By: Jerry Trubman, Owner and Founder
*Disclaimer 1* I am not a doctor, and I don’t play one on the internet. Nothing in this article is intended to be medical knowledge or advice.
*Disclaimer 2* Warning: Dry article. No name-calling, outrage porn, or political stuff. If you’re looking for a colorful article that further polarizes an already divisive topic, you might as well stop reading here and go click on literally every other article on this subject. The purpose of this post is to provide a closer look at the actual data and numbers that surround this conversation to help you better understand the facts and figures. There is some gentle humor sprinkled in to keep you from falling asleep. None of this is intended to minimize the seriousness of the topic or offend anyone.
We are approaching this data from two different perspectives…
Perspective 1: A guy who has been coaching for 17 years and has extensive experience with athletes in strength sports (me).
Perspective 2: A Physical Therapist who has been in practice for 40 years and has personally been using hormone replacement therapy for 11 years (my wife).
I also acknowledge that zero minds will be changed by this article, so I’m not even attempting to try. It’s just a point-of-view that isn’t floating around out there, but should be.
We also need to start by making an important distinction: At the time of this writing, we do not have any transgender students. However, my staff and I have had numerous conversations, and we are all 100% aligned that if a transgender person were to decide to start training in our facility, we would treat them with the utmost amount of respect… as we treat anyone in our diverse clientele.
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News has been making the rounds of a transgender Olympic weightlifter named Laurel Hubbard, who, due to some recent changes in the IOC’s rules, is now allowed to compete in the Tokyo games as a woman (assigned male at birth).
This decision has been met with some controversy, and has become a heavily discussed talking point in my strength training community. I scoured the internet looking for opinions on both sides. Admittedly, the ‘against’ opinions far outweighed the ‘for’, but I did my best to hear both sides of the argument. The most unsettling part about reading these opinions is that very few of them seem to come from a place of true understanding of weightlifting as a sport, as well as what role testosterone/HRT (hormone replacement therapy) play in this conversation. My intention is to put the numbers into some sort of context to help better understand the subject.
What Is Testosterone?
Testosterone is a hormone. The testicles primarily make testosterone. Ovaries also make testosterone, though in much smaller amounts. Production of testosterone starts to increase significantly during puberty and begins to dip after approximately age 30. Testosterone is most often associated with sex drive and plays a vital role in sperm production. It also affects bone and muscle mass, how fat is stored, and red blood cell production.
What Is “Normal” Testosterone?
In the US, testosterone is typically measured in nanograms per deciliter (ng/dL) and is done by a simple blood test. Normal levels in cisgender men range from 270 to 1070, and 15-70 in cis-women. This may seem like a large gap for ‘normal’, especially for cis-men, and it is. However, there are a multitude of factors, both lifestyle and genetic, that can alter the number… hence the gap. For the sake of simplicity, let’s say the closer a person is to their peak testosterone-producing age (late teens/early twenties), the closer it would be to the higher number. And the older they get, the more it can inch its way down to the smaller number.
The reason I start with this is because most of the conversations about transgender athletes in sports revolve around hormone production, not genitalia. Most of us (even those with little medical knowledge) can agree that bone structure, muscle mass, skill, genetic gifts, etc., etc., play a much larger role in sports performance than what’s dangling between one’s legs.
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Gender-Specific Genetic Anomalies In Sports Is Not “New News”
Remember kids… the Olympics is an event where we gather up the absolute very best of the absolute very best. Whenever you throw several hundred of the world’s most elite athletes in the same room together, there will be genetic anomalies. This has been a topic of discussion since the 1940’s and it’s safe to assume it was an issue long before then. These hormonal anomalies were around long before the availability of modern-day synthetic hormones, so we can’t just blame it all on that and/or PEDs (performance enhancing drugs). By the 1960’s, visual genital inspections were used to confirm gender, followed by chromosomal analysis to detect the presence of the SRY and DYZ1 genes, normally found on the Y chromosome. By the 1970’s, the USTA and WTA introduced the Barr test, which identifies the person’s sex chromosomes.
Throughout the course of Olympic history, a small number of athlete's tests have come back… let’s just say… unusual. I don’t mean this disrespectfully. What I mean is that, when you go around the world plucking out the best the gene pool has to offer, there will be anomalies.
Litigating this topic is also not new news: A transgender tennis player, Renee Richards, filed a lawsuit in 1977 claiming her civil rights were violated, and a New York supreme court ruled in her favor. She competed in the US Open in 1977, lost in the first round, and retired four years later.
What Did The International Olympic Committee Say?
In 2003, the IOC drew up guidelines for transgender athletes looking to compete. There were three conditions to competing: First, they must have undergone reassignment surgery, including changes in the external genitalia and gonadectomy. Second, athletes must show legal recognition of their gender. And third, they must have undergone hormone therapy for at least two years. It was not until 2004 that the IOC allowed transgender athletes to participate in the Olympics.
In 2015, the IOC modified these guidelines in recognition that, in some countries, the above stated guidelines could not be executed for a number of reasons, ranging from human rights issues to the fact that gender reassignment is not legal in all parts of the world.
They changed the rules to the following:
- Trans men (assigned female at birth) could compete without restrictions.
- Trans women (assigned male at birth) declare their gender and not change that assertion for four years.
- Trans women demonstrate testosterone levels of less than 10 nanomoles per liter (nmol/l) for at least one year leading up to the competition and throughout the period of eligibility.
These guidelines were in place for the games in Rio in 2016 although there were no trans athletes at that event.
What The Heck Is A Nanomole?
Great question. The US, Belgium, and others use nanograms per deciliter in blood tests, but some countries (UK, Netherlands, Scandinavia, etc.) use SI (System International) units expressed in nmol/l. I used a handy conversion table on Google to discover that 10 nanomoles is approximately 288.42 nanograms per deciliter. This means a trans woman can have 4x the amount of testosterone that is considered to be ‘high’ and nearly 20x the amount of what is considered low-normal and still be allowed to compete with other women.
Most sports scientists agree that this number is pretty high. As a matter-of-fact, other governing committees outside of the Olympics (World Athletics and IAAF) changed the limit to 5 nanomoles per liter, which would be 144.2 nanograms per deciliter… still double the amount of a high-normal cisgender woman.
I’ll let you decide on the fairness in these numbers, but as you’re pondering that, you should also be aware that these guidelines have created other consequences. For example…
Six Cisgender Women Have Been Banned From Competing In Some Running Events
Christine Mboma and Beatrice Masilingi, both Namibian 18-year-old sprinters (both women; assigned female at birth) were banned from competing in any Olympic race between 400m and 1600m because their testosterone was above the minimum amounts set by these new rules. However, they could still compete in the 100m and 200m events (not sure how they came up with that rule).
These two ladies join a list of four other ladies form the 2016 games in Rio… all cisgender women who can’t compete due to genetically high testosterone levels. The only way they would be allowed to compete is by going on hormone therapy to lower their testosterone levels. As far as I could research, none of them have agreed to do so.
Free Testosterone vs. Total Testosterone
One of the elements to the testosterone conversation that is not being talked about is the difference between ‘total T’ and ‘free T’. So, what is free testosterone? Most of the testosterone in your blood attaches to 2 proteins: albumin and sex hormone binding globulin (SHBG). Some testosterone is free, which means it is not attached to proteins. Free testosterone and albumin-bound testosterone are also referred to as bioavailable testosterone. This is the testosterone that is easily utilized by the body.
People who use testosterone replacement therapy (TRT) tend to have higher levels of free test, and therefore can gain/retain muscle mass easier than a person with the same T levels that occur naturally. Also, TRT users experience fewer dips and fluctuations than a non-supplementing individual. Conversely, users of testosterone inhibitors can have disproportionately higher amounts of bio-available ‘T’ (or ‘free test’).
This information is commonly known in my circles. However, I have not found a single mention of it when talking about these therapies in transgender athletes.
So, Is It All About The Testosterone?
In short, the answer is no. There are several other factors at play here. The main one being the difference in the structural differences between a post-puberty cis-man and a post-puberty cis-woman. Cis-men going through puberty gain additional muscular size, muscular strength, a bigger heart, and bigger lungs. These things don’t just instantly shrink with one year of HRT. And it’s just not as simple as using hormone therapies to undo the muscular and structural growth and development that takes place during those formative years as the end-all-be-all solution to leveling the playing field.
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The Sport Of Weightlifting
One of the arguments that is being made in favor of Ms. Hubbard competing with other women is that, since starting her transition in 2012, her totals in the two lifts she performs have gone down by 37kg in the last 9 years (her best snatch is down 12kg, and her best clean and jerk is down 25kg).
In the US, we use the word ‘weightlifting’ generically to refer to any lifting of weights, but in the Olympics, ‘weightlifting’ is a technical term used to describe two lifts: The snatch, and the clean and jerk. These are very powerful and explosive movements that require an amazing amount of technical skill, balance, mobility, explosive power, and strength to perform. Check out Hookgrip's YouTube channel and watch some of the lifts in slow motion, and you will appreciate just how incredible these athletes are. It's like watching a moving work of art!
Explosive power is one of the things that makes Olympic weightlifting what it is. Explosive speed and power are also some of the first things to diminish as one ages. Weightlifters peak around 25 years of age. It’s not uncommon to see max lifts from someone of Ms. Hubbard’s age (43 at the time of this writing) inch down over this amount of time. Also, it’s highly unusual to see an elite-level weightlifter at the age of 43.
So, is the drop in max lifts from the hormone therapy, or father time? I think we can agree it’s hard to say.
So, What’s The Solution?
Herein lies the debate. It seems, at this point, the science is trailing behind the culture… which is what makes this discussion complex and difficult to have. Voices in the LGBTQ+ community are calling for the abolition of hormone testing altogether and allow athletes to compete as they identify themselves. Small groups of anti-LGBTQ+ are saying that under no circumstances should transgender athletes be allowed to compete in women’s sport. Those in middle tend to think that neither of these options are equitable or viable. Even for those who are still as anti-LGBTQ+ rights as they come, they must admit that there is still the existence of those <1% genetic anomalies (found in all elite levels of sport) that color outside the lines of how we have historically defined gender.
One potential avenue to a solution lies in the sport of powerlifting (different sport from weightlifting altogether). At first, most powerlifting federations were not allowing transgender athletes. The USPA (second largest powerlifting federation in the US) has recently changed their official guidelines to ‘not making any distinctions between transgender or non-transgender athletes’ in their non-tested divisions. "Non-tested" means there are no drug tests done at these events.
I wasn’t in the room when they made this decision, but here is what I think the line-of-thinking was: "If we don't require drug-testing, it means that a woman can show up to a meet with an equal/greater testosterone level than any man at the same event. If this is the case, and hormone levels are the standard being used to make this determination, what the hell does it matter how an athlete identifies themselves?"
If an official from the USPA stumbles across this article and has data to the contrary, please feel free to reach out and enlighten me.
So…. You're Saying We Need An “All Drugs Allowed” Olympics?
Most of us are old enough to remember when “drugs were bad” in the Olympics. And by ‘old enough’, I mean you are older than 7. Drugs that alter hormones were strictly forbidden prior to 2004, and for the most part, they still are. Despite all of this, there were still tons of athletes using; they just never got caught. A doctor was quoted in the documentary of Lance Armstrong saying, “The only difference between an amateur and a professional, is that a professional knows how to pass the drug test.” In other words, they were all using… the pros simply knew how to pass the test. If you don’t believe this, just remember: Lance Armstrong was the most heavily tested athlete in sports history. This dude practically walked around with a probe in his butt for ten years. Total number of drug tests he failed? Zero. He later admitted that was using the ENTIRE TIME.
Paradoxically speaking, if you allow any available substance to be used by athletes to perform their absolute very best, you are essentially creating the most-level playing field. Under this theory, the athlete has the personal freedom to make whatever decision they would like with their body, in order to perform their absolute best. Is it perfect? No. Does this create the possibility of altering women’s sports as we know it? Yes. But we must understand this was already happening in the world of sport long before trans people were looking to compete.
That Sounds So Unhealthy!
Yes. Yes it does. But to my non-elite athlete friends, please understand something: If you decide to take on a certain moderate physical activity to get in better shape, improve quality of life, and maybe get a few more good years out of that old body… awesome! HOWEVER, the moment you decide that you want to be the best in the world in said activity, you have now thrown all the life-enhancing, feel-good, warm-and-fuzzy elements of that activity in the trash. There is nothing healthy about training to be the best in the world at an athletic event. These are the people who train until they puke, quickly wipe the sides of their mouth, then go right back to training some more. Elite athletes do not live longer than average folks… as a matter of fact, the opposite is true.
Thanks For Reading
If you’ve read this far down, thank you. I warned you in the beginning it was going to be a different type of article. If you came away from this absolutely certain how I personally feel on this subject, you definitely came up with that on your own. I have a sneaking suspicion that, as more science and data come along, this article will age far more gracefully than some of the other stuff out there. This is also the reason you don’t hear me shooting my mouth off online with simple answers to highly complicated questions. I would encourage my colleagues to do the same.
I’ll be back next month with a much more light-hearted post. Promise!
Until next time,
Jerry Trubman is a coach, clinician, author, blogger, and powerlifting state champion. With over two decades of lifting experience, he has devoted himself to seeking out better answers, and distilling them into practical programs that produce great results. Jerry has coached "Team Protocol" to 4 National Powerlifting Championships in the 100% Raw federation. He writes the internationally-read blog, “The Healthy Addiction” and lives in Tucson, Arizona with his wife, Marie, and dog, Asher. To subscribe to his blog, click here.
