In the Academy’s blog section, Professor Maurizio Fr. Faggioni OFM analyzes the issue of transgender participation in competitive sports. This topic has become a very sensitive issue during the recent Olympic Games in Paris. The professor explains further…
The issue of transgender women’s participation in sports competitions has been a hot topic for some years, accompanied by discomfort and discontent among athletes born female who often find themselves overtaken in competitions by athletes who were born male and who subsequently underwent corrective surgery to their body sex. In the swimming world, great outcry has been caused by the story of Lia Thomas who, born male in Austin, Texas, in 1999, began swimming very early. After having practiced swimming at a competitive level like Will, without exciting results, around the age of nineteen, he manifested the need to adapt his body sex to his psychological identity which he claimed was female. After the surgery Lia, no longer Will, by virtue of his new anagraphic identity, moved from the male to the female categories of university swimming, obtaining victory after victory and establishing record results for women. The controversy regarding the alleged physical advantage deriving from an originally male athletic build has been violent. In February 2022, Republican Florida Governor Ron DeSantis declared runner-up Emma Weyant the winner of a race that Thomas actually won.
The International Olympic Committee (IOC) in a 2021 document entitled IOC Framework on Fairness, Inclusion and Non-Discrimination on the Basis of Gender Identity and Sex Variations indicated a policy that was generally favorable to inclusion and respectful of athletes’ privacy, declaring invasive tests, such as those on chromosomal sex, illegitimate. However, it delegated to individual Federations, based on the nature of each sporting discipline, to establish eligibility and ineligibility criteria [Comment on the British Medical Journal].
In response to the controversy and discreetly distancing itself from the IOC guidelines, the International Swimming Federation (FINA) currently known as World Aquatics, in November 2021 established a working group divided into 3 sections: doctors and scientists; athletes; and legal and human rights experts. A document entitled Policy on Eligibility for the Men’s and Women’s Competition Categories was thus prepared and approved, with a majority of more than two-thirds, during the extraordinary FINA general congress held in conjunction with the World Aquatics Championships in Budapest, in June 2022. The current version of the regulation came into force on 24 March 2023.
The new swimming regulation requires all male and female athletes, without distinction, to have their chromosomal sex tested and, as far as transgender women (“male-to-female”) are concerned, it restricts their ability to compete in women’s competitions. The theoretical cornerstone of this policy is that “biological sex is a key determinant of athletic performance” and that “the gap that is created in them is also due to sex differences that emerge at the beginning of puberty.” In males, at puberty, testosterone promotes muscle development, improves cardiac action and respiratory function, strengthens bone structure, and stimulates the production of red blood cells. Even if, after the removal of the gonads (gonadectomy), ordinarily performed in the context of physical sex correction surgeries, an athlete-born male sees his blood testosterone levels drop drastically, the previous action of androgens on the body, especially muscle mass, heart and lungs, is prolonged over time. For this reason, according to FINA-World Aquatics guidelines, to access competitions reserved for women, transgender athletes must have completed gender transition by the age of 12 or before reaching stage II of the Tanner scale [i]. This eventuality can only be achieved with an early diagnosis of gender dysphoria in the child or adolescent and the use of the controversial pubertal development blockers [ii] .
The second condition contained in the 2022 Policy is that the testosterone level must never be above 2.5 nanomoles per liter. Until the Policy, according to the rules approved by the IOC in 2015 for transgender athletes and those with androgen excess, in order to compete internationally in the female categories, athletes had to demonstrate that they had had blood testosterone levels lower than 10 nanomoles per liter in the previous twelve months [link].
Let us remember that the testosterone value for a cisgender man between the ages of 20 and 40, although highly variable, is between 10 and 37 nanomoles per liter, while for a healthy cisgender woman, it is less than 2 nanomoles per liter.
In order not to be accused of excluding transgender and intersex athletes from elite events, FINA -World Aquatics proposed to create a new “open” category for swimmers whose gender identity does not coincide with their biological sex, so that all have the opportunity to compete at high levels, but at the same time, competitive equity is safeguarded, and the rights of the female category are protected. Dissatisfied with the current rules for swimming, on 6 September 2023, in view of the Olympics, Lia Thomas filed an appeal against FINA -World Aquatics at the Court of Arbitration in Sport in Lausanne (CH), but her request for arbitration was rejected on 10 June 2024 [link].
The sports debate – it is clear – is part of the public debate, which is of an anthropological and socio-cultural nature, about the issue of gender in its relationship with physical sex. In a sports context, the right to change the registered sex and the consequent caput juridicum of a subject after medical-surgical interventions that have irreversibly modified the appearance of the external genitals and, in general, the physical appearance is not up for discussion. Nor is the possibility of obtaining the change of the registered sex attributed at birth to adapt it to a different gender identity without the surgical completion of the transition process [iii]. The FINA-World Aquatics document addresses the issue in a pragmatic way, asking whether it is fair to have subjects compete who present somatic characteristics referable to female standards and subjects with characteristics referable to male standards. When the focus of a social relationship, such as competitive sport, is physical performance, we cannot put the body in parentheses and privilege the subjective dimension of sexuality, nor can the body be considered objectively feminized by law. In sports, bodies matter. The right to affirm one’s gender identity, even if it is different from the sex at birth, cannot violate the opponent’s right to compete on equal terms. For this reason, the IOC’s position is not convincing, which ultimately proposes to take the sex assigned by the passport as the basic criterion, judging tests to verify the genetic makeup of an athlete to be illicit, as they are invasive, not to mention the medical examination of the genitals and which, in any case, accepts levels of androgens that are dramatically higher than the maximum levels in a healthy woman.
The inclusion of people with non-binary sexualities represents an ethical and social challenge. To remain faithful to the human value of inclusion, we must avoid any exclusion that is not reasonably motivated. However, we cannot forget that one of the essential characteristics of sports competitions is fairness, that is, the need for all participants in a competition to have similar physical structures, for example, in the case of boxing, with respect to weight. The two values of inclusiveness and sporting fairness must be reconciled, but subordinating fairness in principle to inclusion – as some would like – would mean harming the fair play that sport demands. For this reason, in our opinion, transgender women who have undergone corrective surgery after the end of puberty cannot compete as women, at least until their body has entered the female standards, nor athletes born female who have had abnormal levels of androgens, both exogenous and endogenous, which have left evident consequences at the metabolic and structural level, nor subjects with alterations of sexual development, called intersex, whatever their genetic makeup, in which there is or has been an abnormal androgen secretion compared to that typical of women and more or less superimposable to that standard of males. The issue is therefore not sexual belonging, be it biological or psycho-social, but the structuring of the body with male or female characteristics, in relation to the dynamics of each sport.
The organization of competitive classes should remain – in our opinion – binary, male and female because it responds first place to two fundamental classes of human subjects with comparable body structures. This sporting binary nature must be determined starting from objective parameters which – it is worth underlining – due to the great variety of biomedical situations, do not always correspond to the classic genetic parameter (XX or XY, to be clear) or to the presence of abnormal androgen levels, but require a more complex and articulated criteriology and always referred to each individual person and not to general categories [link]. We are aware that it is not easy to identify scientific criteria and parameters that take into account the multiplicity of situations and that can objectively ascertain the existence of an advantage based on sex and we are equally convinced that any rule that is too rigid runs the risk of becoming unfair and discriminatory, but we have no doubts about the fact that simplistic and politically correct solutions can turn out to be even more unfair.
[i] The pubertal stages, defined by the English paediatrician James M. Tanner in 1962, express the degree of sexual maturation of the subject and go from grade 1, which corresponds to an infantile appearance, to grade 5, reached at the end of pubertal maturation [cf. https://associazionemediciendocrinologi.it/materiali/clinica/download_file_229.pdf]. [ii] Cf. M. Faggioni, «Triptorelin, a drug prescribed to children too early», in Toscana Oggi , 4 February 2024, p. 5.
[iii] This possibility was confirmed in Italy by the Constitutional Court ruling no. 221 of 2015 according to which “the prevalence of the protection of the individual’s health over the correspondence between anatomical sex and anagraphic sex, leads to considering surgical treatment not as a prerequisite for accessing the rectification procedure (…) but as a possible means, functional to the achievement of full psychophysical well-being”. [cf. https://www.cortecostituzionale.it/actionSchedaPronuncia.do?param_ecli=ECLI:IT:COST:2015:221].
(Translated from the Original Italian Language)
