Transgender women athletes have an athletic advantage over cisgender women
The weight of current physiological and sports science literature indicates that transgender women retain residual athletic advantages in strength, muscle mass, and cardiopulmonary capacity compared to cisgender women, even after standard periods of testosterone suppression and hormone therapy.
The retrieved literature heavily emphasizes empirical studies and systematic reviews (e.g., Harper 2015/2021, Hilton & Lundberg 2021, Roberts et al. 2020) demonstrating that while gender-affirming hormone therapy reduces certain parameters like hemoglobin rapidly, key determinants of athletic performance such as muscle mass, strength, and absolute cardiopulmonary capacity undergo only modest reductions (typically around 5%) and remain elevated above cisgender female baselines even after years of suppression. Although some reviews call for more controlled data or note overlapping relative metrics, the preponderance of recent high-quality physiological evidence supports the presence of an athletic advantage.
David J. Handelsman, Angelica Lindén Hirschberg, Stéphane Bermon. Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance. 2018. https://doi.org/10.1210/er.2018-00020
Circulating testosterone drives male physiological advantages in muscle mass, strength, and hemoglobin, creating an ergogenic advantage.
Bethany A. Jones, Jon Arcelus, Walter Pierre Bouman, Emma Haycraft. Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies. 2016. https://doi.org/10.1007/s40279-016-0621-y
A systematic review found no direct or consistent research demonstrating that transgender female individuals possess an athletic advantage at any stage of transition.
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Emma Hilton, Tommy R. Lundberg. Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage. 2020. https://doi.org/10.1007/s40279-020-01389-3
Testosterone suppression in transgender women results in only modest reductions (about 5%) in muscle mass and strength after 12 months, preserving a muscular advantage.
Joanna Harper, Emma O’Donnell, Behzad Sorouri Khorashad, Hilary McDermott, Gemma L. Witcomb. How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation. 2021. https://doi.org/10.1136/bjsports-2020-103106
After up to 36 months of hormone therapy, transgender women retain lean body mass, muscle area, and strength values that remain above those of cisgender women.
Anna Wiik, Tommy R. Lundberg, Eric Rullman, Daniel P. Andersson, Mats Holmberg, Mirko Mandić, Torkel B. Brismar, Olof Dahlqvist Leinhard, Setareh Chanpen, John N. Flanagan, Stefan Arver, Thomas Gustafsson. Muscle Strength, Size, and Composition Following 12 Months of Gender-affirming Treatment in Transgender Individuals. 2019. https://doi.org/10.1210/clinem/dgz247
One year of gender-affirming treatment results in robust changes for transgender men but only modest decreases in muscle mass and strength for transgender women.
Cassandra Spanos, Ingrid Bretherton, Jeffrey D. Zajac, Ada S. Cheung. Effects of gender-affirming hormone therapy on insulin resistance and body composition in transgender individuals: A systematic review. 2020. https://doi.org/10.4239/wjd.v11.i3.66
Feminizing hormone therapy decreases lean mass in transgender women, but absolute values and retained physiological differences leave residual performance advantages.
Ada S. Cheung, Sav Zwickl, Kirsti Miller, Brendan J. Nolan, Alex Fang Qi Wong, Patrice Jones, Nir Eynon. The Impact of Gender-Affirming Hormone Therapy on Physical Performance. 2023. https://doi.org/10.1210/clinem/dgad414
While some relative performance metrics approach those of cisgender women, absolute lean mass and certain strength measures remain higher in transgender women.
Leonardo Azevedo Mobília Alvares, Marcelo Rodrigues dos Santos, Francis Ribeiro de Souza, Lívia Marcela Santos, Berenice B. Mendonça, Elaine Maria Frade Costa, Maria Janieire Nazaré Nunes Alves, Sorahia Domenice. Cardiopulmonary capacity and muscle strength in transgender women on long-term gender-affirming hormone therapy: a cross-sectional study. 2022. https://doi.org/10.1136/bjsports-2021-105400
Absolute cardiopulmonary capacity and mean strength in transgender women remain higher than in cisgender women, even after long-term hormone therapy.
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