It’s Saturday 4th of March 2023, a cold, snowy day in Biddeford, Maine, USA. I am in the states to defend trans women competing in the female category of sport in a university discussion with the esteemed evolutionary biologist Harvard’s Carole Hooven, PhD.
Carole is not, in my opinion, gender-critical, but she has shared platforms with those who are – she also wrote the fantastic book “T: The Story of the Hormone that Dominates and Divides Us”, which I reviewed last year.
I have been preparing for weeks, and I know exactly the angle Carole will take – that testosterone-suppressed trans women athletes retain an advantage because we suffer (yes, suffer) male puberty.
One gender-critical person Carole has shared a platform with is Professor Emma Hilton, PhD of Manchester University and a Director of Sex Matters.
Who are Sex Matters?
Well, they (like myself) claim that they fight for human rights, but to be precise, Sex Matters advocate for “sex-based rights”.
But the point I am making is I declare a bias – which is more than can be said by Emma Hilton after presenting the research paper “Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage”.
Emma Hilton and Tommy R Lundberg presented their evidence in 2020, saying there was no conflict of interest.
However, ask any British trans person, and they will likely tell you about a fellow Sex Matters Director, Helen Joyce, who said this about trans people, “reducing or keeping down the number of people who transition.” She also went on to say, “every one of those people is basically, you know, a huge problem to a sane world“.
Some trans people took that, rightly or wrongly, as promoting the genocide of transgender people. Helen Joyce rejects that, saying she was simply advocating safeguarding.
However, Helen Joyce was also photographed holding an LGBT Progress flag with the transgender section cut out. In my opinion, actions sometimes speak louder than words.
The issue at hand, though, is how I can fairly critique the work of Hilton and Lundberg – because, for sure, I am not a scientist. My first port of call was a trans rights activist I will call “B”; because B knows much more than me about biology and sports.
“There are issues you should ask Steph”, she said, “not just the question of conflict of interest, for example: Why did”:
* Hilton and Lundberg appear to fail to account for baseline values and the effects of prior Gender Affirming Hormone Therapy on the body composition of transgender women?
* Appear to fail to reference their key data sources?
* Appear to omit their methodological detail, as well as relevant and published data points?
* Appear to avoid discussing any factors that might typically challenge their view, which IS a common practice in a scientific paper?
And then, there is the Canadian Centre of Ethics report, which was published in November 2022. (download the full report by clicking HERE. See pages 56 to 58) which said this about the Hilton and Lundberg paper:
Hilton & Lundberg do not appropriately review the available literature and draw false comparisons between men and women athletes. The assumptions employed and conclusion posed by the authors 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 transgender women athletes undergoing HRT increase their estradiol, affecting total body fat percentage, and also significantly reduces testosterone, reducing muscle mass, red blood cell count and other factors important for athletic performance. In Table 4 of their article, Hilton & Lundberg (2020) summarise their findings from available literature, categorising differences between men’s and women’s athletic performance. This table has many errors and omissions including as some examples:
1. The reference group employed compares “average cis women” 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 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, 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 12 months 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; Sigward & 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 accounted 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 6 months (SoRelle et al., 2019). This is largely ignored by the authors.
9. Table 4 reports absolute values for Wiik et al (2020) instead of the published height adjusted levels.
10. Hilton & Lundberg exclude the female reference values from Fighera et al (2018) presumably as the latter’s 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 that contradicts Hilton & Lundberg’s argument.
All is well and good, but as I will continue to reiterate, I am no scientist, so perhaps someone on YouTube could give an “idiot’s guide” to the Hilton Lundberg paper?
Well, I found this: https://www.youtube.com/watch?v=6VtjgZF9RE8
The issue regarding trans women competing in sports is complex, and from my research, it is clear that at this time, the science presented from both “sides” of this debate is lacking – far more research on elite trans athletes needs to be done and given the minimal number of trans athletes in competition that will take decades. The Candian report states that just three research papers involving active trans women athletes have ever been published.
In the UK, statistics suggest some 32 million people participate in sports or at least undertake exercise of some format. However, stats from 2021 state that just 63 athletes have applied to join the related sports ‘trans inclusion’ policy. In the UK, trans women in sport is not a major issue in comparison with the lack of trans healthcare, the potential demise of human rights and a transphobic press.
As a genuine human rights activist and in my second year as the Women’s Officer in my local Labour Party, I know I represent women – and anything I write or say, I will be accountable.
That’s how it should be.
I certainly don’t want female athletes disadvantaged any more than they already are …for example, most are paid significantly less than their male counterparts, but no one, including Emma Hilton, Helen Joyce or the organisation Sex Matters, seems to care about that.
But equally, I don’t want trans women barred from participating in sports because of who they are.
The gender-critical will promote “open” categories meaning trans women compete with men, where they would have zero chance of winning because of testosterone suppression. That is unfair.
There are answers to this debate, but that requires “thinking out of the box”, because, for now, science doesn’t have the answers.