California State Athletic Commission top doctor preparing for more transgender fighters to be active soon
By Zach Arnold | April 14, 2013
After the fallout from Meathead Mitrione’s comments about Fallon Fox, Ronda Rousey has been taking some heat in the media for her stance on why she would be discomfortable fighting Fallon. Rousey put a reporter in his place last night when she was asked why she wasn’t punished by the UFC for her comments while Mitrione had his contract ’suspended.’
Ronda addressed the issue during a recent Inside MMA video interview:
“My take (is) that if you’re a man who identifies as a woman or a woman that identifies as a man that’s something that you can’t control, it’s not your choice, it’s just the way that you are. But being transgender… that does require a choice. But I think it needs to be a case-by-case basis.
“On Fallon Fox’s case, she went through puberty entirely as a man and, um, though I do believe that, you know, her identity definitely is that of a woman I mean just at this point in her life it’s just not scientifically possible to make her body exactly equal to that of a woman. If it was another case someone who was identified much earlier and underwent Hormone suppression and then later when they’re old enough to make the decision [on having] surgery, I think that would be much more understandable. But I think transgender fighters should be taken on a case-by-case and if you’re already developed through puberty as a man I don’t think you should be able to compete as a woman.
“But, I mean… I really try not to give my opinion on this subject until I really extensively researched it and, you know, just the bone density and the bone structure you have after you’ve gone through puberty as a man. It’s just… it is an advantage over a woman, you know, and with something like MMA if somebody kicks you and if you check a kick the difference between if the person that threw the kick and the person checking the kick gets hurt I mean it has to do a lot with the bone density and it’s just an advantage. So, that’s just my opinion and… if… I know other people before that wanted to compete in sports but also believe that they are identified as a woman and they waited until after their career to undergo the surgery because it’s just.. science hasn’t caught up yet. You can’t do a complete transformation yet after you’ve already gone through puberty.”
Which brings us to a very interesting meeting that took place last Sunday in Sacramento with some of the doctors on the medical advisory panel of the California State Athletic Commission.
Dr. Paul Wallace basically played the role of emcee at the hearing. To his right (your left) in the video embedded is Dr. VanBuren Ross Lemons and Andy Foster. To his left (your right), new CSAC doctor Dr. Karen L Herbst (an endocrinologist from UC San Diego) was basically the main voice when it came to discussing the issue of transgender fighters, a medical testing policy for transgenders, and where medical studies currently stand in terms of data collected.
It was pretty clear from the hearing that transgender fighters like Fallon Fox will be licensed in California. What was a much more interesting news item is that Dr. Wallace stated that there are several transgender fighters out there who will probably be licensed. There have been recent rumors behind the scenes of more transgender fighters in women’s MMA. Just as the UFC is now integrating the women into their matchmaking, the issue of transgender fighters competing in women MMA is here to stay and will be a serious topic to debate in the future.
The CSAC video is over 3 1/2 hours long. Start at the 14 minute mark and you will see Dr. Lemons ask Dr. Herbst some questions about what advantages transgender fighters, especially in women’s MMA, might have. He noted data claiming males becoming females after puberty maintain a 25% higher lung capacity and keep the increased sign of their bone structure. In additions to questions Dr. Lemon asked Dr. Herbst, Dr. Wallace also stressed his concerns about the rampant levels of cheating in MMA and how the issue of properly testing transgender fighters could open the door for a new level of cheating in terms of estrogen & testosterone levels.
Here’s what Dr. Herbst had to say:
“We put together this document to try and better understand the information that was available on transgenders in terms of body composition, which included bone, muscle, fat… and I just want to be really clear that there are no studies whatsoever on changes in strength for transgenders. So, because, you know, even though we know from published data that there is a change in body composition when a man becomes a woman, um, hormonally or a woman becomes a man hormonally but we really don’t know how this translates into a strength difference. That has never been tested. From the data, um, if we just go through… looking at different parts of the body, we do know that one sub-bone has developed then completed its growth then there’s no change in the bone whether you change female hormones or male hormones. We do know that there’s a change, there may be a change in the quality of bone but that would be it. We do know that a female pelvis is different than a male pelvis and that’s not going to change but also in data, um, it showed that the center of gravity was not different between a man and a woman so, again, the size of the pelvis isn’t going to matter.
“But there were two studies out of Europe that examined changed in body composition between and primarily for males becoming females because I think that’s the biggest controversy as whether a man when he becomes a woman has an advantage over females whereas a female becoming a man may have less advantage over males and that’s not a factual statement, that’s just a supposition. So, these studies showed that there is a statistically significant difference in body composition between males and females. As, you know, [the control population of] men who are born men and stayed hormonally men versus women who were born women and stayed hormonally women and when a man becomes a woman hormonally or a woman becomes a man hormonally the overlap between the two gets closer but it’s still remains statistically different. So, then the question is, is that enough for us to say that a transgender man or transgender woman is still statistically significantly different and therefore should, you know, be considered different?”
As Dr. Herbst would soon point out, it’s hard to make any claims with 100% certainty given that we’re talking about Mixed Martial Arts and how young the sport is.
“We don’t really have data on Mixed Martial Arts fighters in terms of their body compositions, so I did attend a Mixed Martial Arts fight or a series of fights and what I noticed was that sometimes in a male/male fight there was quite a big difference in height between the men, arm reach between the men and so is it possible that there is, um, in the Mixed Martial Arts community a significantly different size and height ratio that would make this information different because this was looking at a different population, this was not looking at an MMA population. That, we don’t know, and if we could get that data it might help us to answer that question. But the last thing that we looked at was if a man, um, becomes hormonally a woman, um, she then obviously loses some muscle mass. However, in studies of women who are given estrogen therapy, they’re able to maintain more muscle mass if they’re on Hormone Replacement Therapy compared to being off HRT. So, estrogen actually does help maintain muscle mass and so the question is, is that enough in a man, uh, when he becomes a woman to give him competitive advantage? And I think we can all agree that there’s wide differences between body compositions in people. So, if you have a 6′5″ man who decides to become a woman, what advantage does he have over a 5′4″ man who decides to become a woman? So, um, I think that without more data it may be hard to make some of those decisions as solid as we would want them to be.”
DR. LEMONS: “And strength, there’s absolutely no data out there on data?”
DR. HERBST: “No data. Although, um, there is data on giving testosterone replacement to men and we do know that when men are given testosterone that their strength increases and we also know that when men are deprived of testosterone that their strength decreases. But, again, in the transgender population, we have no data. To my knowledge. There may be data out there that I’m not aware and would definitely welcome receiving that information.”
Dr. Herbst then mentioned the transgender policies that both the IOC & NCAA have implemented. A comparison was then made to what Dr. Sherry Wulkan (New Jersey ACB) & the Association of Boxing Commissions came up with last year. It appears CSAC will be adopting a policy very similar to what ABC has on the table.
“We did look at other policies, so we looked at the International Olympic Committee policy which requires 2 years of hormone replacement and gender reassignment surgery along with verifying that testosterone levels fall within an acceptable level before a male-to-female transwoman can compete as a woman.
“I just want to make a clarification at this time in competitive sports there are individual competitive sports where there’s no contact from person to person such as running or track-and-field events, even gymnastics. Then there are team sports like basketball, soccer which there’s minimal contact in between individuals, so it’s not always a one-on-one individual contact — it’s more of a, you know, bouncing off team member type contact. But in this case, we’re looking at, um, grappling. So, individuals interacting with each other and… so, I think we have to keep that in mind as we review these different policies.
“So, if we look at the NCAA policy, they also require 2 years of hormone therapy and regulation of testosterone levels but they do not have a surgical requirement and, again, that’s because there’s no grappling between individuals. And then for the ABC (Association of Boxing Commissions) medical committee suggested guidelines, even though there may not be a medical committee… they made these recommendations to the commissioners and they are a little bit more complicated and I can go through them. So, transwomen undergoing sex reassignment from male-to-female prior to puberty are regarded as girls and women. So, in that case, a lot of the data out there has shown that in terms of body composition before boys and girls go through puberty, there’s really no differences. And so if hormone therapy is initiated prior to puberty, that person is considered a girl or a boy and there’s no question about that. It’s just in the individuals undergoing sex reassignment after they reach puberty that I think we’re discussing today. So, according to the ABC, individuals undergoing sex reassignment from male to female after puberty are eligible if they have had surgical, anatomical changes that have been completed. This includes external genitalia and gonadectomy. They have to have hormone therapy for the assigned sex and it has to be administered by a board-certified endocrinologist, internist, pediatrician, doctor of osteopathy, or any other specialist with experience in transsexual and transgender individuals and that hormone therapy has to be continued for a minimum of two years after gonadectomy is completed. Then, they have to have a letter from a board-certified physician responsible for the care of the patient and this must be submitted to medical board.
“For transmen undergoing sex reassignment from female to male after puberty, they’re eligible for competition under the following conditions: hormonal therapy appropriate for the assigned sex by a board-certified endocrinologist, internist, pediatrician, DEO, or other specialist, a letter from a board-certified physician. So, it seems as if, um, you know, there are some differences but in terms of we are most similar to the ABC because there’s actual grappling that goes on and so, um, I think that we would fall into the arena where there should be actual surgical changes to the appropriate sex as well as Hormone Replacement Therapy for at least two years after the sexual change has occurred.”
DR. LEMONS: “Let me ask you, can you… assuming this policy was carried out and the male, competing as a female, what kind of testing and how often would you require it in terms of would you get estrogen levels prior to the fight, they need to be that of a routine female, and how much endocrinological testing would you need prior to the fight with the possibility that somebody’s using other male hormones in addition to get a competitive edge?”
DR. HERBST: “So, let me make sure I understand your questions… so, um, in that case, everyone who fights is at risk for abuse for substances and so if you were formally a male you could be either stop using your estrogen for a period of time which may allow your testosterone levels to rise if you not have a gonadectomy and I think that’s the reason why a gonadectomy is required. So, we would set that to the side because that should not occur. However, there is the possibility of testosterone use in any MMA fighter and that includes transgenders as well. So, um, they would be treated under the TUE (Therapeutic Use Exemption) policy, so how do we follow people who have [real] male hypogonadism and are on testosterone replacement and they are required to, well, we should make, you know, confirm our policy on that but a suggestion would be that we require testosterone levels over two years so over the proceeding two years and that, um, they have to have levels within a month prior to their fight. And so that would include for a transgender in either case it would include both estrogen and testosterone levels, or should.”
If you watch the session in full, you’ll notice that two interesting names are in attendance at the meeting to speak in support of Fallon Fox and to answer questions about transgender medicine and what policy would work for California’s commission — Amy Whelan, a legal eagle for the National Center for Lesbian Rights, and Dr. Nick Gorton from UC San Francisco. He’s an ER doctor and a doctor who specializes in transgender medicine. He’s an openly transgender physician.
Fallon Fox’s situation has in fact turned into a cause célèbre for many political activists and a hot potato topic many inside the MMA business are trying to come to grips with. I suspect Andy Foster wasn’t planning on this becoming his first big policy change while trying to repair the California State Athletic Commission’s damaged image due to the behavior of the Department of Consumer Affairs.