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. 2024 May 28;58(11):586-597.
doi: 10.1136/bjsports-2023-108029.

Strength, power and aerobic capacity of transgender athletes: a cross-sectional study

Blair Hamilton  1   2 , Andrew Brown  2 , Stephanie Montagner-Moraes  2 , Cristina Comeras-Chueca  3 , Peter G Bush  2 , Fergus M Guppy  4 , Yannis P Pitsiladis  5   6
Affiliations

Strength, power and aerobic capacity of transgender athletes: a cross-sectional study

Blair Hamilton et al. Br J Sports Med. .

Erratum in

Abstract

Objective: The primary objective of this cross-sectional study was to compare standard laboratory performance metrics of transgender athletes to cisgender athletes.

Methods: 19 cisgender men (CM) (mean±SD, age: 37±9 years), 12 transgender men (TM) (age: 34±7 years), 23 transgender women (TW) (age: 34±10 years) and 21 cisgender women (CW) (age: 30±9 years) underwent a series of standard laboratory performance tests, including body composition, lung function, cardiopulmonary exercise testing, strength and lower body power. Haemoglobin concentration in capillary blood and testosterone and oestradiol in serum were also measured.

Results: In this cohort of athletes, TW had similar testosterone concentration (TW 0.7±0.5 nmol/L, CW 0.9±0.4 nmol/), higher oestrogen (TW 742.4±801.9 pmol/L, CW 336.0±266.3 pmol/L, p=0.045), higher absolute handgrip strength (TW 40.7±6.8 kg, CW 34.2±3.7 kg, p=0.01), lower forced expiratory volume in 1 s:forced vital capacity ratio (TW 0.83±0.07, CW 0.88±0.04, p=0.04), lower relative jump height (TW 0.7±0.2 cm/kg; CW 1.0±0.2 cm/kg, p<0.001) and lower relative V̇O2max (TW 45.1±13.3 mL/kg/min/, CW 54.1±6.0 mL/kg/min, p<0.001) compared with CW athletes. TM had similar testosterone concentration (TM 20.5±5.8 nmol/L, CM 24.8±12.3 nmol/L), lower absolute hand grip strength (TM 38.8±7.5 kg, CM 45.7±6.9 kg, p=0.03) and lower absolute V̇O2max (TM 3635±644 mL/min, CM 4467±641 mL/min p=0.002) than CM.

Conclusion: While longitudinal transitioning studies of transgender athletes are urgently needed, these results should caution against precautionary bans and sport eligibility exclusions that are not based on sport-specific (or sport-relevant) research.

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Conflict of interest statement

Competing interests: YPP is a member of the IOC Medical and Scientific Commission, which recently published articles and framework documents on the topic. BH and FMG have recently published articles on the topic on behalf of the International Federation of Sports Medicine (FIMS). All authors declare no further conflict of interest or competing interests.

Figures

Figure 1
Figure 1
Blood measures. (A) testosterone; (B) oestradiol; (C) haemoglobin. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001. CM, cisgender men; CW, cisgender women; TM, transgender men; TW, transgender women.
Figure 2
Figure 2
Lung function measures. (A) Forced rxpiratory volume in 1 s (FEV1); (B) forced vital capacity (FVC) (C) modified Tiffeneau-Pinelli Index (FEV1:FVC); (D) peak expiratory flow (PEF). *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001. CM, cisgender men; CW, cisgender women; TM, transgender men; TW, transgender women.
Figure 3
Figure 3
Absolute and relative handgrip strength (GS) measures. (A) Absolute strength (right hand); B) Absolute strength (left hand) (C) relative strength to hand size (right hand); (D) relative strength to hand size (left hand); (E) relative strength to fat-free mass (FFM) (right hand); (F) relative strength to fat-free mass (left hand). *p<0.05, ***p<0.001, ****p<0.0001. CM, cisgender men; CW, cisgender women; TM, transgender men; TW, transgender women.
Figure 4
Figure 4
Absolute and relative anaerobic power measures. (A) Absolute CMJ height; B) Relative CMJ height to fat-free mass (FFM); (C) absolute peak power; (D) relative peak power to FFM; (E) absolute average power; (F) relative average power to FFM. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001. CM, cisgender men; CMJ, Counter Movement Jump; CW, cisgender women; TM, transgender men; TW, transgender women.
Figure 5
Figure 5
Absolute and relative cardiopulmonary exercise testing measures. (A) Absolute V̇O2max; (B) relative V̇O2max to body weight; (C) absolute anaerobic threshold (AT); (D) anaerobic threshold (%V̇O2max); (E) relative anaerobic threshold relative to body mass; (F) AT relative to at-free mass (FFM). *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001. CM, cisgender men; CW, cisgender women; TM, transgender men; TW, transgender women.
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