Implications of a Third Gender for Elite Sports

Abstract

The highest court in Germany ruled recently in favor of the introduction of a third gender category for individuals who do not identify as either male or female or are born with an ambiguous sexual anatomy (1). This ruling is in line with at least 10 nations or states that allow a third legal gender (2). This perspective outlines the implications of a third gender for elite sport and is a summary of proceedings of a session entitled “Beyond Fairness: The Biology of Inclusion for Transgender and Intersex Athletes” at the 10th European Sport Medicine — Congress of the European Federation of Sports Medicine Associations (EFSMA) that took place in Estoril, Lisbon, Portugal from November 16 to 18, 2017 (3). Although it may seem simple enough to determine which athletes compete in the men’s division and which athletes compete in the women’s division — after all humans get sorted into male and female bins from the moment of birth — the question of precisely who should compete in the male and female categories is one of the most emotional and complex issues facing elite sport in recent times. Despite the separation of neonates into bundles of “pink” or “blue,” it should be noted that biology does not neatly divide humans into two sexes. There are two main groups of people (i.e., intersex and transgender) who fall outside of the binary division that most people take for granted. Intersex individuals have chromosomal or physical conditions that blur the line separating men from women. Intersex conditions are often referred to as disorders of sexual development or differences of sexual development (DSD). Transgender individuals can be defined as those whose gender identity — an innate sense of whether one is male, female, or somewhere in between — differs from their assigned sex at birth. Some athletes from each of these two groups would like to compete in women’s sport. For this perspective, we focus on issues raised by intersex and transgender athletes in women’s sport because it is generally assumed that transitioning from a woman to a man would not confer a similar competitive advantage. The question of whether transgender and/or intersex women should be allowed to compete against other women, and if so then under what conditions, is extremely contentious. Examining the fundamental concepts of sex and gender can help provide some insights. For the purpose of this perspective, sex is defined as those biological qualities that make humans male, female, or somewhere in between, while gender can be thought of as a nonbinary social construct. Humans possess at least six distinct manifestations of biological sex; internal and external genitalia, chromosomes, hormone levels, secondary sex characteristics, and gender identity. Only when all of the elements of biological sex are examined can one say that someone is male, female, or somewhere in between. The inclusion, however, of gender identity as one of the biological components of sex is not without controversy, albeit an ever larger number of scientists seem prepared to endorse this position (4,5). There is a great deal of debate around the complex and multifaceted concept of gender as a social construct (6). Additionally, terms, such as gender assigned at birth (7) and legal gender (8), are commonly used with the understanding that one’s legal gender might be different from the gender assigned at birth. Given the multifaceted nature of gender, we propose the concept of an “athletic gender” for the purpose of elite competitive sport. Individuals are assigned a gender at birth based on the appearance of one’s external genitalia, one component of biological sex. The external genitalia of many intersex individuals are atypical in appearance, and the process of assigning gender becomes far more complex. An enlightened and informed society should allow people to live as male, female, or somewhere in between, depending on their individual gender identity. In other words, an individual’s gender identity can be used to define their social gender. While self-defined social gender is very important in shaping the way an individual chooses to live, gender identity alone is not sufficient to determine the appropriate sports category for any individual. Our legal gender usually matches the gender assigned at birth but laws dealing with intersex and transgender individuals vary widely depending on the given country. In addition to the 11 or more nations or states that allow a third legal gender, a further seven countries allow people to change their gender markers by self-declaration (9). On the other hand, many other countries either refuse to consider any legal gender beyond that defined at birth or make it extremely difficult to make changes to the legal gender at birth (9). Legal gender, which does not define one’s athletic capabilities, cannot therefore be the sole criterion to determine appropriate sporting categories especially when dealing with elite sport. The concept of an