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Increasingly visible participation by transgender people in athletic competition has resulted in efforts to include transgender women in the women's categories while addressing possible advantage they might have from exposure to typically male levels of testosterone.

There does not seem to be any reason to expect advantage for transgender people prior to puberty of or for transgender people whose gender-affirming treatment begins at the onset of puberty. To date, the only established driver of athletic advantage in men over women is testosterone. Further, the existing literature suggests that treatment to lower testosterone may be sufficient to erase that advantage in at least some athletic activities.

Whether other aspects of puberty are advantages or disadvantages in certain sports remains to be established. There is need for more research on the topic. In addition, there is a need to prioritize the need to motivate people to participate in sport for better health.

Read a Q&A with the author here and additional expert commentaries on the clinical implications here.