Working Diagnosis:
Gender Dysphoria (transgender MTF)

Treatment:
-Placed on estradiol 2mg, spironolactone 100mg daily
-Doses titrated and testosterone and estradiol levels monitored along with patient symptoms

Outcome:
-Red-shirted this year
-Chose not to tell her teammates about reason for red shirt status
-May participate on women's track & field team after 1 calendar year of testosterone suppression treatment
-Followed closely at student health for monitoring of hormonal therapy

Author's Comments:
A growing number of NCAA eligible college students are identifying as transgender -The NCAA strives to be inclusive, but must also address concerns about competitive equity -NCAA policy asserts that hormonally treated athletes may compete on teams that correspond to their gender identity -MTF may compete after 1 year of testosterone suppression therapy, as limited research reveals that the maximal decrease in muscle mass in MTF will occur within that amount of time -Same study asserts that the muscle mass of testosterone suppressed MTF is still significantly greater than that of untreated males, though with a large area of overlap -In addition, some previous effects of testosterone will be unchanged, including greater height and hand size of MTF than biological females -However, in general, athletes vary greatly with respect to muscle mass and size, and in some cases these factors may not lead to a competitive edge -Many variables aside from muscle mass contribute to athletic success, including skill, innate ability, reaction time, drive, discipline, aggressiveness.

Editor's Comments:
This must have been an interesting discussion at the preparticipation physical, and another reason why these exams are best done in a private and not group setting. Physicians must be prepared to address transgender and other nontraditional athletes in a nonjudgmental way, and assist them in their goals to pursue competition.

References:
NCAA Office of Inclusion
http://www.ncaa.org/about/resources/inclusion/lesbian-gay-bisexual-transgender-and-questioning-lgbtq

Return To The Case Studies List.