceptable for Democrats to discuss the issue in public, though many, including the FFRF, appear to still think the issue shouldn’t be discussed, much less raised. Moulton still got savaged, of course, which reflects poorly on his fellow Democrats:

After the 2024 election, a handful of Democrats broke ranks. “I have two little girls,” Representative Seth Moulton of Massachusetts told The New York Times. “I don’t want them getting run over on a playing field by a male or formerly male athlete.” His campaign manager subsequently resigned, protesters gathered outside one of his offices, and he was rebuked by the state’s Democratic governor. But many of Moulton’s fellow Democrats were notably silent. “Asked for comment on Mr. Moulton’s remarks, each of the 10 other members of the state’s congressional delegation, all Democrats, declined to comment or did not immediately respond,” the Times reported. Further evidence that a taboo had been broken came on the Friday before Christmas. The White House abandoned its proposed rule change forbidding blanket bans on trans athletes after 150,000 public responses, acknowledging that the incoming Trump administration will set its own rules.

Lewis is too good a writer not to give her own opinion after weighing the controversy. At the end, she suggests the “empathic compromise” given below, and I must say that I agree with almost every word of it:

In my view, the way forward lies in an empathetic compromise, one that broadly respects transgender Americans’ sense of their own identity—for example, in the use of chosen names and pronouns—while acknowledging that in some areas, biology really matters. Many sports organizations have established a protected female category, reserved for those who have not experienced the advantages conferred by male puberty, alongside an open one available to men, trans women, trans men taking testosterone supplements, and nonbinary athletes of either sex. Unlike Veronica Ivy, many voters who support laws protecting trans people from housing and employment discrimination don’t see trans rights as an all-or-nothing deal; in fact, a few limited carve-outs on the basis of biological sex might increase acceptance of gender-nonconforming people overall.

Not everything has to be an entrenched battle of red versus blue: As more and more Democrats realize that they shouldn’t have built their defense of trans people on the sand of sex denialism, Republicans should have the grace to take the win on sports and disown the inflammatory rhetoric of agitators such as Representative Nancy Mace, who responded to the election of the first trans member of Congress by deploying anti-trans slurs. As the second Trump administration begins, the lesson from the college-volleyball rebellion is that institutions cannot impose progressive values by fiat. Attempts at social change will not survive without the underlying work of persuasion.

My only beef with the above is that it may be dangerous to trans men or “nonbinary athletes of either sex” to compete against biological men, as the greater strength of the latter could be dangerous. This is probably why World Rugby, as well as the International Rugby League, have banned the participation of transgender women in international competitions, presumably because although they are biological men, suppressing testosterone could reduce their ability to withstand injury in this heavy-contact sport.

The athletic effects of testosterone suppression in males:

An opinion piece by Robyn Blumner in Skeptical Inquirer cites references I’ve mentioned before, showing that testosterone suppression isn’t a way to equalize the athletic performance of transgender women and natal women. As she writes:

If we eliminated sex categories for most sports, there would rarely be female winners. For natal women to be able to compete in a way that gives them a fair chance at victories, there have to be sex segregated sports.

The question then becomes whether that advantage can be mitigated through testosterone suppression. That is a matter of scientific inquiry, and the longitudinal biomedical findings to date suggest that “the effects of testosterone suppression in male adulthood have very little impact” on physiological outcomes such as muscle strength, muscle mass, or lean body mass, according to a paper titled “When Ideology Trumps Science” by six international leading researchers (Devine et al. 2022). They cite a cross-sectional study from 2022 that measured the performance of transgender women and found the “advantage may be maintained after 14 years of testosterone suppression.” (For a thorough vetting of the subject, read “Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage” by researchers Emma Hilton and Tommy Lundberg, published in the journal Sports Medicine [Hilton and Lundberg 2021].)

References:

Devine, Cathy, Emma Hilton, Leslie Howe, et al. 2022. When ideology trumps science: A response to the Canadian Centre for Ethics in Sport’s Review on Transwomen Athletes in the Female Category. idrottsforum.org (November 29).

Hilton, Emma N., and Tommy R. Lundberg. 2021. Transgender women in the female category of sport: Perspectives on testosterone suppression and performance advantage. Sports Medicine 51(2): 199–214.

The good news is that the Washington Post, defying the inevitable cries that the paper is “transphobic”, is calling for a “respectful debate on trans women in sports”.  This is, of course, because of the increasing number of biological men who identify as women (I prefer that jawbreaker to “trans women” because the latter plays into the misleading mantra that “trans women are women”), and because men who have gone through male puberty before transitioning have an inherent physical advantage over biological women.  Even the UN now agrees on that, and gives data below on how many women have lost sports medals to transitioned biological men.  I will, however, use “trans women” as shorthand in this article.

Just to see a major op-ed (by the editorial board!) defy the gender activists, who have censored all debate on this important ethical issue, makes me pleased. Read the article by clicking on the headline below or find it archived here.

You’ll note that the tone of the article is carefully monitored to ensure that a) the paper calls for “respectful” debate, when in fact what we need is just debate, and I haven’t seen any people discussing the issue being disrespectful to trans women; and b) although the op-ed doesn’t take sides, it cites accumulating data documenting the athletic advantage of trans women over biological women. There are enough data now, as we see below, to call for reform of sports regulations, so the debate is provisionally settled at present, though of course it’s about facts and those facts—and the resultant prescriptions—may change.  For example, I don’t think there are any data showing that trans women outperform natal women in equestrian sports, though I can’t be sure: if men outperform women in horse sports, that means that even there different rules must be made. One thing is for sure: if there is a sport in which natal men do not outperform natal women, then by all mean let trans women compete with natal women. In such sports everybody can compete against everyone else.

But I digress: here are some excerpts from the op-ed. I have put other references below. Note the paper cited in the second paragraph; you may want to have a look. Also see the papers I cite below.

Trans people deserve to be treated with dignity, and the law should protect them from discrimination in areas such as employment and housing. But the realities of human biology raise legitimate questions about any notion that trans women should always and everywhere be treated exactly like cisgender women.

In athletic competition, male puberty confers significant advantages. While those biological differences vary by skill and sport, a 2023 paper by medical researchers in the United States and Italy noted that “it is well established that the best males always outperform the best females when the sport relies on muscle power, muscle endurance, or aerobic power.” The hormone therapy that many trans women take reduces some of those advantages over time, but research into how much those advantages can be mitigated, and over what time frame, is still ongoing. Other advantages, such as height, are fixed by the end of puberty. This poses obvious fairness and safety questions.

Note that the question is not just one of fairness—of transitioned biological men having unfair advantages competing against cis women—but of safety. A strong, muscular transitioned man could well injure a woman rugby player. This is why the English Rugby Football Union banned trans women from competing in women’s rugby.  More from the WaPo article:

The public needs more and better research to make those decisions. But unless the data show that transitioning can fully erase the effects of male puberty, the country will also need a frank and open debate about the trade-offs between inclusion on the one hand and safety and fairness on the other.

And yet too often, efforts have been made to avoid or prevent discussion of those trade-offs by labeling debate inherently transphobic. This is not how a healthy democracy makes decisions.

Note too that gender activists ignore the palpable safety risk and of course the unfairness to biological women, saying that “trans women are women”, which means that trans women should have every right and privilege enjoyed by biological women.  Well, I’d agree with that if by “right” one means “moral and legal right”, but I’ve always thought that there are some exceptions to the “rights” of trans women. Sport participation against biological women is one, of course. But trans women shouldn’t be allowed willy-nilly to be rape counselors advising unwilling women, monitors of shelters for battered or abused women, or inmates in jails holding biological women. Beyond that, I can’t think of many exceptions.

More from the article; notice that the public clearly recognizes the unfairness of having trans women in women’s sports:

A 2023 Gallup poll showed that almost 70 percent of Americans think sports participation should follow birth sex, not gender identity. Pressuring Democratic politicians to side with the minority, without giving sufficient space to the other side’s argument, is a recipe for irresolution and resentment.

The Democratic bit comes from the recent demonizing of Representative Seth Moulton (D, MA) for saying this: ““Democrats spend way too much time trying not to offend anyone rather than being brutally honest about the challenges many Americans face. … I have two little girls. I don’t want them getting run over on a playing field by a male or formerly male athlete, but as a Democrat, I’m supposed to be afraid to say that.”

For that Moulton was called a transphobe by Democrats, who should be more thoughtful, and Moulton’s campaign manager resigned. This is simple wokeness: performative virtue-signaling that defies the known facts.  Of course the paper isn’t going to say that, but ends its piece this way:

We cannot predict whose argument will prevail. We can only say that no one — and certainly no political party — is entitled to win this debate by default.

Well, I would have put it more strongly, but I’ll take it.

A recent UN report (!) on violence against women and girls (pdf here) documents the possibility of violence and actually gives numbers for the medals lost by biological women to trans women.

Here are some data; the bolding is mine:

Policies implemented by international federations and national governing bodies, along with national legislation in some countries, allow males who identify as women to compete in female sports categories.28 In other cases, this practice is not explicitly prohibited and is thus tolerated in practice. The replacement of the female sports category with a mixed-sex category has resulted in an increasing number of female athletes losing opportunities, including medals, when competing against males. According to information received, by 30 March 2024, over 600 female athletes in more than 400 competitions have lost more than 890 medals in 29 different sports. 

Note that one of the arguments for allowing trans women to compete against biological women is that there are so few of the former that it doesn’t matter. But even one medal taken away from a biological women is unfair, and I don’t see why there should be a threshold below which mixed competition is okay. Further, 890 medals in 29 sports is not a small figure!

Below the report notes that suppression of testosterone in trans women will not equalize the athletic potential of trans women and biological women. Testosterone levels used to be the criterion for Olympic participation of trans women or women with disorders of sex development, but the Olympics recently punted, saying that each sport must set its own criteria (again, my bolding):

Male athletes have specific attributes considered advantageous in certain sports, such as strength and testosterone levels that are higher than those of the average range for females, even before puberty, thereby resulting in the loss of fair opportunity. Some sports federations mandate testosterone suppression for athletes in order to qualify for female categories in elite sports. However, pharmaceutical testosterone suppression for genetically male athletes – irrespective of how they identify – will not eliminate the set of comparative performance advantages they have already acquired.This approach may not only harm the health of the athlete concerned, but it also fails to achieve its stated objective. Therefore, the testosterone levels deemed acceptable by any sporting body are, at best, not evidence-based, arbitraryand asymmetrically favour males.

Here are three recommendations from from the UN report (again, bolding is mine). These are conclusions, so are based on data. While more data are needed, what we have now is sufficient to actually make policy instead of simply calling for “more debate.”  Of course more data will always be useful, but we have sufficient data to make provisional policy.

(b) Ensure that female categories in organized sport are exclusively accessible to persons whose biological sex is female. In cases where the sex of an athlete is unknown or uncertain, a dignified, swift, non-invasive and accurate sex screening method (such as a cheek swab) or, where necessary for exceptional reasons, genetic testing should be applied to confirm the athlete’s sex. In non-professional sports spaces, the original birth certificates for verification may be appropriate. In some exceptional circumstances, such tests may need to be followed up by more complex tests;

(c) Refrain from subjecting anyone to invasive sex screening or forcing a person to lower testosterone levels to compete in any category;

(d) Ensure the inclusive participation of all persons wishing to play sports, through the creation of open categories for those persons who do not wish

(d) Ensure the inclusive participation of all persons wishing to play sports, through the creation of open categories for those persons who do not wish to compete in the category of their biological sex, or convert the male category into an open category. . . 

The last recommendation is one I agree with and have made before.  I have written many times on this issue (see here and especially the papers I cite here).

Finally, here is a new editorial in the Scandinavian Journal of Medicine & Science in Sports. There are many authors, including developmental biologist and geneticist Emma Hilton, a colleague of Matthew’s at the University of Manchester. It’s a short piece (less than two pages); click to read.

Here’s a summary of their recommendations:

During press conferences at the 2024 Olympic Games, theInternational Olympic Committee (IOC) invited solutions to address eligibility for women’s sport. We take this opportunity to propose our solution, which includes: (a) recognizing that female sport that excludes all male advantage is necessary for female inclusion; (b) recognizing that exclusion from female sport should be based on the presence of any male development, rather than current testosterone levels, (c) not privileging legal“passport” sex or gender identity for inclusion into female sport; and (d) accepting that sport must have means of testing eligibility to fulfill the category purpose.

They recommend as an initial test a simple cheek swab that can determine the sex-chromosome constitution of women. If that shows deviations from the regular XX genotype, they then recommend “comprehensive follow-up in the rare cases that require extra consideration, with emphasis on the duty of care to every athlete. . . “.

I’m glad that the Washington Post brought this into the open, and with the approbation of its entire editorial board.  Nobody involved in the discussions above is a “transphobe” who wants to deny men who identify as women legal or moral rights. But it’s time we admit openly that those rights are not unlimited—that the mantra “trans women are women” is not only biologically inaccurate, but also that the inaccuracy places a few limits on the rights of trans women.

There was a bit of confusion yesterday involving my post about the defeat of Italian female boxer Angela Carini by Algerian boxer Imane Khelif, who in all likelihood is male but identifies as female. The bout was over in 42 seconds after Khelif delivered a few powerful blows to Carini’s head. She then refused to shake hands with Khelif, cried, and then explained that she was fighting for her late father (she later apologized for the unsportswomanlike gesture of not congratulating her opponent).  Most of the videos that accompanied the tweets have been taken down by the Olympics for copyright reasons, but I found one on Emma Hilton’s site:

The IOC need to held accountable for this. https://t.co/gVaiZukxch

— Emma Hilton (@FondOfBeetles) August 1, 2024

The first thing I’d like to clear up is my use of the word “transwoman” to refer to Khelif. I meant it to refer to the big brouhaha in sport and gender, which refers to the contested presence of genuine transwomen (i.e., natal males who transition to a female gender identity) competing against women in women’s sports. I kept using the term when applying it to Khelif, but Khelif may indeed have assumed that he/she was a biological female since birth, since Khelif was raised as a female from birth in Algeria.  If that’s the case, then Khelif didn’t really “transition”.  If you use the “trans” term loosely, I suppose you could say that Khelif transitioned from the biological condition of being a male to having the identity of a woman, but since this wouldn’t have been a conscious transition, I thus gladly retract the use of the term “transwomen” for Khelif.  One could, I suppose, call Khelif an “intersex” person, but those afflicted with disorders of sex development (DSDs) prefer the term “person with a disorder of sex development”. Also, definitions of “intersex” vary among researchers.

But that’s a semantic issue. The main question is this: was Khelif a biological male, went though male puberty, and then wound up with the strength, size, speed, and punch-strength advantages that go along with male puberty—advantages that do not go away fully even with testosterone-suppression?  All evidence points to “yes”, and my judgment was based on the fact that Khelif had an XY karyotype, the physical appearance and size of a man, and had previously failed testosterone tests and, on that basis, was denied the opportunity to box women.

Now the only way to ascertain for sure what Khelif’s sex was is to do an ultrasound or some kind of noninvasive examination to see if there are ovaries (making a female) or testes (making a male) or both (making a very rare hermaphrodite).  This hasn’t been done, but the conclusion of those with more expertise than I is that it’s probable that Khelif was a biological male with a DSD and had gone through male puberty, thus having the same advantage against biological women as either a transwoman or, in Khelif’s case, a male afflicted with a DSD who has suppressed his testosterone. If this is the case, the Olympics screwed up in its last-minute method of determining whether an athlete can compete against biological women (the IOC has said that each sport should make its own rule). At the bottom I say what I would judge to be necessary and sufficient tests to determine whether a person is qualified to compete against biological women.

Let’s look at someone who knows the ins and outs of this: Carole Hooven of Harvard University, author of the well known book T: The Story of Testosterone, the Hormone that Dominates and Divides Us. There is a chapter on sports and gender, too.  It’s an excellent book and I recommend it highly.

Hooven issued a long tweet yesterday explaining Khelif’s likely condition. And yes, Khelif appears to be a male with a DSD. Go to the tweet to read the whole thing:

I could have sworn I included the graphs! Sorry. Here they are. pic.twitter.com/dLXqMaaMYK

— Carole Hooven (@hoovlet) August 1, 2024

Here’s an excerpt from the long tweet (my bolding). Note that it’s all about one particular DSD, suggesting that this is what Hooven thinks that Khelif has:

First: People living with DSDs should be treated with compassion and understanding, and receive any heath care they need. These can be challenging conditions for individuals and their families. But when male athletes have DSDs that give them an advantage over females, and they compete in the female category, this raises concerns about safety and fairness, and forces discussion of the relevant physical traits.

Athletes with XY DSDs who have testes (usually internal), XY sex chromosomes, male-typical levels of testosterone, and functional androgen receptors are often described as females with “hyperandrogenism,” i.e., abnormally high levels of testosterone. They experience physical benefits of this high testosterone during puberty, which translate into athletic advantages over females. The issue for sports is that athletes with the XY DSD 5-alpha reductase deficiency (5-ARD), may be socialized as female, may be legally female, and may live and identify as female; but they are male.

These individuals are usually born with female-appearing genitalia, which can lead to being sexed as female. Here’s why. 5-ARD is caused by a mutation in the gene that codes for the enzyme 5-alpha reductase, which converts testosterone into a more potent androgen, DHT. This androgen interacts with the androgen receptor, like testosterone, and is necessary for the typical development of male external genitalia (penis and scrotum) and the prostate. Without DHT, female-typical external genitalia develop. At the end of this monster post is a graphic of the relevant steroid production pathway, from my book T: The story of Testosterone.

DHT is also responsible for male-pattern baldness and dark, coarse facial hair, which is why people with the condition have smooth skin that can give a feminine appearance.

The “decision makers” are aware that athletes with 5-ARD are male, and that they experience the benefits of male puberty. The requirement to reduce their testosterone to typical female levels isn’t discriminatory, since these are males who are asking to compete in the female category. But more significantly, all the relevant scientific evidence shows that reducing male T in adulthood does not undo the physical benefits of male puberty.

And the relevant reference:

Here’s more detail about T, DHT, and male advantage in strength and speed.

I’ve been asked if men with the DSD 5-ARD (in which ppl cannot convert testosterone into the more potent androgen DHT) experience the typical benefits of male puberty, that would give them an advantage in strength and speed relative to women. This is relevant to questions about whether male athletes with 5-ARD should be allowed to compete in the female category. This is an excellent question, because it could be the case that DHT is necessary for the development and maintenance of male-typical muscle, lean body mass and strength. If that were the case, then people with 5-ARD might not have a typical male advantage, because the lack of DHT would perhaps lead to a more feminine pattern of fat, lean body mass and strength. I’ve wondered about this myself and have looked into the evidence.

Perhaps the top researcher in this area, Shalendar Bhasin, who is scrupulous in his methods, has examined this very question. The answer appears to be: no, testosterone does not need to be converted to DHT to exert its typical anabolic effects. These findings are reported in his 2012 study, “Effect of Testosterone Supplementation With and Without a Dual 5α-Reductase Inhibitor on Fat-Free Mass in Men With Suppressed Testosterone Production, A Randomized Controlled Trial.” (It is linked to below—and since it’s paywalled, I’ve included the graphs that show comparisons between the placebo and DHT— inhibited conditions, with no difference on the various outcomes.)

The paper is actually free; click on the link below to go to it, and follow the link to “get pdf” or go to the pdf directly here:

The paper shows, as Hooven notes above, that this DSD has its normal effects on the body even though testosterone isn’t converted to the androgen DHT. In other words, 5-ARD males produce testosterone that, even though not converted to DHT, sill has its normal effects on masculinizing the body.

A bit on the condition from the National Library of Medicine:

The presentation of patients with a deficiency of 5α-RD2 can vary. This condition is an autosomal recessive disorder of sex development associated with the mutation in the SRD5A2 gene. No direct association has been seen between the phenotype and the genotype in this disorder. Two individuals with the same gene defects in SRD5A2 can present with completely different phenotypes. This shows that other additional genes probably control the phenotype and the gene under discussion.[8]

The newborns might have genitalia resembling labia majora, which would be unfused labioscrotal folds. The phallus in these children may look more like a clitoris than a penis.[9] At the same time, the internal genitalia in these children include seminal vesicles, epididymis, vas deferens, and ejaculatory duct, and one may not see any Mullerian structures. The testes in these children might be present in the inguinal sac, and very rarely, they can also be found within the abdomen. These children tend to be raised as females until puberty, when they start exhibiting virilization.[5] At puberty, the phallus may grossly enlarge to form a penis, the testes may descend into the unfused labioscrotal folds, the voice deepens, and a beard starts growing. The development of all these secondary sexual characteristics during puberty does not need the presence of DHT but only the presence of testosterone.[9]

Carole also gives a strong recommendation to this free podcast:

“Inclusivity” is given more weight than science, rationality, and fairness and safety for women. ⁦@Scienceofsport⁩ is right on. Give the most recent episode a listen. https://t.co/yY4Gjj37hL

— Carole Hooven (@hoovlet) August 1, 2024

So the questions that people are probably asking (my questions and my answers):

a.) Does Khelif have a DSD?  Almost certainly, since the chromosomes, testosterone levels, and physiognamy suggest that Khelif is a biological male, but the genitalia probably are female-like, although we don’t know for sure. At any rate, there was some phenotypic trait that caused Khelif to be raised as a female.

b.) Was the DSD XY DSD 5-alpha reductase deficiency (5-ARD)?  It’s likely since Hooven discusses it at length. This is in fact the same DSD that Caster Semenya had: according to the BBC:

The 2018 rules meant that Semenya could not compete in female track events over this distance without taking testosterone-reducing drugs.

She appealed against World Athletics’ proposal at the Switzerland-based Court of Arbitration for Sport (Cas), but eventually lost in what amounted to a landmark case in 2019.

It was in the Cas ruling that Semenya’s specific DSD was confirmed as 46 XY 5-ARD (5-alpha-reductase deficiency). People with this particular DSD have the male XY chromosomes. Some are assigned female or male at birth depending on their external genitalia.

Semenya told BBC Sport that she was “born without a uterus” and born “with internal testicles” and said: “I am a woman and have a vagina”.

Cas said, external athletes like Semenya with 5-ARD have “circulating testosterone at the level of the male 46 XY population and not at the level of the female 46 XX population”, which gives them “a significant sporting advantage over 46 XX female athletes”.

Given that Semenya has the equipment (though perhaps not the ability) for making sperm, Semenya is biologically male. So is Khelif, though people are loath to say it or use the pronoun “he” (check their Wikipedia entries).  It’s possible that Khelif has another DSD, PAIS D (partial androgen insensitivity syndrome), but this is less likely based on phenotype; and this condition is rarer.

. . . which leads us to the next question:

c.) Is Khelif a man?  if he has 5-ARD and went through male puberty, producing testosterone at higher male levels (these don’t overlap with female levels), levels that require suppression to meet sports standards, the answer is yes. Female-like genitalia don’t make someone a biological woman if they have testes (see above).

But there is one last question, and the most relevant one.

d.) Should Khelif be competing in women’s boxing?  Given what we know of his size, strength, and performance, as well as his XY status and what must have been high testosterone, the answer is, at present, no. Suppressing testosterone in his case will not eliminate any athletic advantages Khelif accrued by going through male puberty. But further investigation would be useful (see below).

e.) How should sports organizations determine if someone has a sex-based athletic advantage? Ideally, it should be a three-part test. First, are there testes or ovaries? If there are testes, that’s already a sign of male advantage, particularly when accompanied by an XY karyotype.  Further tests can examine testosterone levels and exposure as well as sequencing of the DNA to see if there are genetic mutations causing DSDs. But there’s already enough information from Khelif’s obvious athletic advantages and his XY karyotype to mandate banning him/her from boxing until these other issues are examined.

Finally, let me add that most people having DSDs are not athletes in the limelight, and in fact have to deal with medical, emotional, and social issues that arise in conjunction with having DSDs.  These people should not be regarded as freaks, have the same moral and legal equality as the non-afflicted, and should be treated with empathy

h/t: Carole Hooven for discussion and clarification

As you may remember, when faced with determining whether trans women should compete against biological women in the Olympics, the IOC threw up its hands and punted, declaring that each separate sport had to make its own rules on the issue. This has led, in the present Olympics, to biological males qualifying to box in the women’s division. The results are predictable, for even men who become transwomen retain a substantial amount of the size, strength, musculature, and other athletic advantages that biological men have over biological women. Hormone suppression doesn’t equalize those athletic abilities.

Nevertheless, according to the NBC News story below, two biological males who identify as women—people who were disqualified from boxing as women in previous competitions—have qualified for the IOC. Note that they both seem to have been raised as women, so they may well believe that they are indeed biological women. Ergo, they may well not think of themselves as having “transitioned”, so I won’t call them “transwomen.” Nevertheless, they are both almost certainly biological men with disorders of sex development (“DSDs”), and their competing against biological women is just as unfair—but not nearly as consciously unfair—as transwomen competing against biological women.

Click to read (the story is by Matt Lavietes):

Excerpts:

Two boxers who were disqualified from competing with women at a global event last year have been permitted to fight in the Paris Olympics, the International Olympic Committee confirmed.

Imane Khelif of Algeria and Lin Yu‑ting of Taiwan failed to meet gender eligibility tests at the Women’s World Boxing Championships in New Delhi last year, prompting their disqualifications. But they have been cleared to compete in the women’s 66-kilogram and women’s 57-kilogram matches in Paris this week, the IOC confirmed in an email Tuesday.

 At the time of their disqualifications, the president of the International Boxing Association, which governs the World Boxing Championships, alleged that the boxers’ chromosome tests came back as XY (women typically have two X chromosomes, while men typically have an X and a Y chromosome).

“Based on DNA tests, we identified a number of athletes who tried to trick their colleagues into posing as women,” the association’s president, Umar Kremlev, told Russia’s Tass news agency at the time. “According to the results of the tests, it was proved that they have XY chromosomes. Such athletes were excluded from competition.”

. . .In an email Tuesday, the IOC said that “all athletes participating in the boxing tournament of the Olympic Games Paris 2024 comply with the competition’s eligibility and entry regulations, as well as all applicable medical regulations.”

The IOC updated its rules regarding athletes’ gender eligibility, including its transgender participation guidelines,  in 2021 to defer to each sport’s governing body. The IOC no longer recognizes the IBA as the governing body over Olympic boxing, and instead refers to the Paris 2024 Boxing Unit — an ad-hoc unit developed by the IOC — for its eligibility standards.

In other words, the IOC made up the qualifications, ignoring what the International Boxing Association says. And they made them up on the spot. Why on earth would they do that? The article continues:

Critics in the United States, where the issue of whether trans women should be permitted to compete in women’s sports has been hotly debated in recent years, condemned the inclusion of Khelif and Lin in this week’s competition. Some questioned whether their participation was fair to other female competitors, while others directed incendiary language toward the boxers. [JAC: Check out the “incendiary language”, which isn’t incendiary at all, and comes from Riley Gaines.]

Khelif is scheduled to compete against Italy’s Angela Carini on Thursday, and Lin is scheduled to fight against Uzbekistan’s Sitora Turdibekova on Friday.

Here’s Khelif from the Wikipedia article, which adds some details (below):

From Wikipedia:

In March 2023, Khelif was disqualified for failing to meet eligibility criteria shortly before her gold medal bout at the 2023 IBA Women’s World Boxing Championships. The Algerian Olympic Committee said Khelif was disqualified for medical reasons. It later emerged that the disqualification was due to high levels of testosterone.^[7][8]

The International Olympic Committee (IOC), using different rules to the IBA, cleared Khelif to compete in the 2024 Summer Olympics in Paris, confirming that she complied with all necessary eligibility and medical regulations for the event,^[8][12] without detailing what these eligibility rules were.^[10] The IOC noted that Khelif was a woman according to her passport and that this was not a “transgender issue“.

She defeated Angela Carini in 42 seconds at the 2024 Olympics, after Carini withdrew citing intense pain in her nose. Reem Alsalem, the United Nations Special rapporteur on violence against women and girls, tweeted about the match, writing, “Angela Carini rightly followed her instincts and prioritized her physical safety, but she and other female athletes should not have been exposed to this physical and psychological violence based on their sex.”^[14]

And from The Daily Fail, the details of the match between Khelif and Carini:

 A boxer deemed a ‘biological male’ today won against an Italian woman in one of the most controversial Olympic bouts ever.

The fight between Italy‘s Angela Carini and her Algerian opponent Imane Khelif took just 46 seconds, with the Italian throwing her helmet onto the floor as the clash was abandoned, yelling: ‘This is unjust.’

The 25-year-old refused the handshake and fell to the canvas sobbing having received just two punches from Khelif – who had been banned from a major boxing contest before the Olympics.

00:17

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Khelif was thrown out of last year’s world championships after failing testosterone tests carried out to establish gender qualification.

After the match was stopped, the referee raised Khelif’s hand in the air. But a visibly furious Carini yanked her own hand away from the fight official and walked off.

Ignoring the Algerian, the Italian fighter then plunged to her knees and burst into tears as she said she had never felt such strong blows in a contest before.

Speaking after the match, the heartbroken Italian said: ‘I’m used to suffering. I’ve never taken a punch like that, it’s impossible to continue. I’m nobody to say it’s illegal.

‘I got into the ring to fight. But I didn’t feel like it anymore after the first minute. I started to feel a strong pain in my nose. I didn’t give up, but a punch hurt too much and so I said enough. I’m leaving with my head held high.’

A couple of punches to the head and it’s all over. /2 pic.twitter.com/6egSrRj51s

— FairPlayForWomen (@fairplaywomen) August 1, 2024

IOC allowed this male boxer to fight a woman. He won. Fight abandoned after 46s /4 pic.twitter.com/YwUfZQ6ssb

— FairPlayForWomen (@fairplaywomen) August 1, 2024

“None giusto!”.
“it’s not fair!” Says Angela /6 pic.twitter.com/ukqReaRHbP

— FairPlayForWomen (@fairplaywomen) August 1, 2024

And the end, with tears. It’s heartbreaking:

Angela Carini’s Olympic dreams smashed today. She breaks down in tears. /7 pic.twitter.com/CBNK2pNFo4

— FairPlayForWomen (@fairplaywomen) August 1, 2024

The loser’s statement, even sadder:

“I wanted this victory at all costs. Just for my father.”

Italian boxer Angela Carini emotionally discusses winning for her late father after securing a spot at the Paris Olympics.

She just forfeited her match against Imane Khelif, who is male. pic.twitter.com/zypHELjldX

— Steve McGuire (@sfmcguire79) August 1, 2024

I’ve written before (see here and here) that taking testosterone suppressors does not eliminate the athletic advantages of natal men over natal women, especially if they’ve gone through male puberty. You can track down the references by going to the thread of Emma Hilton, a biology professor at the University of Manchester. The thread starts here:

There have been two academic reviews of musculoskeletal changes in transwomen suppressing testosterone.

Both conclude that loss of muscle mass and strength is small, and that strength advantage over females is retained.

Citations to follow.

— Emma Hilton (@FondOfBeetles) March 6, 2021

Here’s the huge difference in punching power (my emphasis) between biological men and women (it will probably be somewhat reduced if the man suppresses his testosterone, but not equalized). The reference is at the bottom of the figure.

It’s manifestly unfair to women to force them to compete against biological males who identify as women.  This might be another question to ask to the Presidential candidates—if they have a debate.

h/t: Luana

It would seem superfluous now to argue that women and men are equally competitive in athletics and thus there should be no sex-spcific categories.  We know that, with puberty, comes differences in may traits involved in athletic success, including muscles mass, bone density, grip strength, throwing speed, and so on. (Equestrian sports may be one in which women have either no disadvantage or even an advantage, but I haven’t looked for the data.)  This intersexual difference in athletic ability is in fact why we have separate men’s versus women’s leagues. I was surprised to find, in the Lundberg et al. paper below, that even before puberty boys have significant athletic advantages over girls, which one has to consider when deciding whether to separate the sexes in secondary-school competitions.

But the International Olympic Committee (IOC), which a few years ago punted in a general policy for its athletes, deciding that each sport has to set its own rules, has led to the publication of the Lundberg et al. paper, reiterating again that there seems to be no physical sport in which men don’t have an inherent, sex-related advantage (largely coming from testosterone), so the Bayesian presumption is that there will be a difference. The paper’s publication was apparently prompted by the IOC’s abandoning standards. As the authors note, “The IOC framework does not provide suitable guidance to sports authorities to protect the female category in sports.”

But of course the burning question now is whether or not transgender women (natal men), even under testosterone suppression, retain athletic advantages over natal women, and, if so, whether those advantages disappear over time. And Lundberg et al. paper says that advantages remain and do not go away with time. (We’ve had evidence for this for a long time.)

In classifying individuals for athletics, then, “transgender women don’t count as women”, a fact that goes against all the mantras of gender activism. Nevertheless, truth is stronger than mantras, and the data show that, in those sports that have been examined, transgender women have a similar (but smaller) advantage over natal women as do natal men do over natal women.  The authors (and I) see the inclusion of natal men in women’s sports, then, as unfair. But others disagree, thinking that inclusivity trumps fairness. Since all of us think that those who want to compete athletically should have a way to do so, some hard thinking is involved. Should we have “open” categories, in which only a few will compete? Or should trans women compete only in men’s sports? I have no solution, but surely we need to know the facts before we make a decision like this.

I found the Lundberg paper because a reader sent me an article from the conservative Federalist that linked to it. And yes, the Federalist does accurately characterize the paper. You can read the Federalist by clicking below, but if you want a deeper dive in to the data, one with lots of references, click on the second headline too (get the pdf here). All access is free

Excerpts from the link above:

The International Olympic Committee (IOC) developed its 2021 framework on sex and “gender” around the concepts of fairness, inclusion, and non-discrimination. This framework leaves it to each sport’s governing body “to determine how an athlete may be at a disproportionate advantage against their peers.” However, they admonish sports organizations against “targeted testing … aimed at determining [athletes’] sex, gender identity and/or sex variations.” Instead, it’s up to each sport to “[provide] confidence that no athlete within a category has an unfair and disproportionate competitive advantage.”

The IOC’s sophistic gymnastics to deny sex-based categories in sport prompted 26 researchers from around the world to rebut the IOC’s framework. Their paper, published last week in the Scandinavian Journal of Medicine & Science in Sports, is the latest peer-reviewed study providing evidence of the obvious about sex in sports.

The researchers reviewed studies from “evolutionary and developmental biology, zoology, physiology, endocrinology, medicine, sport and exercise science, [and] athletic performance results within male and female sport” to refute the IOC’s position that male athletes warrant “no presumption of advantage” over female athletes based on “biological or physiological characteristics.”

That statement “is ridiculous on its face,” says Kim Jones, co-founder of the Independent Council on Women’s Sports (ICONS). “This is the basic knowledge we all understand and see play out in front of our eyes every day. [This new] paper is brilliant at laying out how clear the differences are between men and women. There are thousands of differences between male and female development in humans across the entire maturity path that result in these huge performance gaps.”

John Armstrong, a mathematician at King’s College London who was not affiliated with this research, highlights this “central flaw” of the IOC’s framework. “To say we should not presume male advantage in a sport unless we have specific data for that sport is like saying that just because most of the apples in a tree have fallen to the ground, one shouldn’t presume the remaining apples are also subject to gravity,” he said.

“There is overwhelming evidence of male advantage from across different sports and there is little to be gained from demonstrating this again and again, sport by sport,” Armstrong noted.

So much for untreated natal men versus untreated natal women. What about when testosterone is suppressed?

But even sports that have copious research into sex differences in performance have permitted males to compete in the female category at all levels of competition and age. One path has been through misguided policies based on testosterone levels.

Over the last decade, various sports governing bodies — including the IOC and USA Boxing — have attempted to define females through testosterone levels. Those organizations relied heavily on a publication by Joanna Harper, a trans-identifying male medical physicist. The paper consisted of eight self-reports by trans-identifying male recreational runners who had suppressed their testosterone pharmacologically and recalled that they ran slower after doing so. Harper excluded the one respondent who said he ran faster and then concluded that males who were suppressing their testosterone could compete fairly in the female category.

Read the paper if you want to see how weak Harper’s evidence was, yet was used to buttress allowing transgender women to run against natal women. The subjects, whose times were self-reported, weren’t even athletes.  But I digress:

Last week’s paper builds on research by lead authors Tommy Lundberg, Emma Hilton, and others who demonstrate the persistence of male advantage after testosterone suppression.

While testosterone suppression decreases various measures of anatomy, physiology, and physical performance, those changes are a small fraction of the differences between men and women on these metrics. A testosterone-suppressed male will have less muscle mass than his former self, but as a category, testosterone-suppressed men remain larger and stronger than women. Further, testosterone suppression does not change attributes like height, bone length, or hip and shoulder width.

And the part below surprised me, as I always thought athletic differences became significant almost entirely after puberty, which could justify having only a single league for younger kids. I’m not so sure now, but remember that winning may not be as important for younger kids than for high-school, college, or professional athletes, so combined leagues may still be considered “fair” in, say, elementary or some secondary schools.

Even before puberty, though, males outperform females in athletic competitions. Greg Brown is an exercise physiologist at the University of Nebraska at Kearney and was a co-author on the Lundberg paper. Brown recently published research based on national youth track and field championships. He found that by age 8, the boys ran faster in their final rounds than the girls did in theirs, at race distances from 100 meters to 1,500 meters.

Again, click to read:

Here’s the paper’s abstract with the IOC’s unjustified conclusion and the data from transwomen (my bolding). Note that what they consider most fair is disallowing transwomen from competing against natal women.

ABSTRACT

The International Olympic Committee (IOC) recently published a framework on fairness, inclusion, and nondiscrimination on the basis of gender identity and sex variations. Although we appreciate the IOC’s recognition of the role of sports science and medicine in policy development, we disagree with the assertion that the IOC framework is consistent with existing scientific and medical evidence and question its recommendations for implementation. Testosterone exposure during male development results in physical differences between male and female bodies; this process underpins male athletic advantage in muscle mass, strength and power, and endurance and aerobic capacity. The IOC’s “no presumption of advantage” principle disregards this reality. Studies show that transgender women (male-born individuals who identify as women) with suppressed testosterone retain muscle mass, strength, and other physical advantages compared to females; male performance advantage cannot be eliminated with testosterone suppression. The IOC’s concept of “meaningful competition” is flawed because fairness of category does not hinge on closely matched performances. The female category ensures fair competition for female athletes by excluding male advantages. Case-by-case testing for transgender women may lead to stigmatization and cannot be robustly managed in practice. We argue that eligibility criteria for female competition must consider male development rather than relying on current testosterone levels. Female athletes should be recognized as the key stakeholders in the consultation and decision-making processes. We urge the IOC to reevaluate the recommendations of their Framework to include a comprehensive understanding of the biological advantages of male development to ensure fairness and safety in female sports.

Finally, the data on transwomen athletes.  I’ve left the references in showing the plethora of studies concluding that testosterone suppression doesn’t eliminate male advantage. Bolding in the text is mine

4. TESTOSTERONE SUPPRESSION POST-PUBERTY DOES NOT NEGATE MALE PERFORMANCE ADVANTAGE:

The IOC framework suggests that testosterone concentrations could be investigated as a means to mitigate performance in transgender women. However, no study has demonstrated that transgender women with suppressed testosterone levels after puberty reach biological or physical parity with females. Conversely, numerous studies have shown that biological differences persist after testosterone is suppressed,^25, 44, 46 with physical performance implications. There is no plausible biological mechanism by which testosterone suppression could reduce height and associated skeletal measurements (e.g., bone length and hip or shoulder width) that may confer a discipline-dependent performance advantage. Consequently, no study has reported reductions in skeletal advantages in transgender women who suppress testosterone after puberty.²⁵

Twelve controlled longitudinal studies^44, 47–57 collectively following more than 800 untrained or moderately trained transgender women have shown that testosterone suppression for 1 year induces only a 5% loss of pre-transition muscle mass/strength. This loss accounts for only a fraction (one-fifth or less) of typically observed male versus female muscle mass and strength differences.^25, 26, 58 For example, in the study by Wiik et al.,⁴⁴ thigh muscle volume differences of 39% between transgender men and women were reduced only marginally with 1 year of testosterone suppression, and 83% percent of the initial male advantage was retained. The result is higher levels of muscle mass and strength in transgender women compared to females for at least 3 years after testosterone suppression (i.e., the longest sampling duration of current longitudinal studies), with male advantage still evident in cross-sectional studies of transgender women who suppressed testosterone for up to 14 years.^59–61

Note, however, that factors affecting endurance performance, like supermarathon running, have not been tested sufficiently to come to any conclusion. It may turn out that in these endurance sports transwomen are on par with men. But certainly this isn’t the case for marathon running.

The effects of testosterone suppression on biological factors underlying endurance performance are less well explored than those of strength and power. Nonetheless, untrained or moderately trained transgender women who have successfully suppressed testosterone after puberty achieved female-typical hemoglobin concentrations within 3–6 months.^44, 46 In contrast, the effect on hemoglobin mass, which, unlike hemoglobin concentration, is strongly related to VO_2max,^39, 62 is unknown, and other factors related to endurance performance, such as work economy and fractional utilization, have not been studied.

We argue that the existing literature on physical changes induced by testosterone suppression constitutes the most robust dataset currently available, and is relevant for elite athletes, because it confirms the principle of persistence of biological characteristics even in the absence of training. These longitudinal studies are then complemented by studies in which testosterone suppression in males has been accompanied by exercise training, which demonstrate that training can partly, or even completely, attenuate reductions in muscle mass and strength.^63, 64 Therefore, a rational hypothesis based on current evidence would be that retained male advantage would be larger, not smaller, in highly trained transgender women if they continued to train during testosterone suppression, compared with untrained or moderately trained individuals. This hypothesis is also supported by the observation that sex-specific differences in athletic performance are at least equally pronounced in elite athletes compared to untrained or moderately trained individuals.²⁶

The findings documented in the scientific literature, and the hypothesis that retained male advantage would be larger in athletes, predict that the relative ranking of transgender women in competitive sports would improve significantly after they switch from the male to the female category. This is illustrated by a case study of an American transgender swimmer, who achieved significant National Collegiate Athletic Association (NCAA) ranking improvements (from middle to top) across a range of events after switching from the male to the female category.⁶⁵ This occurred as a result of performance decreases that were significantly smaller than male versus female performance differences, supporting the retention of male biological advantage and illustrating the resultant unfairness.

The swimmer referred to above is certainly Lia Thomas. At any rate, 12 women athletes are suing the NCAA for forcing them to compete against trans women. You can read about the suit at the Free Press, by clicking the link below. Again, Lia Thomas seems to have been the spur for this suit (article archived here). The unarchived piece has a YouTube discussion of the lawsuit by two of the plaintiffs, Riley Gaines and Réka György: