Essay: Transsexual athletes—when is competition fair?

Abstract

With the elimination of genetic-based testing to verify gender there remains no controversy with respect to athletic competition by phenotypic females with Y chromosomal material, or by individuals who have undergone prepubertal gender reassignment. The former are generally individuals with androgen insensitivity syndrome, whereas the latter comprise cases of sexual ambiguity caused by various rare genetic defects. In neither group can exposure to male sex hormones be argued to have any competitive advantage. Sports authorities are now attempting to establish when and if individuals who have undergone postpubertal gender reassignment, predominantly male-to-female transsexuals and often with legal recognition, can compete in their reassigned gender. Although there have been anecdotal reports of prominent athletes with proven or suspected genetic intersex disorders, only recently have some transsexual athletes begun to compete successfully in national and international events and many others are presumed to compete at lower levels. Perhaps the most famous of these is Renee Richards, nee Richard Raskin, a physician and competitive amateur tennis player who underwent sex conversion at age 41 years. Richards successfully sued the US Tennis Association to compete in the 1977 US Open Tennis Championships. She subsequently had a modestly successful tennis career— predominantly in women’s doubles—and on one occasion reached the finals of the US Open. In 1990, when the question of postpubertal transgendered athletes was first considered at the Workshop on Methods of Femininity Verification convened by the International Association of Athletic Federations (IAAF) in Monaco, the issue was discussed only in passing with a recommendation that the relevant sports authority assess individuals on a case-by-case basis. Adopted by the IAAF and the International Olympic Committee, this recommendation provided a framework for the next 15 years. With increasing recognition of gender dysphoria as a specific diagnosis, adoption of protocols for treatment via surgery and hormonal therapy, and an increasing number of transsexual athletes seeking to compete, however, the International Olympic Committee’s Medical Commission sought further opinion.