Sport, Ethics and Philosophy

ISSN: 1751-1321 (Print) 1751-133X (Online) Journal homepage: https://www.tandfonline.com/loi/rsep20

Transgender and Intersex Athletes and the

Women’s Category in Sport

Pam R. Sailors

To cite this article: Pam R. Sailors (2020): Transgender and Intersex Athletes and the Women’s
Category in Sport, Sport, Ethics and Philosophy, DOI: 10.1080/17511321.2020.1756904

To link to this article: https://doi.org/10.1080/17511321.2020.1756904

Published online: 07 May 2020.

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SPORT, ETHICS AND PHILOSOPHY
https://doi.org/10.1080/17511321.2020.1756904

Transgender and Intersex Athletes and the Women’s

Category in Sport
Pam R. Sailors
Philosophy, Missouri State University, Springfield, USA

ABSTRACT KEYWORDS
Issues surrounding the inclusion of transgender and intersex ath- Protected categories;
letes in the women’s category in sport have spurred vigorous, and transgender; intersex
sometimes vicious, debate. The loudest voices on one edge of the
debate warn that allowing transgender and intersex athletes to
participate in women’s sport will push women out of sport entirely
as it is equivalent to having men compete against women, while
the other edge dismisses as a transphobic/racist/bigot anyone
advocating for less than full and unconditional inclusion. Between
the edges are more nuanced positions, offering arguments to sup-
port conclusions regarding competition, fairness, equality, and
inclusion. This paper is an attempt to discover and elucidate the
foundational commitments underlying the most common argu-
ments, evaluate the arguments, and consider implications of the
commitments.

The appearance and performance of South African athlete Caster Semenya has been
scrutinized since she won the 800-m world championship race in Berlin in 2009. Semenya
has a naturally occurring high level of testosterone, due to a Disorder of Sex Development,
a group of conditions more familiarly known as intersex (Karkazis 2019). Over the past
decade, her performance has waxed and waned, often in direct relation to the prevailing
International Association of Athletics Federation (IAAF) regulations governing testoster-
one levels for those competing in the women’s category. That is, when the regulations
required testosterone levels in the usual female range, Semenya’s times slowed; when the
regulations were suspended for 4 years, she ran her fastest times. In 2018, the IAAF issued
new testosterone-limiting regulations, which Semenya appealed all the way to the Swiss
Federal Tribunal. Her appeals were unsuccessful, so she is no longer running track, but has
joined a soccer team in South Africa. (For a more detailed background on Semenya’s
history, see Sailors and Weaving 2020, forthcoming.) Olympic athlete Shannon Rowbury
was among those critical of allowing Semenya to compete in the women’s category,
saying ‘It challenges and threatens the integrity of women’s sports to have intersex
athletes competing against genetic women’ (Zaccardi 2016).
Retired tennis great, Martina Navratilova, asserted in a December 2018 tweet, ‘You
can’t just proclaim yourself a female and be able to compete against women. There must

CONTACT Pam R. Sailors PamelaSailors@missouristate.edu Philosophy, Missouri State University, 901 S. National
Ave, Springfield 65897, USA
© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 P. R. SAILORS

be some standards, and having a penis and competing as a woman would not fit that
standard’ (Navratilova 2019a). This started a contentious Twitter exchange with transgen-
der athlete, Veronica Ivy (then known as Rachel McKinnon), who called Navratilova
transphobic and misinformed. The following February, Navratilova wrote an opinion
piece for The Sunday Times, in which she criticized Ivy and sought to ‘make a critical
distinction between transgender and transsexual athletes,’ so as to condemn the former
and approve of the latter. She also expressed support for Caster Semenya because ‘she
has never taken medication or sought an advantage,’ and will have to take drugs to
reduce her naturally occurring level of testosterone (Navratilova 2019a). In March 2019,
Navratilova published an update on her personal website, seemingly abandoning her
support for trans athletes who had transitioned by calling attention to retained physio-
logical advantages (‘height, weight, bone density and muscularity’). Along the way,
former Olympians Sharron Davies, Paula Radcliffe, and Dame Kelly Holmes spoke out in
support of Navratilova’s position that trans athletes should not be allowed to compete in
the women’s category.
Clearly, there are important distinctions between transgender and intersex athletes. To
the extent that the differences lead to different conclusions herein, they will be empha-
sized. However, because the overarching question is about participation in the women’s
category, there are many instances in which the same argument is offered regarding
inclusion. Thus, the argument can be evaluated without distinction. In what follows,
I begin with a brief section on why sport has separate categories for men and women,
discuss how one’s category is currently determined, evaluate common arguments for the
inclusion of trans and intersex athletes in the women’s category, and conclude with a look
at some suggested alternatives to the current binary system.

Why the Protected Category

Since the underlying issue here is participation in the women’s category of sport, it makes
sense to begin with the question of why categories have been carved out in sport at all.
I won’t argue for the claim here, but I think there is a strong case to be made that fairness
in physical competition is the fundamental value in sport, perhaps even a prerequisite for
the existence of sport. If we think of sport as a mutual quest for excellence, then
participants should have a reasonable chance of winning. Without such a chance,
a contest is neither competitive nor fair to the participants who are certain to lose.
Weight classes and age categories are examples of restrictions imposed in sport in an
effort to ensure fair competition where weight and age have a substantial impact on
performance. Physiological differences accompanying puberty result in a sporting per-
formance advantage for males over females, an advantage generally calculated at 10-12%
(TUCKER 2019). This does not mean that all males will possess this advantage over all
females, but it does make it likely enough in the majority of cases that it constitutes
a reason for a protected women’s category.
Along with the purely physical reasons for the protected category, there are more
general reasons for sex segregation in sport. Given their physiological differences,
‘women would only rarely triumph in competitions against men, [thus] mixed competi-
tion could reinforce the attitude that women are inferior’ (Sailors 2016). Jane English
pointed out long ago (1978) that the self-respect of all women would be negatively
 SPORT, ETHICS AND PHILOSOPHY 3

impacted if women failed to attain sporting achievement proportional to men. Beyond

the basic benefits of sport (e.g. health, character development, fun), she argued for the
importance of ensuring that the additional scarce benefits of sport that come with fame
and fortune are available to women. The visible success of women athletes, highly
uncommon if competing against men, undercuts the historical view of women’s infer-
iority and ‘provides not only an example to younger women of the range of the possible
for women, but it also changes our social views of what is appropriate and good for
women to do’ (Schneider 2000, 137).
Hence, there are good reasons, both sporting and more general, to maintain
a protected category for women. This would be a simple matter if gender was binary,
but as has been increasingly obvious, it is not always. This leaves sport in the position of
having to establish criteria for inclusion in the women’s category (Teetzel 2014). (The
men’s category does not need criteria, since it does not need protection, because men
already enjoy a competitive advantage.) Unfortunately, ‘there is no single physiological or
biological marker that allows for the simple categorisation of people as male or female’
(Karkazis 2019). The response to this has generally divided people into three groups: those
who believe an arbitrary trait is better than none at all, those who believe the lack of
a definitive trait means we should not look for one at all, and those who believe the best
solution is to eliminate sex-segregated categories altogether. Alice Dreger has coined the
first two groups the Anatomists and the Identifiers. While acknowledging that the com-
plexity of the matter means there is not a single physiological trait that will serve to
distinguish male and female, the Anatomists believe that the nature of sport and the
importance of maintaining two categories means that some biological marker must be
selected. The Identifiers think the complexity of the matter means sports authorities
should stop looking for a biological marker entirely. ‘Instead, we ought to go simply
with an athlete’s self-identity as man or woman (only requiring, perhaps, that it be
confirmed by her or his legal status)’ (Dreger 2012). The third group, which I’ll call the
Abandonists, believe that if making the distinction risks arbitrariness or unfairness, it
should not be made at all (Coleman 2018, 116). These three positions may be usefully
recalled throughout the examination of the most common arguments regarding partici-
pation of trans and intersex athletes in sport.

Testosterone and the Women’s Category

Anatomists, as noted, insist that some criteria must be applied to protect competition in
the female sporting category, even as they recognize that there is no single perfectly
determinative measure. In the main, the hormone testosterone is the measure that is
chosen because (a) there is a marked difference between the levels of men and women,
and (b) it is generally accepted to confer a performance advantage (which is why
exogenous testosterone is prohibited by anti-doping regulations). The endogenous tes-
tosterone level in females is 0.12–1.79 nmol/L, strikingly lower than the 7.7–29.4 nmol/L
level in males (Sailors and Weaving 2020). With this reasoning, an IAAF group tasked with
considering regulations for trans athlete participation noted:

It is widely recognised that testosterone (T) distributes bimodally among male and female
populations. T is also the primary known driver of the performance gap between males and
4 P. R. SAILORS

females. Consequently, while acknowledging that testosterone is not the only physical basis
for the performance gap, serum T has been found to be an acceptable proxy to distinguish
males from females for sports purposes (IAAF Report 2019).

Thus, current IAAF policy requires that both trans and intersex athletes maintain serum
testosterone levels below 5 nmol/L for at least 12 months prior to, and throughout,
competition in international events. Trans athletes must also identify themselves female
in a written and signed declaration acceptable to the association’s medical manager, and
they are prohibited from competing in the men’s category for at least 4 years after (World
Athletics 2019, 5–6).
It is important to recognize that these regulations were not arbitrarily manufactured,
but are instead supported by a growing body of scientific studies. For example, a 2018
paper in Clinical Endocrinology asserted that,

. . . recent studies of androgen levels in elite athletes have suggested that female athletes with
high testosterone levels, free or total, may have a significant competitive advantage over
those with low testosterone levels. Further controlled studies in both males and females have
shown significant increases in muscle mass and strength, and a clear dose-response effect
with administration of increasing amounts of exogenous testosterone (Clark et al. 2018, 20).

Similarly, Hirschberg and colleagues found ‘a causal effect of testosterone in the increase
in aerobic running time as well as lean mass in young physically active women’
(Hirschberg et al. 2019). Further, Brown (2020) provides an extensive review of studies
regarding sex-based physiological differences, supporting not only the positive athletic
performance effects of testosterone but also the persistence of those effects even after
androgen deprivation (see Handelsman, Hirschberg, and Bermon et al. 2018; Knechtle,
Nikolaidis, and Di Gangi et al. 2018; Lepers et al. 2013; Thibault and Guillaume et al. 2010)
(Gooren and Bunck 2004; Handelsman 2017; Knox, Anderson, and Heather 2019;
Tønnessen et al. 2015).
Still, there are people who argue that testosterone levels should not be the criterion for
sex segregation, some because they think it leads to unfair exclusion, and others because
they think it leads to unfair inclusion. The former position points out that testosterone
levels vary within categories, such that the most successful female (or male) athletes do
not always possess higher levels than their less successful competitors. That is, a chart for
any particular competition ranking athletes by testosterone level will not always match
a parallel chart ranking those athletes by outcome. The argument goes on to conclude
that since we cannot use testosterone levels to predict performance within a category
without error, they cannot be used to distinguish between categories in a meaningful way
because it would unfairly exclude athletes from a category in which they should be
included.
As persuasive as this argument may initially appear, further consideration rules it out as
flawed by the fallacy of generalizing from an atypical sample. Just because something is
true within a special group does not mean that is true across groups. For example, a chart
showing the height of all players in the National Basketball Association will not match
a parallel chart showing the performance ranking of those players. But the fact that we
cannot use height to predict success within the NBA does not mean that height is not
a competitive advantage in basketball. As Tucker explains, ‘when you are looking for the
predictive value of something, call it X, then its predictive power disappears when you
 SPORT, ETHICS AND PHILOSOPHY 5

look at a homogenous group who all have X—basically, you filter it out by selecting for it!
In this case, other factors take over, and X starts to look less important. In fact, X was THE
CRUCIAL FACTOR that got you into the conversation’ (TUCKER 2019). Testosterone does
not predict athletic success within a category because everyone in the category got
thereby possessing a comparably similar level. Therefore, it does not follow that testos-
terone is not predictive of athletic success between males and females, nor that categor-
ization by testosterone level is unfairly exclusionary.
In fact, there are those who argue the opposite, i.e. that categorization by testosterone
level alone is unfairly inclusive. According to this position, the androgynizing effects of
male puberty, experienced by both trans women and Y chromosome intersex athletes,
create performance advantages that are not lost with decreased testosterone. Males are
taller, with longer arms and legs, narrower pelvises, and larger hands and feet. These
‘legacy effect’ differences go deeper as well.

Males have around 40% more muscle mass, even when height is taken into account, and 40%
less body fat. The muscle they have is denser, more fibres, larger fibres. Higher numbers of
muscle stem cells make new muscle fibres, donate nuclei to strengthen existing muscle fibres,
help healing. They have higher proportions of fast twitch fibres—these are the fibres
responsible for explosive movement. Stiffer connective tissue—ligaments and tendons are
tighter springs—means greater storage of potential energy and even more explosive power.
In short, male muscles can move in ways more quickly and with far greater force than female
muscles. And with larger hearts, lungs and haemoglobin pools, they can feed them more
oxygen (Hilton 2019).

Of course, none of this would matter if everything changes such that the advantages are
lost when testosterone is decreased. However, this does not appear to be the case.
At least one recent study found that even though trans men (TM) gained muscle mass
and strength after supplementing testosterone in transition, trans women (TW) were still
stronger because they did not lose as much as the trans men gained. ‘The TM increased
strength over the assessment period, while the TW generally maintained their strength
levels. Despite the robust changes in lower-limb muscle mass and strength in TM, the TW
were still stronger following 12 months of gender-affirming hormone treatment, both in
absolute and height-adjusted values’ (Wiik, Lundberg, and Rullman et al. 2019). The reten-
tion of strength by trans women is sometimes attributed to ‘muscle memory’, a misleading
term for the training model wherein myonuclei once gained are never lost. ‘The elevated
number of nuclei in muscle fibers that had experienced a hypertrophic episode would
provide a mechanism for muscle memory, explaining the long-lasting effects of training and
the ease with which previously trained individuals are more easily retrained’ (Bruusgaard,
Johansen, and Egner et al. 2010). Stated more simply, the precondition for muscle strength
gained through androgenization is not lost when testosterone decreases, which can
account for the retention of strength in trans women.
Much of this is speculative because there have not been enough studies, primarily
because the pool of subjects has been so small. Wiik, Lundberg, and Rullman et al. (2019)
stress the need for studies focused only on trans athletes and of a longer duration (more
than 12 months) to better establish long-term consequences of transition, as well as to
add aerobic capacity and endurance performance to the items investigated. Pitsiladis
et al. (2016) also call for more work to be done in the area. ‘A concerted approach,
involving a series of well-phenotyped training and performance studies . . . will be
6 P. R. SAILORS

required to resolve the complex issues surrounding transgender and intersex athletes and
secure fair competition for all’ (387). So much remains to be established. However,
separating the categories by testosterone level alone will not suffice if physiological
legacy effects confer an unfair athletic performance advantage. Perhaps the questions
surrounding the effects of androgenization and testosterone levels are currently too
complex and contentious to settle policy issues. Hence, it is worth moving to examine
what counts as an unfair advantage.

Competitive Advantages
Faced with the difficulty of establishing a way to protect the women’s category in sport,
one alarmingly common strategy is to concede that trans and intersex athletes may have
an advantage, then assert that it does not matter. One reason given for this supposed
irrelevance is that sport is full of accepted instances of competitive advantage, so there is
no justification not to accept the androgenization advantage as well. US swimmer Michael
Phelps is usually invoked at this point to serve as an example. Phelps has extra-large
flipper-like feet, a long torso, and an alleged capacity to produce an abnormally low
amount of lactic acid, all advantageous traits for competitive swimming. His advantages
are no different, the argument claims, from the advantages possessed by trans and
intersex athletes, so if we allow his—and we do—consistency requires that we allow
theirs also. This argument is problematic for several reasons. First, sport is categorized by
sex, not by height or foot size or wingspan. Far from arbitrary, this serves the purposes
established earlier, i.e. to enhance opportunities for females to compete, to serve as role
models, and to foster a positive change in societal attitudes toward women through
winning. The physiological variables that confer acceptable advantages are within the
male or female categories, not across them.
We might also explain why some advantages are allowed and others are not by
distinguishing between all-purpose and sport-specific advantages. This tack is taken by
Knox, Anderson, and Heather (2019), who point out that high testosterone is a benefit in
every sport, serving as a precondition for sport-specific benefits.

For example, a short person is highly unlikely to become an elite basketballer but may excel in
gymnastics. Individuals of varying height can self-select into sports that suit their physiolo-
gical make-up, whereas people with average or low testosterone levels cannot. Hence it is
arguable that height is a tolerable unfairness, whereas high testosterone levels (being an all-
purpose benefit) is an intolerable unfairness.

The advantages enjoyed by Phelps are acceptable because they are advantages only for
the sport of swimming; the advantages from testosterone’s androgenization enjoyed by
trans and intersex athletes are unacceptable because they are all-purpose benefits,
extending beyond any one sport, creating the conditions that allow for the development
of advantageous traits no matter the sport.
To make the point even more clearly, consider the probable outcome in competitive
swimming if instead of sex, wingspan was the protected category. Missy Franklin and
Ryan Lochte are swimmers who have had great international and Olympic success.
They also have almost identical wingspans, but her best time in the 200-m backstroke is
a full 9 s slower than his, which would have put her half a lap behind him if they swam
 SPORT, ETHICS AND PHILOSOPHY 7

their best times against one another in the same race. ‘In a world in which competitors
were categorized by height and wingspan—or just height or just wingspan—instead of
sex, Franklin would not have had a world record; she would not have been on the
podium; in fact, she would not have made the team. In those circumstances, we might
not even know her name’ (Coleman 2018, 90). Separate categories are justified and
necessary when their absence would leave no doubt about who would triumph
through possession of competitive advantage. This is why university-age track athletes
are not allowed to compete against primary school runners, and heavyweight boxers
are not allowed to compete against bantam weight pugilists, but short people do
complete against tall people, even in sports where height is an advantage (Sailors and
Weaving 2020).

Nondomination
Another way to argue for the inclusion of trans and intersex women in the female
sporting category has been to take the opposite position, claiming that there really is
not an advantage at all. According to this argument, if trans and intersex athletes really
had an unfair competitive advantage, they would be dominating their sports, but the
fact that they do not always win means that fears about their inclusion in the women’s
category are unfounded. This argument is unconvincing for several reasons. To the
extent that it works, it works only for trans athletes, not intersex, since the latter have, in
fact, dominated at least some events. For example, the podium positions for the
women’s 800 m running event at the 2016 Rio Olympic Games were all occupied by
intersex athletes, with Caster Semenya winning gold, Francine Niyonsaba taking silver,
and Margaret Wambui finishing in the bronze medal position (SAILORS and WEAVING
2020). For trans athletes, it is difficult to know to what extent the argument succeeds
since the record of their results in women’s sport is limited and recent. The IOC allowed
trans women to compete in the Olympics beginning only in 2004, and then only after
having undergone sex reassignment surgery. The regulations were modified in 2015 to
drop the surgical requirement for the 2016 Olympics (as well as the requirement for
legal recognition of gender). This timeline provides less than 20 years of any possible
data, and less than 10 years of data under the less restrictive regulations. No argument
dependent on prior results could possibly have any persuasive power with such
a paucity of them.
Further, remember that male athletes have a 10–12% performance advantage over
female athletes, which means that a trans woman athlete would have to have been more
than 10% better than elite female athletes before transitioning in order to be as good as
an elite female. That’s a very small pool, likely composed of elite male athletes, none of
whom are known to have transitioned (while competitive). Even so,
An advantage may still exist. In fact, if the performance of a biological male got worse by
anything less than 10% after lowering testosterone, then the resultant MTF athlete would
have a conceptually “unfair” advantage, and one that could be theoretically insurmoun-
table. At 10% impaired, only truly elite men could win medals in women’s sport. At a 7%
loss of performance, you could be a medal winner even as a sub-elite male. But at 4% or
less lost with lower testosterone, a sub-elite man could totally dominate women’s sport
(Tucker 2019).
8 P. R. SAILORS

But this is as speculative as the argument that trans women will not dominate since they
do not currently dominate. My point is that we have too little evidence to make any
predictive claims at all.
Most importantly, what matters ethically is not how few or many trans or intersex
women succeed in women’s sport, but rather the effects of their participation on women’s
sport as a whole. The women’s category is protected in part to increase female opportu-
nities for participation and success. If trans and intersex athletes have an all-purpose
competitive advantage, their inclusion in the women’s category will have the same effects
as male inclusion, negating the justifying rationale for sex segregation. If even a single
athlete is unfairly deprived of her opportunity to triumph, or even to make the team, the
judgment of unfairness is not attenuated by the scope of the effect.

Human Rights
Still, those in the Identifier group described earlier would concede that trans and intersex
athletes possess a competitive advantage, yet maintain that the advantage is irrelevant
because participation in sport is a human right. Thus, athletes should be allowed to
compete in the category where they self-identify. Support for this claim is found in
number four of the IOC’s list of seven Fundamental Principles of Olympism, which asserts:
‘The practice of sport is a human right. Every individual must have the possibility of
practising sport, without discrimination of any kind and in the Olympic spirit, which
requires mutual understanding with a spirit of friendship, solidarity and fair play’
(International Olympic Committee 2019). The first thing to note about this statement is
that it does not only allow for participation but also prescribes the conditions of that
participation. That is, it requires that the sport be engaged in the proper spirit, and that
spirit includes fair play. If, however, some athletes possess an unacceptable competitive
advantage, fair play is thwarted. Thus, we should acknowledge that the IOC’s principle
contains responsibilities along with the right. It does not suggest that the right is absolute
nor that any person’s rights (or any element of the principle) should override those of
another (Imbrišević 2019).
The principle also restricts itself to participation alone, without guaranteeing that the
level of that participation be within the realm of choice of the individual athlete. To be
precise, what is at issue is not participation in sport, but participation in the women’s
category of sport. Given that there is a human right to sport, that right extends to all men
as well, but it does not confer to all (or any) men the right to compete in the women’s
category. That the right extends to all adults does not confer the right to compete in the
youth category. Along these lines, it is worth pointing out that there are always limits on
who is allowed to compete in any protected category, whether the criterion of inclusion is
weight, age, level of disability, etc. For example, trans athlete Veronica Ivy (then known as
Rachel McKinnon) won two consecutive world titles in the UCI (Union Cycliste
Internationale) Masters Track Cycling Championship in the 35–44 age group (Reza
2019), competing in a protected category within a protected category. That is, she was
protected from competing against both younger cyclists and men. Of course, the human
right to sport is possessed also by those younger cyclists and men, but I suspect Ivy would
dispute any claim that their right entitles them to compete in the women’s 35–44 age
group. It is difficult to see how the human rights argument can be used to permit only
 SPORT, ETHICS AND PHILOSOPHY 9

some humans the autonomy to identify into categories while prohibiting others from
competing in the protected categories of their choice. If self-identity is to be the practice,
we can do away with categories altogether (the Abandonist’s position) or develop an
alternative system of categorization.

Possible Alternatives
Abandonists have called for the elimination of sex segregation for at least a decade,
with FODDY and SAVULESCU (2011) arguing that sport has been forced into a false
dichotomy: ‘ . . . once we recognize that gender is not a binary quantity, sex segregation
in competitive sport must be seen as an inconsistent and unjust policy’ (1188).
Recognizing, however, that testosterone levels and metabolism create performance
advantages, they propose that the policy be determined by consideration of the goal
of sport. If the goal is to reward the greatest athletic performance, the gender of the
athlete is irrelevant and, thus, there is no need for categories. If the goal is to reward the
hardest worker, the gender of the athlete is equally irrelevant, but some form of
categorization will be necessary to compensate for the androgen advantages possessed
by male (and some female) athletes (Foddy and Savulescu 2011). A number of voices
have taken up the latter notion and developed proposals for policy that would align
with it. Before leaving Foddy and Savulescu, however, I note that they have artificially
limited the goals of sport, having not included the value of increasing opportunities for
participation and representation of girls and women, and the attendant positive societal
change. If eliminating sex segregation cannot be accomplished without losing those
valuable aspects, some argument for why that does not disqualify the change must be
provided.
Although maintaining sex categories, Devine argues for a sport-specific sorting system,
contending: ‘We should tailor eligibility criteria to the demands of individual sports, or at
least to clusters of sports that test similar physical excellences’ (Devine 2019, 164). Bianchi
(2019) goes further, eliminating the sex categories to have the Criteria for inclusion ‘based
on characteristics that are most relevant to specific sports as determined by pertinent
stakeholders (e.g. sports organizations, athletes, etc.), thereby allowing sports organiza-
tions to separate athletes with certain types of genetic advantages into categories of their
own, if possible.’ Bianchi recognizes, however, that her proposal might privilege male
athletes, since they may possess the sport-specific traits at a higher level than females.
Recall the earlier example of swimming, where Olympic gold medalist Missy Franklin
would not even qualify for the team, despite her wingspan being comparable to male
swimmers. Given the importance of female opportunities and representation in sport, this
would be a disaster. To avoid this, Bianchi suggests that ‘perhaps sports organizations
would want to develop categories for certain sports that will take into account cisgender
women athletes for representation and inclusivity purposes. At the same time, it would be
important to ensure that any categories developed are not seen as “lesser than” the
others, which may be hard to achieve’ (Bianchi 2019). In one way, this leaves us back
where we started, i.e. with sex-segregated sport and its disputed inclusion criteria. In
another way, it makes the situation even worse, as the number of categories multiply only
to all be filled with male athletes, while the women’s category is shunted to the side like
an afterthought.
10 P. R. SAILORS

Increasing the complexity even further to try to avoid the problem above, Knox,
Anderson, and Heather (2019) propose an algorithm that would sort athletes into multiple
categories designed to ensure fair competition within each. The algorithm would take
into account socioeconomic status, gender identity, and physiological factors, including
‘Size, for example, height and weight; Haemoglobin levels; Maximal oxygen uptake (VO2
max); Whether the athlete transitioned before, during or well after puberty; Past and
present testosterone levels, and the presence of testes; Previous characteristics of phy-
siology that are not changes via hormone therapy, that is, bone strength or structure, lung
capacity and heart size’ (Knox, Anderson, and Heather 2019). The algorithm would vary
depending on the factors most important to success within specific sports. The authors
maintain the necessity for such an algorithm even as they acknowledge the difficulty in
developing one as the scientific evidence continues to evolve.
Sport does not pause to wait on scientific evidence; however, so a possible stop-gap
strategy is to make the category determination athlete-specific instead of sport-specific
until we bridge the gap. Harper takes this approach, saying that while our ultimate goal
should be sport-specific guidelines, the protected category for women should remain for
now, with access to it determined not by sex but by ‘athletic gender’ (Harper et al. 2018).
She outlines her reasoning this way:

To create equitable competition within the women’s category, athletes should be divided into
male and female categories by using a performance-based metric. When athletes are divided
into separate weight categories for sport we do not ask a given athlete “do you feel like
a lightweight or a heavyweight?” Instead, the athlete steps on a scale to determine their weight
category. Likewise, a measurable quantity that directly affects athletic achievement should be
used to determine who plays women’s sport. Testosterone is such a quantity (Harper 2018, 148).

Harper would set the maximum testosterone level for eligibility for the women’s category
at 5 nmol/L, in line with current IOC and IAAF guidelines (Harper 2019), returning us to the
contentious issue of testosterone’s effects on athletic performance.
One way to avoid the conflict regarding testosterone would be to ignore it, along with any
other physical measure, altogether. Karkazis et al. (2012) take this path, arguing that anyone
legally recognized as female should be allowed to compete in the women’s category,
‘regardless of their hormonal levels, providing their bodies naturally produce the hormones’
(13). The condition that the hormones be naturally produced is likely intended both to
disallow doping and to allow the inclusion of intersex athletes. But if the goal is to support
fairness, as the authors claim, then it is the level of testosterone that matters, not how it got
there. Further weakening their argument is the insistence of using legal sex status as
determinant. ‘It is true that countries may define sex in different ways, but this variability is
not necessarily bad; it also allows countries to do so how they see fit’ (Karkazis et al. 2012, 13).
Surely, one’s eligibility ought not vary dependent on one’s geographical location. If this is an
ethical issue, which I think and suspect the authors agree, then it cannot be left to various
countries, some who violate human rights as a matter of course.

Conclusion
I sometimes tell my introductory-level philosophy students that if they are more con-
fused when they leave the class at the end of the semester than they are at the
 SPORT, ETHICS AND PHILOSOPHY 11

beginning, the class will have been a success. By that measure, this paper is a triumph,
since I find myself less certain of some of the views with which I began. However, I do
know, with certainty, two things. One is that we can make no progress on reaching
a satisfactory policy regarding inclusion in the women’s protected category if we
artificially restrict the scope of the question by demanding a simple yes or no answer.
Just as in the larger question of sex segregation in general, we have to recognize that
sports are varied. The existing discussion has tended to focus on individual power
sports, but the variety of sports is far richer. We can distinguish between individual
and team sports, between direct and indirect competition, between contact sports and
noncontact sports, and between amateur and professional sports (Sailors 2014). For
some of the sports, it makes no difference whether one has high testosterone or has
experienced male puberty, and that should make a difference in the policy we create for
the inclusion of trans and intersex athletes in the women’s category. There will be 18
mixed-gender events across 11 sports at the 2020 Tokyo Olympic Games: badminton,
equestrian, sailing, tennis, archery, judo, shooting, swimming, table tennis, track and
field, and triathlon (Price 2019). The variety of these sports and the ways in which mixed
competition has been achieved offer a glimpse of what is possible for the future. It will
take more than multiplying categories, however, because, ‘while they are intended to
be fair and inclusive, multiple categories can also fragment a sport and cause confusion’
(Navratilova 2019b), and multiplying events risks having some be treated as tangential
novelty acts.
The second thing I know with certainty is that sport changes as the culture changes, so
we should be open to arguments for expanding categories and increasing inclusion.
Those making arguments, on either side, have an obligation to ground those arguments
in science and reason, taking special caution to ensure consistency in their underlying
principles and commitments. As well, it is essential to acknowledge that ‘no matter how
little we think anatomy should matter to one’s social and political rights, surely we can’t
pretend biology doesn’t matter in sports. Surely there’s a reason we don’t let adults play in
the t-ball leagues, and a reason most women athletes want their own leagues’ (Dreger
2012). Any changes that affect who is included in the women’s category must advance, or
at least not impede, the goals for the service of which the category is protected in the first
place.

Disclosure statement
No potential conflict of interest was reported by the author(s).

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