Transgender, intersex and non-binary people in sport and physical activity: A review of research and policy September 2020

A review of research and policy relating to the inclusion of transgender, intersex and nonbinary people in sport.

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Executive Summary

Background Information

Historically,  society has conceptualised sex and gender as binary categories (male/female and man/woman or boy/girl). Competitive sport, with a few exceptions1, is organised into the  binary  categories  of  male  and  female.  This  is  to  create  fairness  due  to  the  natural  physical  advantages  of  male  athletes  in  most  sports. Some  argue  that  binary sex classification  has  significant  pragmatic  value  within  competitive  sport,  providing  a  standardised  and  consistent  framework  within  which  sport  can  operate  (Krech,  2017). However, others argue it is a simplistic framework, given the complex array of factors that contribute to athletic performance, and can result in perpetuating the patriarchal status quo and excluding individuals whose gender identity or biological make-up does not neatly fit   into   binary   gender   categories   (Krane,   Barak,   &   Mann,   2012;   Krech,   2017). Developments in human rights law have seen ‘explicit prohibitions against discrimination on the basis of sex or gender enshrined in a range of legal instruments, including national constitutions and human rights legislation’ (Krech, 2017, p. 270). Despite this, research suggests  that  individuals  who  are  transgender,  intersex or    non-binary  continue  to  face  exclusion and/or barriers within both competitive sport and sport-related physical activity.

Sport  policy  relating  to  the  eligibility  of  transgender,  intersex  and  non-binary  athletes  to  compete in sport has developed significantly over the past 60 years. A formalised policy of sex-testing  in  elite  sport  was  introduced  in  the  1960s,  initially  requiring  athletes  participating  in  women’s  events  to  submit  to  visual  and  gynaecological  examinations  at  competitions that are governed by the International Association of Athletics Federations (IAAF) (Love,   2014). The   International   Olympic   Committee   (IOC)   first   introduced   chromosomal testing for competitors in women’s events in 1968 which, over the following three   decades,   included   tests   designed   to   identify   the   presence   of   a   second   X   chromosome or the presence of a Y chromosome. These tests were abandoned prior to the 2000 Sydney Olympics, however, due to the ineffectiveness and ambiguity involved in determining sex through such procedures (Love, 2014). Since 2000, sporting governing bodies  such  as  the  IOC  and  IAAF  no  longer  practise  compulsory  sex-testing  for  athletes  competing in women’s events but have developed eligibility guidelines for the inclusion of athletes in women’s events. From an online search, it was found that several women and sport and LGBTQ+ organisations provide position statements on transgender inclusion in sport, but this is severely lacking in relation to intersex and non-binary inclusion in sport.

Research on transgender, intersex and non-binary inclusion in sport is still in its infancy. Some  sub-topics  of  investigation  are  developing  a  growing  body  of  research,  such  as  transgender  and  intersex  inclusion  in  elite  sport. Other  sub-topics  have  had  limited research attention, such as the inclusion and experiences of non-binary people in any form of sport and physical activity and the experiences of transgender and intersex people in grassroots sport and sport-related physical activity (SPA).

 1 Equestrian  and  luge  include  mixed-sex  events  at  the  Olympics  where  women  and  men  compete  against  each other. Some other Olympic sports include mixed team events where each team has an equal number of men and women, such as tennis, badminton and sailing. 


Transgender people in sport and physical activity

Sport and physical activity can play an important part in maintaining good physical, mental and social wellbeing for the increasing number of people identifying as transgender (Lopez-Canada et al., 2019). However, research suggests that transgender people face barriers in participation across the sporting landscape. At the elite sporting level, eligibility criteria have been introduced by national and international governing bodies to avoid transgender women having an ‘unfair advantage’. This is the result of some scientific studies finding that transgender women have a significant performance advantage over cisgender women due to increased testosterone levels and retaining advantaged accrued from their former male  physiology  (e.g.  Knox,  Anderson,  &  Heather,  2019). Other  experts  have  suggested  that the scientific evidence is not strong enough to warrant the exclusion of transgender athletes via eligibility criteria (e.g. Jones, Arcelus, et al., 2017b). Eligibility criteria can lead to the exclusion of some transgender women from competing in elite sport unless they use medication to reduce their testosterone levels (to below 10 nmol/L for the IOC regulations and below 5 nmol/L for the World Athletics regulations).

In   grassroots   sport   and   SPA,   it   has   been   found   that   discrimination,   lack   of   education/awareness,  binary  gender classifications  and  sex-segregated  changing  areas  can  lead  to  transgender  people  experiencing  harassment,  stigmatisation,   isolation  and  body dissatisfaction (Jones, Arcelus, et al., 2017a; Muchicko et al., 2014. This can result in  transgender  people  choosing  not  to  participate  in  these  activities  or  choosing  to  participate in individual sports that avoid body exposure and are less demanding in terms of social recognition (Hargie, Mitchell, & Somerville, 2015).

Several  women  and  sport  and  LGBTQ+  organisations  have  released  statements  on  transgender  inclusion  in  sport. Only  one  of  these  organisations,  Canadian  Women  and  Sport (CWS), provides a strong and clear statement outlining their position on transgender inclusion  at  all  levels  of  sport  (Canadian  Women  and  Sport,  2017). CWS  call  for  full  participation  for  transgender  people  in  sport  and  physical  activity  and  oppose  medical  intervention of any kind as a condition of competition. Other women and sport and LGBTQ+ organisations  promote  inclusivity  and  fairness  in  sport  but  do  not  clearly  state  their position on eligibility criteria in elite sport.

To  maintain  both  fairness  and  inclusivity  in  sport,  some  scholars  have  called  for  replacement of the gender binary in elite sport with a system that recognises the difference between people while creating space for all athletes (Anderson, Knox, & Heather, 2019; Knox  et  al.,  2019). One  suggestion  of  how  to  achieve  this  is  a  ‘multifaceted  algorithm’  similar  to  that used  in  the  Paralympics  that  would  be  tailored  to  individual  sports  and  account  for  a  range  of  physiological  and  social  factors  that  affect  athletic  performance(Anderson et al., 2019). More exploration and research of such ideas is required to gain a better understanding of the pros and cons of different approaches and their feasibility.

Whilst there is a growing base of sociological, psychological and philosophical research on the topic of the experiences and inclusion of transgender people in sport, there are some clear areas where more research is needed. In competitive sport, this includes research that:

  • Specifically and directly assesses performance advantage in transgender women athletes;
  • Further explores and assesses options for new ways of classifying sport;
  • Provides a  better  understanding  on  the  experiences  of  transgender  people  engaging in non-participation roles e.g. coaching, spectatorship and administration.

In relation to SPA, this includes research that: 

  • Examines pedagogical approaches for transgender children in PE;
  • Better understands the motivations of transgender people to engage in SPA;
  • Better understands the benefits that transgender people can enjoy from SPA.


Intersex people in sport and physical activity

Due  to  having  male  biological  attributes  as  well  as  female  biological  attributes,  some  female intersex people experience hyperandrogenism: a medical concept that is generally defined as women having excess androgen, specifically testosterone (Karkazis & Jordan-Young, 2018). Despite hyperandrogenism being a ‘natural state’ that is not the outcome of any medical intervention or manipulation, it is still considered to be a source of unfair competition  by  many  sporting  governing  bodies.  This  is  due  to  some  scientific  research  concluding  that  increased  testosterone  levels  (as  a  result  of  hyperandrogenism)  can  enhance  the  performance  of  athletes  in  sports  and  events  that  are  dominated  by  basic  biomotor capabilities such as strength, speed and endurance (Bermon & Garnier, 2017; Handelsman,  Hirschberg,  &  Bermon,  2018).   Other  research  has  found  no  convincing  evidence  to  support  the  view  that  hyperandrogenism  is  associated  with  performance  advantage in female athletes (Ferguson-Smith & Bavington, 2014; Sonksen et al., 2018).

Eligibility criteria have been introduced across many national and international governing bodies to try to ensure equality and protect the integrity of women’s classes and events in elite sport. The most controversial and high-profile of recent cases was the introduction of the Eligibility Regulations for the Female Classification (Athlete with Differences of Sexual Development),  more  commonly  known  as  the  ‘DSD  Regulations’,  by  the  International Amateur Athletic Federation  (IAAF)  in 2018 (IAAF,  2019a).  The  DSD  Regulations  require female  athletes  to  have  a  circulating  testosterone  level  below  5  nmol/L  to  compete  in  certain women’s events. The Regulations were challenged by affected South African 800m Olympic  Champion,  Caster  Semenya,  who  argued  that  they  unfairly  discriminate  against  athletes on the basis of sex and gender. However, the Regulations were considered lawful by  the  Court  of  Arbitration  for  Sport (CAS) on  the  basis  that  they  are  a  necessary,  reasonable  and  proportionate  means  of  achieving  a  legitimate  objective:  fair  and  meaningful  competition  in  the  female  category  of  elite  athletics  (Court  of  Arbitration  for  Sport, 2019).

Scholars  and  activists  have  criticised  and  challenged  the  DSD  Regulations  on  ethical  grounds.   The  overriding  ethical  concern  regarding  the  regulations  is  that  they  imply  a  violation against human rights. More specifically, ethical concerns have been raised about: the policing of women’s bodies; the denial of human biological complexity; the numerous breaches    of    confidentiality    surrounding    those    who    have    been    tested    for    hyperandrogenism;  the  reinforcement  of  negative  stereotypes  and  stigma;  the  potential  for  harm  to  athletes  as  a  result  of  suppressive  testosterone  therapy;  and  an  apparent  targeting  of  women  of  colour  from  the  Global  South  among  athletes  singled  out  for  investigation  (Henne  &  Pape,  2018;  Karkazis  &  Jordan-Young,  2018;  Loland,  2020;  Mahomed  &  Dhai,  2019)..  Ethical  debates  against  the  DSD  Regulations  have  also  questioned the sport classification system altogether, due to a privileging of some forms of  genetic  or  physical-based  classification  categories  (e.g.  age,  biological  sex  and  bodyweight) over others (e.g. height, limb length and natural talent) and a complete lack of classification system for social and economic factors  (Loland, 2020; Mahomed & Dhai, 2019).  Whilst individual scholars and activists have been vocal in their criticism of the DSD Regulations,  there  has  been  a  lack  of  collective  voice  amongst  women  and  sport  and  LGBTQ+ organisations on the matter.

Like  transgender  inclusion  in  sport,  some  scholars  have  suggested  scenarios  to ensure both fair competition and the inclusion of intersex athletes in elite sport. These include an intersex  category,  the  development  of  algorithms  that  would  account  for  a  range  of  physiological  and  social  factors  that  affect  athletic  performance,  and  the  reduced  significance  of  sports  emphasise  individual  testosterone-driven  inequalities  in  biomotor  capability (Loland, 2020).

There  is  a  growing  body  of  research  focusing  on  scientific  and  ethical  considerations  in  relation  to  the  inclusion  of  hyperandrogenous  intersex  athletes  in  elite  women’s  sport.  However,  there  is  still  a  lack  of  consensus  among  experts  as  to  the  extent  to  which  hyperandrogenous female athletes enjoy a performance advantage over cisgender female athletes. There is also a lack of conclusive evidence on potential negative health impacts of androgenous athletes  engaging  in  suppressive  testosterone  therapy  and  a  lack  of  research  focusing  on  the  wellbeing  of  athletes  diagnosed  as  intersex  athletes  and  how  they  can  be  best  supported.  Furthermore,  there  is  a  dearth of  research  focusing  on  the  experiences and inclusion of intersex athletes in non-elite sport and physical activity. This is, in part, due to many intersex people being unaware that they are intersex unless they undergo a medical procedure (Cunningham, 2019; Mahomed & Dhai, 2019). Despite this, more research is needed on topics such as the benefits of sport and physical activity for individuals diagnosed as intersex and the specific challenges faced by individuals who are knowingly intersex in engaging in non-elite sport and physical activity.


Non-binary people in sport and physical activity

In  contrast  to  transgender  and  intersex  inclusion  in  sport,  there  has  been  very  little  awareness  or  discussion  of  the  experiences  and  inclusion  of  non-binary  people  in  sport  and  physical  activity  in  the  public,  sporting  nor  academic  domains.  This  is  despite  the  potential benefits that inclusive sport and physical activity could bring to those who identify as  gender  nonconforming  and  encounter  health  disparities  (including  suicide  attempts)  compared to cisgender individuals (Clark et al., 2018).

Whilst many   national   and   international   sport   organisations   now   have   policies   for   transgender and intersex athletes, the vast majority of these policies do not incorporate non-binary  athletes.  From  an  online  search in  July  2020,  no  position  statements  were  found from women and sport nor LGBTQ+ organisations on non-binary inclusion in sport. Furthermore, any research on the experiences of non-binary individuals in sport tends to come under a broader LGBTQ+ umbrella and only relates to athletes.

The small amount of research that has been conducted has found that, in some cases, non-binary  individuals  face  similar  barriers  in  participating  in  sport  and  physical  activity  than those of transgender individuals. This includes the misuse of preferred pronouns and names by coaches and teammates, feeling uncomfortable wearing gendered uniforms and a lack of gender-neutral spaces (Shortridge, 2020; Storr et al., 2020). However, non-binary individuals do also experience different challenges because, whereas binary transgender people identify with one gender, non-binary people do not identify as either male or female. This  makes  it  particularly  challenging  to  participate  in  sport  and  physical  activity  when  most sports are split by gender and there is a lack of mixed-gender sports available (Storr et al., 2020).

It is clear that more research is required on the experiences and inclusion of non-binary people in sport and physical activity to better understand the benefits non-binary people can experience from being physically active, the unique challenges they face in doing so, and how they can be best supported to become and remain physically active.



The following definitions have been sourced from Stonewall (2020):


A (typically) straight and/or cis person who supports members of the LGBTQ+ community


Someone whose gender identity is the same as the sex they were assigned at birth. Non-trans is also used by some people.


The use of the birth or other former name of a transgender or non-binary person without their consent.


Often expressed in terms of masculinity and femininity, gender is largely culturally determined and is assumed from the sex assigned at birth.


Used to describe when a person experiences discomfort or distress because there is a mismatch between their sex assigned at birth and their gender identity. This is also the clinical diagnosis for someone who doesn’t feel comfortable with the sex they were assigned at birth.


How a person chooses to outwardly express their gender, within the context of societal expectations of gender. A person who does not conform to societal expectations of gender may not, however, identify as transgender.


A person’s innate sense of their own gender, whether male, female or something else (see non-binary below), which may or may not correspond to the sex assigned at birth.


A way of describing a person’s transition from their sex assigned at birth to the gender they identify with. To undergo gender reassignment usually means to undergo some sort of medical intervention, but it can also mean changing names, pronouns, dressing differently and living in their self-identified gender.


A term used in medical law to decide whether a child (under 16 years of age) is able to consent to their own medical treatment in relation to gender reassignment, without the need for parental permission or knowledge.


A term used to describe a person who may have the biological attributes of both sexes or whose biological attributes do not fit with societal assumptions about what constitutes male or female. Intersex people may identify as male, female or non-binary.


An umbrella term for people whose gender identity doesn’t sit comfortably with ‘man’ or ‘woman’. Non-binary identities are varied and can include people who identify with some aspects of binary identities, while others reject them entirely.


When a transgender person’s gender identity is disclosed to someone else without their consent.


Words we use to refer to people’s gender in conversation - for example, ‘he’ or ‘she’. Some people may prefer others to refer to them in gender neutral language and use pronouns such as they/their and ze/zir.


Assigned to a person on the basis of primary sex characteristics (genitalia) and reproductive functions. Sometimes the terms ‘sex’ and ‘gender’ are interchanged to mean ‘male’ or ‘female’


An umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth. Trans people may describe themselves using one or more of a wide variety of terms, including (but not limited to) transgender, transsexual, gender-queer (GQ), gender-fluid, non-binary, gender-variant, crossdresser, genderless, agender, nongender, third gender, bi-gender, trans man, trans woman, trans-masculine, trans-feminine and neutrois.


A term used to describe someone who is assigned female at birth but identifies and lives as a man. This may be shortened to trans man, or FTM, an abbreviation for female-to-male.


A term used to describe someone who is assigned male at birth but identifies and lives as a woman. This may be shortened to trans woman, or MTF, an abbreviation for male-to-female.


The steps a transgender person may take to live in the gender with which they identify. Each person’s transition will involve different things. For some, this involves medical intervention, such as hormone therapy and surgeries, but not all transgender people want or are able to have this. Transitioning also might involve things such as telling friends and family, dressing differently and changing official documents.


The fear or dislike of someone based on the fact they are trans, including denying their gender identity or refusing to accept it. Transphobia may be targeted at people who are, or who are perceived to be, trans.


This was used in the past as a medical term to refer to someone whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth. This term is still used by some although many people prefer the term trans or transgender.