Transgender Athletes: A Comprehensive Study - Part II

What Makes a Biological Male or Female?

What a question! I never had a problem identifying these categories because my profession requires Pre-Med anatomy and physiology training, and the differences between the sexes were and still are obvious on the anatomy lab tables for dissections.

Skeletal and Muscular System Differences

Pubertal changes in males lead to a ten times increase in testosterone. Therefore,  males go through puberty for longer, females typically have lower total muscle mass than males and lower muscle mass when compared to total body mass. Males convert more of their caloric intake into muscle and expendable circulating energy reserves, while females tend to convert more into fat deposits. As a consequence, males are generally physically stronger than females. Research indicates that males have greater total muscle areas than females, but the number of muscle fibres in males and females are alike. Instead of muscle fibre composition as the main reason for males’ greater absolute strength, the data indicates that total muscle area is responsible for this difference. 

Fibres and Strength Differences

Males’ muscle fibres are larger than women's, resulting in their more muscular appearance. Their larger muscle fibres appear responsible for more considerable absolute force production. The sex difference in muscle mass remains after adjusting for body weight and height. Males are usually at least one-third stronger than females when adjusting for differences in total body mass due to the higher male muscle mass to body-mass ratio. The greater muscle mass is reported due to a greater capacity for muscular hypertrophy due to higher levels of circulating testosterone in males (the reason the IOC had requested 2 years of testosterone management for transgender to be able to compete in Women’s Sports at the Olympics). 

Gross body strength measures suggest that females are approximately 50-60% strong compared to males in the upper body and 60-70% as strong in the lower body. One study of muscle strength in the elbows and knees – in 45 and older males and females found the strength of females to range from 42 to 63% of male strength. Males have greater hand grip strength than females. Differences in the width of arms, thighs, and calves appear during puberty. Interestingly, biological differences between females and males affect virtually every aspect of medicine and biomedical research. According to test scores and statistics, the science of physiology differentiates between male and female characteristics, organ systems, and functions regarding VOMax, strength, muscular and skeleton structures, etc. In fact, for almost all physical attributes, males have an advantage except flexibility, which seems more natural for females. A scientific statement released by the Endocrine Society called for sex differences to be studied more thoroughly to improve public health (Washington, DC, March 11, 2021). 

Skewed Research

Canada’s SIRC (The Sports Information Research Centre) released: “Despite the past year being significant for women’s sport, evidence demonstrates that athlete research is still heavily skewed towards males. This imbalance leaves large gaps in knowledge about Women’s Sports, sports-related injuries and, in particular, training and the menstrual cycle (SIRC, April 20, 2023). "When we understand the ways sex differences operate at baseline in health, which can either worsen the course of a disease to amplify differences in health outcomes or protect against it, we can more effectively prevent and treat medical conditions," said Aditi Bhargava, Ph.D., of the University of California, San Francisco in San Francisco, Calif., and the chair of the writing group that authored the Society's Scientific Statement.

For instance, SARS CoV-2 infection, the cause of the COVID-19 pandemic, disproportionately affects men. A U.S. Centers for Disease Control and Prevention report found that the overall case fatality ratio was about 2.4 times higher in men than women. Failing to consider sex differences can lead to the failure of promising drug candidates. Drugs are tested in cell lines or animals before drug trials are conducted in humans, and most of these foundational studies rely predominantly on male animals or cell lines. 

Clinical studies fail to consider sex as a variable and often report it as confounding. "Without exploring sex differences, some drug candidates that could be beneficial to women never have the chance to make it to market," Bhargava said. "The process of developing drugs using only males of a species in pre-clinical studies likely contributes to the higher rates of adverse drug reactions in women compared to men, failure to see efficacy in clinical trials and translation to therapeutics."

The statement explores three areas of biological differences between females and males. Imaging has found anatomical and volume differences in the brains of women and men, but these differences do not reveal any functional differences between the sexes. Heart and kidney diseases present differently in women and men. Although twice as many women as men report stress-related diseases, few studies are designed to explore mechanisms that highlight both similarities and differences between the sexes. 

The Confusion

Biological sex is often confused with gender in our society. The two sexes are differentiated as females, who have ovaries and produce eggs, and males, who have testes and produce sperm. Science states that those with two X chromosomes are biologically female, and those with one X and Y chromosome are biologically male. However, a DSD known as Androgen Insensitivity Syndrome (AIS) leads some to have an X and Y chromosome but physically appear to be girls. All sex differences in the zygote, or fertilized egg, stem from harbouring two different sex chromosomes. Both sexes have all classes of reproductive hormones, such as estrogen, progesterone, and testosterone, albeit at different levels. Differences in sexual development may result in a person's biological sex not aligning with these traditional definitions. 

Biological sex is separate from gender identity, which may or may not align with an individual's biological sex. Transgender or gender-diverse individuals should be screened for sex-specific medical conditions such as prostate cancer and cervical cancer based on body parts and tissues that are present, according to the Society's Clinical Practice Guideline on Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons (March 11, 2021).

Research Findings: Male versus Female

Variations in physical performance between men and women mostly come down to differences in body composition. Research shows that men typically have more lean muscle mass than women, while women naturally accumulate more fatty tissue. There are multiple differences between women and men regarding their normal cardiovascular function. For example, men have significantly greater left ventricular mass and chamber size than women. Because the left ventricular ejection fraction is the same in both sexes, the stroke volume is larger in men than in women. In addition, blood pressure regulation differs between sexes in several respects. Women have lower resting blood pressure and higher resting heart rate. 

In essence, Men are generally more muscular than Women, who are just over half as strong as Men in their upper bodies and about two-thirds as strong in their lower bodies. While the male metabolism burns calories faster, the female metabolism tends to convert more food to fat. Women store the extra fat in their breasts, hips, and buttocks, and as subcutaneous fat in the bottom layer of their skin, giving a woman's skin its softer, plumper feel. 

Cardiovascular Differences

There are multiple differences between women and men regarding their normal cardiovascular function. For example, men have a significantly greater left ventricular mass and chamber size than women. The stroke volume is larger in men because the left ventricular ejection fraction is the same in both sexes. On average, sedentary males have a VO2 max of roughly 35 to 40 mL/kg/min, while females score a VO2 max of around 26-30 mL/kg/min. This number is affected by many factors, e.g., heredity, training, age, gender, and body composition, according to the UC Davis Sports Medicine Department. 

Respiratory System

Males typically have larger tracheae and main bronchi and greater lung volume per body mass. They also have larger hearts, 10% higher red blood cell count, and higher hemoglobin hence greater oxygen-carrying capacity. They have higher circulating clotting factors (vitamin K, prothrombin and platelets). Such differences lead to faster clotting of blood and higher peripheral pain tolerance. Sex differences in the trachea and main bronchi are not apparent until at least age 14 on average, females have smaller lungs than males at birth. On average, sedentary males have a VO2 max of roughly 35 to 40 mL/kg/min, while females score a VO2 max of around 26 to 30 mL/kg/min. This number is affected by many factors, e.g., heredity, training, age, gender, and body composition, according to the UC Davis Sports Medicine Department. 

Conclusion: 

The scientific data and facts should be enough to affirm that males and females are indeed different and that males compete with physical and physiological advantages. Interestingly, the Elite had NO problem using ‘science’ to force Covid-19 vaccination onto the general population, lacking true research data to substantiate their action. Science … Science… Science-based… the public was told. On the other hand, ‘true science-based data ‘ collected over years of experimentation does not fit their narrative to strangulate Women’s Sports. 

Differentiating Between Sex and Gender

In recent years, there has been a push from doctors, health organizations, and the queer community to define and differentiate between sex and gender (and, with that, gender identity rose). According to the Planned Parenthood Website, 

… Sex is assigned at birth by a doctor (as either male or female), whereas gender is assigned by social and legal statuses largely informed by mainstream society's ideas of male and female behaviours, characteristics, and thoughts. Gender identity is how one personally feels and chooses to express themselves…

I have no issue with someone's gender identification and/or selected lifestyle. But as a Master Coach and Coach Developer, having educated over 28,000 coaches worldwide during 47 years of service and as an Elite coach in several sports, I am now questioning the emphasis on the ‘preached’ premise that the “Number 1 responsibility” of coaches is to guarantee the “safety of their athletes in the training environment and at competition/games sites”  as per Canadian National Coaching Certification Program’s Code of Ethics (“Ethical Decision Making” Module). The ‘quasi female’ with male anatomy parading nude in a girl’s/women’s locker room violates our safety and rights to privacy as coaches and female athletes! As for the male athletes, transgendering to females, they are entitled to compete BUT in their own class because they are not female or a woman! Period!  

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