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

Abstract

The IOC recently published its framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. This framework is drafted mainly from a human rights perspective, with less consideration for medical/scientific issues. The framework places the onus for gender eligibility and classification entirely on the International Federations (IFs), even though most will not have the capacity to implement the framework. The position of no presumption of advantage is contrary to the 2015 IOC consensus. Implementation of the 2021 framework will be a major challenge for IFs that have already recognised the inclusion of trans and women athletes with differences of sexual development (DSD) using a scientific/medical solution. The potential consequences for sports that need to prioritise fairness or safety could be one of two extremes (1) exclusion of all transgender or DSD athletes on the grounds of advantage or (2) self-identification that essentially equates to no eligibility rules. Exclusion of all transgender or DSD athletes is contrary to the Olympic charter and unlawful in many countries. While having no gender eligibility rules, sport loses its meaning and near-universal support. Athletes should not be under pressure to undergo medical procedures or treatment to meet eligibility criteria. However, if an athlete is fully informed and consents, then it is their free choice to undergo carefully considered or necessary interventions for gender classification for sport to compete fairly and safely in their chosen gender. Free choice is a fundamental human right, but so is the right to fair and safe competition.

Clinical Concerns on Sex Steroids Variability in Cisgender and Transgender Women Athletes

“…Even with individual variability and depending on performed therapy (▶ Tables 2, 6), hyper-androgenic females and TW athletes might have small but useful advantages during sports competition. However, it is necessary to gather proportionate, evidencebased, and reproducible data to draw definitive conclusions [86,124]. Specific case-by-case and sport-by-sport investigations are recommended and all genetic-, endocrine-, and treatment-related factors potentially influencing exercise physiology and the final result in competitions should be addressed (▶ Tables 3, 4, 6).…”

“…Due to the social and political stance against gender discrimination, the scientific evaluation of this question is very difficult. Particularly, the new IOC framework on fairness, inclusion, and non-discrimination based on gender identity and sex variations in sports has generated a very serious debate and discussion in sport and exercise medicine and we are waiting for possible new sport federations' regulations for sport inclusion in these athletes [84][85][86]. In this sense, serious concerns will arise because in some countries it is possible to be a TW athlete without assuming GAHT, thus remaining, from a functional and endocrinological point of view, a male individual (in Switzerland, for example).…”

Advancing feminist innovation in sport studies: A transdisciplinary dialogue on gender, health and wellbeing

“…When IFs are making decisions about eligibility criteria, they grant enormous power to sports doctors. What I find interesting is that in the context of sport, doctors have a kind of double hat: they have a clear responsibility to prioritize athlete health ( 47 ), yet they also value (and typically prioritize) the sports science pursuit of “performance” knowledge ( 48 ). The struggle, then, is to articulate claims about the harms of eligibility regulation that are legible to sports scientists and doctors.…”

Inclusion, fairness and non-discrimination in sport: a wider lens

“…In response to the IOC framework,5 the International Federation of Sports Medicine and European Federation of Sports Medicine Associations argued that ‘if an athlete is fully informed and consents, then it is their free choice to undergo carefully considered or necessary interventions for gender classification for sport to compete fairly and safely in their chosen gender’ 9. We argue that for an athlete under duress with the threat of non-participation at hand, this is not ‘consent’ but rather ‘coercion’, and this approach opens a dangerous door towards invasive examinations and potential abuse, especially for athletes of younger age 10…”