The IOC fails to ensure fairness and safety for women: Here's a scientific rebuttal I co-authored

Ross
21 March 2024

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So this came out today, it’s a paper I co-authored in which we respond to the IOC’s Framework for Inclusion in sport.

This is the IOC document that gave us some remarkable statements and concepts like:

So all of this demanded a scientific, legal and philosophical response, and so we wrote one. This was back in January 2023, a full year ago. That first paper was then submitted to the British Journal of Sports Medicine (BJSM), which is where the IOC Framework was published. And it was rejected, but it did give us what must surely be one of the more incredible reviews I’ve gotten. Here are some of the comments made by the Associate Editor of the BJSM, for example. I particularly enjoyed the highlighted bit.

And also, the issue re using the word “transwomen” - this is the same journal that published TWO papers in the 12 months before receiving ours that used exactly that term. One was Joanna Harper’s systematic review (66 times), the other was a research study by Roberts et al (47 times).

I guess the rules must change depending on whether the editor/reviewer have a personal issue or not with the content.

After this rejection, we took the paper to Sports Medicine Open, in the hope that they’d publish it, and they were very reluctant to even accept the submission. In part because they felt it should go to the place the IOC Framework was published as a direct rebuttal (we saw how that worked out), and in part because of the current social situation around this issue.

So eventually, we went to the Scandinavian Journal of Medicine and Science in Sport, and here it is. It addresses all the key arguments made by the IOC, and explains why what the IOC have done has failed to ensure fairness or safety for women in sport.

The key sections are:

1. MALES AND FEMALES ARE PHYSICALLY DIFFERENT, AND MALES HAVE A CATEGORY-LEVEL ATHLETIC ADVANTAGE

Here we explain the biological reality of male vs female performance differences. It’s amazing that peopled need this to be deconstructed, but as previous reviews and discussions show, they do. We made a figure to summarize sexual dimorphism in sport. That is, all the physiological and resultant performance differences between men and women:

2. TESTOSTERONE EXPOSURE DURING MALE PUBERTY IS THE PRIMARY DRIVER OF THE PHYSICAL DIFFERENCES BETWEEN MALES AND FEMALES

Next, we explain why these differences exist. Yes, this is primarily the result of testosterone’s roles in sex differentiation. And no, it’s not outlandish to say so, despite what some editors at some journals believe. Of course there are other factors, and of course some of them are not biological at all. But anyone who wants to argue that these are the primary drivers needs to explain why not a single female performer has surpassed the best males in any sports requiring strength, power, endurance, speed, etc.

For the IOC to suggest “no presumption of advantage” in their Framework was truly remarkable. That presumption the whole point of women’s sport, Paralympic sport, weight classes, and age gradings. To set it aside on the basis of identity is incredible.
It’s the reason they’re obliged to give two gold medals for events in Paris this year. Their framework tries to ignore this reality.

3. TESTOSTERONE SUPPRESSION POST-PUBERTY DOES NOT NEGATE THE MALE PERFORMANCE ADVANTAGE

This has become the crux of the issue in recent years, because once the policy had been created to allow male participation in women’s sport, the argument that needed to be discussed was whether or not this worked? That previous IOC policy held that if you removed the T, you’d remove the advantage. But there is no evidence that this is the case. In fact, the evidence that does exist is pretty strongly supportive of the opposite reality, namely the persistence of male biological differences (and hence performance advantage) beyond the presence of T in male.

The role of T in this debate has been greatly misrepresented, mostly by what I’ve come to think are dishonest distortions of how sexual differentiation works. The rebuttal to the “T is crucial” argument is often that there is no association between T and performance within women and within men, and thus T is not that crucial for performance.

But this is a false argument, a statistically spurious or illiterate argument that fails to understand that T is not the driver in men, and in women, but between men and women. What this means that if you lack T’s physiological actions, your ceiling for performance is going to be lower than if you have them.

This does not mean that male development or androgenization (that is, T’s job) is sufficient for elite performance, but it is necessary, if humans happened to compete in one class. But we don’t - we have two classes, one of which works by excluding the benefits of that male development. Androgenization, thanks to T, is the ticket into the room. Once inside, you need more than the entry ticket. And then there’s a separate ‘room’ for people who have a different ticket.

So it’s not the T per se, that’s a red herring. It’s the work done by T through development, and that’s why the simple solution of reducing T to normalize performance is doomed to fail.

I wrote a thread on this on twitter, which you can read here:

https://twitter.com/Scienceofsport/status/1484469424837074947

The other thing about T suppression and performance that has punctuated this debate, and that is predictably invoked by the IOC was this claim “That research is not in athletes”.

Yes, absolutely true. Nobody is pretending it was, and trying to fox everyone into thinking the studies are on Olympians. But that does not make the studies irrelevant. Instead, what people should be thinking about is the likely implication of doing the same work on athletes who are both pre-trained, and maybe more crucially, likely to train while suppressing T.

For this, we have some evidence, because we know that in men who are lowering T for medical reasons, training can completely attenuate and even reverse the declines seen when T is reduced. In other words, what we know of biology suggests that athletes who train will see a kind of “protection” against the biological declines of reducing T levels. Athletes appear likely to retain even more of the advantage.

People who simply dismiss research as “not on athletes” never take that next step, and it’s disappointing that the IOC’s scientists stood in place on this matter.

A final point on this, something else we mention in the paper - the T “fix” doesn’t work anyway. At best, it removes “some” of the male advantage, but leaves much of it behind (by the way, even a tiny part should be deemed unacceptable and unfair, just as a tiny bit of assistance from a motor on a bicycle or a tiny bit of doping is recognized as unfair).

So, if you have an intervention that has little to no upside, but that may cause harm to the person, as sports have continually been told by the likes of Kristen Worley and Kirsti Miller among other advocates, then a sport that continues to hold this as a policy is inviting harm for no benefit. What’s the rationale to persist? Seems non-existent.

4. MEANINGFUL COMPETITION IS NOT THE SAME AS FAIR COMPETITION

That IOC Framework introduced this frankly whacky idea that we should accept male advantage into women’s sport, provided it’s not excessive or disproportionate. in other words, some advantage is OK, as long as the result is “meaningful”.

But what does this even mean? If I dope, and win by 1/100th of a second is that fair and meaningful? If a male wins a women’s race, or, heaven forbid, doesn’t win but only makes the final, is that advantage acceptable because it’s not so large as to be insurmountable?

It’s an absurd argument that has to distort what meaningful, fair competition is. In our response, we discuss this.

We also raise the issue created when people try to frame male advantage as “one of many advantages”. Yeah, but if one accepts this, we should follow through and actually get rid of categories entirely, and let the genetic lottery play out, in a way that will ensure that you need a Y-Chromosome to have any chance at all of success. We reproduced a famous figure, this time for the 100m and 800m track events, to show just how significant male advantage is, and why a category for women, closed to males, is essential. Here’s that figure:

5. THE FRAMEWORK’S RECOMMENDATIONS FOR IMPLEMENTATION ARE UNREALISTIC AND UNWORKABLE IN PRACTICE

In this section, we discuss how the IOC is proposing a set of actions that are unrealistic and can likely never happen. One is the call for research before any action is taken.

Firstly, had they called for that right from the outset, we’d never have been in this situation to begin with - the evidence for total removal of male advantage would have been required before even granting access to women’s sport. that didn’t exist, but they continued regardless, and the result is a messy policy that doesn’t work.

Now, they’re saying “let’s gather evidence before changing anything”. Well, that’s not going to happen either, for various reasons, not least of which is the awful quality of a scientific study that seeks to test trans women for eligibility when under-performing in the test is the requirement.

The result is that the call for evidence before acting is a stalling tactic, one that I think even they know won’t work. To quote from the paper: “calls for direct performance related research in controlled trials using trained transgender athletes are a misapplication of the criteria of evidence-based medicine to a context for which they were never intended and should not be prescribed”

6. CASE-BY-CASE CONSIDERATION IS FLAWED IN PRINCIPLE AND UNLIKELY TO BE PRACTICAL OR ROBUST

This is an extension of the ‘meaningful competition’ fudge from earlier. It’s interesting that as the evidence emerged to show that male advantage persisted despite T suppression, many of the people who initially advocated for inclusion with lower T had to find a different way to justify the opening of women’s sport.

This was one such method - just evaluate every case, individually, and provided the advantage is not obvious, let it in. This is analogous to saying that we should allow heavy weight boxers to apply to fight in the middle weight division, and then give them some tests to make sure they’re not too strong and powerful, or just not very good, and then all will be fine.

Well, no. Conceptually, they’re now inferior boxers, fighting at a level that looks well above their station, because they have an advantage over their new rival group, but just aren’t very good within their old rival group. The 90th percentile now looks like the 99th percentile.

That’s the very definition of unfair, so even conceptually, this wouldn’t work.

And now come the practicalities. Imagine doing a test to show someone is ‘weak enough’, or ‘slow enough’. What if you get it wrong in a sport with safety concerns? Fancy judging what physical standards should apply to make someone “enough of a woman, sports wise”, to be allowed in, while others would be rejected on the basis of “not being womanly enough”? How on earth do you make that determination? It’s fundamentally “anti sport” to have to show that you fall below a threshold of performance in order to be matched for performance in competition.

In complex sports where performance is the outcome of Factors A to Z, which do you test, how do you weight them? How often do you test? Do you have different thresholds for someone who wants to play club vs international? What if the same person plays both?

It’s an absurd notion, though a number of sports are seriously considering it. I think it’s a side step of the issue, an attempt to pacify women while avoiding the backlash of not giving in entirely to the inclusion demand.

In short, untenable.

7. FEMALE ATHLETES ARE PRIMARY STAKEHOLDERS AND MUST BE CONSULTED

The last one is kind of two in one. First, the recognition that females deserve access to fair and safe sport. A lot of talk of human rights and rights to fair and safe sport are thrown around by those who want inclusion of males in women’s sport. They tend to forget that there are also females who have the same rights. It is, fundamentally, a collidings rights issue, after all. And females matter, too.

Next, the remarkable reality that the IOC actually wrote this in their Framework:

the athletes “most directly impacted by eligibility criteria” are transgender athletes and/or athletes with sex variations"

Not females, in other words. They are just the stage for the ones who really matter.

It’s an amazing statement to make, and reveals the imbalance in prioritization of one group’s rights, at the expense (because it’s a zero sum game) of the other’s.

We argue that females have had their voices constrained in this debate. They have been threatened, abused and harassed into silence, and it’s no co-incidence that when sports have managed to anonymously and safely survey their female athletes to ask them their own views, they find that 70% and more (80% in the case of swimming, about 90% for cycling) are strongly in support of female only spaces in sport, and do not wish to blur the boundary that keeps male advantage out of it.

FINALLY, A WORD ON THE AUTHORS

I think the most notable thing about it is the size and quality of the author group. We asked a number of scientists to be involved, but many declined. I think many are genuinely afraid of the fallout and response to it.

But the situation is changing. We have 26 on this paper, and that’s a hugely significant shift. Five years ago, there’s no way we would have found even 6 people who would write a paper like this. Obviously, there’s always been Dr Tommy Lundberg, whose email to me some six years ago really got me thinking about the issues with the IOC’s testosterone policy, Dr Emma Hilton, whose analogies and quick wit drove so much good engagement, and Dr Jon Pike, who offered World Rugby the concepts of ‘lexical ordering’, and prioritizing between imperatives, a crucial step, and who has since offered such good insight on the meaningful sport issue and fairness.

But now, we see 22 others, and we know there are many, many more, who will not be afraid to stand behind biological reality and fairness for women, and who will recognize that holding these conclusions is not hateful or personal or ideological. I would encourage you to all speak biological truth for the sake of women’s sport.

Hope it’s of value.

Ross

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