Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage
Open accessAbstract
Males enjoy physical performance advantages over females within competitive sport. The sex-based segregation into male and female sporting categories does not account for transgender persons who experience incongruence between their biological sex and their experienced gender identity. Accordingly, the International Olympic Committee (IOC) determined criteria by which a transgender woman may be eligible to compete in the female category, requiring total serum testosterone levels to be suppressed below 10 nmol/L for at least 12 months prior to and during competition. Whether this regulation removes the male performance advantage has not been scrutinized. Here, we review how differences in biological characteristics between biological males and females affect sporting performance and assess whether evidence exists to support the assumption that testosterone suppression in transgender women removes the male performance advantage and thus delivers fair and safe competition. We report that the performance gap between males and females becomes significant at puberty and often amounts to 10–50% depending on sport. The performance gap is more pronounced in sporting activities relying on muscle mass and explosive strength, particularly in the upper body. Longitudinal studies examining the effects of testosterone suppression on muscle mass and strength in transgender women consistently show very modest changes, where the loss of lean body mass, muscle area and strength typically amounts to approximately 5% after 12 months of treatment. Thus, the muscular advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed. Sports organizations should consider this evidence when reassessing current policies regarding participation of transgender women in the female category of sport.
AI snapshot
Written from the paper’s full text.
TL;DR
This review argues that current testosterone-suppression criteria for transgender women in female sport do not remove the male performance advantage established at puberty. It reports male–female performance gaps of 10–50% and only modest (~5%) average loss of lean mass or muscle size after 12 months of testosterone suppression, with skeletal and strength advantages largely retained.
Key findings
- The male–female performance gap becomes significant at puberty and often amounts to 10–50% depending on sport; it is larger in activities relying on muscle mass and explosive strength, especially upper-body actions (e.g., Olympic weightlifting 31–37%, tennis serve 20%, baseball pitch and field hockey drag flick >50%).
- Across 12 longitudinal studies, testosterone suppression to female-typical levels produced only modest changes: approximately −5% lean body mass or muscle size after 12 months, with no study reporting muscle loss exceeding −12% after 3 years; baseline male–female muscle mass differences are about 40%.
- Strength advantages persist: after 12 months, transgender women remained about 50% stronger than reference females in one study; grip strength fell 4–9% but retained a 17–23% advantage; height, skeletal parameters, and bone mineral density were maintained.
- Endurance effects are less clear: hemoglobin decreases by 11–14% with an estimated 2–5% performance penalty, but effects on VO2max, cardiac parameters, lactate threshold, and exercise economy remain unknown.
Methods
- Narrative/systematic review of biological sex differences in sporting performance and a literature search on anthropometric and muscle characteristics of transgender women (search terms in Supplementary Table S1).
- Performance gaps were compiled from publicly available sports federation databases and competition records; the main synthesis focused on 12 longitudinal studies of testosterone suppression and lean body mass, muscle size, or strength (Table 4), plus cross-sectional and related training/androgen-deprivation evidence.
- No new primary data were collected; the paper synthesizes existing studies and discusses implications for transgender inclusion policies.
Limitations
- The authors state that findings come from healthy adults with regular or low physical activity levels, not highly trained athletes, so further research is required in athletic transgender populations.
- The authors state that no controlled longitudinal study has explored endurance performance, and effects on VO2max, left ventricular size, stroke volume, blood volume, cardiac output, lactate threshold, and exercise economy remain unknown; no research evaluates agility, jumping, sprint, competition strength, or discipline-specific performance.
- Evident from the text: the review relies on heterogeneous studies, some with small samples, and cross-sectional data without baseline measurements; the running analysis by Harper used self-reported, uncontrolled race times, and there is no consensus on an acceptable residual advantage.
Model-written summary. Check it against the paper before relying on it.
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Cites
Statistics
Claims the paper makes
29 of 100 cited sources checked · 12 supported · 0 flagged · accuracy not yet measured
- Premisecitation
The biological effects of elevated pubertal testosterone are primarily responsible for driving the divergence of athletic performances between males and females.
“Thus, the biological effects of elevated pubertal testosterone are primarily responsible for driving the divergence of athletic performances between males and females [4].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [4] Handelsman DJ, Hirschberg AL, Bermon S. Circulating testosterone as the hormonal basis of sex differences in athletic performance. Endocr Rev. 2018;39(5):803–29. source
- Premisecitation
Many physiological factors differ significantly between biological males and females as a result of genetic differences and androgen-directed development of secondary sex characteristics.
“Many of these physiological factors differ significantly between biological males and females as a result of genetic differences and androgen-directed development of secondary sex characteristics [3, 4].”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [3] Haizlip KM, Harrison BC, Leinwand LA. Sex-based differences in skeletal muscle kinetics and fiber-type composition. Physiology. 2015;30(1):30–9. source
The Abstract reports sex differences in skeletal-muscle physiology and gene expression, and the Conclusions implicate testosterone in muscle growth and fiber size (page numbers unavailable). The paper does not establish that broad physiological differences result from genetic differences or androgen-directed development of secondary sex characteristics; its discussion is focused on skeletal muscle. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [4] Handelsman DJ, Hirschberg AL, Bermon S. Circulating testosterone as the hormonal basis of sex differences in athletic performance. Endocr Rev. 2018;39(5):803–29. source
The sections on muscle and bone link several male–female physiological differences to androgen action, and the section on other androgen-sensitive effects says many aspects of physiology differ by sex. But that section says the androgen dependence of other differences remains uncertain, while the section on genetic effects of the Y chromosome does not support a general genetic explanation for them. Our copy provides no page numbers for these passages. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Premisecitation
Segregating sports by biological sex does not account for transgender persons who experience incongruence between their biological sex and their experienced gender identity, and whose legal sex may be different to that recorded at birth.
“Segregating sports by biological sex does not account for transgender persons who experience incongruence between their biological sex and their experienced gender identity, and whose legal sex may be different to that recorded at birth [6, 7].”
Quote in the paperSubstantial claim1 of 2 sources checked - Premisecitation
Despite modest reduction in strength, transgender women retained a 17% grip strength advantage over transgender men measured at baseline.
“Despite this modest reduction in strength, transgender women retained a 17% grip strength advantage over transgender men measured at baseline.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [70] Scharff M, Wiepjes CM, Klaver M, et al. Change in grip strength in trans people and its association with lean body mass and bone density. Endocr Connect. 2019;8:1020–8. source
Table 1 (Results > Characteristics; page unavailable) reports grip strength of 40.0 kg for transgender women after treatment and 33.1 kg for transgender men at baseline, supporting the comparison despite the women's modest decline. The gap is 17% of the women's 40.0 kg value, but approximately 21% of the men's baseline value; the stated 17% advantage over baseline transgender men therefore depends on an unstated denominator. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Findingcitation
Twelve longitudinal studies have examined the effects of testosterone suppression on lean body mass or muscle size in transgender women.
“Including Gooren and Bunck [62], 12 longitudinal studies [53, 63–73] have examined the effects of testosterone suppression on lean body mass or muscle size in transgender women.”
Quote in the paperSubstantial claim4 of 10 sources checked- cites [62] Gooren LJG, Bunck MCM. Transsexuals and competitive sports. Eur J Endocrinol. 2004;151(4):425–9. source
- cites [53] Van Caenegem E, Wierckx K, Taes Y, et al. Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study. Osteoporos Int. 2015a;26(1):35–47. source
- cites [63] Haraldsen IR, Haug E, Falch J, et al. Cross-sex pattern of bone mineral density in early onset gender identity disorder. Horm Behav. 2007;52(3):334–43. source
- cites [64] Mueller A, Zollver H, Kronawitter D, et al. Body composition and bone mineral density in male-to-female transsexuals during cross-sex hormone therapy using gonadotrophin-releasing hormone agonist. Exp Clin Endocrinol Diabetes. 2011;119(2):95–100. source
- cites [65] Wierckx K, Van Caenegem E, Schreiner T, et al. Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: results from the European network for the investigation of gender incongruence. J Sex Med. 2014;11(8):1999–2011. source
- cites [66] Gava G, Cerpolini S, Martelli V, et al. Cyproterone acetate vs leuprolide acetate in combination with transdermal oestradiol in transwomen: a comparison of safety and effectiveness. Clin Endocrinol (Oxf). 2016;85(2):239–46. source
- cites [67] Auer MK, Ebert T, Pietzner M, et al. Effects of sex hormone treatment on the metabolic syndrome in transgender individuals: focus on metabolic cytokines. J Clin Endocrinol Metab. 2018;103(2):790–802. source
- cites [68] Klaver M, De Blok CJM, Wiepjes CM, et al. Changes in regional body fat, lean body mass and body shape in trans persons using cross-sex hormonal therapy: results from a multicenter prospective study. Eur J Endocrinol. 2018;178(2):163–71. source
- cites [69] Fighera TM, da Silva E, Lindenau JDR, Spritzer PM. Impact of cross-sex hormone therapy on bone mineral density and body composition in transwomen. Clin Endocrinol (Oxf). 2018;88(6):856–62. source
- cites [70] Scharff M, Wiepjes CM, Klaver M, et al. Change in grip strength in trans people and its association with lean body mass and bone density. Endocr Connect. 2019;8:1020–8. source
- Findingnone given
The performance gap is more pronounced in sporting activities relying on muscle mass and explosive strength, particularly in the upper body.
“The performance gap is more pronounced in sporting activities relying on muscle mass and explosive strength, particularly in the upper body.”
Quote in the paperSubstantial claim - Findingnone given
In Olympic weightlifting, the performance gap is between 31 and 37% across the range of competitive body weights between 1998 and 2020.
“In Olympic weightlifting, where weight categories differ between males and females, the performance gap is between 31 and 37% across the range of competitive body weights between 1998 and 2020 (Fig. 1).”
Quote in the paperNot a substantial claim - Findingown data
Between 1998 and 2018, in the common 69 kg category, the male record holder lifted a combined weight 30.1% heavier than the female record holder.
“Between 1998 and 2018, a 69 kg category was common to both males and females, with the male record holder (69 kg, 1.68 m) lifting a combined weight 30.1% heavier than the female record holder (69 kg, 1.64 m).”
Quote in the paperSubstantial claim - Findingnone given
Performance differences larger than 20% are generally present when considering sports and activities that involve extensive upper body contributions.
“Performance differences larger than 20% are generally present when considering sports and activities that involve extensive upper body contributions.”
Quote in the paperNot a substantial claim - Findingreasoning
In the top/open weight category of Olympic weightlifting, maximum male lifting strength exceeds female lifting strength by nearly 40%.
“For example, in the top/open weight category of Olympic weightlifting, in the absence of weight (and associated height) limits, maximum male lifting strength exceeds female lifting strength by nearly 40%.”
Quote in the paperNot a substantial claim - Findingnone given
No controlled longitudinal study has explored the effects of testosterone suppression on endurance-based performance.
“No controlled longitudinal study has explored the effects of testosterone suppression on endurance-based performance.”
Quote in the paperNot a substantial claim - Findingown data
The 69-kg male record is 3.2% higher than the record held in the female open category by a 108-kg female (359 kg vs 348 kg).
“and that the 69-kg male record is 3.2% higher than the record held in the female open category by a 108-kg female (359 kg vs 348 kg).”
Quote in the paperNot a substantial claim - Findingown data
The 55-kg male record holder is 6.5% stronger than the 69-kg female record holder (294 kg vs 276 kg).
“Further analysis of Olympic weightlifting data shows that the 55-kg male record holder is 6.5% stronger than the 69-kg female record holder (294 kg vs 276 kg)”
Quote in the paperNot a substantial claim - Findingcitation
Approximately 10,000 males have personal best times that are faster than the current Olympic 100 m female champion.
“For example, approximately 10,000 males have personal best times that are faster than the current Olympic 100 m female champion (World Athletics, personal communication, July 2019).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites World Athletics, personal communication, July 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
Twelve months of testosterone suppression to female-typical reference levels results in a modest approximately −5% loss of lean body mass or muscle size in transgender women.
“The collective evidence from these studies suggests that 12 months, which is the most commonly examined intervention period, of testosterone suppression to female-typical reference levels results in a modest (approximately − 5%) loss of lean body mass or muscle size (Table 4).”
Quote in the paperSubstantial claim - Findingnone given
The male performance advantages described in athletic cohorts are similar in magnitude in untrained people.
“The male performance advantages described above in athletic cohorts are similar in magnitude in untrained people.”
Quote in the paperNot a substantial claim - Findingown data
Male vs. female weightlifting performance gaps increase with increasing bodyweight.
“However, importantly, male vs. female weightlifting performance gaps increase with increasing bodyweight.”
Quote in the paperNot a substantial claim - Findingown data
In the common 55 kg category created in 2019, the current male record holder lifts 29.5% heavier than the female record holder.
“The current male record holder (55 kg, 1.52 m) lifts 29.5% heavier than the female record holder (55 kg, 1.52 m).”
Quote in the paperSubstantial claim - Findingnone given
In powerlifting, the male record (total of squat, bench press and deadlift) is 65% higher than the female record in the open weight category of the World Open Classic Records.
“This is further manifested in powerlifting, where the male record (total of squat, bench press and deadlift) is 65% higher than the female record in the open weight category of the World Open Classic Records.”
Quote in the paperNot a substantial claim - Findingnone given
No study has reported muscle loss exceeding the −12% found by Gooren and Bunck after 3 years of therapy.
“No study has reported muscle loss exceeding the − 12% found by Gooren and Bunck after 3 years of therapy.”
Quote in the paperSubstantial claim - Findingown data
Selected junior male records surpass adult elite female performances by the age of 14-15 years.
“This is further apparent upon examination of selected junior male records, which surpass adult elite female performances by the age of 14–15 years (Table 3), demonstrating superior male athletic performance over elite females within a few years of the onset of puberty.”
Quote in the paperNot a substantial claim - Findingnone given
Research conducted so far has studied untrained transgender women.
“The research conducted so far has studied untrained transgender women.”
Quote in the paperNot a substantial claim - Findingreasoning
The reductions observed in muscle mass, size, and strength are very small compared to the baseline differences between males and females in these variables.
“The reductions observed in muscle mass, size, and strength are very small compared to the baseline differences between males and females in these variables”
Quote in the paperSubstantial claim - Findingown data
Most therapeutic interventions in the reviewed longitudinal muscle mass/strength studies result in almost complete suppression of testosterone levels, well below 5 nmol/L.
“From the longitudinal muscle mass/strength studies summarised here, however, it is apparent that most therapeutic interventions result in almost complete suppression of testosterone levels, certainly well below 5 nmol/L (Table 4).”
Quote in the paperSubstantial claim - Findingreasoning
Suppression of testosterone down to around 1 nmol/L does not remove the anthropometric and muscle mass/strength advantage in any significant way.
“when in fact not even suppression down to around 1 nmol/L removes the anthropometric and muscle mass/strength advantage in any significant way.”
Quote in the paperSubstantial claim - Findingreasoning
Evidence is lacking that extending the time frame of testosterone suppression would diminish the male advantage to a tolerable degree.
“However, based on the studies reviewed here, evidence is lacking that this would diminish the male advantage to a tolerable degree.”
Quote in the paperSubstantial claim - Findingreasoning
Twelve months of testosterone suppression is not sufficient to remove the male advantage.
“although 12 months of treatment is not sufficient to remove the male advantage”
Quote in the paperSubstantial claim - Premisecitation
Males enjoy physical performance advantages over females within competitive sport.
“Males enjoy physical performance advantages over females within competitive sport.”
- Also stated in: § Introduction · boosted
“This confers large sporting performance advantages on biological males over females [5].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Sandbakk Ø, Solli GS, Holmberg HC. Sex differences in world-record performance: the influence of sport discipline and competition duration. Int J Sports Physiol Perform. 2018;13(1):2–8. source
- Also stated in: § Introduction · boosted
- Interpretationcitation
The increasing performance gap between males and females as upper body strength becomes more critical for performance is likely explained to a large extent by males having disproportionately greater strength in their upper compared to lower body, while females show the inverse.
“The increasing performance gap between males and females as upper body strength becomes more critical for performance is likely explained to a large extent by the observation that males have disproportionately greater strength in their upper compared to lower body, while females show the inverse [44, 45].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [44] Lassek WD, Gaulin SJC. Costs and benefits of fat-free muscle mass in men: relationship to mating success, dietary requirements, and native immunity. Evol Hum Behav. 2009;20(5):322–8. source
- cites [45] Stoll T, Huber E, Seifert B, et al. Maximal isometric muscle strength: normative values and gender-specific relation to age. Clin Rheumatol. 2000;19(2):105–11. source
- Premisecitation
The IOC determined criteria by which a transgender woman may be eligible to compete in the female category, requiring total serum testosterone levels to be suppressed below 10 nmol/L for at least 12 months prior to and during competition.
“Accordingly, the International Olympic Committee (IOC) determined criteria by which a transgender woman may be eligible to compete in the female category, requiring total serum testosterone levels to be suppressed below 10 nmol/L for at least 12 months prior to and during competition.”
- Also stated in: § Introduction · plain
“These include a solemn declaration that her gender identity is female and the maintenance of total serum testosterone levels below 10 nmol/L for at least 12 months prior to competing and during competition [14].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] Harper J, Hirschberg AL, Jose M, et al. IOC consensus meeting on sex reassignment and hyperandrogenism. 2015. https://stillmed.olympic.org/Documents/Commissions_PDFfiles/Medical_commission/2015-11_ioc_consensus_meeting_on_sex_reassignment_and_hyperandrogenism-en.pdf. Accessed 28 Nov 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Also stated in: § Introduction · plain
- Interpretationreasoning
The muscular advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed.
“Thus, the muscular advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed.”
- Also stated in: § Key Points · plain
“Here, we report that current evidence shows the biological advantage, most notably in terms of muscle mass and strength, conferred by male puberty and thus enjoyed by most transgender women is only minimally reduced when testosterone is suppressed as per current sporting guidelines for transgender athletes.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The IOC's rationale for the 10 nmol/L testosterone threshold is that it reduces the male performance advantages to an acceptable degree, thus permitting fair and safe competition.
- Also stated in: § Key Points · plain
- Premisecitation
In Olympic javelin throwers, peak linear velocities of the shoulder, wrist, elbow and hand are all 13-21% higher for male athletes compared with females.
“In Olympic javelin throwers, this is manifested in differences in the peak linear velocities of the shoulder, wrist, elbow and hand, all of which are 13–21% higher for male athletes compared with females [43].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [43] Antti M, Komi PV, Korjus T, et al. Body segment contributions to javelin throwing during final thrust phases. J Appl Biomech. 1994;10:166–77. source
- Interpretationreasoning
When comparing athletes who compete directly against one another, such as elite or comparable levels of school-aged athletes, the physiological advantages conferred by biological sex appear, on assessment of performance data, insurmountable.
“When comparing athletes who compete directly against one another, such as elite or comparable levels of school-aged athletes, the physiological advantages conferred by biological sex appear, on assessment of performance data, insurmountable.”
Quote in the paperNot a substantial claim - Interpretationcitation
Prolonged testosterone suppression, well beyond the time period mandated by sports federations, substantially reduces muscle mass and strength in transgender women.
“This cross-sectional comparison suggests that prolonged testosterone suppression, well beyond the time period mandated by sports federations substantially reduces muscle mass and strength in transgender women.”
Quote in the paperSubstantial claim - Premisecitation
Male bone geometry and density may provide protection against some sport-related injuries.
“Male bone geometry and density may also provide protection against some sport-related injuries”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [59] Sigward SM, Powers CM. The influence of gender on knee kinematics, kinetics and muscle activation patterns during side-step cutting. Clin Biomech. 2006;21(1):41–8. source
- cites [60] Francis P, Whatman C, Sheerin K, et al. The proportion of lower limb running injuries by gender, anatomical location and specific pathology: a systematic review. J Sport Sci Med. 2019;18(1):21–31.
- Premisecitation
At 17 years of age, the average male throws a ball further than 99% of 17-year-old females.
“Indeed, already at 17 years of age, the average male throws a ball further than 99% of 17-year-old females [51], despite no single variable (arm length, muscle mass etc.) reaching this numerical advantage.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [51] Thomas JR, Thomas KT. Development of gender differences in physical activity. Quest. 1988;40(3):219–29. source
- Premisecitation
Hand-grip strength in transgender women was reduced from baseline by 7% and 9% after 12 and 24 months, respectively, of cross-hormone treatment.
“van Caenegem et al. [53] reported that hand-grip strength was reduced from baseline measurements by − 7% and − 9% after 12 and 24 months, respectively, of cross-hormone treatment in transgender women.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [53] Van Caenegem E, Wierckx K, Taes Y, et al. Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study. Osteoporos Int. 2015a;26(1):35–47. source
- Interpretationcitation
Sex differences in muscle size and strength are more pronounced in the upper body.
“This reinforces the finding in athletic cohorts that sex differences in muscle size and strength are more pronounced in the upper body.”
Quote in the paperNot a substantial claim - Premisecitation
Thigh volume and quadriceps cross-sectional area decreased by 4% and 5%, respectively, after 12 months of testosterone suppression and estrogen supplementation in 11 transgender women.
“Thigh volume (both anterior and posterior thigh) and quadriceps cross-sectional area decreased − 4 and − 5%, respectively, after the 12-month period”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [71] Wiik A, Lundberg TR, Rullman E, et al. Muscle strength, size, and composition following 12 months of gender-affirming treatment in transgender individuals. J Clin Endocrinol Metab. 2020;105(3):247. source
- Interpretationreasoning
Height and skeletal parameters remain unaltered in transgender women despite testosterone reductions compliant with the IOC's current guidelines.
“Given the maintenance of BMD and the lack of a plausible biological mechanism by which testosterone suppression might affect skeletal measurements such as bone length and hip width, we conclude that height and skeletal parameters remain unaltered in transgender women”
Quote in the paperSubstantial claim- Rests on an assumption: Bone mineral density is maintained in transgender women undergoing testosterone suppression.
- Rests on an assumption: No plausible biological mechanism exists by which testosterone suppression might affect skeletal measurements such as bone length and hip width.
- Interpretationreasoning
The muscle mass advantage males possess over females, and the performance implications thereof, are not removed by currently studied durations (4 months, 1, 2 and 3 years) of testosterone suppression in transgender women.
“We, therefore, conclude that the muscle mass advantage males possess over females, and the performance implications thereof, are not removed by the currently studied durations (4 months, 1, 2 and 3 years) of testosterone suppression in transgender women.”
Quote in the paperSubstantial claim - Interpretationreasoning
Sex differences in parameters such as mass, strength and speed may combine to produce even larger sex differences in sport-specific actions, which often are a product of how various physical capacities combine.
“This highlights that sex differences in parameters such as mass, strength and speed may combine to produce even larger sex differences in sport-specific actions, which often are a product of how various physical capacities combine.”
Quote in the paperSubstantial claim - Interpretationown data
Males are approximately 30% stronger than females of equivalent stature and mass.
“These comparisons demonstrate that males are approximately 30% stronger than females of equivalent stature and mass.”
Quote in the paperSubstantial claim - Interpretationown data
The reduction in testosterone levels required by many sports federation transgender policies is insufficient to remove or reduce the male advantage, in terms of muscle mass and strength, by any meaningful degree.
“our analysis strongly suggests that the reduction in testosterone levels required by many sports federation transgender policies is insufficient to remove or reduce the male advantage, in terms of muscle mass and strength, by any meaningful degree.”
Quote in the paperSubstantial claim - Interpretationreasoning
Sporting advantage conferred by skeletal size and bone density would be retained in transgender women despite testosterone reductions compliant with the IOC's current guidelines.
“and that sporting advantage conferred by skeletal size and bone density would be retained despite testosterone reductions compliant with the IOC’s current guidelines.”
Quote in the paperSubstantial claim- Rests on an assumption: Bone mineral density is maintained in transgender women undergoing testosterone suppression.
- Rests on an assumption: No plausible biological mechanism exists by which testosterone suppression might affect skeletal measurements such as bone length and hip width.
- Premisecitation
Even when expressed relative to fat-free weight, VO2max is 12-15% higher in males than in females.
“Even when expressed relative to fat-free weight, VO2max is 12–15% higher in males than in females [48].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [48] Sparling PB. A meta-analysis of studies comparing maximal oxygen uptake in men and women. Res Q Exerc Sport. 1980;51(3):542–52. source
- Premisecitation
Hemoglobin levels appear to decrease by 11-14% with cross-hormone therapy in transgender women.
“Hemoglobin levels appear to decrease by 11–14% with cross-hormone therapy in transgender women [62, 71]”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [62] Gooren LJG, Bunck MCM. Transsexuals and competitive sports. Eur J Endocrinol. 2004;151(4):425–9. source
- cites [71] Wiik A, Lundberg TR, Rullman E, et al. Muscle strength, size, and composition following 12 months of gender-affirming treatment in transgender individuals. J Clin Endocrinol Metab. 2020;105(3):247. source
- Premisecitation
Transgender women retained a hand-grip strength advantage after 2 years of 23% over female baseline measurements.
“Comparison with data in a separately-published, parallel cohort of transgender men [76] demonstrated a retained hand-grip strength advantage after 2 years of 23% over female baseline measurements”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [76] Van Caenegem E, Wierckx K, Taes Y, et al. Body composition, bone turnover, and bone mass in trans men during testosterone treatment: 1-year follow-up data from a prospective case-controlled study (ENIGI). Eur J Endocrinol. 2015b;172(2):163–71. source
- Premisecitation
Records of lower-limb muscle strength reveal a consistent 50% difference in peak torque between males and females across the lifespan.
“Records of lower-limb muscle strength reveal a consistent 50% difference in peak torque between males and females across the lifespan [31].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [31] Neder JA, Nery LE, Shinzato GT, et al. Reference values for concentric knee isokinetic strength and power in nonathletic men and women from 20 to 80 years old. J Orthop Sports Phys Ther. 1999;29:116–26. source
- Interpretationreasoning
A retained physical advantage remains in transgender women even after 8 years of testosterone suppression.
“Collectively, this implies a retained physical advantage even after 8 years of testosterone suppression.”
Quote in the paperSubstantial claim - Interpretationreasoning
Longitudinal data show a clear pattern of very modest to negligible changes in muscle mass and strength in transgender women suppressing testosterone for at least 12 months.
“These longitudinal data comprise a clear pattern of very modest to negligible changes in muscle mass and strength in transgender women suppressing testosterone for at least 12 months.”
Quote in the paperSubstantial claim - Interpretationreasoning
A plateau or new steady state in muscle mass/strength changes is reached within the first or second year of testosterone suppression treatment.
“This indicates that a plateau or a new steady state is reached within the first or second year of treatment”
Quote in the paperSubstantial claim - Premisecitation
Resistance exercise every third day during 90-days bed rest was sufficient to completely offset the 20% reduction in knee extensor muscle size noted in resting control subjects.
“resistance exercise every third day during 90-days bed rest was sufficient to completely offset the 20% reduction in knee extensor muscle size noted in the resting control subjects [92].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [92] Alkner BA, Tesch PA. Knee extensor and plantar flexor muscle size and function following 90 days of bed rest with or without resistance exercise. Eur J Appl Physiol. 2004;93:294–305. source
- Interpretationreasoning
Available evidence is strong and convincing that strength, skeletal- and muscle-mass derived advantages will largely remain after cross-hormone therapy in transgender women.
“Whilst available evidence is strong and convincing that strength, skeletal- and muscle-mass derived advantages will largely remain after cross-hormone therapy in transgender women”
Quote in the paperNot a substantial claim - Interpretationown data
Superior anthropometric, muscle mass and strength parameters achieved by males at puberty, underpinning a considerable portion of the male performance advantage over females, are not removed by the current regimen of testosterone suppression permitting participation of transgender women in female sports categories.
“The data presented here demonstrate that superior anthropometric, muscle mass and strength parameters achieved by males at puberty, and underpinning a considerable portion of the male performance advantage over females, are not removed by the current regimen of testosterone suppression permitting participation of transgender women in female sports categories.”
Quote in the paperSubstantial claim - Interpretationreasoning
There are major performance and safety implications in sports where muscle mass, size, and strength are competitively significant.
“and thus, there are major performance and safety implications in sports where these attributes are competitively significant.”
Quote in the paperSubstantial claim - Premisecitation
The importance of the nervous system, e.g. muscle agonist activation and antagonist co-activation, for muscle strength must be acknowledged.
“the importance of the nervous system, e.g. muscle agonist activation (recruitment and firing frequency) and antagonist co-activation, for muscle strength must be acknowledged [104].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [104] Balshaw TG, Massey GJ, Maden-Wilkinson TM, et al. Neural adaptations after 4 years vs. 12 weeks of resistance training vs. untrained. Scand J Med Sci Sports. 2018;29(3):348–59. source
- Interpretationreasoning
It is uncertain how transgender women athletes, perhaps undergoing advanced training regimens to counteract muscle loss during therapy, would respond.
“Thus, while this research is important to understand the isolated effects of testosterone suppression, it is still uncertain how transgender women athletes, perhaps undergoing advanced training regimens to counteract the muscle loss during the therapy, would respond.”
Quote in the paperSubstantial claim - Interpretationreasoning
These data significantly undermine the delivery of fairness and safety presumed by the criteria set out in transgender inclusion policies.
“These data significantly undermine the delivery of fairness and safety presumed by the criteria set out in transgender inclusion policies”
Quote in the paperSubstantial claim - Interpretationreasoning
Considering transgender women athletes who train during testosterone suppression, any losses will be similar to or even smaller in magnitude than documented in the longitudinal studies described in this review.
“Considering transgender women athletes who train during testosterone suppression, it is plausible to conclude that any losses will be similar to or even smaller in magnitude than documented in the longitudinal studies described in this review.”
Quote in the paperSubstantial claim - Interpretationreasoning
It is implausible that athletic transgender women would achieve final muscle mass and strength metrics that are on par with reference females at comparable athletic level.
“we argue that it is implausible that athletic transgender women would achieve final muscle mass and strength metrics that are on par with reference females at comparable athletic level.”
Quote in the paperSubstantial claim - Interpretationreasoning
The male performance advantage remains substantial after testosterone suppression.
“Rather, it appears that the male performance advantage remains substantial.”
Quote in the paperSubstantial claim
- May combine two claims. 46
- Classified as probably not a substantial claim. 11
May combine two claims.
PremisecitationTestosterone in males induces changes in muscle mass, strength, anthropometric variables and hemoglobin levels.
“Testosterone in males induces changes in muscle mass, strength, anthropometric variables and hemoglobin levels [4], as part of the range of sexually dimorphic characteristics observed in humans.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [4] Handelsman DJ, Hirschberg AL, Bermon S. Circulating testosterone as the hormonal basis of sex differences in athletic performance. Endocr Rev. 2018;39(5):803–29. source
May combine two claims.
PremisecitationDuring puberty, testes-derived testosterone levels increase 20-fold in males, but remain low in females, resulting in circulating testosterone concentrations at least 15 times higher in males than in females of any age.
“During puberty, testes-derived testosterone levels increase 20-fold in males, but remain low in females, resulting in circulating testosterone concentrations at least 15 times higher in males than in females of any age [4, 25].”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [4] Handelsman DJ, Hirschberg AL, Bermon S. Circulating testosterone as the hormonal basis of sex differences in athletic performance. Endocr Rev. 2018;39(5):803–29. source
- cites [25] Bae YJ, Zeidler R, Baber R, et al. Reference intervals of nine steroid hormones over the life-span analyzed by LC-MS/MS: Effect of age, gender, puberty, and oral contraceptives. J Steroid Biochem Mol Biol. 2019;193:105409. source
May combine two claims.
PremisecitationMales have superior cardiovascular and respiratory function compared with females, with larger blood and heart volumes, higher hemoglobin concentration, greater cross-sectional area of the trachea and lower oxygen cost of respiration.
“superior cardiovascular and respiratory function, with larger blood and heart volumes, higher hemoglobin concentration, greater cross-sectional area of the trachea and lower oxygen cost of respiration [3, 4, 39, 40].”
Quote in the paperSubstantial claim2 of 4 sources checked- cites [3] Haizlip KM, Harrison BC, Leinwand LA. Sex-based differences in skeletal muscle kinetics and fiber-type composition. Physiology. 2015;30(1):30–9. source
The Abstract mentions sex-based differences in cardiovascular health and disease, but does not describe males as having superior cardiovascular or respiratory function. Searches for blood and heart volume, hemoglobin, tracheal area, and the oxygen cost of respiration found no passage in our copy addressing those comparisons. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [4] Handelsman DJ, Hirschberg AL, Bermon S. Circulating testosterone as the hormonal basis of sex differences in athletic performance. Endocr Rev. 2018;39(5):803–29. source
The Hemoglobin section (page not provided) says men have, on average, 12% higher circulating hemoglobin than women and estimates greater maximal oxygen transfer. The Other androgen-sensitive sex dichotomous effects section notes sex differences in exercise-induced cardiac and lung function, but does not establish the claimed larger blood and heart volumes, greater tracheal cross-sectional area, or lower oxygen cost of respiration. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [39] Dominelli PB, Molgat-Seon Y, Sheel AW. Sex differences in the pulmonary system influence the integrative response to exercise. Exerc Sport Sci Rev. 2019;47(3):142–50. source
- cites [40] Wingate S. Cardiovascular anatomy and physiology in the female. Crit Care Nurs Clin N Am. 1997;9(4):447–52. source
May combine two claims.
PremisecitationMales have reduced fat mass and different distribution of body fat and lean muscle mass compared with females, which increases power to weight ratios and upper to lower limb strength.
“reduced fat mass, and different distribution of body fat and lean muscle mass, which increases power to weight ratios and upper to lower limb strength in sports where this may be a crucial determinant of success”
Quote in the paperSubstantial claim2 of 10 sources checked- cites [28] Lee DH, Keum N, Hu FB, et al. Development and validation of anthropometric prediction equations for lean body mass, fat mass and percent fat in adults using the National Health and Nutrition Examination Survey (NHANES) 1999–2006. Br J Nutr. 2017;118(10):858–66. source
The Results (page unavailable) report that men had lower fat mass and higher lean body mass than women; the Discussion (page unavailable) describes a possible sex difference in where fat accumulates. The paper does not establish differences in limb-specific muscle distribution or show that these body-composition differences increase power-to-weight ratios, upper-to-lower limb strength, or sporting success. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [29] Janssen I, Heymsfield SB, Wang ZM, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol. 2000;89:81–8. source
- cites [30] Bohannon RW, Wang YC, Yen SC, Grogan KA. Handgrip strength: a comparison of values obtained from the NHANES and NIH Toolbox studies. Am J Occup Ther. 2019;73(2):1–9. source
The Results (page unavailable) report higher handgrip strength in males than females. The paper does not address fat mass, the distribution of body fat or lean muscle, power-to-weight ratios, or relative upper- and lower-limb strength; those parts of the claim are unsupported. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [31] Neder JA, Nery LE, Shinzato GT, et al. Reference values for concentric knee isokinetic strength and power in nonathletic men and women from 20 to 80 years old. J Orthop Sports Phys Ther. 1999;29:116–26. source
- cites [32] Jantz LM, Jantz RL. Secular change in long bone length and proportion in the United States, 1800–1970. Am J Phys Anthropol. 1999;110(1):57–67. source
- cites [33] Brinckmann P, Hoefert H, Jongen HT. Sex differences in the skeletal geometry of the human pelvis and hip joint. J Biomech. 1981;14(6):427–30. source
- cites [34] Lepley AS, Joseph MF, Daigle NR, et al. Sex differences in mechanical properties of the Achilles tendon: longitudinal response to repetitive loading exercise. J Strength Cond Res. 2018;32(11):3070–9. source
- cites [35] Pate RR, Kriska A. Physiological basis of the sex difference in cardiorespiratory endurance. Sports Med. 1984;1(2):87–9. source
- cites [36] Astrand PO, Cuddy TE, Saltin B, Stenberg J. Cardiac output during submaximal and maximal work. J Appl Physiol. 1964;19:268–74. source
- cites [37] Best SA, Okada Y, Galbreath MM, et al. Age and sex differences in muscle sympathetic nerve activity in relation to haemodynamics, blood volume and left ventricular size. Exp Physiol. 2014;99(6):839–48. source
May combine two claims.
PremisecitationMales have longer and larger skeletal structure than females, creating advantages in sports where levers influence force application, longer limb/digit length is favorable, and height, mass and proportions are directly responsible for performance capacity.
“longer and larger skeletal structure, which creates advantages in sports where levers influence force application, where longer limb/digit length is favorable, and where height, mass and proportions are directly responsible for performance capacity”
Quote in the paperSubstantial claim2 of 10 sources checked- cites [28] Lee DH, Keum N, Hu FB, et al. Development and validation of anthropometric prediction equations for lean body mass, fat mass and percent fat in adults using the National Health and Nutrition Examination Survey (NHANES) 1999–2006. Br J Nutr. 2017;118(10):858–66. source
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [29] Janssen I, Heymsfield SB, Wang ZM, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol. 2000;89:81–8. source
- cites [30] Bohannon RW, Wang YC, Yen SC, Grogan KA. Handgrip strength: a comparison of values obtained from the NHANES and NIH Toolbox studies. Am J Occup Ther. 2019;73(2):1–9. source
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [31] Neder JA, Nery LE, Shinzato GT, et al. Reference values for concentric knee isokinetic strength and power in nonathletic men and women from 20 to 80 years old. J Orthop Sports Phys Ther. 1999;29:116–26. source
- cites [32] Jantz LM, Jantz RL. Secular change in long bone length and proportion in the United States, 1800–1970. Am J Phys Anthropol. 1999;110(1):57–67. source
- cites [33] Brinckmann P, Hoefert H, Jongen HT. Sex differences in the skeletal geometry of the human pelvis and hip joint. J Biomech. 1981;14(6):427–30. source
- cites [34] Lepley AS, Joseph MF, Daigle NR, et al. Sex differences in mechanical properties of the Achilles tendon: longitudinal response to repetitive loading exercise. J Strength Cond Res. 2018;32(11):3070–9. source
- cites [35] Pate RR, Kriska A. Physiological basis of the sex difference in cardiorespiratory endurance. Sports Med. 1984;1(2):87–9. source
- cites [36] Astrand PO, Cuddy TE, Saltin B, Stenberg J. Cardiac output during submaximal and maximal work. J Appl Physiol. 1964;19:268–74. source
- cites [37] Best SA, Okada Y, Galbreath MM, et al. Age and sex differences in muscle sympathetic nerve activity in relation to haemodynamics, blood volume and left ventricular size. Exp Physiol. 2014;99(6):839–48. source
May combine two claims.
PremisecitationMales have larger and denser muscle mass, and stiffer connective tissue, with associated capacity to exert greater muscular force more rapidly and efficiently than females.
“Males have: larger and denser muscle mass, and stiffer connective tissue, with associated capacity to exert greater muscular force more rapidly and efficiently”
Quote in the paperSubstantial claim2 of 10 sources checked- cites [28] Lee DH, Keum N, Hu FB, et al. Development and validation of anthropometric prediction equations for lean body mass, fat mass and percent fat in adults using the National Health and Nutrition Examination Survey (NHANES) 1999–2006. Br J Nutr. 2017;118(10):858–66. source
The Results (page not available in our copy) report that men had, on average, 18 kg more lean body mass than women. Lean body mass is not a direct measure of muscle size or density, and the paper does not establish the claimed differences in connective-tissue stiffness or the speed and efficiency of force production. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [29] Janssen I, Heymsfield SB, Wang ZM, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol. 2000;89:81–8. source
- cites [30] Bohannon RW, Wang YC, Yen SC, Grogan KA. Handgrip strength: a comparison of values obtained from the NHANES and NIH Toolbox studies. Am J Occup Ther. 2019;73(2):1–9. source
The Results report higher handgrip strength values for males than females, supporting the claim of greater measured grip force. The paper does not address muscle size or density, connective-tissue stiffness, or whether males exert force more rapidly or efficiently; it does not establish those as explanations for the grip-strength difference. The indexed copy provides no page numbers for these passages. (LLM, conf=0.90)
Experimental — accuracy not yet measured - cites [31] Neder JA, Nery LE, Shinzato GT, et al. Reference values for concentric knee isokinetic strength and power in nonathletic men and women from 20 to 80 years old. J Orthop Sports Phys Ther. 1999;29:116–26. source
- cites [32] Jantz LM, Jantz RL. Secular change in long bone length and proportion in the United States, 1800–1970. Am J Phys Anthropol. 1999;110(1):57–67. source
- cites [33] Brinckmann P, Hoefert H, Jongen HT. Sex differences in the skeletal geometry of the human pelvis and hip joint. J Biomech. 1981;14(6):427–30. source
- cites [34] Lepley AS, Joseph MF, Daigle NR, et al. Sex differences in mechanical properties of the Achilles tendon: longitudinal response to repetitive loading exercise. J Strength Cond Res. 2018;32(11):3070–9. source
- cites [35] Pate RR, Kriska A. Physiological basis of the sex difference in cardiorespiratory endurance. Sports Med. 1984;1(2):87–9. source
- cites [36] Astrand PO, Cuddy TE, Saltin B, Stenberg J. Cardiac output during submaximal and maximal work. J Appl Physiol. 1964;19:268–74. source
- cites [37] Best SA, Okada Y, Galbreath MM, et al. Age and sex differences in muscle sympathetic nerve activity in relation to haemodynamics, blood volume and left ventricular size. Exp Physiol. 2014;99(6):839–48. source
May combine two claims.
PremisecitationHandgrip strength in transgender women was approximately the 25th percentile for males but over the 90th percentile for females, both before and after hormone treatment.
“handgrip strength in transgender women was in approximately the 25th percentile for males but was over the 90th percentile for females, both before and after hormone treatment.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [70] Scharff M, Wiepjes CM, Klaver M, et al. Change in grip strength in trans people and its association with lean body mass and bone density. Endocr Connect. 2019;8:1020–8. source
The Discussion reports that, after 12 months of hormone treatment, transwomen’s median grip strength was at the 95th percentile for age-matched females. But it assigns the 25th percentile for age-matched males to transmen, not transwomen, and does not give both percentile comparisons for transwomen before treatment. The Results report that transwomen’s grip strength decreased during treatment, but do not establish the claimed pretreatment percentiles. (LLM, conf=0.90)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationIn 249 transgender women, grip strength decreased by 4% after 12 months of cross-hormone treatment, with no variation between testosterone level, age or BMI tertiles.
“examination of 249 transgender women revealed a decrease of − 4% in grip strength after 12 months of cross-hormone treatment, with no variation between different testosterone level, age or BMI tertiles”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [70] Scharff M, Wiepjes CM, Klaver M, et al. Change in grip strength in trans people and its association with lean body mass and bone density. Endocr Connect. 2019;8:1020–8. source
The study population section reports 249 transwomen, and the Results > Grip strength section reports a 1.8 kg decrease after 12 months with no difference across age or BMI groups. Table 1 gives a baseline grip strength of 41.8 kg, making the decrease approximately 4%. However, the Results explicitly say testosterone-concentration analyses could not be performed in transwomen, so the claimed absence of variation across testosterone tertiles is unsupported; age and BMI were analyzed as groups, not tertiles. Page numbers are unavailable in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationCirculating hemoglobin levels are androgen-dependent and typically reported as 12% higher in males compared with females.
“Circulating hemoglobin levels are androgen-dependent [82] and typically reported as 12% higher in males compared with females [4].”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [82] Coviello AD, Kaplan B, Lakshman KM, et al. Effects of graded doses of testosterone on erythropoiesis in healthy young and older men. J Clin Endocrinol Metab. 2008;93(3):914–9. source
- cites [4] Handelsman DJ, Hirschberg AL, Bermon S. Circulating testosterone as the hormonal basis of sex differences in athletic performance. Endocr Rev. 2018;39(5):803–29. source
May combine two claims.
FindingcitationAfter 12 months of treatment, changes in lean body mass are consistently between −3 and −5% on average, with slightly greater reductions in the arm compared with the leg region.
“studies have found very consistent changes in lean body mass (using dual-energy X-ray absorptiometry) after 12 months of treatment, where the change has always been between − 3 and − 5% on average, with slightly greater reductions in the arm compared with the leg region [68].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [68] Klaver M, De Blok CJM, Wiepjes CM, et al. Changes in regional body fat, lean body mass and body shape in trans persons using cross-sex hormonal therapy: results from a multicenter prospective study. Eur J Endocrinol. 2018;178(2):163–71. source
The Results report a 3% decrease in total lean body mass after one year in transwomen, and the regional-results section reports a larger decrease in the arm (6%). But the arm result falls outside the claimed −3% to −5% range, and lean body mass increased by 10% in transmen. The paper therefore does not support the unqualified claim that changes were always within that range. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationRadiological attenuation of the quadriceps muscle, a valid proxy of contractile density, showed no significant change in transgender women after 12 months of treatment, whereas transgender men demonstrated a +6% increase in contractile density with testosterone supplementation.
“The more novel measure of radiological attenuation of the quadriceps muscle, a valid proxy of contractile density [74, 75], showed no significant change in transgender women after 12 months of treatment, whereas the parallel group of transgender men demonstrated a + 6% increase in contractile density with testosterone supplementation.”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [74] Aubrey J, Esfandiari N, Baracos VE, et al. Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol (Oxf). 2014;210(3):489–97. source
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [75] Rasch A, Byström AH, Dalen N, Berg HE. Reduced muscle radiological density, cross-sectional area, and strength of major hip and knee muscles in 22 patients with hip osteoarthritis. Acta Orthop. 2007;78(4):505–10. source
May combine two claims.
PremisecitationThe final average lean body mass of the transgender women was 51.2 kg, which puts them in the 90th percentile for women.
“The final average lean body mass of the transgender women was 51.2 kg, which puts them in the 90th percentile for women [79].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [79] Imboden MT, Swartz AM, Finch HW, et al. Reference standards for lean mass measures using GE dual energy x-ray absorptiometry in Caucasian adults. PLoS ONE. 2017;12(4):e0176161. source
Table 2 (Results) places 51.2 kg approximately at the 90th percentile for women aged 20–29 (51.1 kg), but its percentiles vary by age; it does not establish a single 90th-percentile value for all women. The paper provides reference values, not the reported final average for transgender women. (LLM, conf=0.86)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationChanges in muscle mass are not always correlated in magnitude to changes in strength because muscle mass is not the only contributor to strength.
“We acknowledge that changes in muscle mass are not always correlated in magnitude to changes in strength measurements because muscle mass (or total mass) is not the only contributor to strength [103].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [103] Balshaw TG, Massey GJ, Maden-Wilkinson TM, et al. Changes in agonist neural drive, hypertrophy and pre-training strength all contribute to the individual strength gains after resistance training. Eur J Appl Physiol. 2017;117:631–40. source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationFactors such as fiber types, biomechanical levers, pennation angle, fascicle length and tendon/extracellular matrix composition may all influence the ability to develop muscular force.
“factors such as fiber types, biomechanical levers, pennation angle, fascicle length and tendon/extracellular matrix composition may all influence the ability to develop muscular force [105].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [105] Maden-Wilkinson TM, Balshaw TG, Massey GJ, Folland JP. What makes long-term resistance-trained individuals so strong? A comparison of skeletal muscle morphology, architecture, and joint mechanics. J Appl Physiol. 2020;128:1000–11. source
The Introduction links pennation angle to force-generating capacity and identifies fiber-type composition as a possible contributor to contractile specific tension. The Methods use fascicle length in a measure of muscular force production, and the Discussion says joint leverage may contribute to maximal torque. The paper does not address how tendon or extracellular-matrix composition influences force development. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
Findingnone givenThe performance gap between males and females becomes significant at puberty and often amounts to 10-50% depending on sport.
“We report that the performance gap between males and females becomes significant at puberty and often amounts to 10–50% depending on sport.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingnone givenThe performance gap increases to an average of 16% in track cycling, with higher variation across events (from 9% in the 4000 m team pursuit to 24% in the flying 500 m time trial).
“The performance gap increases to an average of 16% in track cycling, with higher variation across events (from 9% in the 4000 m team pursuit to 24% in the flying 500 m time trial).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingnone givenThe smallest performance gaps between adult elite males and females were seen in rowing, swimming and running (11-13%), with low variation across individual events within each of those categories.
“The smallest performance gaps were seen in rowing, swimming and running (11–13%), with low variation across individual events within each of those categories.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Findingnone givenThe average performance gap is 18% in jumping events (long jump, high jump and triple jump).
“The average performance gap is 18% in jumping events (long jump, high jump and triple jump).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Findingnone givenThe gap between fastest recorded tennis serve is 20%, while the gaps between fastest recorded baseball pitches and field hockey drag flicks exceed 50%.
“The gap between fastest recorded tennis serve is 20%, while the gaps between fastest recorded baseball pitches and field hockey drag flicks exceed 50%.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingreasoningThe net loss of lean mass and grip strength is not substantially decreased at year 2 or 3 of cross-hormone treatment, nor in cohorts after an average 8 years after transition.
“On the contrary, it appears that the net loss of lean mass and grip strength is not substantially decreased at year 2 or 3 of cross-hormone treatment (Table 4), nor evident in cohorts after an average 8 years after transition.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenThere is no research evaluating the effects of transgender hormone treatment on agility, jumping or sprint performance, competition strength performance, or discipline-specific performance.
“there is no research evaluating the effects of transgender hormone treatment on factors such as agility, jumping or sprint performance, competition strength performance (e.g. bench press), or discipline-specific performance.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingreasoningTestosterone suppression in transgender women only trivially affects strength, lean body mass, muscle size, and bone density.
“Rather, the data show that strength, lean body mass, muscle size and bone density are only trivially affected.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationcitationSince the 1990s, the difference in performance records between males and females has been relatively stable, suggesting that biological differences created by androgenization explain most of the male advantage, and are insurmountable.
“Yet, since the 1990s, the difference in performance records between males and females has been relatively stable, suggesting that biological differences created by androgenization explain most of the male advantage, and are insurmountable [5, 26, 27].”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [5] Sandbakk Ø, Solli GS, Holmberg HC. Sex differences in world-record performance: the influence of sport discipline and competition duration. Int J Sports Physiol Perform. 2018;13(1):2–8. source
- cites [26] Thibault V, Guillaume M, Berthelot G, et al. Women and men in sport performance: the gender gap has not evolved since 1983. J Sport Sci Med. 2010;9(2):214–23.
- cites [27] Millard-Stafford M, Swanson AE, Wittbrodt MT. Nature versus nurture: have performance gaps between men and women reached an asymptote? Int J Sports Physiol Perform. 2018;13(4):530–5. source
Classified as probably not a substantial claim. May combine two claims.
InterpretationreasoningIn sports where contact, collision or combat are important for gameplay, widely different physiological attributes may create safety and athlete welfare concerns, necessitating segregation into male and female categories and also into weight and age classes.
“Further, in sports where contact, collision or combat are important for gameplay, widely different physiological attributes may create safety and athlete welfare concerns, necessitating not only segregation of sport into male and female categories, but also, for example, into weight and age classes.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
PremisereasoningMales have longer arms than females, which allows greater torque production from the arm lever when throwing a ball, punching or pushing.
“Males also have longer arms than females, which allows greater torque production from the arm lever when, for example, throwing a ball, punching or pushing.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe performance gap in throwing events is substantial, and throwing represents the widest sex difference in motor performance from an early age.
“the performance gap is known to be substantial, and throwing represents the widest sex difference in motor performance from an early age [42].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42] Thomas JR, French KE. Gender differences across age in motor performance a meta-analysis. Psychol Bull. 1985;98(2):260–82. source
May combine two claims.
PremisecitationVertical jump performance is on average 33% greater in elite men than women, with differences ranging from 27.8% for endurance sports to in excess of 40% for precision and combat sports.
“vertical jump performance is on average 33% greater in elite men than women, with differences ranging from 27.8% for endurance sports to in excess of 40% for precision and combat sports [41].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [41] Haugen T, Breitschädel F, Wiig H, Seiler S. Countermovement jump height in national team athletes of various sports: a framework for practitioners and scientists. Int J Sports Physiol Perform. 2020 (accessed 4 May 2020 from Researchgate) source
May combine two claims.
Interpretationown dataEven after adjustment for mass, biological males are significantly stronger (30%) than females, and females who are 60% heavier than males do not overcome these strength deficits.
“It shows that, even after adjustment for mass, biological males are significantly stronger (30%) than females, and that females who are 60% heavier than males do not overcome these strength deficits.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
Premisenone givenStrength differences between males and females range between 30 and 100%, depending upon the cohort studied and the task used to assess strength.
“Strength differences range between 30 and 100%, depending upon the cohort studied and the task used to assess strength.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationMales have a lower incidence of knee injuries, often attributed to low quadriceps angle conferred by a narrow pelvic girdle.
“males have a lower incidence of knee injuries, often attributed to low quadriceps (Q) angle conferred by a narrow pelvic girdle [59, 60].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [59] Sigward SM, Powers CM. The influence of gender on knee kinematics, kinetics and muscle activation patterns during side-step cutting. Clin Biomech. 2006;21(1):41–8. source
- cites [60] Francis P, Whatman C, Sheerin K, et al. The proportion of lower limb running injuries by gender, anatomical location and specific pathology: a systematic review. J Sport Sci Med. 2019;18(1):21–31.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationIn a study of 342 women and 243 men, males had 57% greater muscle size, 109% greater isometric strength, and 89% greater 1RM strength than age-matched females.
“The males had 57% greater muscle size, 109% greater isometric strength, and 89% greater 1RM strength than age-matched females.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [49] Hubal MJ, Gordish-Dressman H, Thompson PD, et al. Muscle size and strength gain after unilateral resistance training. Med Sci Sport Exerc. 2005;37(6):964–72.
May combine two claims.
PremisecitationThe power produced during a punch was 162% greater in males than in females, and the least powerful man produced more power than the most powerful woman.
“The power produced during a punch was 162% greater in males than in females, and the least powerful man produced more power than the most powerful woman.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [50] Morris JS, Link J, Martin JC, Carrier DR. Sexual dimorphism in human arm power and force: implications for sexual selection on fighting ability. J Exp Biol. 2020;223(Pt 2):jeb212365. source
May combine two claims.
Interpretationown dataTestosterone-driven puberty, as the driving force of development of male secondary sex characteristics, underpins sporting advantages that are so large no female could reasonably hope to succeed without sex segregation in most sporting competitions.
“These data overwhelmingly confirm that testosterone-driven puberty, as the driving force of development of male secondary sex characteristics, underpins sporting advantages that are so large no female could reasonably hope to succeed without sex segregation in most sporting competitions.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationPunch power is 162% greater in men than women even though no single parameter that produces punching actions achieves this magnitude of difference.
“Similarly, punch power is 162% greater in men than women even though no single parameter that produces punching actions achieves this magnitude of difference [50].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [50] Morris JS, Link J, Martin JC, Carrier DR. Sexual dimorphism in human arm power and force: implications for sexual selection on fighting ability. J Exp Biol. 2020;223(Pt 2):jeb212365. source
May combine two claims.
PremisecitationThe final grip strength was 41 kg, 25% higher than the female reference value.
“Similarly, the final grip strength was 41 kg, 25% higher than the female reference value [80].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [80] Bohannon RW, Peolsson A, Massy-Westropp N, et al. Reference values for adult grip strength measured with a Jamar dynamometer: a descriptive meta-analysis. Physiotherapy. 2006;92(1):11–5. source
May combine two claims.
InterpretationreasoningIn running events, where the male-female gap is approximately 11%, many thousands of males are faster than the very best females.
“In running events, for example, where the male–female gap is approximately 11%, it follows that many thousands of males are faster than the very best females.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
Premisenone givenSex differences in endurance performance are generally smaller than for events relying more on muscle mass and explosive strength.
“Sex differences in endurance performance are generally smaller than for events relying more on muscle mass and explosive strength.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationTransgender women had 17% less lean mass and 25% lower peak quadriceps muscle strength than control males after a mean 8 years of cross-hormone treatment.
“The results showed that transgender women had 17% less lean mass and 25% lower peak quadriceps muscle strength than the control males [78].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [78] Lapauw B, Taes Y, Simoens S, et al. Body composition, volumetric and areal bone parameters in male-to-female transsexual persons. Bone. 2008;43(6):1016–21. source
May combine two claims.
PremisecitationAge-graded scores for eight transgender women runners were the same in male and female categories, suggesting cross-hormone treatment reduced running performance by approximately the size of the typical male advantage.
“The age-graded scores for these eight runners were the same in both categories, suggesting that cross-hormone treatment reduced running performance by approximately the size of the typical male advantage.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [81] Harper J. Race times for transgender athletes. J Sport Cult Identities. 2015;6(1):1–9. source
May combine two claims.
PremisecitationMuscle strength after 12 months of testosterone suppression was comparable to baseline strength in transgender women, who remained about 50% stronger than both transgender men at baseline and a reference group of females.
“They reported that muscle strength after 12 months of testosterone suppression was comparable to baseline strength. As a result, transgender women remained about 50% stronger than both the group of transgender men at baseline and a reference group of females.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [71] Wiik A, Lundberg TR, Rullman E, et al. Muscle strength, size, and composition following 12 months of gender-affirming treatment in transgender individuals. J Clin Endocrinol Metab. 2020;105(3):247. source
May combine two claims.
InterpretationcitationTraining during a period of testosterone suppression not only counteracts muscle loss, but can actually increase muscle mass and strength.
“this study demonstrates that training during a period of testosterone suppression not only counteracts muscle loss, but can actually increase muscle mass and strength.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningDifferent sports' physiological determinants may create safety considerations and may alter the importance of retained performance advantages.
“which may create safety considerations and may alter the importance of retained performance advantages.”
Quote in the paperSubstantial claim- Rests on an assumption: Different sports differ vastly in terms of physiological determinants of success.
May combine two claims.
PremisecitationIn select exercises used during the training program, 10RM leg press and bench press increased +32% and +17%, respectively.
“in select exercises used during the training program, 10RM leg press and bench press increased + 32% and + 17%, respectively.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [93] Kvorning T, Andersen M, Brixen K, Madsen K. Suppression of endogenous testosterone production attenuates the response to strength training: a randomized, placebo-controlled, and blinded intervention study. Am J Physiol Metab. 2006;291:E1325-32. source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn transgender men, the increase in muscle mass seems to stabilise between the first and second year of testosterone treatment.
“a phenomenon also noted in transgender men, where the increase in muscle mass seems to stabilise between the first and the second year of testosterone treatment [111].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [111] Elbers JMH, Asscheman H, Seidell JC, et al. Long-term testosterone administration increases visceral fat in female to male transsexuals. J Clin Endocrinol Metab. 1997;82(7):2044–7.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
InterpretationreasoningThe balance between inclusion, safety and fairness differs between sports.
“and the balance between inclusion, safety and fairness therefore differs between sports.”
Quote in the paperSubstantial claim- Rests on an assumption: Performance in most sports may be influenced by factors outside muscle mass and strength.
May combine two claims.
InterpretationreasoningIf the male advantage persists to a large degree, a stated objective of targeting a certain testosterone level to be eligible will not achieve its objective.
“If the advantage persists to a large degree, as evidence suggests, then a stated objective of targeting a certain testosterone level to be eligible will not achieve its objective”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductcitationThe findings presented are from healthy adults with regular or even low physical activity levels, and not highly trained athletes.
“it is acknowledged that the findings presented here are from healthy adults with regular or even low physical activity levels [91], and not highly trained athletes.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [91] Muchicko MM, Lepp A, Barkley JE. Peer victimization, social support and leisure-time physical activity in transgender and cisgender individuals. Leis Loisir. 2014;3–4:295–308. source
May combine two claims.
InterpretationcitationOxygen-carrying capacity in transgender women is most likely reduced with testosterone suppression, with a concomitant performance penalty estimated at 2-5% for the female athletic population.
“Oxygen-carrying capacity in transgender women is most likely reduced with testosterone suppression, with a concomitant performance penalty estimated at 2–5% for the female athletic population [83].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [83] Bermon S. Androgens and athletic performance of elite female athletes. Curr Opin Endocrinol Diabetes Obes. 2017;24(3):246–51. source
May combine two claims.
InterpretationreasoningA reduction in hemoglobin is strongly predicted to impact aerobic capacity and reduce endurance performance in transgender women, but is unlikely to completely close the baseline gap in aerobic capacity between males and females.
“Thus, while a reduction in hemoglobin is strongly predicted to impact aerobic capacity and reduce endurance performance in transgender women, it is unlikely to completely close the baseline gap in aerobic capacity between males and females.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningIn well-controlled studies in biological males who train while undergoing testosterone reduction, training is protective of, and may even enhance, muscle mass and strength attributes.
“Thus, in well-controlled studies in biological males who train while undergoing testosterone reduction, training is protective of, and may even enhance, muscle mass and strength attributes.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Premisenone givenOther factors that may impact sports performance, known to be affected by testosterone and some measurably different between males and females, include visuospatial abilities, aggressiveness, coordination and flexibility.
“Other factors that may impact sports performance, known to be affected by testosterone and some of them measurably different between males and females, include visuospatial abilities, aggressiveness, coordination and flexibility.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationIn a randomized placebo-controlled trial, despite testosterone suppression to female levels of 2 nmol/L, there was a significant +4% increase in leg lean mass and a +2% increase in total lean body mass, and a measurable though insignificant increase in isometric knee extension strength.
“Despite testosterone suppression to female levels of 2 nmol/L, there was a significant + 4% increase in leg lean mass and a + 2% increase in total lean body mass, and a measurable though insignificant increase in isometric knee extension strength.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [93] Kvorning T, Andersen M, Brixen K, Madsen K. Suppression of endogenous testosterone production attenuates the response to strength training: a randomized, placebo-controlled, and blinded intervention study. Am J Physiol Metab. 2006;291:E1325-32. source
The authors state this as an assumption.
The IOC's rationale for the 10 nmol/L testosterone threshold is that it reduces the male performance advantages to an acceptable degree, thus permitting fair and safe competition.
“Given the IOC’s stated position that the “overriding sporting objective is and remains the guarantee of fair competition” [14], it is reasonable to assume that the rationale for this requirement is that it reduces the male performance advantages described previously to an acceptable degree, thus permitting fair and safe competition.”
The paper relies on this without support.
Bone mineral density is maintained in transgender women undergoing testosterone suppression.
“Given the maintenance of BMD”
The paper relies on this without support.
No plausible biological mechanism exists by which testosterone suppression might affect skeletal measurements such as bone length and hip width.
“the lack of a plausible biological mechanism by which testosterone suppression might affect skeletal measurements such as bone length and hip width”
The paper relies on this without support.
The male performance advantage established by testosterone at puberty translates in elite athletes to a 10–50% performance advantage.
“the male performance advantage, established by testosterone at puberty and translating in elite athletes to a 10–50% performance advantage”
The paper relies on this without support.
The biological factors underpinning athletic performance are unequivocally established.
“it is still important to recognize that the biological factors underpinning athletic performance are unequivocally established.”
The paper relies on this without support.
Different sports differ vastly in terms of physiological determinants of success.
“it is clear that different sports differ vastly in terms of physiological determinants of success”
The paper relies on this without support.
Performance in most sports may be influenced by factors outside muscle mass and strength.
“It is also important to recognize that performance in most sports may be influenced by factors outside muscle mass and strength”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The main criticism of Hilton and Lundberg's review is its purely biological argument from an elite male versus elite female position, implying that transwomen athletes are the same as elite male athletes.
“the main criticism of this review is the purely biological argument from an elite male versus elite female position, implying that transwomen athletes are the same as elite male athletes”
From Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement (2021) · cites this paper as [43]
The Introduction and Discussion compare male and female performance characteristics and argue that some advantages may remain after testosterone suppression. But the Discussion’s ‘Perspectives on Athletic Status of Transgender Women’ section says the evidence comes from adults who were not highly trained and calls for research in athletic transgender populations; it does not equate transgender women athletes with elite male athletes. Calling this the review’s ‘main criticism’ is the citing author’s characterization, not a finding stated by the review. (LLM, conf=0.85)
Experimental — accuracy not yet measuredHilton and Lundberg concluded that anthropometric and muscle mass advantages are sustained in transwomen after 12 months of gender-affirming treatment based on studies showing physiological changes caused by HRT in transwomen and chemical castration in men.
“The authors concluded that anthropometric and muscle mass advantages are sustained in transwomen after 12 months of gender-affirming treatment based on studies showing the physiological changes caused by HRT in transwomen and chemical castration in men.”
From Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement (2021) · cites this paper as [43]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Thigh-volume and quadriceps-area reductions are reversed
MinorThe prose assigns a 4% decrease to thigh volume and a 5% decrease to quadriceps area. Table 4 reports the opposite: 5% for thigh volume and 4% for quadriceps area.
“Thigh volume (both anterior and posterior thigh) and quadriceps cross-sectional area decreased − 4 and − 5%, respectively, after the 12-month period”
“Thigh volume1 yr − 5%Quad area1 yr − 4%”
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“No study has reported muscle loss exceeding the − 12% found by Gooren and Bunck after 3 years of therapy.”
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Gender identity and sport: is the playing field level?: Table 1
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Impact of cross‐sex hormone therapy on bone mineral density and body composition in transwomen
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“2 kg, which puts them in the 90th percentile for women [79].”
BackgroundHaemoglobin concentration and mass as determinants of exercise performance and of surgical outcome
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Handgrip strength: a comparison of values obtained from the NHANES and NIH Toolbox studies
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Neural adaptations after 4 years vs 12 weeks of resistance training vs untrained
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“muscle agonist activation (recruitment and firing frequency) and antagonist co-activation, for muscle strength must be acknowledged [104].”
BackgroundSex Differences in the Pulmonary System Influence the Integrative Response to Exercise
Dominelli, P. B., Molgat-Seon, Y., & Sheel, A. W. (2019) · Exercise and Sport Sciences Reviews · doi:10.1249/jes.0000000000000188 · Cited by 68 · see citing works
Change in grip strength in trans people and its association with lean body mass and bone density
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Concepts About V˙O2max and Trainability Are Context Dependent
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“However, hemoglobin mass is not the only parameter contributing to VO2max, where central factors such as total blood volume, heart size and contractility, and peripheral factors such as capillary supply and mitochondrial content also plays a role in the final oxygen uptake [88].”
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Sex differences in the skeletal geometry of the human pelvis and hip joint
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Capillary and venous haemoglobin levels in blood donors: a 42-month study of 36 258 paired samples
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Androgens and athletic performance of elite female athletes
Bermon, S. (2017) · Current Opinion in Endocrinology, Diabetes & Obesity · doi:10.1097/med.0000000000000335 · Cited by 58 · see citing works
Development of Gender Differences in Physical Activity
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Implications of a Third Gender for Elite Sports
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“8% for endurance sports to in excess of 40% for precision and combat sports [41].”
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Fetal hormones and sexual differentiation
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Nature Versus Nurture: Have Performance Gaps Between Men and Women Reached an Asymptote?
Millard-Stafford, M., Swanson, A. E., & Wittbrodt, M. T. (2018) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.2017-0866 · Cited by 40 · see citing works
Transsexuals in Sport–Fairness and Freedom, Regulation and Law
Coggon, J., Hammond, N., & Holm, S. (2008) · Sport, Ethics and Philosophy · doi:10.1080/17511320801896091 · Cited by 39 · see citing works
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Transgender Athletes: How Can They Be Accommodated?
Genel, M. (2017) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000321 · Cited by 33 · see citing works
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“However, testosterone may not be required to elicit a robust muscle protein synthesis response to resistance exercise [100].”
BackgroundBeyond Fairness: The Biology of Inclusion for Transgender and Intersex Athletes
Pitsiladis, Y., Harper, J., Betancurt, J. O., Martinez-Patino, M.-J., Parisi, A., Wang, G., & Pigozzi, F. (2016) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000314 · Cited by 32 · see citing works
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Morris, J. S., Link, J., Martin, J. C., & Carrier, D. R. (2019) · Journal of Experimental Biology · doi:10.1242/jeb.212365 · Cited by 31 · cited 2× · see citing works
“Similarly, punch power is 162% greater in men than women even though no single parameter that produces punching actions achieves this magnitude of difference [50].”
Background“Muscle memory” not mediated by myonuclear number? Secondary analysis of human detraining data
Murach, K. A., Dungan, C. M., Dupont‐Versteegden, E. E., McCarthy, J. J., & Peterson, C. A. (2019) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00506.2019 · Cited by 27 · see citing works
o2max, blood doping, and erythropoietin: Figure 1
Joyner, M. J. (2003) · British Journal of Sports Medicine · doi:10.1136/bjsm.37.3.190 · Cited by 26 · cited 5× · see citing works
“In terms of aerobic capacity, 6- to 7-year-old males have been shown to have a higher absolute and relative (to body mass) VO2max than 6- to 7-year-old females [24].”
BackgroundInfluentialCardiovascular Anatomy and Physiology in the Female
Wingate, S. (1997) · Critical Care Nursing Clinics of North America · doi:10.1016/s0899-5885(18)30237-5 · Cited by 24 · see citing works
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Sex in SportPreprint
Coleman, D. L. (2017) · SSRN Electronic Journal · Cited by 6 · see citing works
The Hermeneutics of Participation of Transgender Athletes in Sports - Intensifying Third Force
Singh, B., & Singh, K. (2011) · Physical Culture and Sport Studies and Research · doi:10.2478/v10141-011-0013-9 · Cited by 3 · see citing works
Carson, R., & Mennenga, H. A. (2019) · American Journal of Occupational Therapy · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Nuzzo, J. L. (2022) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000004329 · Cited by 326 · see citing works
“First, a general update on sex differences in muscle strength would be timely given ongoing discussions about (a) biological male subjects competing in the female category of sport (44,191,218,226,227,385) and (b) sex-specific physical fitness standards within the military (124), law enforcement (281), and firefightin…”
BackgroundHUNTER, S. K., S. ANGADI, S., BHARGAVA, A., HARPER, J., HIRSCHBERG, A. L., D. LEVINE, B., L. MOREAU, K., J. NOKOFF, N., STACHENFELD, N. S., & BERMON, S. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003300 · Cited by 241 · see citing works
Sex differences in skeletal muscle fiber types: A meta‐analysis
Nuzzo, J. L. (2023) · Clinical Anatomy · doi:10.1002/ca.24091 · Cited by 224 · see citing works
Sex differences in human performance
Hunter, S. K., & Senefeld, J. (2024) · Journal of Physiology · doi:10.1113/jp284198 · Cited by 66 · see citing works
“…anatomical structure develop, such that, on average, males are taller; have longer limbs; have larger lungs and greater cross-sectional areas of conducting airways; possess more muscle mass, and have larger hearts than females (Dominelli et al., 2019; Hilton & Lundberg, 2021; Hunter et al., 2023).”
Sex and gender in respiratory physiology
LoMauro, A., & Aliverti, A. (2021) · European Respiratory Review · doi:10.1183/16000617.0038-2021 · Cited by 90 · see citing works
The Impact of Gender-Affirming Hormone Therapy on Physical Performance
Cheung, A. S., Zwickl, S., Miller, K., Nolan, B. J., Wong, A. F. Q., Jones, P. R., & Eynon, N. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad414 · Cited by 95 · see citing works
Pataky, M. W., Dasari, S., Michie, K. L., Sevits, K. J., Kumar, A., Klaus, K. A., Heppelmann, C. J. H., Robinson, M. M., Carter, R. E., Lanza, I. R., et al. (2023) · Cell Metabolism · doi:10.1016/j.cmet.2023.10.010 · Cited by 69 · see citing works
Safety, fairness, and inclusion: transgender athletes and the essence of Rugby
Pike, J. (2020) · Journal of the Philosophy of Sport · doi:10.1080/00948705.2020.1863814 · Cited by 67 · see citing works
The Gender Wars, Academic Freedom and Education
Suissa, J., & Sullivan, A. (2021) · Journal of Philosophy of Education · doi:10.1111/1467-9752.12549 · Cited by 64 · see citing works
Alvares, L. A. M., dos Santos, M. R., de Souza, F. R., Santos, L. M., Mendonca, B. B., Costa, E. M. F., Alves, M. J. D. N. N., & Domenice, S. (2022) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-105400 · Cited by 55 · see citing works
“8 Alterations in both of these parameters start in the first year after initiation of GAHT.”
BackgroundEvidence on sex differences in sports performance
Joyner, M. J., Hunter, S. K., & Senefeld, J. W. (2024) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00615.2024 · Cited by 60 · see citing works
Strength, power and aerobic capacity of transgender athletes: a cross-sectional study
Hamilton, B., Brown, A., Montagner-Moraes, S., Comeras-Chueca, C., Bush, P. G., Guppy, F. M., & Pitsiladis, Y. P. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-108029 · Cited by 63 · see citing works
“11 Both the absolute and relative V̇ O 2 max differences between groups contradict one previous study in non-athlete transgender populations that found transgender women had higher absolute O 2 peak and no difference in relative O 2 peak compared with cisgender women.”
BackgroundResultInfluentialLundberg, T. R., Tucker, R., McGawley, K., Williams, A. G., Millet, G. P., Sandbakk, Ø. B., Howatson, G., Brown, G. A., Carlson, L. A., Chantler, S., et al. (2024) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14581 · Cited by 47 · see citing works
“Conversely, numerous studies have shown that biological differences persist after testosterone is suppressed, 25,44,46 with physical performance implications.”
InfluentialSelf-citationHunter, S. K., Angadi, S. S., Bhargava, A., Harper, J., Hirschberg, A. L., Levine, B. D., Moreau, K. L., Nokoff, N. J., Stachenfeld, N. S., & Bermon, S. (2023) · Translational Journal of the American College of Sports Medicine · doi:10.1249/tjx.0000000000000236 · Cited by 43 · see citing works
Hormonal Basis of Biological Sex Differences in Human Athletic Performance
Senefeld, J. W., & Hunter, S. K. (2024) · Endocrinology · doi:10.1210/endocr/bqae036 · Cited by 43 · see citing works
Chan, A. S. W., Choong, A., Phang, K. C., Leung, L. M., Tang, P. M., & Yan, E. (2024) · BMC Psychology · doi:10.1186/s40359-023-01493-9 · Cited by 36 · see citing works
“Notably, the public announcement by Caitlin Jenner, a former athlete and current television personality, about her transgender identity during a widely viewed television interview, has contributed to increased visibility [28].”
BackgroundSex Differences in Athletic Performance: Perspectives on Transgender Athletes
Nokoff, N., Senefeld, J. W., Krausz, C. G., Hunter, S. K., & Joyner, M. J. (2023) · Exercise and Sport Sciences Reviews · doi:10.1249/jes.0000000000000317 · Cited by 37 · see citing works
Toward a Robust Definition of Sport Sex
Handelsman, D. J. (2024) · Endocrine Reviews · doi:10.1210/endrev/bnae013 · Cited by 33 · see citing works
Devine, C. (2021) · International Review for the Sociology of Sport · doi:10.1177/10126902211021559 · Cited by 33 · see citing works
Reynolds, A., & Jahromi, A. H. (2021) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2021.704178 · Cited by 33 · see citing works
“Interestingly, the muscular advantage of TGW over cis-gender women is only minimally reduced after testosterone suppression (Hilton and Lundberg, 2021).”
BackgroundNuzzo, J. L., & Pinto, M. D. (2025) · European Journal of Sport Science · doi:10.1002/ejsc.12282 · Cited by 33 · see citing works
“…et al. 2023; Brown et al. 2024a; Brown et al. 2024b, 2025a, 2025b; B. Hamilton et al. 2024; B. R. Hamilton et al. 2024a, 2024b; Handelsman 2017; Hilton and Lundberg 2021; Hunter et al. 2023; Hunter and Senefeld 2024; B.A.Jonesetal.2017;Lundberg,O’Connor,etal.2024;Lundberg, O’Connor, et al.…”
Fit Transitioning: When Can Transgender Airmen Fitness Test in Their Affirmed Gender?
Chiccarelli, E., Aden, J., Ahrendt, D. M., & Smalley, J. M. (2022) · Military Medicine · doi:10.1093/milmed/usac320 · Cited by 32 · see citing works
Baglietto, N., Vaquero‐Cristóbal, R., Albaladejo-Saura, M., Mecherques-Carini, M., & Esparza-Ros, F. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1445892 · Cited by 37 · see citing works
Integrating transwomen athletes into elite competition: The case of elite archery and shooting
Hamilton, B., Guppy, F. M., Barrett, J., Seal, L., & Pitsiladis, Y. P. (2021) · European Journal of Sport Science · doi:10.1080/17461391.2021.1938692 · Cited by 30 · see citing works
“Secondly, this strength advantage is also typically coupled with a larger skeletal structure (Hilton & Lundberg, 2021).”
BackgroundResultInfluentialHunter, S. K. (2024) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00866.2023 · Cited by 28 · see citing works
Hamilton, B. R., Lima, G., Barrett, J., Seal, L., Kolliari-Turner, A., Wang, G., Karanikolou, A., Bigard, X., Löllgen, H., Zupet, P., et al. (2021) · Sports Medicine · doi:10.1007/s40279-021-01451-8 · Cited by 27 · see citing works
Sex Differences in Track and Field Elite Youth
Atkinson, M. A., James, J. J., Quinn, M., et al. (2024) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003423 · Cited by 25 · see citing works
“However, the magnitude of the sex differences in athletic performance can range from ~10-30%, depending on the athletic event (2), with larger sex differences observed in events that rely heavily on muscular power including weightlifting and jumping events (2, 3, 5).”
Trans women participation in sport: A feminist alternative to Pike’s position
Burke, M. D. (2022) · Journal of the Philosophy of Sport · doi:10.1080/00948705.2022.2043754 · Cited by 23 · see citing works
Why ‘Meaningful Competition’ is not fair competition
Pike, J. (2023) · Journal of the Philosophy of Sport · doi:10.1080/00948705.2023.2167720 · Cited by 22 · see citing works
Lundberg, T. R., Tryfonos, A., Eriksson, L. M. J., Rundqvist, H., Rullman, E., Holmberg, M., Maqdasy, S., Linge, J., Leinhard, O. D., Arver, S., et al. (2024) · Journal of Internal Medicine · doi:10.1111/joim.20039 · Cited by 23 · see citing works
“Despite the untrained status of the participants, the results may also be relevant for inferences regarding athletic performance proxies and the associated effects of hormone therapy in this respect [45].”
Self-citationSex‐based limits to running speed in the human, horse and dog: The role of sexual dimorphisms
Senefeld, J. W., Shepherd, J. R. A., Baker, S. E., & Joyner, M. J. (2021) · The FASEB Journal · doi:10.1096/fj.202100161r · Cited by 19 · see citing works
Influence of Sex and Gender on Musculoskeletal Conditions and How They Are Reported
Tosi, L. L., Templeton, K. J., Pennington, A. M., et al. (2024) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.24.00194 · Cited by 20 · see citing works
Martínková, I., Parry, J., & Imbrišević, M. (2021) · Sport Ethics and Philosophy · doi:10.1080/17511321.2021.1974530 · Cited by 20 · see citing works
Equity360: Gender, Race, and Ethnicity: Sex and Fairness in Sports
O’Connor, M. I. (2023) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000002679 · Cited by 19 · see citing works
Kuikman, M. A., McKay, A. K. A., Smith, E. S., Ackerman, K. E., Harris, R., Elliott-Sale, K. J., Stellingwerff, T., & Burke, L. M. (2023) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2022-0214 · Cited by 19 · see citing works
Bezuglov, E., Ahmetov, I. I., Lazarev, A. M., Mskhalaya, G. J., Talibov, O., Ustinov, V., Shoshorina, M., Bogachko, E., Azimi, V., Morgans, R., et al. (2023) · Physiology & Behavior · doi:10.1016/j.physbeh.2023.114344 · Cited by 22 · see citing works
Ma, N., & Gao, F. (2025) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-024-08272-6 · Cited by 17 · see citing works
Sex Differences in Grip Strength From Birth to Age 16: A Meta‐Analysis
Nuzzo, J. L. (2025) · European Journal of Sport Science · doi:10.1002/ejsc.12268 · Cited by 16 · see citing works
Jakubowska, H. (2023) · International Review for the Sociology of Sport · doi:10.1177/10126902231194570 · Cited by 16 · see citing works
“…“ male ” advantages, which raises the question of whether these advantages concern all sport events or to what extent these advantages should be perceived as (in)tolerable (Devine, 2019; Knox, Anderson and Heather, 2019; see also Harper et al., 2021; Hilton and Lundberg, 2021; Jones et al., 2017).”
BackgroundFemale Sports Participation, Gender Identity and the British 2010 Equality Act
Devine, C. (2021) · Sport Ethics and Philosophy · doi:10.1080/17511321.2021.1993982 · Cited by 14 · see citing works
Physical Fitness and Exercise Performance of Transgender Women
Saitong, A., Naeowong, W., Suksom, D., & Tanaka, H. (2024) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003536 · Cited by 13 · see citing works
“Previous research studies investigating sex-related differences indicate that upper body muscle strength of women is markedly lower than those of men, although such differences are smaller in lower body strength (6,9).”
Patriarchy in Disguise: Burke on Pike and World Rugby
Imbrišević, M. (2022) · Sport Ethics and Philosophy · doi:10.1080/17511321.2022.2114534 · Cited by 13 · see citing works
Exploring Hormone Therapy Effects on Reproduction and Health in Transgender Individuals
Moustakli, E., & Tsonis, O. (2023) · Medicina · doi:10.3390/medicina59122094 · Cited by 12 · see citing works
“Nevertheless, certain disparities regarding the effects of GAHT on anger and aggression require further investigation [57].”
BackgroundWho Is a Woman: Sex, Gender and Policy Making
Joel, D., & Fine, C. (2022) · Journal of Controversial Ideas · doi:10.35995/jci02020006 · Cited by 12 · see citing works
Kataoka, R., Spitz, R. W., Wong, V. H. Y., Bell, Z. W., Yamada, Y., Song, J. S., Hammert, W. B., Dankel, S. J., Abe, T., & Loenneke, J. P. (2023) · American Journal of Human Biology · doi:10.1002/ajhb.23862 · Cited by 12 · see citing works
A dialectical-relational approach to anti-trans sentiments on Hupu
Peng, A. Y., & Sun, Y. M. (2022) · Discourse Context & Media · doi:10.1016/j.dcm.2022.100654 · Cited by 11 · see citing works
“Yet , while raising legitimate questions concerning the fairness of trans-inclusivity in current sports governance that deserves scientific scrutiny (Hilton and Lundberg, 2021), the post simultaneously entails an anti-trans undertone, evidenced by the male Hupu user ’ s nomination of transwomen as…”
The Future of Women's Sport Includes Transgender Women and Girls
Schultz, J., Baeth, A. C., Lieberman, A., Pieper, L. P., & Sharrow, E. A. (2022) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-80262-985-920221002 · Cited by 11 · see citing works
Trans women participation in sport: a commentary on the conservatism of gender critical feminism
Burke, M. D. (2022) · International Journal of Sport Policy and Politics · doi:10.1080/19406940.2022.2101503 · Cited by 11 · see citing works
Physiology of Health and Performance: Enabling Success of Women in Combat Arms Roles.
Dyches, K. D., Friedl, K., Greeves, J., Keller, M., McClung, H., McGurk, M., Popp, K., & Teyhen, D. (2023) · Military Medicine · doi:10.1093/milmed/usac256 · Cited by 9 · see citing works
Brown, G. A., Shaw, B. S., & Shaw, I. (2024) · European Journal of Sport Science · doi:10.1002/ejsc.12237 · Cited by 10 · see citing works
“In adults, the sex - based differences in competitive running and swimming performance are similarly in the 5%–13% range for both running and swimming (Hilton & Lundberg, 2021; Hunter et al., 2023; Millard - Stafford et al., 2018).”
Testosterone, Athletic Context, Oral Contraceptive Use, and Competitive Persistence in Women
Casto, K., Arthur, L. C., Hamilton, D. K., & Edwards, D. A. (2021) · Adaptive Human Behavior and Physiology · doi:10.1007/s40750-021-00180-6 · Cited by 10 · see citing works
“There is a demonstrated sporting benefit, e.g., physical strength and power, to both testosterone-mediated developmental masculinization and the long-term exogenous supplementation of testosterone in men and women (for review, Handelsman et al., 2018; Hilton & Lundberg, 2020; Wood & Stanton, 2012).”
BackgroundBrown, G. A., Shaw, B. S., & Shaw, I. (2024) · European Journal of Sport Science · doi:10.1002/ejsc.12241 · Cited by 9 · see citing works
Schiappa, E. (2021) · Routledge eBooks · doi:10.4324/9781003250494 · Cited by 9 · see citing works
Nolan, D. A., Horgan, P., MacNamara, Á., & Egan, B. (2023) · International Journal of Sports Science & Coaching · doi:10.1177/17479541231169371 · Cited by 9 · see citing works
Tidmas, V., Halsted, C., Cohen, M., & Bottoms, L. M. (2023) · Sports · doi:10.3390/sports11070133 · Cited by 10 · see citing works
“The performance difference is greater when assessing powerlifting; the World Open Classic Records show that the open male records for squat, bench press, and deadlift total weight are ~65% greater than the female equivalents [18].”
BackgroundInfluentialLopes‐Silva, J. P., Richardson, D., & Franchini, É. (2022) · Journal of Science in Sport and Exercise · doi:10.1007/s42978-021-00149-7 · Cited by 9 · see citing works
“It has been reported that in Olympic weightlifting, where the weight categories differ between sexes, the performance gap is between 31% and 37% [7].”
BackgroundHamilton, B., Guppy, F. M., & Pitsiladis, Y. P. (2023) · Sports Medicine · doi:10.1007/s40279-023-01928-8 · Cited by 10 · see citing works
“This publication by Hilton and Lundberg [3] has been prominently cited in numerous policies that exclude [4–7] and restrict [8] transgender women from the female category, with the suggestion that it offers relevant scientific evidence.”
InfluentialA Scoping Review of Transgender Policies in the 15 Most Commonly Played UK Professional Sports
McLarnon, M. E. D., Thornton, J. S., Knudson, G., Jones, N. E., Glover, D., Murray, A. D., Cummings, M., & Heron, N. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043568 · Cited by 9 · see citing works
“Researchers and policymakers cite variables that differentiate biological male and female athletic performance [7–10] produced by exposure to testosterone from the onset of male puberty, amongst other influences [5,11,12], which include height, muscle mass, pelvic and lower limb anatomy (e.”
BackgroundInfluentialGoldbach, C., Chambers-Baltz, S. M., Feeser, K., et al. (2022) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2022.2161109 · Cited by 8 · see citing works
Sex Differences in Competitiveness in Massively Multiplayer Online Role-Playing Games (MMORPGs)
Deaner, R. O., Dunlap, L. C., & Bleske-Rechek, A. L. (2022) · Evolutionary Psychology · doi:10.1177/14747049221109388 · Cited by 7 · see citing works
Greey, A. D. (2023) · Canadian Review of Sociology/Revue canadienne de sociologie · doi:10.1111/cars.12415 · Cited by 7 · see citing works
Sgrò, P., Antinozzi, C., Wasson, C. W., Galdo, F. D., Dimauro, I., & Luigi, L. D. (2024) · Biology · doi:10.3390/biology13100796 · Cited by 7 · see citing works
Jensen, M., Schorer, J., & Faber, I. R. (2022) · Sports Medicine - Open · doi:10.1186/s40798-022-00520-0 · Cited by 7 · see citing works
“Hilton EN, Lundberg TR. Transgender women in the female category of sport: perspectives on testosterone suppression and performance advantage.”
BackgroundMaking Sense of Debate Over Transgender Athletes in Olympic Sport
Pielke, R. A. (2022) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-80262-985-920221003 · Cited by 7 · see citing works
Trans* Athletes in Sport: Not Ceding to the Sex/Gender Binary of Gender Critical Feminism1
Burke, M. D., & Klugman, M. (2024) · Sociology of Sport Journal · doi:10.1123/ssj.2024-0030 · Cited by 7 · see citing works
Frías, F. J. L., & Torres, C. R. (2023) · Sport Ethics and Philosophy · doi:10.1080/17511321.2023.2260112 · Cited by 6 · see citing works
“Among these differences are larger and denser muscle mass, reduced fat mass, longer and larger skeletal structure, superior cardiovascular and respiratory function, and higher hemoglobin concentration (Hilton and Lundberg 2021).”
Shaw, A., Williams, A. G., Stebbings, G. K., Chollier, M., Harvey, A., & Heffernan, S. M. (2024) · Journal of Sports Sciences · doi:10.1080/02640414.2024.2326354 · Cited by 6 · see citing works
“…it should be recognised that ath-letes’ understanding of the available scientific research regarding retained advantage may affect their perception towards trans-gender inclusion (Flores et al., 2020; Hilton & Lundberg, 2021; Jones et al., 2017) and their opinion regarding eligibility criteria.”
BackgroundClinical Concerns on Sex Steroids Variability in Cisgender and Transgender Women Athletes
Luigi, L. D., Greco, E. A., FOSSATI, C., Aversa, A., Sgrò, P., & Antinozzi, C. (2022) · International Journal of Sports Medicine · doi:10.1055/a-1909-1196 · Cited by 7 · see citing works
English, C., & Pieper, L. P. (2022) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-80262-985-920221008 · Cited by 6 · see citing works
Hamilton, B., Hu, K., Guppy, F. M., & Pitsiladis, Y. P. (2024) · Translational Exercise Biomedicine · doi:10.1515/teb-2024-0017 · Cited by 6 · see citing works
The future of sex in elite sport
Photopoulos, J. (2021) · Nature · doi:10.1038/d41586-021-00819-0 · Cited by 6 · see citing works
Ren, Y., Gou, B., Chen, R., et al. (2025) · Work · doi:10.1177/10519815251351849 · Cited by 5 · see citing works
“…which could be attributed to the fact that lower CDG settings result in a greater range of arm movement and that testosterone levels are usually higher in men than in women 48 ; therefore, male muscles are usually more developed and more easily adapted to a greater range of muscle activity.”
McGarrigal, L. D., Morse, C. I., Sims, D. T., & Stebbings, G. K. (2025) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000005191 · Cited by 5 · see citing works
Harper, J. M., Blagrove, R. C., Hunsicker, E., Witcomb, G. L., Ferguson, R. A., & O’Donnell, E. (2025) · European Journal of Sport Science · doi:10.1002/ejsc.70036 · Cited by 5 · see citing works
The gender-diverse/non-binary category in sport
Smith, I. A. (2025) · Sport Ethics and Philosophy · doi:10.1080/17511321.2025.2490553 · Cited by 5 · see citing works
Teaching About Sex and Gender in Neuroscience: More Than Meets the “XY”
Casto, K. V., Leininger, E. C., & Tan, T. M. (2022) · Journal of Undergraduate Neuroscience Education · doi:10.59390/azvz2988 · Cited by 5 · see citing works
Analyzing brain data by sex: Are we asking the right question?Preprint
Alon, N., Meilijson, I., & Joel, D. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.11.09.373258 · Cited by 5 · see citing works
Reply to Imbrišević: Moving Outside the Bubble of Gender Critical Feminism
Burke, M. D. (2022) · Sport Ethics and Philosophy · doi:10.1080/17511321.2022.2150784 · Cited by 5 · see citing works
Perception Matters: Attitudes Toward Transgender Inclusion in Campus Recreational Sports
Knee, E., Anderson, A. R., Miller, A. M., & Ramos, W. D. (2024) · Recreational Sports Journal · doi:10.1177/15588661241280414 · Cited by 4 · see citing works
“While Hilton and Lundberg (2021) attributed speci fi c attributes to male competitive advantage, this research is far from providing consensus that this advantage is biologically based (Jones et al., 2017a).”
Biology and Management of Male‐Bodied Athletes in Elite Female Sports
Handelsman, D. J., & Bermon, S. (2025) · Drug Testing and Analysis · doi:10.1002/dta.3876 · Cited by 4 · see citing works
Defining sex in the sporting world
Handelsman, D. J., & Bermon, S. (2025) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2025.102005 · Cited by 5 · see citing works
McCoy, L. (2022) · Journal of Global Sport Management · doi:10.1080/24704067.2022.2071321 · Cited by 4 · see citing works
Bascharon, R. A., Sethi, N. K., Estevez, R., Gordon, M., Guevara, C., Twohey, E. E., & deWeber, K. (2023) · The Physician and Sportsmedicine · doi:10.1080/00913847.2023.2286943 · Cited by 4 · see citing works
“…the future will bring in terms of revised transgender policies, it is clear that different sports differ vastly in terms of physiological determinants of success, which should create sports-specific safety considerations and may alter the importance of retained performance advantages [12,44,46].”
InfluentialMaking History in 1 h: How Sex, Aging, Technology, and Elevation Affect the Cycling Hour Record
Harnish, C., Swinand, G. P., & Fisher, A. E. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003328 · Cited by 4 · see citing works
“…this study is the first direct comparison between men and women of wide age ranges during the quintessential time trial test, the CHR. Based on running performance (12,17,22,34 – 36) and triath-lon performance (15,22), we hypothesized that across all CHR men would be more than 10% faster.”
BackgroundInfluentialTransgender athletes and the sex category: change in competition level
Sadamasu, A., Travlos, A. K., Martínková, I., & Parry, J. (2024) · European Journal for Sport and Society · doi:10.1080/16138171.2024.2420488 · Cited by 4 · see citing works
“…Imbrišević, 2023; Lopez frias & Torres, 2023; Pike, 2023; Sailors, 2020), via qualitative research (e.g. Devine, 2022a; Pérez-Samaniego et al., 2019; Phipps, 2021; Sadamasu et al., 2022) and from a scientific point of view (e.g. Hamilton et al., 2021; Hilton & Lundberg, 2021; Knox et al., 2019).”
InfluentialSport, Transgender Athletes, and Nonbinary Experience
Travers, T. (2022) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197519011.013.49 · Cited by 4 · see citing works
Alvares, L. A. M., Ferreira, R. E. S., Nakamoto, F. P., Quaresma, M. V. L. D. S., Santos, L. M., Degani‐Costa, L. H., Navarro, L. S., Navarro, G. S., Oliveira-Junior, A. A., Barbosa, R. C. C., et al. (2023) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2023-001641 · Cited by 4 · see citing works
Female Testosterone: Contested Terrain
Krane, V., Calow, E., & Panunti, B. A. (2021) · Kinesiology Review · doi:10.1123/kr.2021-0062 · Cited by 4 · see citing works
Eberman, L. E., Winkelmann, Z. K., Crossway, A. K., Lopez, R. M., Nye, E. A., Rogers, S. M., Walen, D. R., & Olewinski, L. (2022) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000001067 · Cited by 4 · see citing works
Improving competition and mental health for transgender athletes
Kamis, D., & Glick, I. D. (2021) · The Physician and Sportsmedicine · doi:10.1080/00913847.2021.1949250 · Cited by 4 · see citing works
World in transition: sport and transgender athletes
Rizzone, K. H. (2022) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-105075 · Cited by 18 · see citing works
Baglietto, N., Albaladejo-Saura, M., Esparza-Ros, F., Mecherques-Carini, M., & Vaquero‐Cristóbal, R. (2025) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2025.2542368 · Cited by 4 · see citing works
Anti-doping sciences, abjection and women’s sport as a protected category
Schneider, A. J.-A., Oldham, A. C., & Butcher, L. (2023) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2023.1106446 · Cited by 3 · see citing works
Aghazadeh, S. A., Capizzo, L. W., & Tindall, N. T. J. (2023) · Journal of Public Relations Research · doi:10.1080/1062726x.2023.2285067 · Cited by 3 · see citing works
“For instance, Save Women’s Sports’ (n.d.) webpage, simply titled “The Facts,” argued against including trans women in sports, often misgendering trans women as “male” and sharing scientific studies that claim muscular advantages of male puberty (e.g., Hilton & Lundberg, 2021).”
BackgroundHow can universities promote academic freedom? Insights from the front line of the gender wars
Suissa, J., & Sullivan, A. (2022) · Impact · doi:10.1111/2048-416x.2022.12007.x · Cited by 3 · see citing works
Casto, K. V., & Carré, J. M. (2023) · Policy Insights from the Behavioral and Brain Sciences · doi:10.1177/23727322231197583 · Cited by 3 · see citing works
“On average and at the upper levels, men outperform women on certain sporting outcomes, particularly when the sport involves physical strength and power (for review, Bassett et al., 2020; Handelsman et al., 2018; Hilton & Lundberg, 2021; Wood & Stanton, 2012).”
BackgroundA burst of fenoterol excretion during the recovery of a weight loss protocol
Cheibub, A. M., Muniz‐Santos, R., Murgu, M., et al. (2022) · Journal of Pharmaceutical and Biomedical Analysis · doi:10.1016/j.jpba.2022.115209 · Cited by 3 · see citing works
Gender Differences and Performance Changes in Sprinting and Long Jump Among Young Athletes
Bezuglov, E., Ачкасов, Е. Е., Vakhidov, T., Malyakin, G. I., Kapralova, E., Kolesnichenko, V., Vinogradov, M. A., Zharikova, T. S., & Emanov, A. (2024) · Sports · doi:10.3390/sports12120347 · Cited by 2 · see citing works
“In sports where muscle mass and explosive strength are key to success, this difference can reach 50% [19].”
Biological Breakdown of Sports in Athletics Based on Multimedia Image Acquisition Techniques
Sun, P., Zhang, B., Chen, Q., et al. (2022) · Computational Intelligence and Neuroscience · doi:10.1155/2022/3497942 · Cited by 2 · see citing works
“However, if the chain ball does not move correctly from the preswing phase to the spin phase, then even if the spin technique is used properly, the best throwing results will not be achieved [10].”
MethodRetractedMomb, B. A., Szabo, G. K., Mogus, J. P., Chipkin, S. R., Vandenberg, L. N., & Miller, M. S. (2023) · Endocrinology · doi:10.1210/endocr/bqad132 · Cited by 2 · see citing works
- Authors
- Hilton, E. N., & Lundberg, T. R.
- Affiliations
- University of Manchester (GB)
- Karolinska University Hospital (SE)
- Corresponding author
- Lundberg, Tommy R.
- Venue
- Sports Medicine
- Published
- 2020-12-08
- Volume
- 51
- Issue
- 2
- Pages
- 199-214
- ISSN
- 0112-1642 (ISSN-L)
- 1179-2035
- PMC
- PMC7846503
- OpenAlex
- W3112696807
- Cited by
- 170
- References
- 112
- Citations by year
- 2026: 17 · 2025: 31 · 2024: 33 · 2023: 37 · 2022: 32 · 2021: 17 · 2020: 3
- FWCI
- 31.86
- Type
- journal article
- Language
- en
- Update notices
- correction (2021-04-29)
- Open access
- hybrid
- doi.org
- Locations
- Sports Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- PubMed Central (submittedVersion, cc-by)
- Funders
- Karolinska Institute
- Topics
- Social Sciences › Gender Studies › Sports, Gender, and Society
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Keywords
- transgender women, testosterone suppression, serum testosterone levels, muscle mass, muscle strength, lean body mass, puberty, gender identity
- MeSH terms
- Emotions, Female, Gender Identity, Humans, Male, Sports, Testosterone, Transgender Persons
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