Association of Ringside Physicians: Trans Women in Female Combat ‘Inherently Unfair and Less Safe’
The Association of Ringside Physicians (ARP), a non-profit professional organization dedicated to the health and safety of athletes in combat sports, released their position statement on the topic of transgender athletes in combat sports earlier this year.
The authors of the ARP position conducted an “extensive literature search” in crafting their guidelines. They acknowledge that studies evaluating transgender athletes in combat sports “are lacking” but used “extrapolation from related research” as well as “decades of combat sports medical experience” to form the foundation of their position.
The report notes that “generally, males are bigger and stronger than females,” “enjoy significant performance advantages over females” in competitive sport, and that these biological differences are “insurmountable by training and physical conditioning alone.”
In addition to the effects of elevated pubertal testosterone, which are “primarily responsible for driving the divergence of athletic performances between males and females,” they cite “an estimated 6,500 genes” that are expressed differently between the sexes which result in “an estimated 3,000 sex-specific differences in skeletal muscle” that affect performance beyond the effects of androgenization.
“Testosterone levels in isolation are inadequate to ensure fairness at the time of a competition.”
The report states that “advantageous physiology such as bone density and morphology, lung volume, heart size and stroke volume, and joint articulation are unlikely to be affected” by suppressing testosterone levels in transgender women.
While the report acknowledges that “testosterone suppression is known to decrease muscle mass and strength and oxygen-carrying capacity,” it asserts that “the reduction does not make up for the significant baseline differences between males and females, even after three years of treatment.”
The report concludes that “the permanent testosterone advantage persists to a large degree” and that exogenous hormones therapies have “not been scientifically shown to eliminate this advantage.”
“Most of the effects driven by testosterone are irreversible with estradiol (or cross) hormone therapy.”
Combat sports uniquely carry an “exceedingly high risk” for neurological and musculoskeletal injuries compared to other sporting disciplines. A mismatch in physical capabilities between opponents “leaves [female athletes] at risk” if allowed to compete with opponents of the opposite biological sex.
As mixed-sex combat sports are “inherently unfair and less safe based on proven anatomic and physiologic advantages,” the ARP asserts that “restricting transgender women from the female category of combat sport and transgender men from the male category is necessary and proportionate to the goal of ensuring fair, safe, and meaningful competition.”
“Gender identity has no role in determining competition classification in combat sports.”
The report questions the use of serum testosterone levels as the basis for male participation in the female category, stating that “from a medical-ethical point of view, it is questionable whether a solitary requirement to lower testosterone below a certain level to ensure sporting participation can be justified.”
The report also subtly denigrates some existing policies that have replaced the female category with a mixed-sex one based on gender identity, noting that “several transgender inclusive sports policies demonstrate a lack of scientific evidence to support their conclusions and struggle to protect the integrity of women’s sports.”
It continues: “those states or organizations that allow transgender women to compete against cis women, or transgender men against cis men in combat sports, neglect the inherent safety risks.”
The ARP’s strong statement sits in stark contrast to that of the International Olympic Committee (IOC), which as of 2021 has declined to set any restrictions on male athletes in female sport, or vice-versa. Instead, the IOC has deferred to the governing bodies of various sporting disciplines to set their own guidelines.1
The release of the ARP’s report highlights a policy gap in the world of organized combat sports. Despite an increasing number of sports governing bodies releasing guidelines for transgender athlete eligibility, currently no combat sports organization has released any formal policies regarding transgender athlete participation.
The ARP guidelines provide “basic recommendations that are supported by synthesis and analysis of the current literature,” but are ultimately non-binding. As more transgender athletes compete in combat sports such as Brazilian Jiu-Jitsu2 and boxing,3 it will be incumbent on various sports governing bodies to set formal policies to ensure safe and fair competition for all involved.
“International Olympic Committee Releases New Framework on Transgender Inclusion.” BBC, 16 Nov. 2021, www.bbc.com/sport/olympics/59312313. Accessed 17 Sept. 2023. https://archive.ph/ViN7D.
“The Trans Jiu-Jitsu Fighter Who Breaks down Barriers in Mexican Sport.” Los Angeles Times En Español, 18 June 2023, Accessed 17 Sept. 2023. https://archive.ph/TkW06.
Gaydos, Ryan. “Transgender Male Boxer Patricio Manuel Picks up Victory in Third Career Fight.” Fox News, 22 June 2023, www.foxnews.com/sports/transgender-male-boxer-patricio-manuel-picks-up-victory-third-career-fight. Accessed 17 Sept. 2023. https://archive.ph/ClDLE.