IOC approves consensus with regard to athletes who have changed sex

18 May 2004
IOC News Press Release

The Executive Board of the International Olympic Committee (IOC) today approved the consensus proposed by the IOC Medical Commission stating the conditions to be respected for a person who has changed sex to compete in sports competitions. These conditions will be applied as of the Games of the XXVIII Olympiad in 2004 in Athens.

The consensus reads as follows: 

Statement of the Stockholm consensus on sex reassignment in sports

On 28 October 2003, an ad-hoc committee convened by the IOC Medical Commission met in Stockholm to discuss and issue recommendations on the participation of individuals who have undergone sex reassignment (male to female and vice versa) in sport.

The group was composed of:

- Prof. Arne Ljungqvist (SWE) - Prof. Odile Cohen-Haguenauer (FRA) - Prof. Myron Genel (USA) - Prof. Joe Leigh Simpson (USA) - Prof. Martin Ritzen (SWE) - Prof. Marc Fellous (FRA) - Dr Patrick Schamasch (FRA)

The group confirms the previous recommendation that any “individuals undergoing sex reassignment of male to female before puberty should be regarded as girls and women” (female). This also applies to individuals undergoing female to male reassignment, who should be regarded as boys and men (male).

The group recommends that individuals undergoing sex reassignment from male to female after puberty (and vice versa) be eligible for participation in female or male competitions, respectively, under the following conditions:

-Surgical anatomical changes have been completed, including external genitalia changes and gonadectomy

-Legal recognition of their assigned sex has been conferred by the appropriate official authorities

-Hormonal therapy appropriate for the assigned sex has been administered in a verifiable manner and for a sufficient length of time to minimise gender-related advantages in sport competitions.

In the opinion of the group, eligibility should begin no sooner than two years after gonadectomy.

It is understood that a confidential case-by-case evaluation will occur.

In the event that the gender of a competing athlete is questioned, the medical delegate (or equivalent) of the relevant sporting body shall have the authority to take all appropriate measures for the determination of the gender of a competitor. 

Explanatory note to the recommendation on sex reassignment and sports

In the past there have been rare cases of athletes who have competed under one gender and later in life undergone sex reassignment. Occasionally, such an athlete has gone on competing under the new gender. Such cases seem to have been dealt with individually by the responsible sports federations without any clear rules. They have, however, been extremely rare and do not seem to have created a significant problem for sport in general. 

With the arrival of improved methods for the identification of transsexual individuals, and improved possibilities to rectify any sexual ambiguity, the number of individuals undergoing sex reassignment has increased. The increase has become particularly significant after the introduction of legislation with respect to sex reassignment in many countries. 

The increasing number of cases of sex reassignment has also come to affect sport. Although individuals who undergo sex reassignment usually have personal problems that make sports competition an unlikely activity for them, there are some for whom participation in sport is important. Thus, the question has been raised whether specific requirements for their participation in sport can be introduced, and what any such requirements should be. 

The first international sports organisation to address the issue was the IAAF in 1990. An expert seminar unanimously recommended that any person who has undergone sex reassignment before puberty should be accepted in sport under the assigned gender. Individuals who have undergone sex reassignment after puberty were considered to represent a more complex problem, since they have been under the influence of hormones under their former gender during their puberty. In particular, a male puberty would mean an influence of testosterone, which could, in theory, be of importance even after a reassignment to female gender. It was, therefore, recommended that any such case be evaluated on an individual basis by competent experts before a decision be taken by the relevant sports authority. These recommendations have served as guiding principles also by the IOC when questions have been asked. 

In recent years it has become apparent that the recommendation to make a case-by-case evaluation of athletes who have undergone sex reassignment after puberty is insufficient. The IOC has been asked to explain what such an evaluation should include. What requirements should be fulfilled before the athlete is allowed to compete under the new gender? 

The present recommendation is the result of an updating of the IAAF guidelines by a panel of experts and to which clear requirements have been added with respect to eligibility for competition under the new gender following sex reassignment after puberty. The most debated aspects have been: (A) For how long will the hormonal influence of the earlier puberty be of importance? (B) Will the testosterone influence on the muscular strength during male puberty ever disappear? (C) For how long should the treatment with female hormones last in order to be considered sufficient? (D) How can one make sure that the required treatment with female hormone does really take place? All those questions were addressed by the panel, which also sought advice from further outside experts, before the enclosed recommendations were agreed upon. 

IOC Medical Commission Chairman Arne Ljungqvist

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