New research regarding transgender athletes

[WatchingBoat]

Was interested to see this on the LEAPsports website.

https://leapsports.org/news/webinar-research

It’s publicising an online briefing based on recently published research about ‘the strength, power and aerobic capacity of transgender athletes’. It’s been published in the BMJ and was carried out by Dr Blair Hamilton. Its findings suggest that some transgender athletes perform worse than their non-transgender counterparts in certain cardiovascular tests, have lower bone density (which affects muscle strength) and reduced lung capacity.

I haven’t gone through the report in detail but believe the participants were similarly matched in terms of their athletic fitness - so it wasn’t a case of comparing a male couch potato with a female competitive athlete.

I know there will be people on this board with the knowledge and experience to dig down into the data/research. A link to the actual report is contained within the press release.

Apologies if this has already been discussed but I thought it was useful to know about the webinar briefing too.

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???

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

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."

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?

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.

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/

Thank you to those who have offered their insights into this report. Really interesting. It’s raised many questions. I hope some of these questions and issues will be raised by some of those signed up to the webinar with Hamilton on June 4th. It would be good to hear the response from them.

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/

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.

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.

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.

Activism identifying as science 🙄

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?