By Carla Jaeger
Basketballer Lexi Rodgers.
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The first thing you hear on game nights when you walk through the glass doors of Kilsyth stadium, in Melbourne’s outer east, is the rhythmic sound of bouncing basketballs.
At the second game of the 2023 WNBL1 South season, kids run around the stadium, teenagers fry chips at the tuckshop and adults mingle at the bar dubbed “the snake pit”.
It’s a tight-knit community that forms the Kilsyth Basketball Club’s 10,057 members – two spectators in the snake pit only half joke that game nights are as sacrosanct as prayer on Sunday mornings.
As the raucous crowd watches the women’s game between the Kilsyth Cobras and the Dandenong Rangers unfold, Lexi Rodgers sits on the bench.
Rodgers, a transgender athlete, was not permitted to join the players with whom she’d been training for weeks on the court.
At the time, her eligibility to join the Cobras’ senior women’s team was being considered by a three-person panel assembled by Basketball Australia.
Less than a month later, the panel rejected Rodgers’ application, and a media storm ensued, one that all boiled down to the 23-year-old woman’s bid to play in a league that, although it is a tier below the elite WNBL competition, is seen as a funnel into the top competition.
The timing of Rodgers’ application coincided with a polarising debate on the inclusion of transgender athletes in high-performance women’s competitions, one that has divided experts and decision makers alike.
The current policies in place for elite sports in women’s competitions are inconsistent, largely because scientific research on the athletic performance of trans athletes who undergo feminising hormone treatment is still developing.
At a grassroots level, the overwhelming majority of Australia’s sporting codes are in agreement: inclusion should be the emphasis, and players should be welcomed to play in the competitions which best align with their identity.
The exception to that rule is Rugby Australia, which assesses the eligibility of trans women on a case-by-case basis.
But that consensus does not translate to high-performance settings, where eliminating unfair advantages is the priority.
Joanna Harper, who researches transgender athletes and has advised international sporting federations on policies, is conducting three studies at Loughborough University in England to understand the effect of gender-affirming hormone therapy on the performance of trans athletes.
Harper, who is a transgender athlete herself, has first-hand experience of the effects of hormone treatment.
“It’s obviously clear that we shouldn’t have men in women’s sports. Anyone who goes through a testosterone-fuelled puberty gains substantial advantages over anyone who doesn’t,” Harper says.
“That includes trans people – but trans women also undertake gender-affirming hormone therapy that affects athletic performance.”
The reason the surge in testosterone at the time of male puberty – about 15 to 20 times the amount that women produce – provides an advantage is because of its effect on the body.
The increase results in various changes, including an uplift of muscle mass and bone density, and increases in cardiovascular and lung capacity.
Those uplifts provide a considerable advantage in the majority of sports, which is why men’s and women’s competitions are separate.
Because of this, the bulk of policies currently in place in Australia require trans and gender diverse athletes to reduce their testosterone levels down to either 10, five, or 2.5 nanomoles per litre for a matter of years.
By adulthood, normal testosterone levels in females range between 0.3 and 2.4 nanomoles per litre. Females with polycystic ovary syndrome have levels considered to be between 3.1 nmol/L and 4.8 nmol/L.
Comparatively, the normal range in males is between 9.2 and 31.8 nmol/L.
Trans women are able to reduce their testosterone levels through hormone treatment, which can reverse some but not all the effects of male puberty.
Ada Cheung, an endocrinologist who leads the Trans Health Research Centre at the University of Melbourne, provides this treatment to trans patients.
“Feminising hormone therapy will reduce muscle, increase fat. It reduces muscle by about 3 to 5 per cent, but it increases fat by about 30 per cent, so there’s a big shift in body composition,” she says.
The rationale for reducing testosterone is that suppressing the hormone changes the body’s composition, including a reduction in muscle mass.
But once someone has completed male puberty, they cannot change their height, bone size, or their voice, regardless of treatment.
Transgender athlete Hannah Mouncey, whose failed bid to join the AFLW was covered extensively in the media, welcomes a testosterone threshold in elite settings.
“This might sound harsh for some people … you can’t have people say ‘I am female, now I’m going to compete’ because, you know, it doesn’t create a level playing field,” Mouncey says.
Transgender athlete Hannah Mouncey supports testosterone thresholds for elite settingsCredit:Darrian Traynor
Harper agrees: “Testosterone should be the primary marker.”
But whether reducing testosterone levels removes the advantage well enough to compete equitably against cisgendered women (who were registered as women at birth) is debated, as is how long it takes to remove those advantages.
It is also one that experts argue is dependent on the sport. Maintaining a higher muscle mass, for example, would be far more advantageous for a sprinter than for a long-distance runner.
In a May editorial published in The Australian, biologist Emma Hilton and endocrinologist David Handelsman argued that the majority of physical advantages developed as a result of male puberty are irreversible, no matter how low testosterone levels are kept.
Renee Richards was the first openly transgender athlete to compete in professional women’s tennis.Credit:Getty Images
A 2020 study published in the British Journal of Sports Medicine compared the fitness results of trans women and trans men before and after they began gender-affirming hormone treatment.
It found that trans women still had a 9 per cent faster mean run speed after one year of testosterone suppression.
Another study, published in The Journal of Clinical Endocrinology & Metabolism in 2019, analysed 11 transgender women. It found that after one year of testosterone suppression, there was only a minimal decrease in strength in their thigh muscles and only a 5 per cent loss of muscle mass.
Some, but not all, experts on either side of the debate agreed that these studies have limitations, which includes the lack of analysis on elite athletes.
The New York Times reported that one of the researchers in the 2019 study said participants were untrained, and because “there are no longitudinal studies”, it was difficult to speculate about physical changes to elite athletes.
“I’m not sure there will be any reliable data at any point,” the researcher said.
But one expert, who spoke on the condition of anonymity due to the sensitive nature of the debate, said longitudinal data was unnecessary. While he agrees that data on transgender athletes is a key reason why there is a lack of consensus, he believes that it is impossible to ever get the required amount of information needed.
“We can depend on physical measurement during exercise in non-athletes,” he said, adding that existing knowledge about the performance of cisgendered men and women could be applied to transgender athletes.
Harper and Cheung disagree.
“We have clues – we don’t have definitive evidence,” Harper says.
As a long-distance runner, Harper knew she would become slower over time as her testosterone levels were suppressed.
“I thought it’d be kind of a gradual thing, and it wouldn’t be that severe – and I was wrong on both cases.
“Within weeks I was noticeably slower. Within nine months, I was running 12 per cent slower – and that’s the difference between serious male distance runners and serious female distance runners.”
The interest in her own performance resulted in her conducting a study, published in 2015, which found that a non-elite group of eight transgender distance runners was no more competitive as women than as men. The study’s findings did not apply to sprinters.
In the coming months, the Australian Institute of Sport will release a new framework for the nation’s sporting codes to use when transgender athletes such as Rodgers want to join elite competitions. These guidelines will be non-binding, but might even out the inconsistencies that currently exist across sports.
The anonymous expert, however, is sceptical.
“[I] personally don’t believe regulations which try to accommodate post-pubertal male-bodied athletes into female events can succeed to remove unfair advantage,” he said.
Cheung believes a case-by-case basis is the best way to assess eligibility. She says sporting federations must decide what they value when determining their policies.
“It really depends on what are the values and the principles for that sporting federation. Do they want to send a message that basketball is for everyone?” she asks.
What Harper would like to make clear regardless of the outcome of these guidelines is one key point: “The biggest piece of misinformation is the suggestion that trans women represent a threat to the integrity of women’s sports.
“It has been 46 years since the first trans woman competed in elite women’s sports,” she said, referencing tennis player Renee Richards, who became a pioneer for transgender athletes when she sued to play at the 1977 US Open. “Trans women haven’t taken over women’s sports in those 46 years, and won’t in the next 46 years.”
As for Rodgers, Basketball Australia have said they will support her to reapply if she wants to. “I hope that one day basketball’s governing body can replicate the inclusion and acceptance I have found on the court with my teammates,” she said.
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