Agree with OP. For the supposedly highly esteemed NEJM to publish such a 'perspective' - with no application/consistency of the meaning of words- with numerous bold and obviously false assertions - with absolutely no evidence base - is truly appalling.
Centering the needs of males in female sports is not acceptable and not progressive.
The anatomical, physiological, biomechanical and anthroprometric advantage males have over females is fact. This is irrespective of reduced testosterone - which still can be mitigated against by males with muscle training due to sexed-based differences in muscles structure. The historical disadvantage of women to equal access and opportunity to sport - at all levels - is fact. There is a wealth of evidence to support need for single-sex spaces for the equal participation of women/girls in society.
This is a concern - not just for those of us working in science and academia - but for all of society. Science is about evidence. Perspectives in science should be evidence based - not biased political agendas camouflaged as science. For these editors to publish such sub standard, un-evidenced nonsense, and consider it of value to science and society - is chilling.
Hopefully - it might wake up some more people?
Full article here:
In the spring of 2020, the Idaho legislature passed a bill that effectively precludes transgender girls and women (from kindergarten through college) from joining female athletic teams. Idaho Governor Bradley Little signed the Fairness in Women’s Sports Act into law in late March 2020.1 The law’s title suggests that it should be understood as an effort to expand “fairness.” The presumptive beneficiaries are cisgender (i.e., nontransgender) girls and women on school athletic teams who, the law suggests, should not have to compete against transgender girls and women. However, the assumptions underlying the law’s responses to transgender women and girls hoping to join sports teams are so flawed as to suggest animus. The right of girls and women to fairness in school sports is protected by Title IX of the Education Amendments of 1972. Protecting fairness for cisgender females cannot, however, serve as a pretext for excluding transgender athletes from sports teams, especially if fair accommodations can be crafted.
Two women have brought a legal action challenging the law’s constitutionality.2 One, Lindsay Hecox, is a transgender woman attending Boise State University, where she hopes to join the women’s cross-country and track teams. Hecox has had hormone treatments that have reduced her testosterone levels. The second plaintiff, “Jane Doe,” is a 17-year-old cisgender girl who plays on her high school’s soccer team. She is worried that, pursuant to the new law, her sex could be disputed by a competitor because she appears “masculine.” Such a challenge could lead to an invasive process of sex verification.2 Idaho is the only state that has barred transgender girls and women from joining girls’ and women’s school athletic teams, though other states are considering similar laws.
The Idaho law was passed with apparent urgency during the early days of the Covid-19 pandemic, when many states had sent state legislators home. A companion bill, signed into law in March 2020, bars transgender people from changing the sex indicated on their birth certificates to harmonize with their gender identity. An attorney for the state, defending the Fairness in Women’s Sports Act to the federal district court in Idaho, explained that it protects the rights of “real women.”3 The implications of this assertion are clear: transgender female athletes are not “real women” and must therefore be excluded from playing on school athletic teams. Judge David Nye, for the federal district court in Idaho, concluded in response to preliminary motions that the law “was motivated by a desire for transgender exclusion, rather than equality for women athletes.”2
There are few cases on which the Hecox court can rely should the case go to trial, as seems likely, and none that is directly on point. However, the recent decision of the U.S. Supreme Court in Bostock v. Clayton Countymay carry some weight.4 In Bostock, the Court held that Title VII of the Civil Rights Act of 1964, which prohibits employers from discriminating against employees on the basis of sex, encompasses and thus prohibits discrimination on the basis of sexual orientation and gender identity. The holding may be helpful to transgender athletes seeking to join school teams corresponding to their gender identity. Sex-related traits, however, may have different implications under Title IX than they have under Title VII.
The claim that sex can be easily determined by reference to straightforward biologic markers may seem persuasive. In reality, the biology underlying sex is complicated and open to continuing scientific review. Similarly, the claim that it is unfair to cisgender women athletes to allow transgender women on their sports teams may seem compelling. Both the defendants and the state legislators who voted for the law that effectively excluded Lindsay Hecox from participating in college sports on any women’s team assumed that transgender women on athletic teams have an “unfair” advantage over cisgender women even after a year of treatment involving suppression of androgens. This assumption is not based on strong scientific evidence.
The Idaho law provides three criteria for resolving a dispute about the sex of a student athlete. A clinician verifying a student’s sex may rely “only on one (1) or more of the following: the student’s reproductive anatomy, genetic makeup, or normal endogenously produced testosterone levels.”1 By any or all of these criteria, Hecox would probably be ineligible to participate on any women’s college team in Idaho. But if clinicians were to assess student athletes on the basis of circulating testosterone levels after treatment for hormone suppression, she would be able to play on a women’s team.
Sex can be classified according to a variety of markers that are not always consistent with each other, but measuring testosterone levels is the standard practice in a number of other athletic settings. Under the rules of the National Collegiate Athletic Association (NCAA), which governs intercollegiate competition, transgender women who receive hormone treatments for a year may play on women’s sports teams. Hecox began treatment to suppress testosterone in September 2019. Thus, under NCAA rules, which guided Idaho schools’ responses to transgender athletes before the new law was passed, she would be eligible to join the women’s cross-country and track teams at her college. Moreover, the 2015 rules of the International Olympic Committee (IOC) allow transgender women athletes to play on women’s teams if they have identified as female for at least 4 years and if their testosterone level has been less than 10 nmol per liter for at least a year. That level is considered the lower limit for cisgender men by the IOC commission that recommended the standard. The IOC rules are undergoing reconsideration but will remain in place at least through the Tokyo Olympics (which have been postponed until 2021 because of the Covid-19 pandemic).
There is controversy about the role of testosterone levels in athletic success. Most experts agree that they affect performance, at least in some sports. But reliance on “endogenously produced testosterone levels” — listed as one of three options for assessing sex by the Idaho law — is misguided. Measuring endogenous testosterone would require transgender female athletes to suspend hormone treatments. Furthermore, the Idaho statute includes in its sweep girls who transitioned before puberty — before their bodies even began producing the circulating levels of testosterone typical of cisgender males.
Interpretations of research about the effect of testosterone levels on athletic success are conflicting. Moreover, evidence-based conclusions vary from sport to sport. The Idaho legislature’s apparent presumption that all transgender women, including those who have undergone hormone therapy for at least a year, have an unfair advantage over cisgender women on all school teams relies at least as much on assumptions as on evidence.
Fears about challenges to the presumptions that sex is binary and that it is, and should remain, immutable continue to hinder fair accommodation for transgender female athletes and for transgender people in many other settings. Litigants opposing transgender rights have too often grounded their advocacy on fear — fears about inappropriate sexual behavior (which undergird responses to rules prohibiting transgender people from using bathrooms appropriate to their gender identity), fears about disguising identities for nefarious purposes (seen in challenges to laws that preclude changes in sex designation on official documents so that people’s sex designation matches their gender identity), and fears about unfair competitive advantage (as seen in Hecox). Those fears jeopardize the rights and the personhood of transgender people.
Fair accommodations can be shaped for many contexts in which the rights of transgender people have been curtailed. Within the specific context of sports, accommodation, which must safeguard the rights of all women — whether cisgender or transgender — will probably vary from sport to sport, from age group to age group, and in light of the level of competition at stake.
Thoughtful consideration of this issue can help advance human rights for transgender people. It is important for educators whose responses to transgender students affect all students, for lawyers who aim to broaden social justice, and for physicians whose knowledgeable treatment of transgender patients can affirm personhood with positive consequences for health outcomes.
- Idaho Code Ann. § 33-6201-6206 (2020).
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- Hecox v. Little (Memorandum Decision and Order), 2020 WL 4760138, Case No. 1:20-cv-00184-DCN (U.S.D.C. D. Idaho 2020).
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- Oral Tr. of Mot. Hr’g Proceedings at 82, Hecox v. Little, No. 1:20-cv-00184-DCN, 2020 WL 4760138, at *1 (D. Idaho Aug. 17, 2020) (Att’y for Pls., Elizabeth Prelogar).
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- Bostock v. Clayton Cnty, Ga., 590 U.S. _, 140 S. Ct. 1731 (2020).
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