Dr Akshai Mansingh says in spite of World Athletics’ (WA) ban on transgendered athletes competing against females, there is still much work to be done to address the issue.

WA announced on Thursday that no transgender athlete who had gone through male puberty would be permitted to compete in female world ranking competitions as of March 31. The decision comes after criticism from female athletes that transgendered athletes are at an advantage when competing against them because by nature they are likely to produce higher levels of testosterone.

But this was even in spite of WA’s previous ruling based on their scientific research that required transgender women to reduce their blood testosterone to a maximum of 5 nanomoles per litre (nmol/L) and remain at this level continuously for at least 12 months before being allowed to compete against females.

These new rules are similar to those imposed by FINA in swimming last year that bar athletes who have transitioned from male to female and have gone through male puberty. No such athletes are now at the highest elite levels of athletics.

WA also adopted new regulations that could keep Olympic Women’s 200m silver medallist Christine Mboma and other athletes with differences in sex development (DSD) from competing.

“There’s still a lot of work to sort out this problem,” Mansingh told the Jamaica Observer.

WA President Sebastian Coe agrees.

“All the decisions we’ve taken have their challenges,” Coe said. “If that’s the case, then we will do what we have done in the past, which is vigorously defend our position. And the overarching principle for me is we will always do what we think is in the best interest of our sport.”

But he warns that WA’s new rules on transgendered athletes should not be confused with those for DSD athletes.

“The first thing we’ve got to do is to distinguish transgender athletes from those with DSD,” he said.

A transgendered athlete is born of one sex but identifies with another, and may even use surgery to change their appearance to match that sex they seek to identify as. They may also use hormonal therapy to do this. A female who may want to identify as a male poses no challenge to the rules as she does not produce enough testosterone to have what is considered an unfair advantage. However, when a male decides to identify as a female and then compete against athletes born female, their testosterone levels would be considered too high, which WA seeks to address.

“Even if you reduce their testosterone level, which was what was done before — here’s where the tricky part comes in, how much do you reduce it to?” Mansingh asked.

“They used to use 400 nanograms, now they’re using 200 nanograms over two years. The problem is if they developed as a male through puberty, then they’ve already got their biology of major muscles.

“Once you’ve had testosterone in your system at a high level, it takes four years to reverse that, not two. So there’s definitely a disadvantage to the rest of the females if there’s somebody who has all these male hormones in the past and now over the last two years or so, decided they are going to reduce the hormones. That’s where the problem lies. We’ve seen repeatedly in many sports where these people seem to have an advantage.”

DSD athletes, however, fall into a category with rare conditions where their hormones, genes, and/or reproductive organs may be a mix of male and female characteristics. They are now required to reduce their blood testosterone level to below 2.5 nmol/L, down from five, and must remain under this level for two years to compete internationally in the female category in any athletics event.

Mboma has not publicly stated whether she would be willing to undergo hormone therapy. However, South African former Olympic 800m double gold medallist Caster Semenya stopped competing in this event because she refused therapy. She now aims to make a return to the Olympics over longer distances.

But Mansingh says the impact on athletes feeling disadvantaged is also psychological.

“It’s also how the others feel about it,” he said. “In swimming and in rugby they’ve banned them. Now WA is saying it’s not a ban forever, it requires some more research, but for now, we feel that there’s an unfair advantage, and I agree with that.”

Mansingh says because the global transgendered population is so large, the issue can no longer be avoided.

“What I think is being said right now is that, ‘We cannot address it by allowing them to compete as females, because of the advantage, and perhaps we don’t have enough numbers right now to have a separate category called transgender, but a day may come where we need to either have another category, or we’re gonna have to find a way to allow them into mainstream sports.

“I don’t want to throw cold water on the issue because there are many people who are ostracised because of how they feel.”

WA is, however, still exploring the issue and has set up a council to explore it over 12 months to make updates to the rules. This group will consist of an independent chair, three council members, two athletes from the Athletes’ Commission, a transgender athlete, three representatives of World Athletics’ member federations, and representatives of the World Athletics health and science department.