In the joint position statement signed by members of the International Federation of Sports Medicine (FIMS) and European Federation of Sports Medicine Associations (EFSMA) on the International Olympic Committee (IOC) framework on fairness, inclusion and non-discrimination based on gender identity and sex variations, more than 35 experts proposed approaches to integrate transgender women and female athletes with differences of sex development (DSD) into elite competition (1).
This joint statement highlighted the fact that serum testosterone can be a valuable marker to regulate the inclusion of such athletes into the elite female category but has limitations due to the multifactorial nature of sports performance. This limitation led the authors to conclude that innovative research studies are needed to enhance our knowledge of the impact of testosterone on performance and identify biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. Subsequently to this joint position, the IOC published their position statement in the British Journal of Sports Medicine (BJSM) (2), after consulting with many stakeholders including FIMS and EFSMA.
A more recent editorial on the same topic published in the BJSM by Olewinski (3), surprisingly disregards the recent IOC position statement (2) and fails to provide novel insights into the ongoing debate. One of the assertions by Olewinski (3) is that the FIMS and EFSMA joint position statement (1) cites “non-applicable, discredited, or flawed sources”. However, Olewinski (3) does not provide any specific details or evidence to substantiate this claim, rendering it unsupported.
Furthermore, Olewinski (3) claims that FIMS and EFSMA endorse “compulsory pre-participation genital exams and mandatory medical transition”, misrepresenting our position. In reality, our position and reflected in the publication, neither endorses nor advocates for such practices. We emphasize the importance of accurately representing the positions held by organizations involved in resolving this complex issue. It is surprising to see that such editorial misrepresentation is published in BJSM, a journal that prides itself on upholding high standards in the review and editorial process. High standards are crucial given the complexity surrounding the topic of transgender athletes in elite sports.
In response to Olewinski (3), a letter to the Editor of BJSM was drafted by many experts involved in leading medical roles in International Sports Federations and looking after athletes competing in numerous previous international events, including the Olympics/Paralympics. The letter was drafted to correct the misrepresentation of facts and to avoid further confusion. However, the letter was rejected without review with the option to be considered for a “rapid response”. This essentially downgraded response, is the second case following a previous rapid response (4) to another recent flawed publication in BJSM by Alvares et al. (5) on the same topic, which had limited to no impact in the field given it was not published but did enforce numerous corrections by the authors (6). This rapid response (4) presented a range of recommendations regarding misrepresenting published data, highlighting the need for high-quality and relevant research to inform policy and guidelines but as it is unpublished, these recommendations will not be seen. Therefore, our concern is that International Sports Federations will continue to support their transgender athlete policy with flawed publications and editorials. No author(s) correction can undo all the damage caused by its initial publication. It is the responsibility of the editorial team to prevent such occurrences which seem to be occurring more frequent on this topic in journals, not only confined to BJSM (e.g. (7) in the journal Sports Medicine).
While we acknowledge this chosen response by BJSM with different perspectives is integral to informing future and evolving research and policy, we strongly emphasize the need for accuracy and integrity in such academic discourse. In scientific debate, different opinions are welcomed based on evidence but also with full disclosure of connections to interest groups.
Editors of Journals should exercise caution in providing a platform for writings that may further complicate the already intricate issue of including transgender athletes in elite sport. It is a publishers and editors obligation according to the International Committee of Medical Journal Editors recommendations to publish corrections and comments (8). The editor may request reasonable modifications of a submission but rejecting this right and suppressing the core content of a response by posting it somewhere in the unseen part of the journals website, raises important concerns on the quality of the Journals processes.
■ Pitsiladis Y, Hamilton B, Geistlinger M, Bermon S, Bigard X, Migliorini S, Wolfarth B, Di Luigi L, Ionescu A, Schneider C, Bachl N, Miller M, Shroff M, Singleton P, Constantinou D, Swart J, Beltrami G, Arroyo F, Badtieva V, Kaux J-F, Rozenštoka S, Dienstbach-Wech L, Casajus J, Zelekova I, Steinacker JM, Ülkar B, Papadopoulou T, Webborn N, Casasco M, Fossati C, Barrett J, Bilzon JLJ, Dohi M, Li G, Ak E, Pedrinelli A, Pigozzi F
Pigozzi F, Bigard X, Steinacker J, Wolfarth B, Badtieva V, Schneider C, Swart J, Bilzon JLJ, Constantinou D, Dohi M, Di Luigi L, Fossati C, Bachl N, Li G, Papadopoulou T, Casasco M, Janse van Rensburg DCC, Kaux JF, Rozenstoka S, Casajus JA, Zelenkova I, Ak E, Ulkar B, Arroyo F, Ionescu A, Pedrinelli A, Miller M, Singleton P, Shroff M, Webborn N, Barrett J, Hamilton B, Geistlinger M, Beltrami G, Migliorini S, Dienstbach-Wech L, Bermon S, Pitsiladis YP. Joint position statement of the International Federation of Sports Medicine (FIMS) and European Federation of Sports Medicine Associations (EFSMA) on the IOC framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. BMJ Open Sport Exerc Med. 2022;8:e001273. doi:10.1136/bmjsem-2021-001273
Martowicz M, Budgett R, Pape M, Mascagni K, Engebretsen L, Dienstbach-Wech L, Pitsiladis YP, Pigozzi F, Erdener U. Position statement: IOC framework on fairness, inclusion and non-discrimination on the basis of gender identity and sex variations. Br J Sports Med. 2023;57:26-32. doi:10.1136/bjsports-2022-106386
Olewinski L. We should oppose policies based on false science or distorted evidence with the potential to cause harm. Br J Sports Med. 2023:bjsports-2023-106946. doi:10.1136/bjsports-2023-106946
Budgett R, Pitsiladis YP, Pape M. High quality and relevant research needed to inform policy and help in decisions about the participation of transgender women in elite sport. Rapid Response to Alvares L. AM, Santos MR, Souza FR, et al. Cardiopulmonary capacity and muscle strength in transgender women on long-term gender-affirming hormone therapy: a cross-sectional study. British Journal of Sports Medicine 2022;56:1292-1299 doi:10.1136/bjsports-2021-105400 [21 August 2023].
Alvares LAM, Santos MR, Souza FR, Santos LM, Mendonça BB, Costa EMF, Alves MJNN, Domenice S. Cardiopulmonary capacity and muscle strength in transgender women on long-term gender-affirming hormone therapy: a cross-sectional study. Br J Sports Med. 2022;56:1292-1298. doi:10.1136/bjsports-2021-105400
Correction: Cardiopulmonary capacity and muscle strength in transgender women on long-term gender-affirming hormone therapy: a cross-sectional study. Br J Sports Med. 2023;57:e2. doi:10.1136/bjsports-2021-105400corr1. Erratum for: Br J Sports Med. 2022;56:1292-1298
Hamilton B, Guppy F, Pitsiladis Y. Comment on: “Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage”. Sports Med. 2023. Epub ahead of print. doi:10.1007/s40279-023-01928-8