Medical Examiner

Different Strokes

Pro golf goes transsexual.

Bagger plays like a girl 
        Click image to expand.
Bagger plays like a girl

It’s been a bittersweet year for Danish golfer Mianne Bagger. In her first season on the European women’s circuit, the 38-year-old athlete earned less than $3,500 and a ranking of 143 out of 172. Last weekend, after a promising first round at the KLM Open in Amsterdam, she faltered and finished in a tie for 35th place. Bagger’s poor showing has an upside, though: It helps refute the charge that, as a male-to-female transsexual, she has an unfair physical edge over other women. As Bagger put it on the phone from Denmark, “What this shows is that I have to work just as hard as everyone else to do well on tour.”

Bagger is the first player to take advantage of a decision by officials of the Ladies European Tour, the governing body for the women’s circuit, to let transsexuals compete. Their move followed a similar one by the International Olympic Committee, which last year ruled that athletes who transition from male to female, or from female to male, can compete as their new selves two years after gender reassignment. The entry of former men into women’s competitive sports may seem to recall the days when women athletes from Eastern Europe were routinely suspected of taking androgens, or male hormones. But it shouldn’t. Male-to-female transsexuals go the opposite route: They take female hormones, and their testosterone levels drop sharply once their testes are removed. As Bagger, who transitioned a decade ago, explains, “estrogen is a performance-diminishing drug.”

Men who undergo gender reassignment typically have surgery and permanently take female hormones like estrogen. (Nobody seems too worried about female-to-male transsexuals, who are treated with testosterone, dominating other men.) Studies show that male-to-female transsexuals lose much of their former muscle mass, which minimizes or eliminates any built-in power advantage they might have because of their genetic sex. Their body fat redistributes into typical female patterns, with pads forming at the hips and breasts. Their levels of hemoglobin, which carries oxygen in the blood, and insulinlike growth factor-1, or IGF-1, which stimulates protein synthesis, also fall to amounts approaching those normally found in women. Both hemoglobin and IGF-1 are believed to enhance endurance, and sports associations generally bar athletes from artificially boosting their levels of either.

Of course, some traits don’t change. As a group, male-to-female transsexuals are taller and have bigger hands and feet than the average woman. But they remain well within the normal range, which means that many non-transsexual women are taller and stronger than the average male-to-female transsexual.

The recommendation of the IOC advisory panel to admit transsexuals to the Olympic Games implicitly acknowledged that the strict division of human beings into females and males does not fully reflect the broad variation in chromosomal, hormonal, and genital characteristics found in people of both sexes. It’s a division that works for most but not all of us. Some women, for example, have high natural levels of testosterone. Should they be excluded from competing against women with only average amounts of testosterone? And what about people with “complete androgen insensitivity syndrome,” who are born with female bodies and genitals but have male-pattern XY chromosomes? Such variations are rare, but how rare is a matter of dispute.

Transsexual athletes also represent a challenge to a central tenet of organized sports: that artificial enhancement of the body destroys the level playing field essential to fair competition. The difference between “artificial” and “natural” enhancements is not always clear-cut. Why, for example, is it OK for athletes to undergo laser eye surgery that improves their vision to 20/15 but not to take steroids, which are similar to substances already found in the body? Why are swimmers allowed to shave their bodies to increase speed but not to transfuse themselves with their own blood to boost their hemoglobin levels? Why does boxing separate people on the basis of weight while other sports in which body mass also affects performance, such as football, do not?

Given such arbitrary distinctions, the European women’s golfing officials and the IOC are right to err on the side of inclusion. Of course, these questions will get more complicated if transsexuals start dominating their sports. So far, that hasn’t happened, though the number of male-to-female professional competitors is too small to draw broad conclusions. Renee Richards, the former Richard Raskind, reaped huge publicity but few victories when she joined the women’s tennis circuit in the 1970s. Her age—she was already over 40—didn’t help her. At 38, Bagger, too, is older than many of her competitors. That didn’t allay initial concerns that she might steamroll past the other women on tour but it could help explain why she hasn’t. Another recent male-to-female athlete, Canadian downhill mountain-bike racer Michelle Dumaresq, formerly Michael, won her country’s national championship. But then Dumaresq, who is 33, fared poorly at international events, finishing 24th at the 2002 world championships and 17th the next two years.

No known transsexuals took advantage of the Olympic offer in Athens last year. If they make off with lots of gold medals at next year’s Winter Olympics in Turin or the 2008 Summer Games in Beijing, maybe the scientists will have to figure out where their calculations went wrong. In the meantime, barring players like Mianne Bagger on the basis of speculative concerns would be ungenerous. The sports world should let in any transsexual who is good enough to qualify, and may the best woman win.