Training Considerations for the Trans Athlete

Apr 24

training-trans-athlete-hormones-genetics

Takeaway Points:

The human body is remarkably plastic, and while there are physical differences between trans and cis clients, these differences are overhyped.
Hormones are one of the biggest factors that determine the “base pool” of our athletic talent. However, people across a wide range of hormonal profiles gain ability at roughly the same relative rates, regardless of their hormonal profile, and a transition from one profile to another effects the base pool and not the relative results.
There can be height differences between trans and cis exercisers, and this can impact performance, but the differences are generally small and we don’t bother adjusting for height within cis athletic populations anyway, so it’s not a concern that we seem to care about otherwise.
Trans athletes may face difficulty competing publicly, which needs to be taken into account as a coach or athlete.
There are concrete practical training differences between cis and trans exercisers, but this has little to do with what kinds of exercises you need to use or what constitutes a good exercise program. Trans exercisers can adapt and improve similarly to the way cis exercisers do.
Trans exercisers may face harassment or discomfort in the gym setting, and need to put extra effort into finding an appropriate gym.
As a coach, one of the most important things you can do is be respectful and understanding of your trans clients, and educate them on what to expect (athletically) when transitioning.

Here at GAINS, I’ve had the opportunity to work as an online coach with hundreds of clients. I am proud to say that, up to this point, I have worked with about fifteen or twenty trans clients, including some who have begun their transitions during our time together. As a result, I have frequently been asked how this impacts training.

Fortunately, there is one important fact that helps simplify training for trans clients: that all bodies are roughly the same physiologically in terms of how they adapt and respond to exercise, minus a few concrete differences due to hormone levels and differences in body fat.

Unfortunately, there is little research on women (most studies are performed on men, and are intended to analyze male athletic performance) and there is little to no direct research on trans athletes - likely due to the controversial status of transition and the general ignorance of the wider public to trans issues. Further, trans athletes face particular scrutiny due to the gendered system of athletic competition, which forces all athletes to compete in the blanket categories of male and female, with little standardization for hormonal variations. Often, they are imagined to have unique advantages to their cisgender counterparts.

Luckily, since we know that most bodies are roughly physiologically similar to begin with, I’d say that it’s safe to make the assumption that the primary concerns of trans athletes are related to hormones, and the effect that hormones have on our bodies. So to start, we need to talk about the importance of hormones.

Hormones

Hormone profiles are related to sport performance. This is a well-known and demonstrated fact.

Cis men tend to have much higher concentrations of testosterone than cis women, though there can be great individual variance. As a result, cis men tend to grow more during puberty, becoming taller. Testosterone is responsible for the growth of greater muscle mass (and correspondingly less fat mass), more body hair, and a deeper voice. High testosterone levels are also associated with (but not necessarily causative of) aggressive and confident behavior.

The importance of testosterone levels to sport performance is well known - more testosterone equals more muscle mass which means greater strength, higher metabolism, better recovery from exercise, and more.

The word “steroid” most commonly refers to anabolic steroids - the drugs we associate with enhanced performance. What is less commonly known is that steroid can refer to any variant of this particular molecular structure - including testosterone. Anabolic steroids are basically just synthetic testosterone variants that we use to influence our hormonal balance, signalling our bodies to build more muscle and take on more of the properties associated with these hormones.

The value of these steroids for sport performance has been repeatedly demonstrated, and I would argue that steroids account for the majority of the improvements in sport performance in the past 50 years or so. This is equivalent to an open secret at the highest levels of sport, and countries like Russia are known for the ubiquity of their drug usage.

Cis men using steroids can expect roughly a 10% increase in their competitiveness in strength athletics as well as a massive increase in muscle mass versus their non-aided counterparts. The modern sport of bodybuilding is highly dependent on the use of steroids to create the kinds of physiques that win world-class competition.

This makes it clear that hormone replacement therapy for those transitioning will have a similarly powerful effect on exercise performance. Hormone replacement therapy isn't the same kind or degree of hormone manipulation seen with the use of steroids, but it still matters. Trans people who start taking testosterone will see a sudden jump in recovery, speed, power, muscle, and strength as they train, and trans people taking estrogen will see similar effects in the opposite direction.

One concern for those who begin to take estrogen is that they will have to accept the fact that they will be seeing their performance decrease steadily as they begin hormones - a fact which will be disappointing, since none of us want to see our hard earned gains go away. However, once your hormone levels have stabilized, provided you continue to train, you will be at roughly the same relative level of athleticism as you were beforehand, simply adjusted for your new hormonal profile. In short, while your objective performance will have dropped, your relative performance will not.

Those who start taking testosterone will be moving in the opposite direction, seeing a sudden jump in their capabilities until their hormones reach a new, stable level. Again, you will be seeing an absolute change in ability, but not a relative one - you’ll still be roughly as good of an athlete, just adjusted for your new hormone levels.

The irony of the importance of hormones is quite clear: their importance to absolute performance is so self-evident that even cis men inject steroids in an effort to be the man they’ve always wanted to be.

A recent study showed that when transitioning, trans women runners saw a dropoff in performance consistent with the average dropoff between cis male world records and cis female world records - showing that, on average, hormones really are what make up most of the difference between cis male and cis female athletes. More research is necessary, but this data is a good start.

Yet this is a problem because we have NO standards for differences within group. Two cis female athletes may have vastly different hormone profiles due to natural variations - but we don’t bother to hormone test cis women to ensure that all competitors have roughly the same hormone profiles. These natural variations provide natural variations in the performance of cis athletes, and enable some cis athletes to perform better than others. There will always be an unfair playing field when it comes to the status of hormone levels, and this is not reducible to a cis-trans binary given the wide range that already exists between cis athletes.

Recently, Greg Nuckols did a massive personal meta analysis to analyze the impact of strength training for cis women. What he found was that, when he reviewed all the research, he found that cis women actually tend to gain relatively more strength than cis men as a result of training - although he hypothesized that this may partially be due to the fact that cis women are very rarely trained to begin with (so they're starting off at a lower level), while cis men are often encouraged to do at least some kind of recreational training here and there.

I think Greg summarized the impact of hormones quite well in this quote:

stronger-by-science-greg-nuckols-quote-steroids-women-men-strengthtraining

(And again, here's the link to that article, if you wanted to read further.)

In short, steroids (and thus to a certain extent hormonal differences between cis men and women) modify your base level of muscle/strength, but have minimal impact on the relative gains that you make by following a well-structured training program, regardless of gender.

Genetic Predisposition To Exercise

At the same time, hormones certainly aren’t everything. In many years of working with athletes and coaches, and many years of frank conversations with these athletes and coaches behind the scenes, I’ve had the ability to see a lot of perspectives on the importance of hormones to athletics.

It is common to believe that hormone levels are everything, or at least so big a part of the picture as to make everything else irrelevant. In one study, it was found that the use of steroids alone (without any training) caused greater muscle growth than simply training alone (with a placebo). Of course, it also found that a combination of the use of steroids and training produced the best results.

The typical interpretation of this study is clear: steroids (and by extension, testosterone levels) are more important than training. Hormones matter more than hard work. Chemical assistance is all that matters.

The reality is that while steroids are quite ubiquitous at high levels of sport, we can also assume that not all athletes are using. Sure, there’s a huge draw, but it can’t be completely universal. Many athletes with little to no vested interest in lying (talking about their careers years after the fact) have admitted that they weren’t actually using, or weren’t using nearly as much as people thought they were. I’ve had honest discussions with coaches who have worked with world-class athletes who weren’t using.

In one conversation with a coach, the coach told me that one of his athletes admitted that he had run bloodwork just to find that he actually had lower than average testosterone levels, despite competing at a national level.

Hormones are clearly a huge part of the picture, but they aren’t everything. We can assume that genetic predisposition to exercise (assuming similar training levels) and other non-hormonal factors are responsible for this difference. Science has not yet really identified many of the genetic factors responsible for our bodies’ ability to adapt and respond to exercise, so we’re still left with a great big question mark as to why some people’s bodies react so much differently than others’.

Since these genetic factors would be constant regardless of hormonal profiles, it’s safe to say that any impact that hormones would have on relative performance levels (AKA, how good you are as an athlete compared to other athletes) is probably still outshone by genetic factors. In short, if you weren’t a great athlete before transitioning, you probably won’t suddenly turn into an amazing one just by doing so. Likewise, if you were a good athlete beforehand, chances are that you will still be good relative to your peers after transitioning.

For example, trans weightlifter Laurel Hubbard first set junior world records in 1998 (before her transition) and then went on to further set records in 2017 (after her transition). While this sparked controversy about her having some kind of advantage, it’s clear that she was a world-record athlete even before her transition. Notably, while she has performed near the top of the pack since her transition, she's also actually nowhere near the world records in her weight class, set by Tatiana Kashirina.

Height Differences Between Cis and Trans Athletes

It’s popular to believe that trans athletes (particularly trans women) have some sort of unfair advantage over their cis counterparts. As of right now, there is little hard research on the differences between cis and trans athletes, making it difficult to draw evidence-based conclusions.

Cis men tend to be taller than cis women, and correspondingly tend to more easily build body mass. There is a correlation between height and how much muscle we can build. However, this is simply an average - the possibility of very short men or very tall women of course means that there’s a lot of crossover in terms of who wins the height lottery.

In certain sports, height, size, and limb length variations can also carry with them certain sport-specific advantages. For example, a tall frame is preferred in basketball, which reduces the need to jump as high. A powerlifter with particularly long arms relative to their legs will have a slightly easier time deadlifting (don’t have to lift the bar as far) but a slightly harder time bench pressing (have to push the bar further). Long arms can be a benefit in combat sports, where having reach can grant you an advantage at striking your opponent without fearing reprisal. A lighter body is an advantage in sports that rely heavily on movements involving your bodyweight, such as gymnastics. A heavier body is an advantage for absolute strength in the strength sports.

It’s often argued that since cis men are born on average with greater height and longer limbs, this means that trans women with longer limbs would have a corresponding advantage over their competitive cis counterparts with shorter ones.

However, this introduces numerous problems in terms of regulation: if having long limbs as a female competitor was a problem, this would mean that we would have to start banning naturally long-limbed cis women as competitors, or implement some sort of testing/normalization/division method that would sort competitors by limb length in order to ensure absolute fairness. Since such regulations don’t exist, it’s clear that these natural genetic variations in height and limb length are not normally a concern - except, of course, when it can be used as a way to exclude trans people.

On average, the impact of limb length differences is pretty small anyway, simply because most people’s limb lengths are pretty average relative to their height. Huge deviations from the mean are rare.

If anything, the advantage of height and weight doesn't make the trans woman athlete more competitive - they just mean that she is more likely to end up sorted into heavier weight classes, which are less commonly populated among cis women. In short, she is more competitive not because she has any advantage, but simply because there are fewer competitive athletes in her weight class. Likewise, most sports where body size has a huge and notable correlation with performance already have athletes sorted into weight classes, meaning that this would already be accounted for.

Less important to the public perception are ways in which trans men could also have a theoretical advantage. Male gymnasts often need to be quite short in order to be light enough to be tenable athletes. A trans man, typically having a shorter frame, could be seen to have an advantage against cis male competitors - but again, this isn’t something that most people seem to concern themselves about.

In short, while some slight advantages in terms of height difference and limb length may exist between cis and trans athletes, these advantages are the kind of natural difference that exist across the spectrum of cis athletes as well, without any concern from the general public. No one gets up in arms about particularly tall cis women excelling in basketball against other women, for example. So why is it that the instant that a tall trans woman starts competing in a sport in which height is an advantage is the instant in which the public gets out the pitchforks?

Competing Publicly

Trans athletes face additional scrutiny when competing publicly, in large part because of negative public attitude towards trans persons in general. Most of this scrutiny seems to be focused on trans women, who are expected to have more advantages than trans men due to their former hormonal profiles. It is unclear what status is given to non-binary trans athletes.

The International Olympic Committee (IOC) is the governing body for the Olympic games. In 2003, the IOC drew up new guidelines allowing trans athletes to compete. There are three major guidelines:

Athletes must have undergone full genital reassignment surgery.
Athletes must have their gender legally recognized, including proper documentation, by their country.
Athletes must have undergone hormone therapy for a minimum of two years prior to competition.

These guidelines have since been modified in 2015 due to various criticisms. The new guidelines are:

Trans men are allowed to compete without restriction.
Trans women must declare their gender as female, and maintain this declaration for a minimum of four years before competition.
Trans women must maintain a testosterone level below 10 nmol/L for a minimum of one year before competition.
Trans women must maintain this level throughout the competitive period.
Trans women must comply with additional testing (for example, blood work) intended to verify this level throughout.

These changes were designed to reflect a few major concerns: that athletes may compete from countries where it is difficult to get their gender status recognized by their country, that not all trans athletes will desire genital reassignment, and that “undergoing hormone therapy” puts no standard on exactly what hormone profiles will result. Some trans women may have profiles different from other trans women due to different dosages of hormone replacement.

Trans athletes have competed under these guidelines for years. However, they continue to face public scrutiny despite these additional rules.

Outside of the Olympics, it can still be difficult for trans athletes to compete. Bodybuilding and powerlifting competitions, for example, don’t really offer any accommodations for trans divisions or trans athletes. While one could still compete in cisgendered divisions, this may or may not be desirable. Some trans competitions exist, but they’re much harder to find.

Athletes in school sports will face additional pressure from their peers. Since school sports are far less centralized than the Olympics, it may be hard to see recognition in your school. For further info, I recommend looking through the resources at transathlete.com to find out what the laws for competition in your state are.

Practical Training Differences

Differences between trans men and women and their cis counterparts are roughly similar to the differences between cis men and cis women, so you can get an idea of how to train by studying the general training guidelines for your cis counterparts.

Here are some guidelines I’ve developed, in working with trans exercisers and athletes over my years of being a trainer and coach:

Sudden changes in hormonal profile. Going onto or off of HRT will cause initial bumps or drops in performance. These bumps or drops need to be planned for when working with transitioning athletes. Those going on testosterone should expect to take it easy and not push themselves too quickly (don’t get too overconfident with your newfound ability) and those going on estrogen should be aware that they should focus on maintenance of existing ability but expect to still see a drop. The general guideline is about 10% for speed related sports, but may be different in different domains (strength, muscle, power development, endurance, etc). This drop may be very discouraging, meaning that the psychological needs of the exerciser need to be put first and foremost.
Weight gain and loss. Estrogen causes people to hold more body fat while testosterone causes people to gain more muscle mass. As a result, when going on hormones, it is likely you will see fluctuations in your weight and muscle mass.
Monthly hormone cycles. Athletes will continue to have monthly cycles (or begin monthly cycles) after beginning hormones. This has some implications for training, and should be managed as with the monthly cycles of cis women.
Height and limb lengths. Trans athletes may have height and limb length proportions that are less common in their cis counterparts. This may predispose you to being better at certain movements and worse at others - but this is no different than the same considerations for cis exercisers.
Upper Body/Lower Body work. It’s commonly believed that the upper body muscles are the site of more androgen receptors than the lower body. This means that as you add more and more testosterone to the equation, the upper body tends to develop slightly faster than the lower body. This may explain some of the differences in strength and muscle standards for men and women (women tend to have about ½ the upper body muscle mass and about ¾ the lower body muscle mass of men) and why men’s physiques tend to get more “top heavy” as we add steroids into the mix. Aside from the normal response to changes in hormonal profile, these differences should be taken into account when transitioning and expecting changes in strength and muscle mass.
Muscle fiber type differences. Cis women tend to be more fatigue resistant and less suited for short, intense bursts of activity than cis men, largely due to hormones and muscle fiber type differences. Muscle fibers come in a variety of different types, some of which are more suited for endurance and others which are more suited for strength and size development. (This is why it is commonly experienced that women can handle a greater number of reps at any given intensity than men - 75% of 1RM might correspond to a weight that a man can lift for about 10 reps, and that a woman could lift for more than that.) Cis men and women tend to have different relative amounts of each type, so these differences may persist after transition. In short, trans men may still need to train similarly to cis women for a while after transition, and trans women may still need to train similarly to cis men for a while after transition. This doesn’t mean much, except for the volume of training that you can tolerate and adapt to.

Gym Selection

In the past, I’ve worked at many gyms as a trainer, as a manager, and as a desk worker. In one case, I made friends with a trans woman who frequented the gym. She was partway through her transition, and as a result did not feel comfortable using either the mens or womens locker rooms at the gym.

Since it was a small gym, we did not have separate unisex bathrooms within the gym itself. However, the outside building did have separate bathrooms, accessible via key. Each day, she would arrive and I would immediately fetch the key for her when I saw her walking through the door, knowing that she needed it.

At one point after we had been friends for a while, she came to me to ask about an issue with her gym membership. It was under her former name (deadname), so I immediately did up the paperwork to change her name within the system so that she wouldn’t have to deal with this issue again in the future. She seemed surprised that I would be so helpful.

Looking back, these are simple kindnesses, but it’s easy to see where such events could have been terribly stressful for her, if for example someone else had been in my place and less understanding.

Likewise, gym floors can be hostile. Cis men tend to crowd the weight room so much that it can be stressful and difficult to navigate the process of getting a barbell and getting in a good workout. This is the same for everybody, but can be doubly difficult for beginners, who feel like they don’t know what they’re doing and want to minimize potential embarrassment with all eyes on them.

Such stresses are, I assume, even more concerning for trans exercisers who simply wish to get in their workouts without being harassed. The crowded gym is uncomfortable for everybody, but particularly stressful for certain bodies.

The selection of a welcoming and empowering gym space is thus an important step for trans exercisers. Some of my trans clients have opted to use home gym setups, or small and un-crowded (but also relatively under-equipped) apartment gyms, since this offers them a greater degree of privacy. Some gyms tend to be less crowded than others (particularly more expensive ones) so in some cases the additional privacy is worth the premium cost or a slightly further gym commute. One gym I worked at included a small room, normally used for classes, that was free for members during non-class hours, and was generally used by those who wanted added privacy.

Working With Trans Athletes

Obviously, working with trans athletes presents unique needs in terms of managing the psychology of the client. After all, our training results can be greatly enhanced with good sleep and stress management techniques, and the life of the trans athlete presents unique stressors.

My first and greatest concern as a coach is empathy and understanding. This often means taking steps to be aware and respectful of your trans clients’ unique struggles, including an understanding of trans culture and terminology.

In one amusing anecdote, I received an email from a client I had been working with for some time saying that he was starting his transition soon - we had never discussed it previously, and I hadn’t even known that he was planning to transition! We discussed his preferred pronouns and I made appropriate changes to his long term plan.

In another, a client who had been in the process of transitioning let me know that her name change was being finalized that week. I went back through her sheet and did a find/replace on her deadname so that every instance was replaced with her new name, and was sure to refer to her by her preferred name from then on.

Steps like these should be the rule when working with trans clients, and constitute a basic level of human decency. Working with trans clients as a coach should entail effort of understanding and empathy.

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