Thread by @KirstiMiller30

Blanket banning trans woman from playing rugby on the basis of risk outcomes of a group level aggregate of physical characteristics that any given individual in this group may demonstrably not possess individually cannot be considered reasonable, proportionate or justified.

This is before we consider the uncomfortable fact that none, zero, zip of the evidence presented by World Rugby involves empirical research of trans women rugby players actually playing rugby or in fact any sport. There were no injuries reported & zero elite trans players.

There is clear evidence that increasing the acceptable period of testosterone suppression further reduces parameters thought to be associated with “meaningful” performance advantage in trans women (which would clearly be more reasonable than banning all trans women).

There is currently no definitive threshold of what this “meaningful” reduction should be anyway, & there is no current scientific work demonstrating specifically what the performance advantages of men over women in rugby itself could be said to be composed of.

This means there is no current threshold of “meaningful” performance advantage reduction that any transgender woman rugby player could satisfy.

The @WorldRugby policy, trans women are placed in an uncomfortable double-bind: accused of performance advantage they cannot prove they do not possess.

Sports like #WorldRugby banning #transgender women on safety grounds place themselves on a slippery slope. Safety has no gender.

The sex, gender or chromosomal status of an athlete does not create any inherent danger or risk to safety. Rather, it is dis- parities in strength, speed & endurance and/or physique of each individual athlete that may, depending on the sport.

Rugby union is a contact sport in which players require high levels of physical fitness, which is a
composite of aerobic and anaerobic endurance, muscle strength and power, speed, agility and body composition.

All of these attributes can be assessed on a case by case basis very easily for any athlete, male, female, trans, intersex.

Assessing any group of athletes as a monolithic group especially amongst trans athletes is flawed. Trans is an umbrella term many different body types & stages of transition. Blanket inclusion or exclusion does not work.

@WorldRugby and Ross Tucker say case by case is not possible. The AFLW already do have a case by case policy at the elite level of their game. We have already seen the AFL delay the approval of trans player that had a disparity in size, strength & endurance.

Within the AFLW Policy
he Applicant must provide the following information to enable the AFL to assess the relevant aspects of their strength, stamina or physique having regard
to the particular characteristics of the AFLW game:

Medical records that establish that the Applicant’s total testosterone level in serum, has been maintained below 5 nmol/L1 for at least 24 months prior to the date of the Application;

To the extent available to the Applicant, unless otherwise advised by the AFL, data over the 24 month period prior to the date of the Application pertaining to the Applicant’s:
height;
weight;
bench press (1RM and/or 3RM);
squat (1RM and/or 3RM);

20m sprint time;
vertical jump;
match raw GPS data (sample of three (3)
Australian Rules Football matches if available); and
2 kilometre run time.

Relevant Competitive Advantage Criteria: if there is a relevant, & significant, disparity in the Applicant’s strength, stamina, speed or physique when compared to data procured from cisgender AFLW
players in the preceding two seasons
of the competition.

The subject of the Application (Comparison Data) which may reasonably be regarded to give rise to
an unreasonable competitive advantage to the Applicant having regard to:
the Applicant’s mean, median and range of the Comparison Data pertaining to height, weight, 20m sprint,

vertical jump, 2km run, squat and bench press; and
incidence or absence of any evidence of any significant difference or competitive advantage arising from the Applicant’s participation in other sports:

Unacceptable Safety Risk Criteria: there is an unacceptable safety risk arising from the person’s potential participation in the competition the subject of the Application whether that be a risk to the safety of the gender diverse player or a risk to the safety of other players).

Where the “Sports Committee” assesses, on a preliminary basis, that there may be an unacceptable safety risk, a risk assessment must be undertaken, noting:
unacceptable safety risks will likely arise only in exceptional circumstances and will not arise simply from the proposed

participation of a gender diverse person in an Elite Competition (Women) or Elite Pathway Competition (Women);

Exceptional circumstances may arise where there is a significant disparity in the Applicant’s physique as compared to that of cisgender players in the relevant competition.

The risk assessment must, amongst other things, consider whether the rules applicable to the relevant Elite Competition (Women) or Elite Pathway Competition (Women) are unable to safely manage the risks arising from the proposed participation of the gender diverse person.

It is possible that a larger & stronger trans or intersex athlete could pose a safety risk to smaller cis athletes (and vice-versa).

To exclude bigger and stronger trans athletes from these sports on safety grounds would create a precedent that would argue for the exclusion of equally big & strong cis athletes remembering that,

from a safety perspective, it is the disparity in size & strength that is relevant, not the source of the disparity.

WHS law presents sport governing bodies, clubs & athletes trans, cis & intersex with a valuable avenue to pivot the discussion away from the moralism of a debate grounded in competing rights to a focus on risks & solutions grounded in a debate about safety.

To the extent that larger & stronger athletes (trans, intersex or cis) may pose a H & S risk, it is best to address that risk by amending the rules of the sport to engineer out (or at least minimise) the risks at their source (to employ more mainstream WHS parlance).

Risks from disparities in strength and physique also arise in all contact and collision sports such as AFL & rugby where aggressive physical contact is permitted under the rules and occurs continuously throughout the game.

In these sports, the risks from disparity in strength and physique are mitigated and managed through the rules of the sport.

This was made clear in the AFL’s 2018 Policy which stated that the rules of the sport (including those dealing with rough conduct, unsafe play & other on-field disciplinary matters) are designed to ensure the safety of all AFLW & AFL (men’s) players, including trans cis players.

It is also clear in the 2020 Policy that while a trans or non-binary person may be excluded on the basis that their participation poses an unacceptable safety risk,

Such an exclusion would only arise in ‘exceptional circumstances’ involving a significant disparity in physique that cannot be managed safely within the rules of the sport.

Importantly, the 2020 Policy states it ‘will not arise simply from the proposed participation of a gender diverse person’. The AFL’s ‘exceptional circumstances’ approach stands in stark contrast to World Rugby’s blanket ban.

The @WorldRugby blanket ban trans policy is also in stark contrast to the recently released IOC Gender Framework which strictly forbids trans athletes being treated as a monolithic community.

outsports.com/platform/amp/o…

The Hilton & Lundberg essay (2020) is especially important here because of the impact of this single paper on the @WorldRugby & policies regarding trans women. The paper has several notable weaknesses which are never addressed, which are categorized and listed below.

It is a reasonable conclusion that this paper draws from a prior ideological position seeking to discredit and exclude trans athletes & misuses the available literature to justify this position.

In other words, Hilton Lunberg (2020) is at best an argumentative paper presented as a scientifically rigorous review.

Author bias:
The primary author, Dr. Emma Hilton, does not have a background of sports medicine, and none of her prior publication credits are on topic with sports performance, transgender health or any kind of exercise.

Co-author Dr. Tommy Lundberg does have a background in sports science. He has never studied a single trans athlete in any sport.

Both Hilton and Lunberg are Unfamiliar with trans women as a population: they Use of terminology ‘Biological Males’

Use of cis-men population comparators
Drawing false conclusions:

Hilton & Lundberg do not appropriately review the available literature & draw false comparisons between men and women athletes. As a specific example, the authors state “This Olympic weightlifting analysis reveals key differences between male and female strength capacity.

It shows that, even after adjustment for mass, biological males are significantly stronger (30%) than females.”

This is a disingenuous statement as:
1. Sport (historical and cultural context aside) is segregated by gender because men produce higher strength in terms of total mass. Because women have a higher percentage of body fat mass in comparison with lean body mass,

we segregate some sports in respect to both total mass and gender because it allows for an approximate comparison of total lean body mass.

2. In sports without weight categories, height and weight do not meet the threshold to be considered characteristics involved with “intolerable unfairness.”

Advantages due to being taller or heavier in these sports (e.g., basketball, volleyball, rugby) are not currently considered “unfair”. The average NBA player, for example, is nearly 10 inches taller than the average man and 40 pounds heavier.

3. Male and female muscle is the same strength when comparing equivalent cross section/size (Costill et al., 1976; Schantz et al., 1983).

4. Much of the increased strength of cis-men compared to cis-women can be explained by height differences. When adjusting for height and fat free mass, this relative difference disappears (Castro et al., 1995; Harms, Cooper, & Tanaka, 2011).

5. Lean body mass increases with height for both men and women (Forbes, 1974).

6. It is unsafe for cis-women to attempt to achieve cis-male levels of fat (Nazem &
Akcerman, 2012). This affects speed and endurance activities due to having excess non- performant mass.

The assumptions employed & conclusion posed by the authors Hilton et al is therefore not supported by evidence found in the literature. The authors systematically use adjustment for mass instead of fat-free mass which leads to significant errors when comparing population groups.

This argument is of key importance as trans women athletes undergoing HRT increase their estradiol, affecting total body fat percentage, & also significantly reduces testosterone, reducing muscle mass, red blood cell count & other factors important for athletic performance.

(The authors appear to be aware of the distinction between total mass and fat free mass as shortly after they state, “even when expressed relative to fat-free weight, VO2(max) is 12-15% higher in males than in females”.)

What is needed to have effective comparisons is:

1. Comparing trained athlete cohorts.

2. Body composition (fat-free mass %) – affected by testosterone.

3. Height-matched control groups. Omissions and errors in Table 4:

In Table 4 of their article, Hilton & Lundberg (2020) summarize their findings from available literature, categorizing differences between men’s and women’s athletic performance.

This table has many errors, some of which demonstrate the authors’ disregard for scientific objectivity. In addition, there were omissions of contradictory data from this table. These errors and omissions are listed below.

1.The reference group the authors employed compares“average ciswomen”to cis-men, without adjustment for height or weight. This is significant since cis men are, as a population, taller than cis women, and we would expect to see similar results in comparing any

taller group to a shorter group (for example, comparing five foot four inches tall cis women to five foot ten inches tall cis women).

2.Authors state that ””grip strength provides an excellent proxy measurement for general strength in a broad population”. However, this is distinctly incorrect (Yeung et al., 2018).

Grip strength is largely correlated with hand size rather than strength due to gripping testing device easier (Alahmari et al., 2019).

3.The authors cite a study whereby testosterone-suppressed untrained transgender women see an increase of lean mass (4% leg and 2% overall) after an intense 8 week training cycle.

However, in doing so, they omit Roberts, Nuckols, & Krieger’s (2020) findings that untrained females also show high capacity to build muscle mass especially in upper body strength. The authors also do not show the relative strength compared to trained female competitors -

a more appropriate comparison group - nor do they include that their control group without testosterone suppression gained significantly more mass and a 400% greater increase to isometric strength.

The authors additionally omit that trans women participants failed to gain any noticeable gains to isometric strength. Yet despite these observations, the authors conclude “endogenous testosterone is of paramount importance for the muscular adaptation to strength training.”

4.They claim the 12months hormone suppression as determined by the IOC is insufficient by using data where hormone suppression was present for less than two months.

5.Pelvic width comparison is used as a measure, but studies show that pelvic width difference, including q angle, does not have any benefit for athletic ability (such as moving or jumping);

gait differences, lift ability and risk to injury also are not meaningful as a result of q angle (Bruton, O’Dwyer & Adams, 2013; Hertel, Dorfman & Braham, 2004; Kernozek & Greer, 1993; Thomas, Corcos & Hasan, 1998; Nguyen et al., 2009; Sigawrd & Powers, 2006).

This includes a study by Sigward & Powers which was referenced by the authors as leading to increased injury in athletics, but the original paper states “No differences in kinematics were found.”

6. Bone density was used extensively as evidence of the advantage trans women retain. The claims were unsubstantiated, with no citations to demonstrate bone density as a performance enhancer.

7.The authors argue that larger lung size is a retained advantage. However, they do not adjust for height and ignore studies which have demonstrated that lung size is not a good predictor for sport performance.

The differences are due to respiratory muscles enhancement, not lung size (Degens et al., 2019; Hopkins et al., 2018).

These findings are misrepresented in the table with the conclusion that “Respiratory function, pulmonary ventilation (maximal)” are significant, when they are not. Specifically,

“MBC is not likely to be an adequate physiological measure of the competence of the respiratory system in strenuous work and should be regarded rather as the biomechanical limit of the possibilities of the ventilatory apparatus” (Breslav, Segizbaeva, & Isaev, 2000).

Or that it is not a limiter for exercise “After differences in lung volume are acconted for there is no intrinsic sex difference in the DLco, Vc, or Dm response to exercise” and “together, these data suggest that the pulmonary capillary blood volume response is

proportional to lung size and is adequate to meet individual oxygen demand during exercise” (Bouwsema, Tedjasaputra & Stickland, 2017).

The limiting factor in endurance sport however is oxygen carrying capacity of blood (red blood cell count which is affected by hormones dramatically) and heart muscle (Fomin et al., 2012; Åstrand et al., 1964).

8.Hemoglobin(red blood cell count) is drastically affected by HRT, falling in cis women’s range after 3-4 months (SoRelle et al., 2019). This is largely ignored by Hilton & Lundberg.

9.Hilton & Lundberg misrepresent lean body mass of trans-women throughout Table 4 by assuming baseline strength levels are comparable to cis-men.

But Van Caenegem et al. (2015) - whom they cite elsewhere in the paper - show that trans women as a population start with far lower muscle mass. This means that the reductions recorded in Table 4 are mostly “on top of” the already reduced population level in comparison to cis-men

10. Table 4 reports absolute values for Wiik et al (2020) instead of the published height adjusted levels.

11. Hilton & Lundberg exclude the female reference values from Fighera et al (2018) in Table 4, presumably as Fighera et al.’s (2018) conclusion was that appendicular lean mass was similar among trans and reference women, and

lower in trans women when compared to cis men - a point which contradicts Hilton & Lundberg’s argument.

The authors do not report on advantages that women have over men, which are salient to their argument and conclusion:

1.Endurance is higher and recovery is quicker in women than in men (due to higher proportion of type 1 muscle fibers; Haizlip, Harrison & Leinwand, 2015).

This performance advantage is important, since individual variation is higher than the variation between genders, and individuals with high level of type 1 muscle fibers gravitate towards endurance sport.

3. The author suggest that men outperform women on items such as flexibility, which is not supported in literature (Rene’, 1984).

4.Women have increased glycogen sparing fat oxidation during endurance exercise (Tarnopolsky, 2008).

5. Women experience higher perfusion, ECV and MBV at stress (Nick ander etal., 2020).

6. At a population level untrained ciswomen outperform men with balance(Torres, Reis & Abreu, 2014).

Each of these pieces supports the claim that the Hilton & Lundberg article is an argumentative essay, but it has been interpreted as a scientific review by @WorldRugby, with severe impacts on trans women’s participation in @WorldRugby & other sports.

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