I posted this in the Title IX demolition thread, and since it directly relates to troons it needed to be posted here. It was published in July of 2023, so it is very recent. It's done by Ada Cheung, at the University of Melbourne and resident troon Kirsti Miller. It states there are no biological differences between transwomen and women. The paper is open access, and available
here.
This is a classic case of a paper stating one thing, with its own evidence saying another. Here is its evidence synthesis:
Evidence Synthesis
Existing literature comprises cross-sectional or small uncontrolled longitudinal studies of short duration. In nonathletic trans men starting testosterone therapy, within 1 year, muscle mass and strength increased and, by 3 years, physical performance (push-ups, sit-ups, run time) improved to the level of cisgender men. In nonathletic trans women, feminizing hormone therapy increased fat mass by approximately 30% and decreased muscle mass by approximately 5% after 12 months, and steadily declined beyond 3 years. While absolute lean mass remains higher in trans women, relative percentage lean mass and fat mass (and muscle strength corrected for lean mass), hemoglobin, and VO2 peak corrected for weight was no different to cisgender women. After 2 years of GAHT, no advantage was observed for physical performance measured by running time or in trans women. By 4 years, there was no advantage in sit-ups. While push-up performance declined in trans women, a statistical advantage remained relative to cisgender women.
It admits there are sex differences in sport, yet casually mentions that in swimming, there isn't much of a difference:
Cisgender males have a performance advantage over cisgender females in multiple sports (
14). Unequivocally, competitive sporting records for sports that are determined by maximal skeletal muscle or cardiac muscle performance demonstrate male advantage after the age of puberty (
15). The difference between male and female performance differs depending on the sport.
The lowest differences are seen in rowing, swimming, and running (11-13%), but the greatest differences are seen in movements utilizing the upper body (
16). For instance, there is a 20% male advantage for the fastest tennis serve and >50% difference in speed for baseball pitching (
16). This is largely the result of pubertal testosterone concentrations in the male range of 7.7 to 29.4 nmol/L relative to 0.06 to 1.68 nmol/L in females. This results in taller height, higher hemoglobin, larger bones, lower body fat, and higher muscle mass and strength in postpubertal males (
14,
17).
...do they not think upper body strength is used in rowing? Lia Thomas was on hormones for 3 years, and he still had a massive advantage over his female competitors.
Medically necessary GAHT is safe and effective at reducing gender incongruence or dysphoria, and can significantly improve psychological well-being and quality of life (
26-28).
Masculinizing hormone therapy with testosterone for trans men and nonbinary people recorded female at birth will commonly achieve serum testosterone concentrations in the male reference range (14, 26, 29, 30). This induces lowered voice, body and facial hair growth, menstrual cessation, as well as changes in body composition (increase in muscle mass and reduction in fat mass) (
26,
29,
30). Common risks include acne, unmasking polycythemia (particularly in the setting of other conditions such as sleep apnea), infertility, androgenic alopecia, hypertension, reduced high-density lipoprotein cholesterol and an increased risk of myocardial infarction relative to cisgender women (
26,
31).
What is interesting is that this claim - that trans men will get T levels in the male range - is not supported by this study's own evidence. Trans men are not winning gold or smashing records in men's sports, despite having 'equal' T levels.
Feminizing hormone therapy for trans women and nonbinary individuals recorded male at birth will typically achieve serum estradiol (100-200 pg/mL or 367-734 pmol/L) and testosterone concentrations (<2 nmol/L or <58 ng/dL or <2 nmol/L) in the female range (
26,
29). Estradiol therapy is often paired with antiandrogen agents such as cyproterone acetate, spironolactone, bicalutamide, or gonadotropin-releasing hormone analogues for people with testes. Depending on the mechanism of action, peripheral androgen receptor antagonists such as spironolactone or bicalutamide may not lower testosterone concentrations but will block the action of testosterone at the receptor level (
32,
33). Feminizing hormone therapy induces gynoid fat redistribution and breast growth, softens skin, and reduces muscle mass, body and facial hair growth, and libido (
26,
29,
30). V
oice pitch and skeletal size do not change (
26,
29,
30).
Adverse effects include an increased risk of venous thromboembolism, infertility, weight gain, and hypertriglyceridemia as well as elevated risk of myocardial infarction and stroke relative to cisgender women and men in the setting of additional risk factors (
26,
30,
31,
34).
Surprised they even mentioned the risks. So much for it being 'safe and effective'.
Now, despite the paper saying transmen had the same T levels as real men, do they have the same advantages?
For trans men, longitudinal studies examining lean mass using DXA have consistently shown a 10% increase over the first 12 months associated with a 10% decrease in fat mass (
41-45).
Muscle area (as opposed to mass) measured in a single-slice magnetic resonance imaging cross-section of the thigh found that muscle area increased in trans men by 19% over 3 years but most change had plateaued by 1 year (
46). After a median of 44 months of GAHT, a cross-sectional analysis of 43 trans men showed that lean mass was 7.8 kg higher than cisgender women but fat mass was not statistically significantly different (
47). Trans men had fat mass 29% with lean mass 68.3%, which was statistically significantly different to cisgender men (fat mass 19.7%, lean mass 77%,
P < .001) (
47).
The paper admits transwomen are taller than natal women:
Conversely, for trans women, longitudinal cohort studies show that reductions in absolute lean mass are modest, approximately 3% to 5% in the first 12 months (
43,
45,
48-52). A longitudinal study in 179 trans women over the first 12 months of GAHT showed a decrease of total lean mass by 3% from baseline but fat mass increased by 28% (
45). A 2-year study assessing relative lean mass percentage in trans women found reductions from 77.5% at baseline to 72.5% at 1 year and 71.7% at 2 years, whereas relative fat mass increased from 19% at baseline to 24.2% at 1 year and 25.6% at 2 years (
51).
A 3-year study assessing cross-sectional thigh muscle area in 19 trans women showed a decrease of 9% from baseline at 1 year and 12% from baseline at 3 years, although the loss between 1 to 3 years was statistically not significant (
46).
Muscle area in trans women remained statistically significantly greater than that measured in untreated trans men (used as the female comparison group), though with an almost complete overlap between the 2 groups. The authors noted that trans women were on average 10.7 cm taller than untreated trans men and in a linear regression model, height was a strong predictor of muscle area, even after correction for the effect of sex (46).
So, transwomen are taller, have greater muscle mass, and only experience a 12% reduction, just what the Air Force study showed. But they're totally weaker and have no advantages ever.
While longitudinal studies have followed trans women for relatively short durations, there have been 2 cross-sectional studies in nonathletic trans women that have aimed to describe the longer-term effects of GAHTs.
After a mean 8 years of feminizing hormone therapy, 23 trans women were found to have 32% higher fat mass, 17% lower lean mass, 25% lower grip strength, 33% lower biceps peak torque, and 25% lower quadriceps peak torque relative to cisgender men (
53).
There was no cisgender female control group. Similarly, in another recent study designed to match participants for the same birth-recorded sex, 41 trans women (median 39 months GAHT) had a statistically significant 6.9 kg lower lean mass and 9.8 kg higher fat mass relative to cisgender men measured by DXA (
47). Overall body composition in trans women (fat mass 32.3%, lean mass 65.0%) was similar to cisgender women (fat mass 32.8%, lean mass 64.5%,
P > .05) (
47), consistent with Alvares et al's cross-sectional analysis showing that fat mass percentage in trans women (median GAHT duration 14 years) was not statistically different to cisgender women (29.5% vs 32.9%,
P > .05) (
54). Lean mass corrected for height was also not statistically different between trans women and cisgender women (
54).
While the raw lean mass in trans women was higher than cisgender women, trans women were on average taller and as such, to compare body composition changes between groups, the percentage fat and lean mass may be a more appropriate comparison.
They only thing they have in common is fat mass, but they're still pushing it.
On grip strength:
In trans men, a prospective controlled analysis found that 23 trans men had a mean 18% increase in hand grip strength over 12 months relative to 23 cisgender women (
41). A larger longitudinal analysis of 278 trans men showed an increase in grip strength of 6.1 kg (18% from baseline) over 12 months (
65). Interestingly, in trans men, the increase in grip strength was associated with an increase in lean body mass (per kg increase in grip strength: +0.010 kg, 95% CI +0.003; +0.017), while this was not statistically significant in trans women (per kg increase in grip strength: +0.004 kg, 95% CI −0.000; +0.009) (
65).
A cross-sectional study comparing hand grip in 19 trans men (mean 29 kg, 2 years after GAHT) with 19 cisgender men (mean 40 kg) showed that strength was considerably lower in the trans men (66). In a group of 12 trans men followed over the first 12 months of GAHT, knee flexion and extension strength increased, but, even when adjusted for height, remained lower than cisgender men (67).
What? I thought their T levels made them equal to men? What's going on?
In trans women, several uncontrolled longitudinal studies (
42,
43,
51,
53,
54,
65,
67) and cross-sectional studies have made comparisons with cisgender men (
53,
54). All assessed hand grip strength, except for 2 small studies that assessed knee extension/flexion (
53,
67).
Hand grip changes in trans women have shown variable results, with some studies demonstrating significant reductions of −4 to −7% over 12 months (51, 65) and smaller studies showing no significant change (42, 43). Mean hand grip strength if corrected for total lean mass has been shown to be no different in trans women compared with cisgender women, but was significantly lower than cisgender men (
54).
> Only have a decrease in 7%
> Equal to women
Ho hum.
In terms of lower-body strength, a cross-sectional analysis of 23 trans women (mean 8 years GAHT) showed knee extension was 25% lower than cisgender men (
53). In contrast, a small longitudinal cohort study of 11 trans women over the first 12 months of GAHT found no statistically significant change in knee flexion/extension strength in trans women (
67). While the study was small and the comparison group were not concurrently assessed, the findings suggest that 12 months of GAHT is insufficient to change knee flexion/extension strength to the level of cisgender women.
Lmao weak knees.
Their conclusion:
Overall, handgrip strength is limited as a proxy for overall strength. In trans men, absolute and relative muscle mass and strength increases with GAHT and are higher than cisgender women but remain lower than cisgender men. Trans women after GAHT have higher absolute muscle mass, but their relative muscle and fat mass percentages and muscle strength corrected for lean mass are no different to cisgender women.
Transmen can't win against men, yet transwomen are exactly the same as women despite only losing a bit of muscle strength and being taller than the average woman.
On Bone Mineral Density. Rather based despite what TRAs say.
Bone microarchitecture measured by high-resolution peripheral quantitative computed tomography may overcome limitations of DXA and has been shown to improve fracture risk prediction (
83,
84).
A recent cross-sectional analysis involving 41 trans men and 40 trans women compared with cisgender comparison groups of the same birth-recorded sex found that trans women had compromised bone microarchitecture. There was lower total volumetric BMD (vBMD) with lower cortical and trabecular vBMD and higher cortical porosity relative to cisgender men (
85). Prospective studies are required to confirm these findings, as previous research has shown that trans women have low areal BMD compared with cisgender men even before starting any hormonal therapy (
86).
Conversely, bone microarchitecture in trans men was preserved with higher total vBMD relative to cisgender women (85) but lower than that of cisgender men (
66). These vBMD data are consistent with fracture data from a population-based study showing a higher percentage of fractures in trans women relative to cisgender men, but fracture risk in trans men was no different to cisgender women (
87).
Estrogen is supposed to make them uwu females, gives them fractures instead.
On red blood cell counts:
Hemoglobin concentrations in men are higher than that for women in the general population (
88). Increases in hemoglobin may contribute to enhanced performance of elite endurance athletes (
89,
90). Interestingly, gene polymorphisms that regulate hemoglobin are more prevalent in endurance male cyclists (
90). Androgens induce erythrocytosis via upregulating erythropoietin and downregulating ferritin and hepcidin concentrations (
91), and it is not surprising that GAHT has marked and consistent effects on hemoglobin and hematocrit concentrations (
92).
In those on established GAHT, hemoglobin, hematocrit, and red blood cell count increases to the male reference range in trans men (48, 49, 93, 94) and correspondingly decreases to the female reference range in trans women (49, 94-96) within 3 months (97). Such changes in erythrocytosis are likely to impact endurance (running times are discussed under “Physical Performance Changes With Gender-Affirming Hormone Therapy”).
Despite this, transmen continue to fall behind real men, and transwomen - as the paper later admits - fall between males and females.
On VO2 uptake:
There has been only 1 cross-sectional study, assessing VO2 peak in 15 trans women compared with 13 cisgender men and 14 cisgender women, and findings are summarized in
Table 2 (
54). While the trans women included had received GAHT for a mean of 14 years, the serum testosterone concentrations were widely distributed with mean 3.2 nmol/L (range 0.4-22.1) relative to cisgender women (
Table 2).
Trans women were taller than cisgender women and absolute values suggest that trans women appear to have muscle mass, strength, and VO2 peak in between that of cisgender women and cisgender men. However, when VO2 peak is corrected for weight or lean mass, there are no statistical differences between trans women and cisgender women, but are significantly lower than cisgender men (
54).
They have to keep putting them in the female level just to make them equal, even when the previous sentence said otherwise. It's their male bodies, retard. The chart also shows their testosterone still being higher than women, at 3.8 nmol/L compared to the female 0.7. They are right between the male and female values, while being closer to the male ones.
On estrogen potentially impairing them:
Interestingly, Alvares et al noted that trans women had a lower VO2 peak/lean mass index, and lower mean strength/lean mass index than both cisgender groups, suggesting that trans women produce less force per gram of muscle (
54).
Possible cellular dysfunction in the muscle of trans women following GAHT has been postulated (54). This notion is supported by animal models of androgen receptor knockout mice, which show impaired skeletal muscle function with reduced fast-twitch muscle mass and force production in male mice but not female mice (
114). Gene expression in the muscle of these male mice suggested reduced polyamine biosynthetic enzymes and impaired myoblast differentiation.
There are no differences, but estrogen still wants to nuke your male body anyways.
Expiratory volume was also lower in trans women than in cisgender men, but there was no statistically significant difference compared with cisgender women (
54). The authors hypothesized that there may be an effect of estradiol acting as a potential bronchoconstrictor or respiratory muscle weakness (
115,
116).
Still trying to kill them.
Although no direct studies have assessed cardiac size or function in trans people, high-sensitivity cardiac troponin (hs-cTn) concentrations are an indirect reflection of cardiac mass in healthy individuals (
117-119). This likely explains the higher hs-cTn male reference range relative to females. A cross-sectional study assessing hs-cTn in trans people on GAHT for >12 months found that median concentrations of hs-cTn in trans men were similar to cisgender men, and trans women were similar to cisgender women (
120). These findings are concordant with animal models demonstrating androgen deprivation in male mice induces metabolic remodeling of the heart with reduced cardiac mass and impaired cardiac output during stress (
121).
I wonder how they got to that conclusion despite admitting they never assessed cardiac size.
On performance differences:
More recent data from Chiccarelli et al have expanded the analysis with a larger cohort of 146 trans men and 228 trans women compared with cisgender mean aggregate scores in 2022 for Air Force members with an aim to guide fitness targets for their trans service members undergoing GAHT (
124). There were 346 who dropped out from analysis, with only 28 trans individuals (15 trans women) completing follow-up to 4 years of GAHT (
124). Dropouts are extremely important to consider in skewing results, given that those who remain in the military likely display a higher level of physical fitness or have better access to health care than those who leave.
This was the same study, mind you, that this paper acknowledged where transwomen still have greater thigh muscle strength and still ran faster than females. Same one.
T
rans men service members prior to testosterone therapy performed 43% fewer push-ups and ran 1.5 miles 15% slower than cisgender men in the initial Roberts et al study (
123). After commencing GAHT, there was progressive increase in push-ups and sit-ups performed and improvement in running times, and by 2 years, trans men were no different to cisgender men (
123).
In Chiccarelli's expanded analysis, while sit-ups achieved the level of cisgender men within 1 year, push-ups and run times took 3 years to reach that of cisgender men (124). By 4 years, trans men appeared to exceed the average performance of cisgender men (
124).
This despite them not having the same grip strength, VO2 levels, or larger hearts. This same study also showed that hand grip strength decreased for transmen after a few years.
Trans women prior to feminizing hormone therapy performed 31% more push-ups, 15% more sit-ups in 1 minute, and ran 1.5 miles 21% faster than cisgender women in Roberts et al's study (
123).
It should be noted that height and size were not matched between trans women and cisgender women (Fig. 1). After 2 years of taking feminizing hormones, the push-ups and sit-ups performed in 1 minute significantly reduced and were no different to cisgender women (
123).
In Chiccarelli's analysis, the number of push-ups and sit-ups performed steadily declined over 4 years; however, although sit-ups were not statistically different to cisgender women at the 4 year time-point, push-ups performed remained statistically higher than cisgender women (albeit that 208 of 223 trans women dropped out over 4 years) (
124). Run times slowed in both studies; however, statistical results were discrepant;
Roberts et al found that trans women remained statistically faster than cisgender women at 2 years, but the larger Chiccarelli et al study found that run times among trans women were no different from cisgender women by 2 years of GAHT (123,
124).
Anything to make them equal.
Overall, trans men have improvements in physical performance after 1 to 2 years of testosterone therapy. In trans women, declines were seen in areas of physical performance but the discrepancy between statistical significance in Roberts et al and Chiccarelli et al may reflect a residual advantage in some parameters over cisgender women, or a type 1 error with survivorship bias influencing results given dropouts over time. Fitness test results must be interpreted in light of limitations. Tests have a minimum standard to pass, and, as such, are effort dependent and do not quantify maximal performance. Failure to pass a fitness test typically affects job prospects and requires service members to attend additional physical training sessions until they can meet the fitness requirements or leave military service. As such, there is survivorship bias across time with those remaining in the study likely maintaining higher fitness levels. Moreover, test results are uncontrolled for lifestyle variables; the type and intensity of training of service members vary by occupation. Further prospective studies in trans people are needed.
I'll be bringing up this Air Force paper again, because the summary is a doozy.
Physical performance is dependent upon many factors that vary greatly depending on the needs of individual sports. There are no published research studies on the effect of GAHT on coordination, flexibility, cardiac size, lung function, maximal power output (Wmax), anaerobic capacity, lactate threshold, exercise economy, efficiency, or factors such as Wmax/body weight ratio that are an important marker of ability in competitive cyclists.
>There are no published studies on these variables
> Still argues that transwomen are equal to women
This despite them saying in the paper cardiac troponin was the same.
Existing studies in nonathletic trans men have shown that increases in muscle mass and strength occur with testosterone therapy, and physical performance appears to be no different to cisgender men by 1 to 3 years after GAHT.
That's not what their own evidence said. Earlier in the paper, it states muscle mass
plateaus over a year, and grip strength
decreases in comparison to men. Despite transmen having the same T levels, they still cannot reach men on their level. How strange.
Studies in nonathletic trans women after GAHT demonstrates no change in height, but have shown decreases in hemoglobin, bone density compromise, and decrease in muscle mass and strength, which continue to decline beyond 2 years. While absolute muscle mass is higher, their relative muscle and fat mass percentages and muscle strength corrected for lean mass are no different to cisgender women. Cross-sectional studies of trans women on GAHT for over 4 years show that relative percentages of muscle mass and fat mass as well as fitness as measured by VO2 peak corrected for lean mass are no different to cisgender women and lower than that of cisgender men. Steady decrements are seen in physical performance of nonathletic trans women in the military, with no significant difference with cisgender women for running times by 2 years and sit-ups by 4 years after GAHT. An advantage in push-ups or upper body strength over cisgender women may remain at 4 years.
One AGAIN, the Air Force paper Cheung is referring to s
howed transwomen had 12% more muscle mass and still ran faster than their female counterparts. They still performed more pushups, which this paper acknowledges. Hand grip strength ONLY decreases by 7%, and allow me to reference this little tidbit from earlier in the paper:
A 3-year study assessing cross-sectional thigh muscle area in 19 trans women showed a decrease of 9% from baseline at 1 year and 12% from baseline at 3 years, although the loss between 1 to 3 years was statistically not significant (
46).
Muscle area in trans women remained statistically significantly greater than that measured in untreated trans men (used as the female comparison group), though with an almost complete overlap between the 2 groups. The authors noted that trans women were on average 10.7 cm taller than untreated trans men and in a linear regression model, height was a strong predictor of muscle area, even after correction for the effect of sex
Transwomen are women, yet they're still bigger, only have a decrease of 12% in their abilities, and still have more muscle because they are 10 cm taller than pooners. You gotta love studies like these. Once again, Lia Thomas was on hormones since 2019. He was still bigger, taller, and quicker than the other female swimmers - which this paper insists there are no sex differences. The main author, Ada Cheung, was called out by Emma Hilton for openly denying sex differences in sport. (See related argument
here). And
here.
.
