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We sit down with William Lynes, a urologist, to discuss the complexities surrounding the inclusion of SGID athletes in female sports. William explores the impact of biology on performance, the potential risks for female athletes, and the ethical dilemmas faced by sports organizations today. From historical cases to current controversies at the 2024 Paris Olympics, this conversation delves into the intersection of science, policy, and fairness in competitive sports.

William Lynes is a urologist.

He discusses the KevinMD article, “Should transgender athletes compete in women’s sports?”

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Transcript

Kevin Pho: And welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back William Lynes. He’s a urologist. Today’s KevinMD article is “Should Transgender Athletes Compete in Women’s Sports?” William, welcome back to the show.

William Lynes: Thank you, Kevin. Thank you for inviting me back.

Kevin Pho: So let’s jump straight into this one. It certainly came up in the news during the Paris Olympics. Tell us why you wrote this article in the first place and then talk about the article itself.

William Lynes: Well, I watched the Paris Olympics, as did a lot of people. I love sports, and I especially love women’s sports. I was a competitive swimmer as a child, which is a co-ed sport, and I swam with many female athletes. I respect them, and I enjoy watching them. For example, Simone Biles in gymnastics—her beauty, majesty, and power. Katie Ledecky, the great swimmer with similar characteristics, and so many other female athletes at the Paris Olympics that set world records, Olympic records. It was just wonderful. It really brings me to tears sometimes when I think about my childhood.

I was especially concerned about the boxing events in the women’s sports, in which there were two transgender individuals who actually won gold medals. That brought me to writing this article about my concerns with sexual gender identity disorders in women’s sports.

Kevin Pho: All right, so tell us about the article itself.

William Lynes: It’s a complicated subject, isn’t it? I mean, if you think about it, if you took an embryologic or genetic textbook, there would be at least one chapter, if not more, on this situation. I categorize it as what might be the chapter title: “Sexual Gender Identity Disorders.” Under that topic are things like intersex, hermaphroditism, sexual dysmorphism, and one that came into particular significance during the Olympics—disorders of sexual differentiation.

What they basically are is a lack of congruity between the genetic sex of the individual—and we’re talking about men in women’s sports, so these would be individuals with an XY chromosome. But in various ways, their biology is female. These individuals can be great athletes, and I want them to compete in a fair forum, but when you have a person who is biologically male with an XY genotype or karyotype, they carry an unfair advantage in sports when competing against women. We just know that those individuals are stronger, bigger, and more aggressive. This really puts them in an unfair situation.

The troubling thing is that we’re talking about injuries here, and I categorize those into two types. The most obvious type is physical injuries. We know of multiple examples where transgender individuals playing in women’s sports have injured female athletes. But there’s also psychological injury. You can imagine what it’s like to be on an international stage and be pummeled and humiliated.

One case was Iman Khalif, an Algerian DSD (disorder of sexual differentiation) or transgender athlete, who pummeled her opponent. The opponent had to pull out of the competition, and this was on international television. You can imagine the psychological injuries this causes. The same thing happened in the U.S. with Lia Thomas, a contemporary competitive transgender swimmer who competed against Riley Gaines. Riley has spoken openly about the psychological problems that caused her.

So, I ask people: Do we want to protect women’s sports? Ask yourself, do you want your daughter competing against a biological male where they risk psychological and physical injury? I think the overwhelming answer to that is no. I feel sorry for the transgender athlete, but they are at an unfair advantage, and something needs to be done. I would suggest we have a separate transgender competition, much like the Paralympic competition, where they have their own league. But the answer is not to have them in women’s sports.

Kevin Pho: I’m sure a lot of what you’ve said is known by regulatory bodies. So, is there anything they’re doing to mitigate some of your concerns, like establishing hormone level regulations or other guidelines? What’s currently happening?

William Lynes: Thank you. Well, I think there’s a mixed bag in that regard. As you know, Title IX is legal writing that has tried to support women’s sports. But in certain states, there are now rulings that make transgender athletes a protected class. In the case of the Olympics, the International Boxing Commission ruled on the two transgender boxers. I’m using the term “transgender” just for simplicity because the terminology is more complicated. But the Olympic Committee decided to allow them to compete, and they both won. There was Iman Khalif, the Algerian boxer, and Li Yung Ting, a Taiwanese boxer. They both won gold medals at the Paris Olympics.

So, I think regulatory bodies are mixed. I don’t think they’re doing enough, and I’m not sure we’re on the trajectory I would like to see to solve this problem.

Kevin Pho: Some advocates argue that not all transgender athletes have an advantage, and that performance should be evaluated on a case-by-case basis, depending on the sport. How do you respond to that argument?

William Lynes: I think the overwhelming number of cases shows that transgender athletes have an unfair advantage. We’re making it so complicated when everyone really knows—even if they won’t admit it—the differences between men and women. Men are bigger, stronger, and more aggressive. So, I can’t see a sport or an individual where there would be a fair playing field.

We have to remember that these individuals are rare, and we can’t change the entire structure of women’s sports for these rare cases. As I said, I would argue for them to have their own forum in which to compete.

Kevin Pho: Short of having their own forum, do you see any solution where they could compete within women’s sports, like more stringent hormone level regulations? Is there no other solution in the current framework?

William Lynes: Kevin, I think it’s much more complicated than just hormone levels. I’ve heard talking heads on television discuss this, and they really don’t know what they’re talking about. Again, as I mentioned earlier, a genetic textbook would have a chapter or more on this subject. We’re talking about multiple types of intersex, hermaphroditism, sexual dysmorphic disorders, and disorders of sexual differentiation. The differences between a female athlete and these individuals aren’t just based on blood testosterone levels. You can’t reverse the fact that these individuals were born as males. Even if their testosterone levels are normalized for competition, that doesn’t change everything. So no, I really don’t see a situation where a blood test could make everything equal.

Kevin Pho: After you wrote this article and shared your opinion, what kind of response or feedback did you receive?

William Lynes: I haven’t had any negative feedback, though I’ll admit I don’t have a large forum. But every person who has discussed this with me has completely agreed with my article. I think it’s an almost black-and-white issue. It’s one of those things where I just cannot see the other side. I respect transgender athletes and understand their desire to compete, but competing with an unfair advantage is something I don’t understand.

Kevin Pho: As far as you know, is there any movement toward creating a separate division for transgender athletes? Is that something being considered by regulatory bodies?

William Lynes: I don’t think it is. I haven’t heard that as a possible solution. I think people are either in the camp of excluding transgender individuals from professional or high-level sports, or they’re in the camp that says they’re OK and we need to accept it. I haven’t heard much about the idea of a transgender league.

Kevin Pho: We’re talking to William Lynes, a urologist. Today’s KevinMD article is “Should Transgender Athletes Compete in Women’s Sports?” William, let’s end with some take-home messages that you want to leave with the KevinMD audience.

William Lynes: I think women’s sports are beautiful, and we have a responsibility to support them. Title IX, since 1972, has done tremendous things in supporting women’s sports. But recently, there’s been a disturbing trend to allow transgender athletes into women’s sports, and I think this is very problematic. I would leave you with this thought: If you have a daughter, would you really want her competing against a biological man?

Kevin Pho: William, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

William Lynes: Thank you, Kevin.