Positioning of the Spanish Society of Sports Medicine concerning participation in sport of gender-affirmed, transsexual or intersex persons

The social changes related to gender identity that have been taking place in recent years have a notable and growing impact on sports practice. The incorporation of people with sex reassignment, transsexuals, and intersex (different sexual development) in sports competition raises issues that until now were very rare and relevant but that are currently causing doubts, debate, and controversy. The Spanish Society of Sports Medicine (SEMED), aware that this issue has important repercussions, both on the professional practice of physicians who care for athletes, and on the health of the athletes themselves, understands that it is necessary to deepen the knowledge of the sports practice of people with sex reassignment, transsexuals and intersexuality and considers it appropriate to make an official position on this issue. This work addresses sex reassignment, transsexuality, and intersexuality, shedding light on their definitions, their prevalence, and the differences in sports performance between men and women. He also considers it important to make a reference to the forms of classification in sport, as well as the role of androgens (testosterone and dihydrotestosterone, DHT) in sport. It analyzes the sports participation of people with sex reassignment, transsexuals and intersexuals since the emergence of the Caster Semenya case to end with the positioning of the Spanish Society of Sports Medicine and the recommendation on actions proposed to the sports authorities on addressing the sports participation of people with sex reassignment, transsexuals, and intersex from the perspective of the functional, injury and incentive consequences of women's sports practice.