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Trans Haven is a SAFE FOR WORK, open, friendly and accepting community focused on transgender, nonbinary and genderfluid individuals! | members. Sports Act. Living , 27 October Thus, many sport and athletic events have regulations separating male and female participants. However, the inclusion or exclusion of transgender individuals in athletics has recently received outsized attention despite relatively few cases of transgender athletes.

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Unfortunately, there are few studies investigating this topic, and several complications that confound this research. Finally, this review seeks to offer considerations for whether trans individuals should be excluded from sports and athletics, and how future research should proceed to better understand this marginalized population.

While transgender individuals have likely always existed, they have recently received an outsized level of attention and scrutiny from governments and other regulatory bodies 1 — 5. This scrutiny spans multiple issues, one of which has been participation in sports and athletics 1 , 2 , 6 , 7. Concerns have been raised for whether trans individuals should be allowed to compete in sports with cisgender individuals, suggesting they should not compete in the category that aligns with their gender identity or that they should participate in a separate category entirely 1 , 3 — 6 , 8 — Addressing these concerns requires consideration of several concepts: sex and gender, how sports and athletics currently regulate participation by sex and gender, potential human right violations or discrimination coming from exclusionary approaches, what sex differences exist in athletics and how these develop and affect athletic performance, and whether trans individuals' participation in sports inherently leads to risks of either inequity or injury.

Articles were included if they met the following criteria: 1 original research rather than review, 2 research compared transgender individuals on gender affirming hormone therapy to cisgender individuals rather than comparing cis men and cis women, and 3 some measures of fitness or performance were measured. This was done to find articles that investigated transgender performance, accounting for hormonal differences, and comparing these with cisgender counterparts.

Articles were excluded if no more than one trans individual was compared to cisgender individuals. These criteria were used for the following reasons. Gender affirming hormone therapy can alter physiologic parameters 12 — Thus, transgender individuals must be directly measured rather than assuming cisgender sex differences are analogous to cisgender and transgender differences.

While case studies can be informative, selecting an exceptional trans athlete or a sedentary trans individual and assuming they represent an entire community would likely lead to misleading conclusions. Before discussing gender as a criterion for sports participation, the concepts of sex and gender should be clearly understood. Although often used synonymously, sex and gender are two different terms used to describe related concepts.

Sex is a biological concept having to do with chromosomes, genitalia, gonads, and hormones 17 — These related concepts can be conflated, as biological sex and bodily appearance influences how members within a society interact with one another 20 , The various interactions among members of a community pressure individuals within the community to behave in a particular manner or display certain characteristics based on their perceived sex 20 , To a casual observer, the differences between sex and gender may seem trivial, however they address individual qualities which have wide variations even within what may be considered a single group.

Thus, to further a discussion of transgender individuals in sport and athletics, the concepts of sex and gender must first be understood, although they may be impossible to entirely disentangle. Prior to understanding chromosomes, sex was determined to be male or female based on the genitalia possessed by an individual and their secondary sex characteristics 23 — However, by the early 20th century, scientists were beginning to understand that chromosomes shared between mother and father would determine something about the sex of the offspring, but it would still be decades before a greater understanding of the variety of possible outcomes could be better understood 26 — Currently, chromosomes, gonads, hormones, and genitals and to a lesser extent secondary sex characteristics have all been used to describe the concept of biological sex in humans Differences in sex chromosomes have also led to discoveries of sex chromosome dose effects leading to variations in gene regulation as well as in body size and other phenotypic differences 33 , Besides variations in chromosomes, there are other possible anatomical deviations from what is typically considered male or female, such as males with ambiguous external genitalia, a uterus, and fallopian tubes to females who also carry a Y chromosome, have ambiguous external genitalia, and possess both ovaries and testis 18 , Hormonal concentrations, particularly of testosterone, are also used to distinguish male from female 18 , Both males and females have some concentration of both testosterone and estrogen, and these concentrations vary among individuals 37 — Despite this, there are also wide variations within cisgender men and women which do not make them more or less male or female 36 — Hence, even a biological concept of sex, whether based on chromosomes, anatomy, hormones, or other criteria, does not fit neatly into two rigid categories 17 ,