I've already questioned the review process for the journal. However, the more I read, the more I am questioning the integrity of the PhD process. He presumably had regular reviews each year with people other than his supervisor. Why did they not flag the lack of rigour? I would also question how he got through the viva. Even allowing for careful selection of examiners by the supervisor, surely someone questioned the lack of rigour?

Activism identifying as science 🙄

So, men pretending to be women that have been subjected to hormone therapy might be weaker than elite female athletes that are at the peak of their physical prowess. Groundbreaking news.

It still stands that most men are physically superior to most women, hence why the whole thing is such an unfair farce. Not to mention that men aren't women regardless of how they feel or how many hormones they take, and they SHOULD NOT be allowed to enter female competitions under any circumstances.

Judging by my Twitter feed, there seem to be plenty of trans athletes in female High School track and field (so the ones looking for Uni scholarships).

Cycling and skateboarding too (albeit different ages).

Those would be good cohorts to recruit. Take the same discipline and the same level of competition.

I remember the ads that they used for recruiting for this. There has to be every doubt that this paper was destined to have significant difficulties in integrity of data. Yet, it will be used to somehow support the inclusion of male athletes in female sports events just by its existence. Just as that Canadian paper has been leveraged despite the very public rejection by sport scientists, biologists etc pointing out the valid flaws.

The recruitment method of this study also provided a limitation as social media advertising was used rather than recruitment from a clinical provider.

Oh yes, Hamilton’s recruitment ad that telegraphed the preferred outcome of the study:

Trans men and women athletes, we need you!

If you feel unjust about the recent policies, why not provide your data to influence the next policy making decisions?

https://fairplayforwomen.com/sport-policy-do-we-need-more-evidence/

why did the reviewers not point out this lack of clarity?

afaict, there was only one reviewer and it's not an open review.

For women, when you conduct metabolic and standard fitness tests, it's helpful to know where women are in their menstrual cycles. Given the age profiles, it's not implausible that some of the female athletes might have been in perimenopause.

E.g., if women did an all out VO2 max test during the luteal phase, I'd wonder how long the recovery phase would have to be. And I might want to know the phase they were in when judging the intensity of the 4 workouts they recorded in the run up to the lab day.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916245/

It gets better and better.

The summary is misrepresenting the paper. Not observing a significant difference between the groups does not necessarily mean the groups are equivalent.

Just to clarify - not seeing a significant difference, which is the terminology they should have used, simply means that we cannot be sure the differences between the samples are due to the different conditions (i.e. transwomen vs women) rather than chance. It doesn't mean the densities are the same. Given the small sample size, the lack of significant difference is a "no shit Sherlock" finding.

In the report they say:

"No differences in whole-body bone mineral density (BMD) (F(3–66)=4.6, p=0.01), femoral neck BMD (F(3–66)=1.0, p=0.39, table 2), total proximal femur BMD (F(3–66)=1.5, p=0.22, table 2) or total lumbar spine BMD (F(3–66)=0.4, p=0.78, table 2) were found between transgender athletes and cisgender athletes (table 2)."

What that suggests to me is that they are comparing trans athletes (i.e. a group of male and female athletes) with athletes who are not trans (i.e. a group of male and female athletes). Surprise, surprise, no difference. Now, maybe they did look at transwomen vs women and transmen vs men but if they did they have not specified that, which obviously raises the question of why did the reviewers not point out this lack of clarity?

Then in the discussion they say:

"No differences in BMD were observed between transgender and cisgender women athletes in this study (table 2), despite prior research hypothesising that transgender women athletes have a significant BMD advantage over cisgender women. The sample size for each gender was n<30 participants and may be insufficient to characterise BMD differences reliably. Exercise has been shown to have a protective effect on BMD in CM26 and CW,27 and our results suggest a protective effect of exercise in transgender women, given that there is evidence of low BMD in transgender women with low weekly sports activity.28 Nevertheless, the results suggest the complexity of bone health in athlete populations and the need for a more comprehensive assessment to understand the long-term impact of GAHT on transgender athletes’ BMD."

This suggests they did actually break it down (again, where were the reviewers/editor?). Regardless, they compared 11 transwomen with 18 women. The additional variables (e.g. sport, level of activity etc) within each group means the groups are so varied as to make the comparison a nonsense anyway even if the sample size was sufficient. Even if they were comparing like with like, the numbers are so low that the comparison would not be reliable.

The summary of the report states that "the bone density of the trans women athletes was found to be equivalent to that of the cis women. Bone density is linked to muscle strength."

But in the actual report Bone Mineral Density was 1.10±0.08* for women, 1.17±0.13 for transwomen and 1.22±0.10 for men.

Some of the other results also don't seem to back up the conclusions, but maybe I'm reading it wrong?

All of that plus the tests involved a single visit to the lab so presumably each measurement was only done once so not exactly accurate.

The limitations section in the paper basically admits the study is nonsense as there were too many confounding variables in the samples to allow accurate comparison:

"Additionally, the composition of the study cohort may not fully represent the diversity of athletes in elite sports from worldwide populations. Athletes from various sporting disciplines and performance levels were included, and the athlete training intensity was self-reported. Therefore, the results may suffer from selection and recall bias. The results may not apply to all levels or ages of athletes, specifically as this research did not include any adolescent athletes competing at the national or international level. The athletes participating in the present study represented a variety of different sports, and this would have undoubtedly impacted the results of the study as different sports stress different training and sports modalities. Exercise type, intensity and duration all have an impact on physiological responses and overall laboratory performance metrics. The subgroups of sports that emerged were also too dissimilar to allow meaningful subgroup analysis."

"The recruitment method of this study also provided a limitation as social media advertising was used rather than recruitment from a clinical provider. Social media recruitment leaves this study open to sample bias as social media advertising, although great for recruiting hard-to-reach participants for observational studies, does not represent a clinical population in 86% of comparisons. As the participants were not recruited from a clinic, this also means that the gender-affirming treatment of the transgender athletes was not controlled."

It's irrelevant imo. If a male person has modified his body by use of hormones or surgery that is his choice but it doesn't make him female. No male person should be in female sport

Following ethical approval (ref: 9496), 75 (19 CM, 12 transgender men, 23 transgender women and 21 cisgender women) participants were recruited through social media advertising on Meta Platforms (Facebook and Instagram, Meta Platforms, California, USA) and X (Twitter, California, USA). Following the initial response, all participants were provided with the participant information sheet by email at least 7 days before being invited to travel to the laboratory, with further oral information about the study procedures and written informed consent provided on their visit to the laboratory.

Translation
Study began with only 75 participants, selected from Social Media
19 biological men
12 Trans identified (biological) females (with one year of chemical alterations and ? surgery)
23 Trans identified (biological) males (with one year of chemical alterations and ? surgery)
21 biological females

All knowing what was being tested, not a blind study, no control group. Recruited on social media so from very diverse sporting backgrounds. All possibly having a vested interested in the results of the study.

Two cisgender women and one transgender man could not provide blood samples and were consequently excluded from all analyses as their endocrine profiles could not be verified. Furthermore, two transgender women and one cisgender woman were excluded from all analyses due to testosterone concentrations exceeding recommended female testosterone concentrations (2.7 nmol/L).

Translation
Study was then reduced to 69 participants
19 biological men
11 Trans identified females
21 Trans identified males
18 biological females

Equity, diversity and inclusion statementThe author group consists of early (n=3) and senior researchers (n=3) from different disciplines and universities (n=3). Two authors are members of a marginalised community; the lead early-career author is a transgender woman, and one of the junior authors is a woman from the global south. Our study population included male and female transgender athletes from within the UK participating in competitive sports in comparison with cisgender male and female athletes participating in competitive sports; thus, findings may not be generalisable to global athlete populations.
Translation
Knowing this about the author group gives me great confidence in the results - oh wait, it gives me no confidence at all, I suspect bias from the inside out.

Participant characteristics
Our investigation encompassed a diverse cohort of athletes, with endurance sports representing 36% of the athlete cohort, team sports representing 26% and power sports representing 38%. No cisgender or transgender athletes were competing at the national or international level. No significant differences were found in age (F(3–66)=1.9, p=0.14), training intensity score (χ2 (3)=1.2, p=0.76) or length of GAHT between transgender men and transgender women (F(1–32)=0.5, p=0.48,)

Translation
This was all over the shop - no common sport or level of participation, the training intensity was "self-rated", could you not have got the 69 people from a single sport and assembled them together for a common training session a few times?

Conclusion While longitudinal transitioning studies of transgender athletes are urgently needed, these results should caution against precautionary bans and sport eligibility exclusions that are not based on sport-specific (or sport-relevant) research.

Translation - utter poppycock!

My personal view
Where sex-based categories exist in sport, the women's category should be exclusively for (non-chemically altered) biological women on the grounds of safety and fairness. The men's category could become an Open category catering for all biological men including trans women, and chemically altered females, where that is safe for the female. Lia Thompson, Emily Bridges and others are cheats in the same way as Lance Armstrong was. We don't tolerate doping in men's swimming and cycling and other sports, why should we tolerate it in women's sport???

The expert witness for Caster Semenya in the CAS legal case is based at MMU:

https://www.mmu.ac.uk/research/our-impact/case-studies/genetics-sport

Yes. According to their LinkedIn they've been a research associate at MMU since May 2024 - these are usually temporary posts assisting on someone else's funded project - and they have their PhD. The MMU website hasn't caught up yet but if they've only just started that's hardly surprising

This is why I think that Hamilton has a post as an RA with MMU's Institute of Sport.

I note Hamilton is an associate editor for a sister BMJ journal.

The whole thing is absurd. What kind of competitive athlete deliberately enfeebles themselves in order to be able to compete in an elite category. It’s so insulting to the women who would do anything and everything to hone their athletic abilities.

Fairly sure they now have PhD and a post in Manchester Metropolitan Uni.

ETA: I'm probably wrong about the post but can't think where I saw something about this.

https://www.mumsnet.com/talk/womens_rights/5048565-d-telegraph-report-on-transgender-womens-disadvantage-in-sport

This one?

Which basically concluded with ‘testosterone suppression makes men less able to compete with other men (it doesn’t make them the same as women, but shhh! bury that bit under the leader!)’

The "athletes" were all recruited via social media:

"Our investigation encompassed a diverse cohort of athletes, with endurance sports representing 36% of the athlete cohort, team sports representing 26% and power sports representing 38%. No cisgender or transgender athletes were competing at the national or international level".

"Athletes from various sporting disciplines and performance levels were included, and the athlete training intensity was self-reported"

" The athletes participating in the present study represented a variety of different sports, and this would have undoubtedly impacted the results of the study as different sports stress different training and sports modalities. Exercise type, intensity and duration all have an impact on physiological responses and overall laboratory performance metrics"

I'm not sure that you can really compare a pole-vaulter with a sprinter or long distance runner.

Also a top 30 runner is going to be at a completely different level of fitness to somebody ranked 2,000.

It's a start, I suppose.

According to the website Blair is a PhD student so not yet Dr Hamilton. Assume they have nearly finished if they're publishing from it.

😶 Gosh!

(I'm trying to limit my swearing)

That's erm... Interesting! Please tell me they didn't actually willingly put that twaddle online!

British Journal of Sports Medicine: https://bjsm.bmj.com/content/58/11/586

One reviewer and I can't see the review (I've a feeling this isn't an open review journal in the BMJ family).

Interesting recruitment criteria for which I can't find additional breakdown re: whether the participants are competitive athletes or "undergo physical training at least three times per week". There's something later about nobody competing at national or international level (unhelpful).

diverse cohort of athletes, with endurance sports representing 36% of the athlete cohort, team sports representing 26% and power sports representing 38%.

I haven't read it carefully but, given the small number of participants (understandable) there's an interesting number of exclusions by failure to have an endocrine profile, transgressing T levels, failing to meet required respiratory exchange ratio.

19 cisgender men (CM) (mean±SD, age: 37±9 years), 12 transgender men (TM) (age: 34±7 years), 23 transgender women (TW) (age: 34±10 years) and 21 cisgender women (CW) (age: 30±9 years)

I don't know what the normal 'failure' rates are for experienced users of metabolic carts and tests but this feels quite high.

Blood measures
There was a significant gender effect on testosterone concentration (F(3–66)=80.6, p<0.001). CM (20.5±5.8 nmol/L) exhibited significantly higher total testosterone concentration than transgender women (0.7±0.5 nmol/L, t(66)= 11.1, p<0.001, figure 1A). Transgender men (24.8±12.3 nmol/L) had elevated total testosterone concentration compared with transgender women (t(66)=11.3) and cisgender women (0.9±0.4 nmol/L, t(66)=10.9, both p<0.001, figure 1A). There was also a significant gender effect on oestradiol concentration (F (3−66)=7.6, p<0.001), with transgender women (742.4±801.9 pmol/L) showing higher oestradiol concentration than CM (104.3±24.8 pmol/L, t(66)=4.4 p<0.001), cisgender women (336.0±266.3 pmol/L, t(66)=2.7, p=0.045) and transgender men (150.2±59.4 pmol/L, t(66)=3.4, p=0.01, figure 1B).
Transgender women’s total testosterone concentration (0.7±0.5 nmol/L) falls within the recommendations for GAHT of ≤1.8 nmol/L,5 and oestradiol concentrations (742.4±801.9 pmol/L) exceed the target of 400–600 pmol/L5 for GAHT. Transgender men’s testosterone concentration (24.8±12.3 nmol/L) exceeds the NHS target of 15–20 nmol/L6 for GAHT, although not the Endocrine Society target of 11–34.7 nmol/L.7

A missing callout comparison in the above is relative testosterone for TW and women. (Authors provide what they term: CM vs TW; TM vs TW and CW.) Then there is an oestradiol set of comparisons.

The general lung function tests are in line with what I'd expect (Table 2) although I could do with more information about the participants (who were the endurance/power performers) and whether they're accustomed to a VO2 max test). And, as for why they've highlighted the countermovement jump in the lower body anaerobic power section…

ETA: several people posted in the time it took me to do the above, apologies for x-overs.

Emily Bridges, the cyclist who is desperate to compete with elite women, is currently part of a study to see if ++ loses h++ male advantage.

I don’t see how any study measuring reduction in sports performance could ever be taken seriously for this very reason.

Yeah I had a quick look at the paper summary - it struck me that the transwomen could be in full woman-LARPing mode and do their "best girly jump". In a study like this, the participants ought not to know it's about comparing TiMs to females, otherwise they could easily sway the results. For a proper comparison, TiMs need to put in a genuine effort to (for example) jump as far as they can.

I noticed that they didn't put the TiF - male results in the summary... TiFs would presumably be trying their absolute best to be as good as the men, so I'd assume that the results would be accurate there at least.