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Integrating transwomen athletes into elite
competition: The case of elite archery and
shooting
Blair R. Hamilton, Fergus M. Guppy, James Barrett, Leighton Seal & Yannis
Pitsiladis
To cite this article: Blair R. Hamilton, Fergus M. Guppy, James Barrett, Leighton Seal & Yannis
Pitsiladis (2021): Integrating transwomen athletes into elite competition: The case of elite archery
and shooting, European Journal of Sport Science, DOI: 10.1080/17461391.2021.1938692
To link to this article: https://doi.org/10.1080/17461391.2021.1938692
© 2021 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis
Group
Published online: 22 Jun 2021.
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Integrating transwomen athletes into elite competition: The case of elite archery
and shooting
Blair R. Hamilton
a,b
, Fergus M. Guppy
a
, James Barrett
b
, Leighton Seal
b
and Yannis Pitsiladis
a,c,d,e,f
a
Centre for Stress and Age-related Disease, University of Brighton, Brighton, UK;
b
The Gender Identity Clinic Tavistock and Portman NHS
Foundation Trust, London, UK;
c
University of Rome “Foro Italico”, Rome, Italy;
d
Centre for Exercise Sciences and Sports Medicine, FIMS
Collaborating Centre of Sports Medicine, Rome, Italy;
e
European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland;
f
International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
ABSTRACT
The inclusion of transwomen into elite female sport has been brought into question recently with
World Rugby banning transwomen from the elite female competition, aiming to prioritise safety
over fairness and inclusion, citing the size, force and power-producing advantages conferred to
transwomen. The same question is being asked of all Olympic sports including non-contact sports
such as archery and shooting. As both these Olympic sports are the polar opposite to the contact
sport of rugby in terms of the need to consider the safety of athletes, the IF of both archery and
shooting should consider the other elements when deciding the integration of trans individuals in
their sports. Studies on non-athletic transwomen have reported muscle mass and strength loss in
the range of 5–10% after 1 year of their transition, with these differences no longer apparent after
2 years. Therefore, based on the current scientific literature, it would be justified for meaningful
competition and to prioritise fairness, that transwomen be permitted to compete in elite archery
after 2 years of GAT. Similarly, it would be justified in terms of shooting to prioritise inclusion and
allow transwomen after 1 year of GAT given that the only negligible advantage that transwomen
may have is superior visuospatial coordination. The impact of this considered integration of
transwomen in elite sports such as archery and shooting could be monitored and lessons learned
for other sports, especially where there are no safety concerns from contact with an opponent.
Abbreviations: IF: International Sports Federation; FDS: Flexor Digitorum Superficialis; IOC:
International Olympic Committee; EA: Elite Archer; NA: Non-elite Archer; INT: International Athletes;
NAT: National Athletes; GAT: Gender Affirming Treatment; O
2
: Oxygen; cHb: Haemoglobin
Concentration in Blood
KEYWORDS
Transwomen; archery;
shooting; eligibility;
competition; sport
1. Introduction
The inclusion of transwomen into elite female sport has
been brought into question in recent times, not least by
the decision of World Rugby to ban transwomen from
elite female competition (Rugby, 2020). As the main phys-
ical attributes of rugby are strength, speed, and power
and the rules and strategies of the game encourage
intense physical contact with opponents, in their recent
deliberations World Rugby prioritised the safety of ath-
letes over fairness and inclusion as reflected in the pro-
posed decision-making triangle (Figure 1A) (Rugby,
2020). A recent review of studies conducted in non-ath-
letic transwomen undergoing gender affirming treatment
(GAT) highlights the time course changes in lean body
mass, muscle cross-sectional area, and muscular strength
(i.e. 12–36 months) and haemoglobin and/or haematocrit
(i.e. 3–4 months) (Harper, O’Donnell, Khorashad,
McDermott, & Witcomb, 2021). Similarly, another recent
review argued that lean body mass, muscle size, bone
density and strength were are only trivially affected by
12 months of GAT; the period previously advocated for
inclusion of transgender women in female sports cat-
egories (Hilton & Lundberg, 2021). These two recent
reviews highlight the urgent need for research examining
the impact of GAT in transwomen athletes to inform the
decision-making process and properly consider the inte-
gration of transwomen in elite female sport (Hamilton
et al., 2021). These examples also show that there is a
clear need for a roadmap demonstrating how integration
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-
nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built
upon in any way.
CONTACT Yannis Pitsiladis Y.Pitsiladis@brighton.ac.uk Professor of Sport and Exercise Science, University of Brighton, Welkin House, 30 Carlisle Road,
Eastbourne, BN20 7SN, UK
EUROPEAN JOURNAL OF SPORT SCIENCE
https://doi.org/10.1080/17461391.2021.1938692
of transwomen in elite female sport may be achieved and
clarifying the decision-making process for international
sporting federations (IFs).
The primary aim of this review is to propose a decision-
making process that can be used by IFs to assist the process
of determining the eligibility of transwomen in their
respective sports. We apply the proposed decision-
making process to the sports of archery and shooting
making particular comparisons to the recent decision-
making process and the subsequent recommendations by
World Rugby. The recommendations made on the eligibility
of transwomen in the sports of archery and shooting should
be treated with caution as the respective IFs are best placed
to determine the priorities in the orientation of the decision-
making triangle (Figure 1) and therefore the most appropri-
ate recommendations for their respective sports. To illus-
trate this decision-making process, we have developed a
sliding scale that could be used for individual IFs to focus
on the relevant sport-specific attributes appropriate to
their sport (Figure 2). As some sports do not include
contact with an opponent safety is then not an issue, but
the essence of meaningful competition might be placed
into question. However, the same decision-making prin-
ciples are used for all sports individually to evaluate the inte-
gration of transwomen into elite competition.
The decision-making process used by World Rugby is
an excellent baseline model that can be adopted by
other international sporting federations (IF) to develop
guidelines for the inclusion of trans individuals within
their sport. World Rugby developed their guidelines
with utmost transparency. Their main proceedings
were conducted in public and arguments from both
sides of the inclusion and exclusion debate were pub-
lished. World Rugby then developed a scientific hypoth-
esis, based on the arguments and evidence, that “the
injury risk is too great (Rugby, 2020)”for transwomen
to compete in elite female rugby, describing the
effects of gender affirming treatment (GAT) on trans-
women’s physiology to justify their position, and using
a“hypothetical cross-over scenario of a typical male
tackler mass involved in a tackle against ball carrier
with a typical female mass (Rugby, 2020)”to illustrate
the injury risk for ciswomen players if they played
against transwomen. However, an improvement in the
process used by World Rugby to develop their guide-
lines may be the use of a panel of three independent
experts for each specific aspect (i.e. legal, performance,
health) to evaluate the evidence presented by experts
in their specificfield. The working group of World
Rugby relied on only one expert from each aspect and
some experts were not independent of World Rugby.
This revised process would allow for consensus to be
made across three independent experts and would be
less open to accusations of potential bias, therefore
strengthening the final outcome. Whether World
Rugby’s conclusions and subsequent guidelines are
Figure 1. The declared weightings for World Rugby (A) and the derived weightings for World Archery (B) and International Shooting
Sport Federation (C) using the three primary criteria for formulating the guidelines and/or rules for the fair and safe integration of
transwomen athletes.
Figure 2. Proposed sliding scale tool that IF’s may use to decide what weighting to prioritise in their respective sports for the
inclusion/exclusion of transwoman athletes. This sliding scale may be used holistically as a sport to decide their orientation in the
decision-making triangle of Figure 1, or it can be used to prioritise what to assess in an individual transwomen’s eligibility case
for that sport.
2B. R. HAMILTON ET AL.
indeed scientifically justified is outside of the scope of
this manuscript but the process used forms a good
basis for future guidelines in other sports. Additionally,
we propose the triangular weightings model shown in
Figure 1 to be considered together with the sliding
scale in Figure 2 to help the decision making process.
Archery involves some strength-based features such
as core strength, shoulder strength and local muscular
endurance, particularly of the Flexor Digitorum
Superficialis (FDS) muscle (i.e. the largest muscle in the
forearm), coupled with visuospatial coordination and
breathing control. Applying these features of archery
to our sliding scale illustration, including the fact that
there are no safety risks to opponents, World Archery
could objectively justify prioritising fairness over safety
and inclusivity (Figure 1B) as reflected in the shifting of
the sliding scale to prioritise fairness (Figure 2). In com-
parison, shooting does not involve a significant strength
component given the nature of the sport that requires
heightened visuospatial coordination, control of breath-
ing and lengthy periods of concentration, hence this lack
of strength component in shooting may be why there is
no discernible difference between cis-male and cis-
female shooters (Table 1) (Mon-López, Tejero-González,
Calero, & Ardigò, 2019). Therefore, using the same
decision-making process, the International Shooting
Sport Federation could objectively justify prioritising
inclusivity over fairness and safety (Figure 1C, Figure
2). These three contrasting examples (i.e. rugby,
archery, and shooting) and the use of the sliding scale
illustration with supporting evidence that alters the
orientation of decision-making triangle orientation,
accordingly, demonstrate how IFs can apply an objective
decision-making process to this complex issue of inte-
grating transwomen athletes into elite competition.
The position of the IOC on integrating transwomen
athletes into elite competition does not focus on any
specific sport and prioritises fairness, as reflected in the
2015 IOC consensus on sex reassignment and hyperan-
drogenism (Committee IO, 2015), which states: “The
overriding sporting objective is and remains the guarantee
of fair competition. Restrictions on participation are appro-
priate to the extent that they are necessary and propor-
tionate to the achievement of that objective (Committee
IO, 2015).”While it is unknown whether “the guarantee
of fair competition (Committee IO, 2015)”“remains the
overriding sporting objective (Committee IO, 2015)”of
the IOC at present, this prioritisation has been adopted
by many IF such as archery (Archery, 2020a), shooting
(Federation ISS, 2021a) and World Athletics (Athletics,
2019) as their eligibility guideline to integrate elite and
non-elite transwomen athletes into their sport.
2. Materials and methods
Studies published up to 15/02/2021 were reviewed from
four electronic sources (PubMed™, Embase™, SportDis-
cus™and Google Scholar™). Keywords relevant to all
searches included \transwomen and/or transgender
and/or transsexual", \archery", \shooting", and \perform-
ance". Based on PRISMA guidelines (Moher, Liberati,
Tetzlaff, Altman, & Group, 2009), an example search
Table 1. Comparison between Male and Female rifle shooting
performance in World Records and Olympic/Paralympic Games
Event
Male (Score /
Maximum
score) Year
Female
(Score /
Maximum
score) Year
%
Difference
World
Records
10m Air Rifle 252.8 / 261.6 2019 252.9 / 261.6 2019 0.04%
10m Air Rifle
(t)
1887.7 /
1962
2018 1893 / 1962 2018 0.28%
50m Rifle3
positions
465.3 / 490.5 2018 464.7 / 490.5 2015 −0.13%
50m Rifle3
Positions (t)
3540 / 3924 2019 3531 / 3924 2019 −0.25%
50m Rifle
Prone
633 / 654 2015 628.5 / 654 2019 −0.71%
50m Rifle
Prone (t)
1878.3 /
1962
2019 1871.6 /
1962
2019 −0.36%
300m Rifle3
Positions
1190 / 1308 2019 1181 / 1308 2019 −0.76%
300m Rifle3
Positions (t)
3533 / 3924 2019 3518 / 3924 2019 −0.42%
300m Rifle
Prone
600 / 654 1990 599 / 654 2009 −0.17%
300m Rifle
Prone (t)
1796 / 1962 2019 1787 / 1962 2010 −0.50%
10m Air Pistol 246.5 / 261.6 2019 246.9 / 261.6 2017 0.16%
10m Air Pistol
(t)
1759 / 1962 2014 1739 / 1962 2018 −1.14%
25m Pistol 38 / 40 2018 40 / 40 2019 5.26%
25m Pistol (t) 1756 / 1800 2018 1768 / 1800 2002 0.68%
Trap 48 / 50 2017 48/ 50 2018 0.00%
Trap (t) 369 / 375 2011 354 / 375 2018 −4.07%
Double Trap 148 / 150 2014 136 / 150 2018 −8.11%
Skeet 60 / 60 2018 59 / 60 2019 −1.67%
Skeet (t) 371 / 375 2016 363 / 375 2019 −2.16%
10m Running
Target
590 / 654 2004 575 / 654 2018 −2.54%
10m Running
Target (t)
1739 / 1962 2017 1673 / 1962 2018 −3.80%
10m Running
Target
Mixed
393 / 436 2008 391 / 436 2018 −0.51%
10m Running
Target
Mixed (t)
1158 / 1308 2006 1158 / 1308 2010 0.00%
Olympic/
Paralympic
Records
50m Rifle3
Positions
458.8 / 490.5 2016 458.6 / 490.5 2016 −0.04%
25m Pistol 592 / 654 2016 592 / 654 2016 0.00%
The average performance difference −0.84%
Standard Deviation 2.23%
Range −8.11% –
5.26%
Notes: m = metres, t = team, Information obtained from the International
Shooting Sport Federation (Federation ISS, 2021a).
EUROPEAN JOURNAL OF SPORT SCIENCE 3
strategy can be seen in Appendix 1. The first author (BH)
conducted all electronic database searches. In addition
to electronic database searches, cross-referencing from
retrieved studies was also conducted. Literature
review, reporting, and critical revision of the work were
performed by the first author (BH). Material preparation
was performed by the first (BH), the second (FG) and the
last author (YP).
Data to assess cis-male vs cis-female performance in
archery and shooting was extracted online from the
websites of archery and shooting (Archery, 2020b; Fed-
eration ISS, 2021b) and imputed into Microsoft Excel™
(Washington, USA). The difference between cis-male
and cis-female performance in each event was then cal-
culated using a percentage difference calculation [(Cis-
female Performance- Cis-male Performance)/Cis-male
performance]. The average performance difference was
taken from these results and the standard deviation
and the ranges calculated, as displayed in Table 1 and
Table 2. World record performances were used as
opposed to an averaged top 8 world ranking perform-
ance, as world records represent the maximum and
best ever performance scores for cis-males and cis-
females in the sport of shooting and/or archery. The
inclusion of Olympic and Paralympic records allows the
assessment of whether a possible more stable shooting
position (i.e. wheelchair shooting) can influence the
shooters performance.
3. Archery
To comprehensively address how to integrate trans-
women athletes into the elite competition, one must
consider the physical demands and attributes needed
for the sport. The sport of archery requires the athlete
to retain postural balance and loose an arrow to a
target with accuracy and when the athlete prepares to
loose the arrow, they must hold the bow using a strong
hand press with the non-dominant hand while drawing
the bowstring with the dominant hand and arm
(Leroyer, Van Hoecke, & Helal, 1993), with the deltoid
muscle being shown to be important in providing
shoulder joint stability at release in the dominant arm
(Hennessy & Parker, 1990). There is a common miscon-
ception that archery is solely a technique-based sport
where physical components matter little. However, as
many shots are taken per competition (Leroyer et al.,
1993), athletes must manage factors such as central
and peripheral fatigue. Central fatigue involves neural
and psychobiological components such as skeletal
muscle recruitment and motivation (Fitts, 2008; Kent-
Braun, 1999), while peripheral fatigue involves the
depletion of muscle energy supply to the active motor
units (Kent-Braun, 1999). For example, in a study compar-
ing an EA (n=1) to a NA (n=1) over a simulated 12 set
archery competition, it was found that markers of
fatigue such as blood lactate were less pronounced in
the EA (i.e. NA: 2.8 mmol.L
−1
vs EA: 1.9 mmol.L
−1
)
(Borges et al., 2020), suggestive of some level of periph-
eral fatigue in archery. Handgrip strength and its main-
tenance are also important attributes influencing
performance in archery (Borges et al., 2020). The NA
had an average handgrip strength of 77.3 lbs in their
dominant arm and 72.2 lbs in their non-dominant arm,
whereas the EA average handgrip strength was 94.3 lbs
in their dominant hand and 90.4 lbs in comparison,
showing that the EA had a much greater grip strength
than the NA. The EA was also able to maintain their
grip strength over the simulated competition, gaining
1% grip strength in their dominant-hand and losing 3%
in their non-dominant arm over the simulated 12 sets,
Table 2. Comparison between Male and Female archery
performance in World Records and Olympic/Paralympic Games.
Event
(Distance)
Male (Score /
Maximum
score) Year
Female
(Score /
Maximum
score) Year
%
Difference
World
Records
Barebow
(50m)
665 / 720 2020 637 / 720 2020 −4.21%
Recurve (70m) 662 / 720 2019 657 / 720 2015 −0.76%
Compound
144 arrows
1394 / 1440 2019 1406 / 1440 2010 0.86%
Compound
(70m) 36
arrows
351 / 360 2005 350 / 360 2011 −0.28%
Compound
(50m) 36
arrows
353 / 360 2007 350 / 360 2011 −0.85%
Compound
(50m) 72
arrows
707 / 720 2019 695 / 720 2016 −1.70%
Double round
(50m) 144
arrows
1375 / 1440 2019 1347 / 1440 2019 −2.04%
Olympic/
Paralympic
Records
Recurve (70m) 700 / 720 2016 673 / 720 1996 −3.86%
Recurve open
(70m)
637 / 720 2016 637 / 720 2016 0.00%
Compound
open (50m)
687 / 720 2016 674 / 720 2016 −1.89%
15 Arrow
match
146 / 150 2016 144 / 150 2016 −1.37%
W1 (50m) 648 / 720 2016 634 / 720 2016 −2.16%
W1 15 Arrow
match
142 / 150 2016 141 / 150 2016 −0.70%
The average female
performance difference
−1.46%
Standard Deviation 1.38%
Range −4.21% –
0.86%
Notes: m=metres, Information obtained from World Archery (Athletics,
2019).
4B. R. HAMILTON ET AL.
compared with the NA loss of 11% and 3% in their domi-
nant and non-dominant handgrip strength, respectively.
The authors suggested that the NA might not have been
able to maintain the recruitment of all the motoneurons
in the FDS muscle during maximal voluntary contractions
during the latter sets (set 6–12), causing the loss of grip
strength over this time. Despite n=1, this data clearly
shows there is a high local skeletal muscle metabolic
demand in the sport of archery and therefore, a potential
source of muscle fatigue.
Cognitive factors also play an important role in both
EA but also elite shooting performance. In a recent
study investigating the efficiency and enhancement in
attention networks of 62 national EA and shooting ath-
letes (27 cis-female 35 cis-male, 23.66 ± 4.95 years) com-
pared with 49 NA and non-elite shooters (19 cis-female
30 cis-male, 19.53 ± 3.38 years) it was found that EA
and elite shooters responded significantly faster overall
than NA and non-elite shooters (Diff= 28.84 ms, p=
0.006) (Lu, Li, Wu, Liu, & Wu, 2021). These results
suggest that EA and elite shooters are more efficient in
all three attention networks, meaning that EA and elite
shooters can reach the alerting state faster, make
better use of environmental information and suppress
interference from distractors more efficiently than NA
and non-elite shooters.
4. Shooting
Olympic shooting comes in multiple disciplines. Rifle,
where athletes try to hit a stationary target from 10, 50
m or 300 m from a standing, prone or knelt position or
a moving target from 10 m; pistol, where athletes try
to hit a stationary target from 10 m or 25 m; and
skeet, trap and double trap, where athletes, using shot-
guns, attempt to break clay targets mechanically flung
into the air from one or two fixed stations at high
speed from a variety of angles (Federation ISS, 2021a).
Ihalainen, Kuitunen, Mononen, and Linnamo (2016),
recently analysed 13,795 shots in 319 tests, of which
204 (8,501 shots) were conducted by International Ath-
letes (INT) and 115 (5,294 shots) by NAT with no differ-
ences in training regimes. The authors found that INT
had better mean shot scores (10.32 ± 0.08 vs 10.20 ±
0.11, p< 0.001), a more stable hold (95 ± 2% vs 90 ±
6%, p< 0.01), a cleaner triggering action (1.01 ± 0.08 vs
1.07 ± 0.08, p< 0.05), and better-aiming accuracy (10.51
± 0.06 vs 10.41 ± 0.11, p< 0.01) compared with the NAT
group (Ihalainen et al., 2016), showing that these techni-
cal variables are key determinants of successful perform-
ance in rifle shooting.
While Ihalainen et al. (2016) elected to measure mean
shot scores, stable hold, triggering action and aiming
determinants with a simulated competition series
using a shooting training device (Noptel ST 2000,
Noptel Inc., Oulu, Finland), in a follow-up study by the
same authors (Ihalainen, Mononen, Linnamo, & Kuitu-
nen, 2018), they investigated how these technical com-
ponents changed from simulated competition to real
competition. This second study was conducted on 10
Finnish NAT and 3 junior NAT and took place during 2
national training camps and 2 Grand Prix of Leppa.fi
competitions. The authors found that shooting perform-
ance and their related technical variables decreased
from training to competition in the whole subject
group. Specifically, there was a decrease in mean shot
scores (10.31 ± 0.13 vs 10.14 ± 0.17, p< 0.05), holding
ability (0.39 ± 0.06 vs 0.54 ± 0.07, p< 0.001), aiming accu-
racy (10.52 ± 0.10 vs 10.35 ± 0.20, p< 0.05), cleanness of
triggering (0.25 ± 0.05 vs 0.34 ± 0.07, p< 0.05) and pos-
tural balance (0.22 ± 0.05 vs 0.29 ± 0.09, p< 0.05).
Despite this overall decrease in shooting performance
and in the shooting technical variables from simulated
to real competition, some athletes were able to replicate
their simulated competition results in real competition
(Ihalainen et al., 2018). This reduction in shooting per-
formance in real competition may be the result of
psychological factors during shooting competition
such as a heightened sport state anxiety, which is
characterised as being a trait and/or state-like response
to a stressful sport-related situation, which the individual
perceives as potentially stressful and induces a range of
cognitive appraisals, behavioural responses, and/or
physiological arousal (Ford, Ildefonso, Jones, &
Arvinen-Barrow, 2017). The suggestion is that psycho-
logical factors such as increased anxiety can negatively
affect shooting performance through the mediation of
self-control (Sade, Bar-Eli, Bresler, & Tenenbaum, 1990)
as evidenced by the fact that interventions aimed at
reducing sport state anxiety such as meditation and cog-
nitive–behavioural training, can increase shooting per-
formance in competition (Solberg, Berglund, Engen,
Ekeberg, & Loeb, 1996). These observations affirm the
high psychological demands of Olympic shooting.
5. Cis-male and cis-female differences in
archery and shooting performance
One of the arguments for the exclusion of transwomen
from elite female sport is that these individuals were
assigned male at birth, and have benefited from the
androgenising effects of male puberty (Hilton & Lund-
berg, 2021). Therefore, it is informative to compare cis-
male and cis-female differences in archery and shooting
performance. The difference between cis-male and cis-
female performance in terms of points scored in
EUROPEAN JOURNAL OF SPORT SCIENCE 5
archery is small (Mean ± SD, −1.46 ± 0.86%, Range −4.2–
0.86%, Table 2) in favour of cis-men. The findings are
similar in the sport of rifle shooting (Mean ± SD, −0.84
± 2.23%, Range −8.11–5.26%, Table 1), albeit rifle shoot-
ing has 42% less of a mean cis-male advantage in points
scored than archery, but a substantially higher range of
about 13% compared with 5% for archery, although this
higher range in shooting may be attributed to the
approximate 5% performance difference in favour of
cis-females in the 25 m pistol event. Paralympic shooting
and archery scores were found to be no different from
each other, ruling out the possibility of a more stable
hold in Paralympic events. The smaller range in archery
could suggest that the cis-male performance advantage
in this sport is more consistent, whereas the smaller cis-
male advantage in rifle shooting coupled with a large
range may indicate that the cis-male performance
advantage in rifle shooting is more variable and not as
predictable as the cis-male performance advantage of
archery due to the numerous confounding factors pre-
viously discussed such as psychobiological factors.
However, it is interesting that the performance differ-
ence in shooting favours cis-males if one considers
events involving a moving target (i.e. trap, double trap,
skeet and running target) suggesting a cis-male advan-
tage in spatial ability. Nevertheless, the mean cis-male
performance advantage in both the sports of archery
and shooting are markedly below the male performance
advantage reported in aerobic sports such as running,
rowing, and swimming of 11–13% (Hilton & Lundberg,
2021) and even more markedly below the range of
16% to >50% reported for sports requiring strength
and power such as track cycling and baseball (Hilton &
Lundberg, 2021). There are a number of likely expla-
nations for why cis-males outperform cis-females in
archery. First, due to superior muscle strength in cis-
males such as in the elbow flexors, which are signifi-
cantly stronger in men than women both before (49.35
± 10.18 vs. 25.09 ± 4.89) and after (55.08 ± 9.95 vs.
28.04 ± 5.52) a training period when measured using 2
sets of 4 maximal concentric repetitions at 60°/s (Gentil
et al., 2016). Secondly, this strength advantage is also
typically coupled with a larger skeletal structure (Hilton
& Lundberg, 2021). Taken together, these two synergistic
factors would result in a greater arrow speed for the cis-
male archer, meaning that there is less wind interference
(Miyazaki et al., 2013) and more forgiveness for fluctu-
ations in technique (Kim, Kim, & So, 2015) resulting in
the 1.5% average performance advantage cis-males
have over cis-females in terms of scoring in archery.
Thirdly, as archery performance involves smaller upper
body musculature and judged as moderate intensity
by assessing the activity of the local muscles such as
the FDS muscle (Borges et al., 2020), a small component
of the cis-male advantage in performance over cis-
female archers may also be explained by the higher
cHb in cis-males combined with the greater O
2
transport
system and musculature (Cureton et al., 1986). It is well
documented that altering O
2
transport capacity and
availability to the exercising muscle can have profound
consequences on muscle fatigue (Wan, Qin, Wang,
Sun, & Liu, 2017) and aerobic athletic performance (Mair-
bäurl, 2013). However, there are no studies to date
examining the impact of altering O
2
transport capacity
and availability to the exercising muscle on archery per-
formance in order to evaluate this idea. Oxygen avail-
ability is unlikely to explain archery performance
differences between cis-males and cis-females given
the mainly isometric performance attributes of the
sport. Nevertheless, cHb levels are reduced in trans-
women to normal cis-female levels (9.3 ± 0.7 vs 8.0 ±
0.7 mmol/l, p<0.05) after 4 months of GAT (Gooren &
Bunck, 2004; Harper et al., 2021) reducing any perform-
ance advantage of greater O
2
availability that may be
perceived to remain in transwomen. Further research is
required to examine the role of O
2
availability and
fatigue on archery performance in both cis- gender
and trans- gender individuals. Fourthly, cognitive func-
tions such as perception, attention, memory (short-
term or working and long-term), motor, language,
visual and spatial processing, and executive functions
are different in cis-males and cis-females (Upadhayay &
GUraGaiN, 2014). These spatial and perception differ-
ences may be the reasons why males outperform
females in terms of moving target shooting competition.
Cis-females show advantages in verbal rhythm, mental
speed and accuracy, and fine motor skills, while cis-
males outperform females in visuospatial, working
memory, and mathematical abilities (Sherwin, 2003;
Zaidi, 2010). Visuospatial coordination, which is
defined as a person’s capacity to identify visual and
spatial relationships among objects (Aleman, Bronk,
Kessels, Koppeschaar, & van Honk, 2004), is an important
feature in both archery and shooting performance as it
the occipital lobes, which are related to visual percep-
tion and visual-spatial movement (Cavanagh & Frank,
2014; Zanto, Rubens, Bollinger, & Gazzaley, 2010), seem
to play an important role in the process of aiming
(Gong, Liu, Jiang, & Fu, 2018). Recent research where
visual reaction time was compared in healthy cis-male
(n=21) and cis-female (n=21) volunteers who were
aged between 19–37 years, has confirmed that cis-
males consistently outperform cis-females in this area
(i.e. 331.7 ms vs 367.8 ms; p<0.05 [Upadhayay & GUra-
GaiN, 2014]) and this cis-male advantage in visuospatial
abilities has also been previously confirmed (Breda &
6B. R. HAMILTON ET AL.
Napp, 2019; Palmiero, Nori, Rogolino, D’amico, & Pic-
cardi, 2016). Therefore, the visuospatial advantage of
cis-males may in part explain an unknown amount of
their small performance advantage of 1.46% ± 0.86
(Table 2) in archery and their smaller performance
advantage of 0.84% ± 2.23 (Table 1) in the sport of
shooting.
6. The effects of GAT on indices of archery
and shooting performance
Transwomen are typically but not always treated with
GAT that involves cross-sex hormone therapy (i.e. testos-
terone suppression and oestrogen administration) and
optional gender-affirming surgery (NHS, 2020). There-
fore, it is essential to determine especially in the case
of archery whether the effects of GAT will negate the
potential advantages in strength, O
2
availability, visuos-
patial coordination that may collectively result in the
small but significant performance advantage of cis-
males (−1.46% ± 0.86, Table 2). Shooting, on the other
hand, requires mostly isometric contraction to maintain
postural balance in the standing or kneeling position,
while requiring little concentric or eccentric muscular
strength contractions in the standing, prone or kneeling
positions. There is also no obvious mechanism by which
alterations in O
2
availability could impact shooting per-
formance. It is necessary, therefore, to determine
whether the small advantage of cis-males in rifle shoot-
ing (Mean ± SD, −0.84% ± 2.23, Range −8.11–5.26%,
Table 1), explained potentially by a slightly superior
visuospatial coordination in cis-males, is impacted by
GAT in transwomen athletes.
The results of studies in transwomen show reduced
strength muscle mass with a study on 50 non-athletic
transwomen who had undergone GAT (mean treatment
time 7.6 yrs., range 3–33 years) coupled with gender-
affirming surgery (mean 5 yrs. post-surgery, range 1–26
yrs.) showing a reduction of 27% of muscle mass at
the radius and 21% at the tibia when compared with a
population of young healthy men (T’Sjoen et al., 2009).
Although these subjects were non-athletic, 21–27%
muscle mass loss would lead to a greater than 1.46%
loss in strength and therefore, in archery performance
due to the loss of strength in the elbow extensors, the
deltoids and the FDS muscles. In a more recent study
also on non-athletic transwomen (n=11) by Wiik et al.
(2020), it was found that transwomen lost 5% muscle
volume and 4% muscle cross-sectional area after 12
months of GAT but importantly, transwomen main-
tained isometric torque in flexion (hamstrings) and
extension (quadriceps) after 12 months. This data,
albeit again in a non-athlete population of transwomen,
would suggest that 12 months, as currently required by
World Archery (Archery, 2020), may not be enough to
negate any strength advantage held by transwomen
before treatment, with this concern having been pre-
viously reported elsewhere (Hilton & Lundberg, 2021),
and not enough to negate the average, cis-male per-
formance advantage in archery (Table 1). While one
year may not be sufficient to negate advantages in
strength and therefore, in archery performance, there
is evidence that this strength advantage is negated
after 24 months of GAT. Pre- and post-GAT military
fitness test results in transwomen (n=46) of the U.S. Air
Force were compared and found that the 31% advan-
tage in push up performance and 15% advantage in
sit-up performance that transwomen had over cisgender
women at baseline had been negated after 24 months
(Roberts, Smalley, & Ahrendt, 2020). In contrast, recent
reviews highlight the fact that most of the strength
changes in transwomen occur after 12 months of GAT
and that muscle strength may be maintained in trans-
women for 36 months (Harper et al., 2021) or longer
(Hilton & Lundberg, 2021). However, in most studies
described in these reviews, muscle strength was
assessed using handgrip or lower body strength
measures such as knee flexion or extension. The upper
body data in the Roberts et al study (Roberts et al.,
2020) represents a more direct and meaningful compari-
son for the sport of archery, as both push-up perform-
ance (i.e. elbow extensors, deltoids, FDS for the
drawing action of the bowstring) and sit up performance
(i.e. rectus abdominis for postural balance) involve upper
body skeletal muscles. Therefore, meaningful compe-
tition between transwomen and cis-women archers
after 2 years of GAT may be possible. More data is
needed, however, to confirm this.
Neuroimaging studies have also shown changes in
brain structure in transgender individuals under hormo-
nal treatment (Hahn et al., 2015), therefore, it is biologi-
cally plausible that cognitive performance during GAT
might change towards that of the experienced gender
(Karalexi et al., 2020). Previous research has focused on
the potential adverse impact of GAT on cognitive func-
tion (Slabbekoorn, Van Goozen, Megens, Gooren, &
Cohen-Kettenis, 1999)and at baseline found that
untreated transwomen had higher visuospatial coordi-
nation than untreated transmen. After 3 months of
GAT that difference had disappeared and after 10
months of GAT, the original difference was reversed,
with the treated transmen performing better than the
treated transwomen. However, although the sex differ-
ence in visuospatial coordination was reversed, this
was because of a significant improvement in visuospatial
coordination in transmen (Slabbekoorn et al., 1999), with
EUROPEAN JOURNAL OF SPORT SCIENCE 7
no change in transwomen. These results suggest that
the androgenising effect of testosterone benefits visuos-
patial coordination, and this effect is maintained over
time with GAT in transwomen.
A recent meta-analysis set out to explore the effect
of GAT on the cognitive function of transwomen (Kar-
alexi et al., 2020) where standardised mean differences
(Hedges’g[Lakens, 2013], an unbiased effect size) were
pooled using random-effects models. The authors
assessed visuospatial coordination in transwomen
(n=91) in 4 different studies (Haraldsen, Egeland,
Haug, Finset, & Opjordsmoen, 2005; Miles, Green, &
Hines, 2006; Slabbekoorn et al., 1999; Van Goozen,
Slabbekoorn, Gooren, Sanders, & Cohen-Kettenis,
2002) and found no impact of GAT on post-treatment
visuospatial coordination performance in transwomen
(g=0.28, 95% CI −0.01, 0.58) after an average 7.44
years of follow up. This meta-analysis confirms the pre-
viously observed results (Slabbekoorn et al., 1999) that
transwomen’s visuospatial coordination remains
unaffected by GAT. The implications of these findings
for sports such as shooting and archery are that trans-
women are not expected to be at a visuospatial disad-
vantage compared to cis-males and transwomen and
may even have a visuospatial advantage over cis-
females due to the previously observed cis-gender
differences (Breda & Napp, 2019; Gong et al., 2018).
To discover whether this maintained advantage in
visuospatial coordination in transwomen after GAT
has worthwhile performance implications in terms of
archery and shooting performance, studies would
need to be conducted longitudinally in preferably
elite or sub-elite transwomen archers and shooters
throughout their early transition period. However,
potential advantages in visuospatial ability possessed
by transwomen may be negated in archery due to
reductions in other physiological attributes that theor-
etically could affect performance such as the reduction
in strength (Roberts et al., 2020) and local muscular O
2
availability (Gooren & Bunck, 2004). Any visuospatial
advantage held by transwomen may be negated less
in shooting where performance attributes, especially
strength, are less important.
7. Conclusion
The main challenge in drawing conclusions as to the
inclusion of transwomen in archery or shooting is a
lack of direct evidence of transwomen’s elite archery
or shooting performance and this is also true of all
other sports. Transwomen in elite level sport are still
exceedingly rare and the available indirect evidence
is the only existing avenue of evaluation presenting
itself to IFs until such direct evidence becomes avail-
able. This review is primarily aimed at demonstrating
the efficacy and value of the proposed decision-
making triangle (Figure 1) and the sliding scale
(Figure 2) process that can be used by IF’s to assess
the eligibility of transwomen in their respective
sports. Any Sports could have been chosen but this
review specifically chose the sports of archery and
shooting and applied the decision-making process
using a critical analysis of the literature available,
while comparing our decision-making process to the
subsequent recommendations of World Rugby.
However, it must be recognised that each respective
IF is best placed to determine their own priorities in
the decision-making triangle orientation (Figure 1)
and may find it helpful using our sliding scale tool
(Figure 2) to help guide their decision-making
process considering the limited relevant scientific
data. Based on using this approach and the sparse evi-
dence presented, it would be justified for meaningful
competition and to prioritise fairness, that transwomen
be permitted to compete in elite archery after 2 years
of GAT due to the reductions in strength resulting in a
potential and negligible visuospatial coordination
advantage. Similarly, it would be justified in terms of
shooting to prioritise inclusion and allow transwomen
after 1 year of GAT given that the only potential and
negligible advantage that transwomen may have is in
visuospatial coordination. The impact of this con-
sidered integration of transwomen in elite sports
such as archery and shooting could be updated
when more data becomes available on the effects of
GAT on any performance-related parameters and
lessons learned for other sports, especially where
there are no safety concerns from contact with an
opponent.
Acknowledgements
The concept of this manuscript was devised by the first (BH)
and the last author (YP). The first draft of the manuscript was
written by the first (BH) and last author (YP) and all authors
commented on subsequent versions of the manuscript until
all authors were able to approve the final manuscript.
Disclosure statement
No potential conflict of interest was reported by the author(s).
ORCID
Blair R. Hamilton http://orcid.org/0000-0001-7412-1188
Fergus M. Guppy http://orcid.org/0000-0002-8526-9169
Yannis Pitsiladis http://orcid.org/0000-0001-6210-2449
8B. R. HAMILTON ET AL.
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Appendix 1.
Example Search Strategy:
(((Transwomen) OR (transgender)) OR (transgender)) AND
(performance),
((Archery) OR (Shooting)) AND (performance).
10 B. R. HAMILTON ET AL.
