NEW YORK • Should the primary aim of elite sports be competitive fairness? Or does maintaining integrity mean that inclusiveness is just as vital as a level playing field?

The issue - which has roiled the water of pools everywhere with the success of transgender swimmer Lia Thomas and weightlifter Laurel Hubbard being the first trans athlete to compete at the Olympics - burst to the surface again last week.

FINA'S DECISION

Fina, swimming's world governing body, essentially banned transgender women from the highest levels of international competition with its proposal to create an "open category" of competition to "protect competitive fairness".

But Anne Lieberman, a director at advocacy group Athlete Ally, which seeks to end transphobia and homophobia in sport, insisted that a separate category is "isolating, demeaning and has the potential to make transgender and non-binary competitors into a spectacle on an international stage".

The attempt to balance fairness and inclusiveness, especially regarding the eligibility of transgender athletes, is among the most complicated and divisive issues in sport, with reasoned arguments being made on both sides.

WHAT DOES THE SCIENCE SAY?

Fina made its decision after setting up legal, medical and athletes' committees to examine the issue.

It decided that male-to-female athletes could join women's races only if they had not experienced any part of male puberty. Fina said its medical committee found that males acquired advantages in puberty, including in the size of their organs and bones, that were not lost in hormone suppression.

It also said that it has studied "the best available statistical, scientific, and medical evidence concerning sex differences in sports performance".

In January, the international and European federations of sports medicine issued a joint statement which said, in part, that high testosterone concentrations "confer a baseline advantage for athletes in certain sports" and that to uphold the integrity and fairness of sport, these advantages "must be recognised and mitigated".

Yet there has been relatively little scientific research involving elite transgender athletes. And studies have also not quantified testosterone's precise impact on performance.

World Athletics, the governing body of track and field which has instituted stringent regulations on permitted levels of testosterone, last year corrected its own research. It acknowledged that it could not confirm a causal relationship between elevated testosterone levels and performance advantages for elite female athletes.

Some have also argued that "the science is not clear".

Associate professor Ada Cheung, a leading endocrinologist at Austin Health and who leads the Trans Health Research programme in partnership with the University of Melbourne, said: "We actually don't know if there's a biological advantage for trans women over cisgender women.

"Fina's report is really based on a group of people's opinion, it's not a gold standard. No research has really been done into trans female swimmers or any elite athletes that are transgender. The jury is out."

IOC'S FRAMEWORK

Last November, the International Olympic Committee (IOC) issued a framework and cautioned against presuming, without evidence, that athletes have an unfair competitive advantage "due to their sex variations, physical appearance and/or transgender status".

It also removed its policy of having transgender athletes to have testosterone levels under 10 nanomoles/litre and to be on testosterone-suppressing medication for at least a year.

But the IOC stopped short of implementing the guidelines across the board, leaving it up to individual sports to determine their own rules and restrictions.

With that, the International Cycling Union (UCI) tightened its rules on transgender participation instead, by increasing the transition period on low testosterone to two years and reducing the permitted testosterone level.

Fina's decision followed, the strictest so far. Two days later, the International Rugby League (IRL) said transgender athletes would be "unable to play" in international matches while its officials undertook consultations and research to finalise a new policy for next year.

World football's governing body Fifa, the World Netball Federation, New Zealand Rugby and the International Hockey Federation are among many others which subsequently said they are also reviewing their transgender regulations, while World Athletics has hinted of tougher policies, with president Sebastian Coe saying "fairness is more important than inclusion".

REACTIONS TO FINA'S CALL

Fina left itself vulnerable to critics who argued that it acted hastily and recklessly, taking retribution against Thomas and trying to create a solution for a problem that does not exist.

The Human Rights Campaign, a lesbian, gay, bisexual, transgender and queer (LGBTQ) civil rights organisation, blamed the body for "caving to the avalanche of ill-informed, prejudiced attacks targeted at one particular transgender swimmer".

Even in victory, University of Pennsylvania swimmer Thomas did not deliver a shattering performance at the National Collegiate Athletic Association championships in March. Her winning time in the 500-yard freestyle was nine seconds off the 2017 collegiate record set by Katie Ledecky.

"It's very unfortunate that Fina has made this ruling," said Joanna Harper, a medical physicist who has researched transgender athletes. "Trans women are not taking over women's sports, and they are not going to."

But following Fina's announcement, swimmers like Olympic gold medallist Emily Seebohm welcomed the call, saying the sport could now move on with certainty.

"We can all just go back to the sport that we love... and know that it's going to be a fair, level playing field and that's what we want," the five-gold world champion said.

Fellow Australian and four-gold Olympic champion Cate Campbell also urged people to "listen to the science and experts".

However, their compatriot Madeline Groves, a double silver medallist at the 2016 Rio Games, was scathing of Fina's ruling, saying: "You're okay with ostracising an already marginalised group? Shame on everyone that supported this discriminatory and unscientific decision."

There were also mixed reactions among transgender athletes.

Cyclist Veronica Ivy said that the Fina ruling is "unscientific" and that it was an "extreme indignity".

But retired Olympic champion decathlete Caitlyn Jenner, formerly Bruce and one of America's best-known transgender celebrities, tweeted: "Fair is fair! If you go through male puberty, you shouldn't be able to take medals away from women. Period."

Caroline Layt, a former rugby player, criticised the IRL's decision, saying: "We are human beings, we have feelings, and we feel like we are being singled out."

NOT A NEW ISSUE

The issue of transgender athletes participating in top-level events is, in fact, not that new as they have already been competing for decades in sports like tennis.

Renee Richards won a legal battle to play in the women's events of the 1977 US Open and had a powerful backer in Billie Jean King, her doubles partner and witness in court who claimed Richards did not "enjoy physical superiority or strength so as to have an advantage over women competitors".

The sporting world, however, has not always been kind to them.

Even South Africa's two-time Olympic 800m champion Caster Semenya, who was born a female but with differences in sexual development, was in 2018 prohibited from running in distances from 400m to a mile unless she reduces her elevated testosterone levels through medicine or surgically.

World Athletics has consistently said the regulations are aimed at creating a level playing field for all.

WHAT'S NEXT?

So what does the future hold for transgender athletes?

The Fina ruling could have a trickle-down effect and increase pressure for similar moves from other sports federations, like what the IRL has done. Some predict World Athletics could be next, drawn to Fina's solution to the issue of what levels of testosterone should be permissible.

Will the Court of Arbitration for Sport (CAS) overrule Fina's decision, if it is challenged? History suggests otherwise.

Semenya lost her attempt before that court to overturn World Athletics' testosterone rules, effectively ending her Olympic career. CAS ruled in 2019 that track's policy was "discriminatory" but also "necessary and reasonable" to ensure fair play in women's events.

The sporting world will be watching any legal moves with keen interest.

NYTIMES, AGENCE FRANCE-PRESSE, REUTERS