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Trans-Inclusion in Sports: History, Scientific Evidence and Future Directions.

Ananya M Krishna1, Carlie Bauer2, Kimberley L Way1,3,4

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Current transgender inclusion policies in sports lack robust scientific evidence. This review examines hormone therapy effects, finding low-certainty data insufficient for uniform rules, advocating for sport-specific frameworks.

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Area of Science:

  • Sports Science
  • Endocrinology
  • Policy Studies

Background:

  • Sporting organizations face challenges in developing transgender eligibility policies.
  • Existing regulations vary widely and are often not evidence-based.

Purpose of the Study:

  • To review the history of transgender inclusion in sports.
  • To map current international transgender eligibility regulations.
  • To evaluate the scientific evidence supporting these policies.

Main Methods:

  • Historical analysis of eligibility frameworks.
  • Review of sex hormone roles in performance.
  • Assessment of physiological changes from gender-affirming hormone therapy (GAHT).

Main Results:

  • GAHT causes physiological changes relevant to fitness, but evidence is limited.
  • Studies suffer from small sample sizes, short follow-up, and non-sport-specific outcomes.
  • The certainty of evidence is low, precluding uniform policy recommendations.

Conclusions:

  • Existing data are insufficient to support universal transgender sports policies.
  • Fairness and safety require more than biological considerations.
  • A structured, sport-specific framework is proposed for policy development under uncertainty.