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Effect of gender affirming hormones on athletic performance in transwomen and transmen: implications for sporting organisations and legislators
Open accessAbstract
Objective: To examine the effect of gender affirming hormones on athletic performance among transwomen and transmen. Methods: We reviewed fitness test results and medical records of 29 transmen and 46 transwomen who started gender affirming hormones while in the United States Air Force. We compared pre- and post-hormone fitness test results of the transwomen and transmen with the average performance of all women and men under the age of 30 in the Air Force between 2004 and 2014. We also measured the rate of hormone associated changes in body composition and athletic performance. Results: Participants were 26.2 years old (SD 5.5). Prior to gender affirming hormones, transwomen performed 31% more push-ups and 15% more sit-ups in 1 min and ran 1.5 miles 21% faster than their female counterparts. After 2 years of taking feminising hormones, the push-up and sit-up differences disappeared but transwomen were still 12% faster. Prior to gender affirming hormones, transmen performed 43% fewer push-ups and ran 1.5 miles 15% slower than their male counterparts. After 1 year of taking masculinising hormones, there was no longer a difference in push-ups or run times, and the number of sit-ups performed in 1 min by transmen exceeded the average performance of their male counterparts. Summary: The 15–31% athletic advantage that transwomen displayed over their female counterparts prior to starting gender affirming hormones declined with feminising therapy. However, transwomen still had a 9% faster mean run speed after the 1 year period of testosterone suppression that is recommended by World Athletics for inclusion in women’s events.
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Baseline muscular strength in transwomen is not significantly diminished after 1 year but is after 2 years of HRT.
“This finding agrees with previous studies that have shown that baseline muscular strength in transwomen is not significantly diminished after 1 year [51, 53] but is after 2 years of HRT [53].”
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 [53]
The table in the Conclusion shows that transwomen’s mean push-ups and sit-ups declined from pretreatment values, with a larger decline at 2–2.5 years than at 0–1 year. The Athletic performance section also says their push-up advantage over female controls disappeared after two years. However, the paper does not report the claimed significance tests comparing muscular strength with transwomen’s own baseline at one and two years; its stated comparison is with female controls. (LLM, conf=0.82)
Experimental — accuracy not yet measuredA very recent study reported changes in fitness levels of 29 transmen and 46 transwomen in the United States Air Force, from before and after 30 months of GAHT.
“a very recent study reported changes in fitness levels of 29 transmen and 46 transwomen in the United States Air Force, from before and after 30 months of GAHT.67”
From How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation (2021) · cites this paper as [67]
The Research participant characteristics section confirms that the study included 29 transmen and 46 transwomen serving in the United States Air Force. The Outcome measures section says it compared fitness scores from before hormone treatment with scores obtained during the first 30 months after treatment began, not specifically after 30 months of treatment. The reported average follow-up was about 394 days. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn Roberts et al., push-up (31% more than female counterparts) and sit-up (15% more) advantages over ciswomen at baseline had been negated after 2 years, but not after 1 year.
“These authors found that the push-up (31% more than their female counterparts) and sit-up (15% more than their female counterparts) advantages over ciswomen at baseline had been negated after 2 years, but not after 1 year.”
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 [53]
Roberts et al. retrospectively reviewed pre- and post-HRT military fitness test results in transwomen individuals (n=46) of the U.S. Air Force.
“Recently, Roberts et al. [53], retrospectively reviewed pre- and post-HRT military fitness test results in transwomen individuals (n = 46) of the U.S. Air Force.”
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 [53]
Running performance in the 1.5 mile run remained 12% faster on average in transwomen after 2 years of HRT.
“Roberts et al. also found that running performance in the 1.5 mile run remained 12% faster on average in transwomen after 2 years of HRT [53].”
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 [53]
Studies like Roberts et al. show that transwomen are heavier when presented as a pre-treatment average.
“This assumption is due to studies like Roberts et al. showing that transwomen are heavier when presented as a pre-treatment average [53].”
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 [53]
In that study, after 2 years on GAHT there were no significant differences between ciswomen and transwomen in the number of push-ups or sit-ups performed in 1 min.
“The study reported that after 2 years on GAHT there were no significant differences between ciswomen and transwomen in the number of push-ups or sit-ups performed in 1 min.”
In that study, transwomen ran significantly faster during the 1.5 mile fitness test than ciswomen.
“However, transwomen ran significantly faster during the 1.5 mile fitness test than ciswomen.”
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Citations
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Metadata
- Authors
- Roberts, T. A., Smalley, J., & Ahrendt, D.
- Affiliations
- Children's Mercy Hospital (US)
- Brooke Army Medical Center (US)
- Corresponding author
- Roberts, Timothy A
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2020-12-07
- Volume
- 55
- Issue
- 11
- Pages
- 577-583
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W3113340799
- Cited by
- 92
- References
- 20
- Citations by year
- 2026: 14 · 2025: 14 · 2024: 13 · 2023: 27 · 2022: 14 · 2021: 10
- FWCI
- 13.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Children's Mercy Hospital
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Social Sciences › Gender Studies › Sports, Gender, and Society
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- gender-affirming hormones, athletic performance, transgender women, transgender men, testosterone suppression, body composition, military fitness testing, United States Air Force, sports eligibility, anti-doping policy, sex differences in physical fitness
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