Transgender women in sport: is it just a matter of serum testosterone levels?

Autores/as

  • Vincenzo Garofalo Dipartimento di Medicina Clinica e Sperimentale dell’Università di Catania
  • Rossella Cannarella Dipartimento di Medicina Clinica e Sperimentale dell’Università di Catania
  • Aldo E. Calogero Dipartimento di Medicina Clinica e Sperimentale dell’Università di Catania

DOI:

https://doi.org/10.13129/2612-1514/APJEP.90-91.2021-22.25-343

Palabras clave:

Transgender athletes, Testosterone, Gender affirming hor-mone therapy, Sex differences, Gender identity

Resumen

Elevated serum testosterone levels and their physiological effects in men lead to an advantage in most sports. Based on biological sex, many sports competitions segregate athletes into two categories, male and fe-male, to avoid inequalities. This division does not account for transgender people who experience an incongruence between biological sex and gen-der identity. The International Olympic Committee (IOC) allows transgender athletes to compete in women’s divisions if their serum testos-terone levels have been below 10 nmol/L for at least one year. However, this value is significantly higher than that found in cisgender women. Gen-der-affirming hormone therapy (GAHT) reduces circulating testosterone levels and causes certain changes in testosterone physiology in transgender women resulting in changes in the physical performance of these athletes.
However, some testosterone-induced changes are irreversible and can af-fect the athletic ability and performance of transgender women. Therefore, this review aims to evaluate the physiological effects of testosterone and how these are modified by the GAHT, with the ultimate goal of making sport inclusive and equitable for all athletes.

Referencias

1. T.A. ROBERTS – J. SMALLEY – D. AHRENDT. “Effect of gender affirming hormones on athletic performance in transwomen and transmen: implications for sporting organ-isations and legislators". Br J Sports Med. 2020. bjsports-2020-102329. doi: 10.1136/bjsports-2020-102329.


2. International Olympic Committee. IOC consensus meeting on sex reassignment and hyperandrogenism (2015). https://stillmed.olympic.org/Documents/Commis-sions_PDFfiles/Medical_commission/201511_ioc_consensus_meeting_on_sex_reas- signment_and_hyperandrogenism-en.pdf.


3. International Association of Athletics Federations. IAAF regulations governing eligibil-ity of athletes who have undergone sex reassignment to compete in women’s competi-tion. http://media.wix.com/ugd/2bc3fc_476cfbfe00df48c3aa5322a29d5e11b2.pdf.


4. D.J. HANDELSMAN – A.L. HIRSCHBERG – S. BERMON. “Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance”. Endocr Rev. 2018. 39(5):803-829. doi: 10.1210/er.2018-00020.


5. M.R. LAURENT – D. VANDERSCHUEREN. (2014). “Reproductive endocrinology: functional effects of sex hormone-binding globulin variants”. Nat Rev Endocrinol. 2014. 10(9):516-7. doi: 10.1038/nrendo.2014.120.


6. E. BACHMAN – T.G. TRAVISON – S. BASARIA – M.N. DAVDA – W. GUO – M. LI – J.C. WESTFALL – H. BAE – V. GORDEUK – S. BHASIN. “Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a
Transgender women in sport: is it just a matter of serum … 33
new erythropoietin/hemoglobin set point”
. J Gerontol A Biol Sci Med Sci. 2014. 69(6):725-35. doi: 10.1093/gerona/glt154.

7. I.H. GARDNER – J.D. SAFER. “Progress on the road to better medical care for transgender patients”. Curr Opin Endocrinol Diabetes Obes. 2013. 20(6):553-8. doi: 10.1097/01.med.0000436188.95351.4d.


8. J.J. LIANG – D. JOLLY – K.J. CHAN – J.D. SAFER. “Testosterone levels achieved by medically treated transgender women in a united states endocrinology clinic cohort”. Endocr Pract. 2018. 24(2):135-142. doi: 10.4158/EP-2017-0116.


9. J.C.K. WELLS. “Sexual dimorphism of body composition”. Best Pract Res Clin Endo-crinol Metab. 2007. 21(3):415-30. doi: 10.1016/j.beem.2007.04.007.


10. M. KLAVER – M.J.H.J. DEKKER – R. DE MUTSERT – J.W.R. TWISK – M. DEN HEIJER. “Cross-sex hormone therapy in transgender persons affects total body weight, body fat and lean body mass: a meta-analysis”. Andrologia. 2017. 49(5). doi: 10.1111/and.12660.
A. WIIK – T.R. LUNDBERG – E. RULLMAN – D.P. ANDERSSON – M. HOLMBERG – M. MANDIĆ – T.B. BRISMAR – O.D. LEINHARD – S. CHANPEN – J.N. FLANA-GAN – S. ARVER – T. GUSTAFSSON. “Muscle Strength, Size, and Composition Fol-lowing 12 Months of Gender-affirming Treatment in Transgender Individuals”. J Clin Endocrinol Metab. 2020. 105(3):dgz247. doi: 10.1210/clinem/dgz247.


11. K. IKEDA – K. HORIE-INOUE – S. INOUE (2019). “Functions of estrogen and estro-gen receptor signaling on skeletal muscle”. J Steroid Biochem Mol Biol. 2019. 191:105375. doi: 10.1016/j.jsbmb.2019.105375.


12. J. DEFREYNE – B. VANTOMME – E. VAN CAENEGEM – K. WIERCKX - C.J.M. DE BLOK – M. KLAVER – N.M. NOTA – D. VAN DIJK – C.M. WIEPJES – M. DEN HEI-JER – G. T'SJOEN. “Prospective evaluation of hematocrit in gender-affirming hormone treatment: results from European Network for the Investigation of Gender Incongru-ence”. Andrology. 2018. 6(3):446-454. doi: 10.1111/andr.12485.


13. J. HARPER – E. O'DONNELL – B.S. KHORASHAD – H. MCDERMOTT – G.L. WITCOMB. “How does hormone transition in transgender women change body com-position, muscle strength and haemoglobin? Systematic review with a focus on the im-plications for sport participation”. Br J Sports Med. 2021. 55(15):865-872. doi: 10.1136/bjsports-2020-103106.


14. M. SCHARFF – C.M. WIEPJES – M. KLAVER – T. SCHREINER – G. T'SJOEN – M. DEN HEIJER. “Change in grip strength in trans people and its association with lean body mass and bone density”. Endocr Connect. 2019. 8(7):1020-1028. doi: 10.1530/EC-19-0196.


15. B. TUNÇ – B. SOLMAZ – D. PARKER – T.D. SATTERTHWAITE – M.A. ELLIOTT – M.E. CALKINS – K. RUPAREL – R.E. GUR – R.C. GUR – R. VERMA. “Establishing a link between sex-related differences in the structural connectome and behaviour”. Philos Trans R Soc Lond B Biol Sci. 2016. 371(1688):20150111. doi: 10.1098/rstb.2015.0111.


16. A.K. HEATHER. “Transwoman Elite Athletes: Their Extra Percentage Relative to Fe-male Physiology”. Int J Environ Res Public Health. 2022. 19(15):9103. doi: 10.3390/ijerph19159103.


17. P. VAN KESTEREN – P. LIPS – L.J. GOOREN – H. ASSCHEMAN – J. MEGENS. “Long-term follow-up of bone mineral density and bone metabolism in transsexuals treated with cross-sex hormones”. Clin Endocrinol (Oxf). 1998. 48(3):347-54. doi: 10.1046/j.1365-2265.1998.00396.x.


18. M.A. CAREY – J.W. CARD – J.W. VOLTZ – S.J. ARBES JR – D.R. GERMOLEC – K.S. KORACH – D.C. ZELDIN. “It's all about sex: gender, lung development and lung dis-ease”. Trends Endocrinol Metab. 2007. 18(8):308-13. doi: 10.1016/j.tem.2007.08.003.


19. L. ANDERSON – T. KNOX – A. HEATHER. “Trans-athletes in elite sport: inclusion and fairness”. Emerg Top Life Sci. 2019. 3(6):759-762. doi: 10.1042/ETLS20180071.

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Publicado

2023-10-31

Número

Vol. 90 (2022)

Sección

Contributi

Licencia

Creative Commons LicenseQuesto lavoro è concesso in licenza con licenza Creative Commons Attribution 4.0 International License

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