I am back at my desktop, so I will just post the link bank for those reading along who want to read the 'science'. You know, the science that @EmiliaB71 doesn't want to believe is out there.
And I encourage Emilia that if Emilia has studies that I have not included, that they should link us up. Because we read those studies. We are very keen to read those studies to deepen our understanding of the topic.
No. 1. This one from Dr Hilton and T Lundberg. This and No. 2. are reviews of 13 previous studies.
https://link.springer.com/article/10.1007/s40279-020-01389-3
No. 2. The second from Harper et al.
bjsm.bmj.com/content/early/2021/02/28/bjsports-2020-103106
Conclusions are in line with No. 1. For information (considering many people will seek to discredit based on alleged bias) Harper is the transwoman who has released some sports studies in the past that had some methodology issues.
No. 3. Adding the USAF study here for people to read.
bjsm.bmj.com/content/early/2020/11/06/bjsports-2020-102329
Timothy A Roberts, Joshua Smalley, Dale Ahrendt
Effect of gender affirming hormones on athletic performance in transwomen and transmen: implications for sporting organisations and legislators
Summary The 15–31% athletic advantage that transwomen displayed over their female counterparts prior to starting gender affirming hormones declined with feminising therapy. However, transwomen still had a 9% faster mean run speed after the 1 year period of testosterone suppression that is recommended by World Athletics for inclusion in women’s events.
It is interesting reading as it also leaves the suggestion that even after 3 years advantage still exists.
And Sean Ingle’s take on it.
www.theguardian.com/sport/2020/dec/07/study-suggests-ioc-adjustment-period-for-trans-women-may-be-too-short
No. 4. Here is an interesting video led by Prof Jo Phoenix, with Dr Emma Hilton and Jon Pike. OUGCRN Seminar : Sex, Gender, and Sport after Tokyo
As they point out the 69 kg male weightlifting champion at 164 cm can lift more weight and any female weightlifting champion. Even Tatiana Kashirina who is 108 kg an 177 cm tall. She goes through Hubbard's advantages.
An interesting seminar particularly for anyone who perhaps wants a summary of sex vs gender or a reminder.
No. 5.
https://open.spotify.com/episode/7jb9DiVtsmfavJamTOcGz3?si=hfYx8qnpSuiag9xFIHU_Sg
The Real Science of Sport Podcast: Facts and Fallacies in the trans athlete debate, a conversation with Dr Emma Hilton.
No. 6. Trans girls grow tall: adult height is unaffected by GnRH analogue and estradiol treatment. This is still an advantage that these males continue to have despite ‘puberty blockers’. This is where future studies will start to focus on these cases. This may also then bring in those athletes with CAIS who are currently not the focus of regulations.
Lidewij Sophia Boogers, Chantal Maria Wiepjes, Daniel Tatting Klink, Ilse Hellinga, Adrianus Sarinus Paulus van Trotsenburg, Martin den Heijer,
Sabine Elisabeth Hannema
published: 06 June 2022
academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgac349/6603101
No. 7. For all those who believe ‘males were always competing in the female category’. No. They were not. Up until the Atlanta games in the 90s female athletes were tested for their valid entry into female sports events. Whoever tries to say ‘males were always competing’ is lying.
www.nature.com/articles/gim2000258.pdf?origin=ppub&utm_medium=affiliate&utm_source=commission_junction&utm_campaign=CONR_PF018_ECOM_GL_PHSS_ALWYS_DEEPLINK&utm_content=textlink&utm_term=PID100045542&CJEVENT=f4d4c8630a0411ed831b01a80a1c0e11
No. 8. The Brazilian study.
bjsm.bmj.com/content/early/2022/09/01/bjsports-2021-105400.info
Cardiopulmonary capacity and muscle strength in transgender women on long-term gender-affirming hormone therapy: a cross-sectional study
Leonardo Azevedo Mobilia Alvares, Marcelo Rodrigues Santos, Francis Ribeiro Souza, Lívia Marcela Santos, Berenice Bilharinho de Mendonça, Elaine Maria Frade Costa, Maria Janieire Nazaré Nunes Alves, Sorahia Domenice
Conclusion
In this small cohort of non-athlete TW, who were previously exposed to male pubertal development and underwent long-term oestrogen therapy, we identified higher grip strength and VO2 peak levels than in non-athlete CW, but these same parameters were lower compared with non-athlete CM.
These findings add new insights to the sparse information available on a highly controversial topic about the participation of TW in physical activities. Future studies involving transgender athletes that account for and quantify variable exposure times to pubertal development and assess muscle cell metabolism are needed to elucidate the effects of long-term GAHT on TW sports performance.
And from Ross Tucker on this study
From Ross Tucker on this study above:
Over a decade (14.4 yrs average) of T-suppression, and TW have VO2max 20% higher, grip strength 19% higher & skeletal mass 40% than women. More evidence that male biology persists long after T is removed. Another piece of the same puzzle, albeit from a cross-sectional study.
The cross-sectional bit is important - the study hasn't (like over a dozen others) tracked people from Day zero onwards, so the differences are a 'snapshot' rather than a 'movie', if that makes sense? Means you don't know how those TW began, 14.4 yrs earlier, but the finding of quite large differences compared to women (20% or more) is striking, because a) they either began as typically representative of males, and lost some, but retained significant advantages vs women, or b) they began well below men, and lost hardly any advantages. In either case, the end point, over a decade later, is biological differences compared to women that will create performance implications. Of interest, the mass retention and VO2max advantage mean that relative VO2max (ml/kg/min) ends up similar, which means in some sports (weight-determined) the performance implication may differ - sometimes very large, sometimes smaller, as in some categories within endurance sports.
But zero? Unlikely, because cardio function, FFM & strength are greater. Important paper, showing striking biological 'persistence' 14 yrs on.
Two further thoughts on the study. First, the TW vs women differences in muscle mass and strength remain large (20%) after more than a decade of T suppression. One year vs ten, biology "persists". Second, add training to the mix and TW and women would obviously get stronger.
You could TRY to argue that women would get stronger relatively more than TW (you'd have a job on your hands to explain why this would be, but anyway). More likely is that the differences - TW vs women - would persist or even increase with the addition of training. What this study confirms is that non-trained TW retain biological differences with performance implications after 14 years of T suppression. You'd have to believe that W could make up these gaps with training to believe in fairness in sport. That is, trained W = non-trained TW = fair!
No. 9. This is quite a good discussion on transitioned males in sport done by Australia's SBS TV channel. It includes people like Jane Fleming (Olympic athletics champ), Deborah Acason (Commonwealth games female weighlifting champion and pioneer), Holly Lawford-Smith, Prof David Handelsman (Uni of Sydney) specialist in Testosterone, Dr Roslyn Carbon (part of the team developing UK Sports guidance), Mianne Baggar and Joanne Harper.
Overall, it showed just how much the inclusive side fall onto emotional manipulation in the face of overwhelming evidence that counters their claims.
No. 10. Discussion about ethics and inclusion.
The rebuttal of Canadian Centre for Ethics in Sport ‘Transgender Women Athletes and Elite Sport: A Scientific Review’ has been released.
Here is the original:
www.cces.ca/sites/default/files/content/docs/pdf/transgenderwomenathletesandelitesport-ascientificreview-e-final.pdf
here is the rebuttal:
idrottsforum.org/wp-content/uploads/2022/11/devineetal221129.pdf
”When Ideology Trumps Science: A response to the Canadian Centre for Ethics in Sport’s Review on Transwomen Athletes in the Female Category”
Cathy Devine, Emma Hilton, Leslie Howe, Miroslav Imbrišević, Tommy Lundberg, Jon Pike
Independent Scholar; University of Manchester; University of Saskatchewan; Open University (UK); Karolinska Institutet
29 November 2022
This is good reading for anyone who wants some background. Although it is a long read.
Some highlights:
"Descriptive accounts tell us how things are. Normative accounts tell us how things ought to be. To answer the question: ‘is it fair for TW to compete in female sport?’ we need both."
and
"For example, the anonymous authors claim evidence showing that male advantage is lost after one year of testosterone suppression, while the two papers cited in support of this statement explicitly argue that male advantage is retained well beyond one year of suppression. In fact, a recent cross-sectional study (Mobilia Alvares et al, 2022) measuring the perfor- mance of transwomen suggests that the advantage may be maintained after 14 years of testosterone suppression." (p. 4-5)
and
"The Range Argument rests on a misunderstanding of fairness in sport. The same misunderstanding lies behind the repeated claim that it is wrong to compare TW with male athletes (‘cis’ men), and that they should be com- pared with female athletes (‘cis’ women). The difference is between the two conceptions of fairness in play: the ‘Advantage’ conception and the ‘Range’ conception. The Advantage view justifies our current categorisation into male and female sport, and so justifies the existence of women’s sport. The Range view does not justify the existence of women’s sport: rather, it would prescribe a sports category defined on the basis of some metric or set of metrics as a substitute for women’s sport – for example, tall sport and short sport. On the Advantage account of fairness, what matters is male advan- tage, so the appropriate comparison is between Transwomen and males to see whether there is retained male advantage. On the Range view, what mat- ters is whether TW are in the range of female athletes, so this prescribes that the appropriate comparison is with female athletes. This leads to the result that some TW metrics are within the female range. But the same objection applies: what matters is the removal of male advantage, not whether some males are (for example) shorter than some females." p 5-6
and
"Sports categories do not exist to account for undertraining and poor fitness; there are plenty of opportunities at the recreational level for TW to join other equally under- trained and unfit males." p 7
Also on p 7
"The CCES write in the conclusion of their Executive Summary (9): ‘There is no firm basis available in evidence to indicate that trans women have a consistent and measurable overall performance benefit after 12 months of testosterone suppression.’ If that really were the case, then the inclusion of TW would not be prudent. Suppose it turns out that they do have a sig- nificant advantage over women (which is actually the case), then, having included TW would have been unfair (and unsafe) for women. The pruden- tial principle is this: if we lack conclusive evidence, but a change of policy could lead to bad outcomes, then we should not implement such a policy – until we have such evidence. The paper equivocates between three claims: that there is no evidence of advantage, that there is no advantage, and that there is advantage (but fairness must be traded off against inclusion). This is deeply confused, but we note here that absence of evidence does not support a policy of including possible male advantages in female sport."
then
"Furthermore, what is supposed to happen once we have achieved ‘rep- resentative levels’ of participation? Should we then resurrect the fairness criterion and exclude all TW? With zero participation, we would have to open the female category again for TW, and this ‘game’ (close, open, close, open) could go on forever." p 8
and
"The other view is to say that, because the sociocultural disadvantages faced by TW are ‘special’ and differ fundamentally from the disadvantages of other athletes, sports authorities should accede to the demand that they be included in female sport. On this line of argument, inclusion of TW in female sport is not fair, but is an act of solidarity with them. This justifica- tion, though, must attend to the opposite claim: that because inclusion is not fair, it amounts to an act of animosity towards female athletes." p 10
Page 12 & 13 bring in sex testing and how olympic women athletes were all in support of it but that it was ignored.
And how sexism is rife.
"Similarly, the voices of black elite female athletes from the Global South without these XY DSDs/VSDs, are ignored in the name of anti-racism, in fa- vour of advocacy for athletes who do have them. This completely disregards the black elite female athletes without these congenital conditions from the Global South, who are well represented in, for example, elite athletics, and depend on female categories and the World Athletics DSD regulations for their success"
No. 11. (One I have not read, but only read the dissemination of as I cannot access this one)
Study released 14th December 2022 from Nederlands and Denmark.
pubmed.ncbi.nlm.nih.gov/36534950/
Lisanne H P Houben, Maarten Overkamp, Puck van Kraaij, Jorn Trommelen, Joep G H van Roermund, Peter de Vries, Kevin de Laet, Saskia van der Meer, Ulla R Mikkelsen, Lex B Verdijk, Luc J C van Loon, Sandra Beijer, Milou Beelen
Abstract
Purpose: To assess the effects of 20 weeks resistance exercise training with or without protein supplementation on body composition, muscle mass, muscle strength, physical performance and aerobic capacity in prostate cancer patients receiving androgen deprivation therapy (ADT).
Methods: Sixty prostate cancer patients receiving ADT were randomly assigned to perform 20 weeks of resistance exercise training with supplementation of 31 g whey protein (EX+PRO, n = 30) or placebo (EX+PLA, n = 30), consumed immediately after exercise and every night before sleep. A separate control group (CON, n = 36) only received usual care. At baseline and after 20 weeks, body composition (dual energy X-ray absorptiometry), muscle mass (computed tomography scan), muscle strength (1-repetition maximum strength tests), physical performance (Timed Up and Go Test, 30-second Chair Stand Test, Stair Climb Test), aerobic capacity (cardiopulmonary exercise test) and habitual dietary intake (food diary), were assessed. Data were analyzed using a two-factor repeated-measures ANOVA.
Results: Over time, muscle mass and strength increased in EX+PRO and EX+PLA and decreased in CON. Total fat mass and fat percentage increased in EX+PRO and CON, but not in EX+PLA. Physical performance did not significantly change over time in either group. Aerobic capacity was maintained in EX+PLA, while it decreased in EX+PRO and CON. Habitual protein intake (without supplements) averaged >1.0 g·kg body weight-1·day-1, with no differences over time or between groups.
Conclusions: In prostate cancer patients, resistance exercise training counteracts the adverse effects of ADT on body composition, muscle mass, muscle strength and aerobic capacity, with no additional benefits of protein supplementation.
No. 12. This is just a peak for Harper’s new study of just Bridges.
twitter.com/runthinkwrite/status/1621072256846950400?s=46&t=ig4wy4ZxTb223nzt6s9t9Q
These are the slides released by Harper on Bridges performance. There is an increase in performance that correlates to the training effort. And when training drops so does performance.
The IOC paid a lot of money for this.
No. 13. Meaningful competition by Jon Pike
Why ‘Meaningful Competition’ is not fair competition
6th Feb 2023
www.tandfonline.com/doi/full/10.1080/00948705.2023.2167720
ABSTRACT
In this paper I discuss a new conception that has arrived relatively recently on the scene, in the context of the debate over the inclusion of transwomen (hereafter TW) in female sport. That conception is ‘Meaningful Competition’ (hereafter MC) – a term used by some of those who advocate for the inclusion of TW in female sport if and only if they reduce their testosterone levels. I will argue that MC is not fair. I understand MC as a substitute concept, as an attempt to substitute for the perfectly serviceable concept of fair competition. It is an attempt at conceptual engineering that should be resisted. This is important because some International Federations have accepted MC as good coin, and the underlying theory of MC, which I explicate for the first time, underpins the stance taken by the IOC (International Olympic Committee) in its Framework Document. To establish that the inclusion of TW in female sport meets the criteria of MC in the sense I explicate here, does not show that the inclusion of TW in female sport is fair. Such inclusion is not fair, and the proper currency of sport is fair competition. ‘Meaningful Competition’, on the other hand, is a snare and a delusion.
No. 14. An article about the connection of injury with menstrual cycle.
https://www.economist.com/science-and-technology/2021/06/24/acl-injuries-are-a-growing-problem
Plug this into archive dot is for the full version.
One of the most curious features of ACL injuries, though, is that they afflict women far more often than men—as much as eight times more, some investigations suggest. Why this might be is the subject of intensive research. But a clue lies in an apparent connection with the menstrual cycle.
A study published in 2013, of a group of women skiers in the Alps, for example, found that those in the pre-ovulatory stage of the cycle were more than twice as likely to suffer an ACL tear than were those in the post-ovulatory stage. A four-year survey of 113 female England footballers, published in March, also found a clear correlation. Muscle and tendon injuries were far more common in the late follicular phase of the cycle, just prior to ovulation, than in the other phases.
The reason for this menstrual-cycle link is unclear. The ACL has oestrogen receptors, which might help to explain what is happening. But it is not unique among ligaments in this, and the receptors’ job is, in any case, obscure. Levels of oestrogen in the body do spike just before ovulation—the point when tear-frequency rises—but uncertainty remains about the exact link.
Other contributory factors to women’s higher ACL tear rate may be female body shapes and movement patterns. Compared with men, women have wider hips, more inverted knees and “over-dominant“ quad muscles (meaning that the quadriceps femoris muscle group in front of the thigh bone is relatively stronger than the hamstring group behind it). All these factors put pressure on the elaborate workings of the knee joint. Women also tend to land in a more flat-footed manner than men do, and to pivot more awkwardly.
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No. 15
This is from a PCOS advocate on twitter.
PCOS raises female testosterone to up to 5.5 nmol/L (and above 4 can cause serious issues).
5-ARD raised Caster's testosterone to 21 nmol/L.
twitter.com/NathanielHart72/status/1550916276490477568?s=20&t=E8muLvV5kUEpbPeemz8zwQ
twitter.com/seaningle/status/1537480540068225031?s=20&t=E8muLvV5kUEpbPeemz8zwQ
Sean Ingle (Guardian sports journalist) mentioned this
The latest scientific publications clearly demonstrate that the return of markers of endurance capacity to "female level" occurs within six to eight months under low blood testosterone, while the awaited adaptations in muscle mass and muscle strength/power take much longer (two years minimum according to a recent study). Given the important role played by muscle strength and power in cycling performance, the UCI has decided to increase the transition period on low testosterone from 12 to 24 months. In addition, the UCI has decided to lower the maximum permitted plasma testosterone level (currently 5 mol/L) to 2.5 mol/L. This value corresponds to the maximum testosterone level found in
99.99% of the female population.
No. 16. Just for those who need to know the difference
A link to a recent paper from the Endrocrine Society.
Considering Sex as a Biological Variable in Basic and Clinical Studies: An Endocrine Society Scientific Statement
Aditi Bhargava, Arthur P Arnold, Debra A Bangasser, Kate M Denton, Arpana Gupta, Lucinda M Hilliard Krause, Emeran A Mayer, Margaret McCarthy, Walter L Miller, Armin Raznahan, Ragini Verma
Published: 11 March 2021
academic.oup.com/edrv/advance-article/doi/10.1210/endrev/bnaa034/6159361#.YG386Eqj1v4.twitter
Some key points:
-Sex is an important biological variable that must be considered in the design and analysis of human and animal research. The terms sex and gender should not be used interchangeably. Sex is dichotomous, with sex determination in the fertilized zygote stemming from unequal expression of sex chromosomal genes. By contrast, gender includes perception of the individual as male, female, or other, both by the individual and by society; both humans and animals have sex, but only humans have gender.
-The classical biological definition of the 2 sexes is that females have ovaries and make larger female gametes (eggs), whereas males have testes and make smaller male gametes (sperm); the 2 gametes fertilize to form the zygote, which has the potential to become a new individual. The advantage of this simple definition is first that it can be applied universally to any species of sexually reproducing organism. Second, it is a bedrock concept of evolution, because selection of traits may differ in the 2 sexes. Thirdly, the definition can be extended to the ovaries and testes, and in this way the categories—female and male—can be applied also to individuals who have gonads but do not make gametes.
-many people cannot make either eggs or sperm, yet are recognized as female or male based on other physical characteristics; people who do not have either ovaries or testes are rare. For individuals that possess a combination of male- and female-typical characteristics, these clusters of traits are sufficient to classify most individuals as either biologically male or female.
-Biological sex is dichotomous because of the different roles of each sex in reproduction. For scientific research, it is important to define biological sex and distinguish it from other meanings.
There are plenty of interesting points in this paper.
However, it does focus too on the importance of clarity around male and female for medical purposes and treatment outcomes.
No. 17. The New Zealand review of whether IOC 10nm/l would work to reduce advantage. It is actually rather a good explainer.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9331831/#B44-ijerph-19-09103
Transwoman Elite Athletes: Their Extra Percentage Relative to Female Physiology
Alison K Heather, Stacy T. Sims, Academic Editor and Christopher T. Minson, Academic Editor
August 2022
Abstract:
There is increasing debate as to whether transwoman athletes should be included in the elite female competition. Most elite sports are divided into male and female divisions because of the greater athletic performance displayed by males. Without the sex division, females would have little chance of winning because males are faster, stronger, and have greater endurance capacity. Male physiology underpins their better athletic performance including increased muscle mass and strength, stronger bones, different skeletal structure, better adapted cardiorespiratory systems, and early developmental effects on brain networks that wires males to be inherently more competitive and aggressive. Testosterone secreted before birth, postnatally, and then after puberty is the major factor that drives these physiological sex differences, and as adults, testosterone levels are ten to fifteen times higher in males than females. The non-overlapping ranges of testosterone between the sexes has led sports regulators, such as the International Olympic Committee, to use 10 nmol/L testosterone as a sole physiological parameter to divide the male and female sporting divisions. Using testosterone levels as a basis for separating female and male elite athletes is arguably flawed. Male physiology cannot be reformatted by estrogen therapy in transwoman athletes because testosterone has driven permanent effects through early life exposure. This descriptive critical review discusses the inherent male physiological advantages that lead to superior athletic performance and then addresses how estrogen therapy fails to create a female-like physiology in the male. Ultimately, the former male physiology of transwoman athletes provides them with a physiological advantage over the cis-female athlete.
Conclusion:
Testosterone drives much of the enhanced athletic performance of males through in utero, early life, and adult exposure. Many anatomical sex differences driven by testosterone are not reversible. Hemoglobin levels and muscle mass are sensitive to adult life testosterone levels, with hemoglobin being the most responsive. Studies in transgender women, and androgen-deprivation treated cancer patients, show muscle mass is retained for many months, even years, and that co-comittant exercise mitigates muscle loss. Given that sports are currently segregated into male and female divisions because of superior male athletic performance, and that estrogen therapy will not reverse most athletic performance parameters, it follows that transgender women will enter the female division with an inherent advantage because of their prior male physiology.
The current IOC regulations allow transwomen athletes to compete if testosterone levels have been lowered to <10 nmol/L for 12 months prior to competition. While this begins to address the advantageous effects of circulating testosterone on athletic performance, it does not take into account the advantage afforded by testosterone exposure prior to transitioning. The existing data suggests that lowering testosterone to less than 10 nmol/L for 12 months decreases muscle mass but not to biological female levels and despite the decrease in mass, muscle strength can be maintained, especially if concurrently exercising. Estrogen therapy does not affect most of the anatomical structures in the biological male that provide a physiological benefit. Hemoglobin levels are lowered by estrogen therapy, and consequently, maximum aerobic effort may be lower, but this parameter will only be manifested if testosterone levels are suppressed to levels within the biological female range and maintained for extended periods of time. Reported studies show it is difficult to continuously suppress testosterone in transgender women. Given that the percentage difference between medal placings at the elite level is normally less than 1%, there must be confidence that an elite transwoman athlete retains no residual advantage from former testosterone exposure, where the inherent advantage depending on sport could be 10–30%. Current scientific evidence can not provide such assurances and thus, under abiding rulings, the inclusion of transwomen in the elite female division needs to be reconsidered for fairness to female-born athletes.
This dailymail link discusses it.
www.dailymail.co.uk/health/article-12111455/The-trans-advantage-womens-sports-explained.html
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