Transwomen in elite sport: scientific and ethical considerations

J Med Ethics. 2019 Jun;45(6):395-403. doi: 10.1136/medethics-2018-105208. Epub 2019 Jun 19.


The inclusion of elite transwomen athletes in sport is controversial. The recent International Olympic Committee (IOC) (2015) guidelines allow transwomen to compete in the women's division if (amongst other things) their testosterone is held below 10 nmol/L. This is significantly higher than that of cis-women. Science demonstrates that high testosterone and other male physiology provides a performance advantage in sport suggesting that transwomen retain some of that advantage. To determine whether the advantage is unfair necessitates an ethical analysis of the principles of inclusion and fairness. Particularly important is whether the advantage held by transwomen is a tolerable or intolerable unfairness. We conclude that the advantage to transwomen afforded by the IOC guidelines is an intolerable unfairness. This does not mean transwomen should be excluded from elite sport but that the existing male/female categories in sport should be abandoned in favour of a more nuanced approach satisfying both inclusion and fairness.

Keywords: feminism; human dignity; regulation; scientific research; sexuality/gender.

MeSH terms

  • Athletes
  • Athletic Performance / ethics
  • Female
  • Humans
  • Male
  • Sports / ethics*
  • Sports / standards
  • Testosterone / blood
  • Transgender Persons*


  • Testosterone