Transgender Women in the Female Category of Sport with Emma Hilton PhD | Koopcast Episode 68

trail and ultra runners what is going on what's happening welcome to a very special episode of the KoopCast i'm glad you are all tuned in today and let's get one thing straight right from the get go today's episode is all about transgender policy in sport and this is an incredibly complicated and charged topic and i realize that it's incredibly charged and complicated and it can go far beyond the hour and a half that emma and i spent on it but what i wanted to do with this podcast is just offer an initial taste of what we know about the science of some of this stuff so that the listeners the race directors the runners and the elite athletes out there can better inform some of their opinions on these particular policies on the podcast today i have the incredible emma hilton PhD who is a developmental biologist out of the university of manchester in the uk and more importantly to this conversation she's the lead author on a brand new review article in the journal sports medicine which is titled transgender women in the female category of sport perspectives on testosterone suppression and performance advantage emma is well known in both

social and athletic circles for having very strong opinions on this and i knew this when i asked emma onto the podcast everybody listening is more than more than welcome to go and google any of those viewpoints they are readily accessible throughout all corners of the internet and some of you are going to agree and disagree with her various viewpoints i wanted to bring emma on the podcast today to talk very specifically about the science i understand that there is going to be an inevitable venn diagram overlap between the social constructs of transgender policy and the scientific constructs of of transgender policy i understand that that's inevitable but my bias as a coach especially a coach that works with elite athletes is to focus on the performance and to focus on the science not to discount the rest of it or not to completely ignore the rest of it but to put more of the focus on that particular aspect if we want to have a conversation about the social side of it absolutely we can have that but let this podcast be a first little tease into this entire discussion i hope that everybody listens to this with an open heart and an open and curious mind and one that is free from any of the biases that you had coming into listening to this podcast so here we go i'm gonna get right out of the way here's my conversation with emma hilton all about transgender policy in sport

it's a weird quirky sport as you can imagine um and i think the big thing is is you know we have no we have no regulating we have no singular regulating or governing body and so the the rules are essentially race by race you know some races and even if you look at things like do you have to follow the marked course some rule some races you can kind of go wherever you want to and it's a point to point and first person there wins no matter what route they take exactly yeah yeah no no exactly in other races you have to follow a very specified route and then there's hybrids of that and different interpretations of those rules and so i think that um uh kind of the reason for me sending you over the western states policy was to kind of orient you not only with their specific policy but the fact that a lot of different races were are trying to like navigate this all by themselves which is as you can imagine incredibly you know incredibly difficult to do it's difficult at the like you say the kind of overarching uh like a federation level let alone the the kind of um you know the variety that's something like ultra running long distance running provides in terms of course types and you know over how many days and i'm learning about people running you know 3 000 kilometers

like 40 something days this is just i mean this is a sport for the insane well i i always i have this cheeky little saying that there's always another idiot right it doesn't matter it doesn't matter how long i've been in the sport which is about 20 years now there's always another idiot that's willing to do something more grandiose than the idiots before them and that's kind of what makes it you know that it's a little bit of what makes it fun so i'm glad i can expand your horizons a little bit into a new sport and i like i said i really appreciate your your uh your time in advance i want to start out by talking about a sport that you and i actually we we both know i'm a big fan of and it's my understanding that part of this part of one of the happenings in the sport is why you got involved in some of this policy and research in the first place and that's this issue in mixed martial arts with fallon fox and i want to i want to start out with that because all too often in the endurance space and i think in ultra running in particular we get caught in this really narrow silo of sports and of rules that pertain to sport that that they should only be applied within the sport that we are focused on and that's fine that's because we care about running and things like that but all too often we lose context that there's a bigger sporting environment around there and when we come to conclusions about

hey listen this is the type of policy or direction that we should take or here's this you know rule that we want to put in place that there might be ramifications of that outside of the endemic sport that we're used to and i think that i think that there's no more different sport as compared to ultra running as mixed martial arts but also for the things that we're going to talk about it serves as a really big magnifying glass for what's at the heart of this issue and so i've heard you describe this before so i'm going to turn it over to you the the listeners are not going to be familiar with this story so why don't you take them through the whole thing and how you and how this initially caught your eye so the the story of phallum fox um and we'll talk about the details shortly then the story of phallum fox was the first time as a feminist and i would say a kind of you know someone who does feminism but wouldn't politically label themselves as a feminist and also someone who's sporty but not an elite kind of competitor i'm a bit old now but i was never you know particularly in the elite this was the first kind of conjunction of sport and feminism where i really thought hang on a minute there's something going on here that's um you know not really fair not really right so for your listeners phallum fox is a trans woman she's a mma fighter she's a former u.s navy veteran who transitioned and and and became this

you know mixed martial art fighter and was put up in a match against a a very very good female mma fighter and phallum fox uh i mean battered her you know absolutely kind of overpowered her opponent who's called tamika brentz uh to the point and i know mixed martial art is a violent sport by its very nature it's a violent combat sport um left tamika brentz with the need for lots of stitches uh shattered her orbital um bone and tamika brentz after this and after you know being stitched up and that kind of thing tamika brentz said that she had fought an awful lot of females an awful lot of women fighters and and as and she's described herself as an abnormally strong woman in her own right had never felt so overpowered and and we're talking things you know like grip strength and and just the abilities kind of like i say completely overpower this very actually very elite female fighter and that's when i thought hang on that you know we're we're watching now we're celebrating we're we're arguing for inclusion of someone who has had for me i'm a developmental biologist so you know this kind of understanding of

how bodies develop and grow and become different between males and females we're celebrating how someone who's had the advantage of being male for for a very you know informative part of their physical development and being in a ring where they are physically where the sport is to physically harm the other person and that this is a dangerous situation so that's really where i started to think or or as you say it captured my desire to understand like how why are we in this situation is this some unique type of thing that is not happening across sports for example but but or is this you know a signal about where sports is going and that this is going to be a an issue that we have to start to do it so i started kind of digging into it from that um event and and like i said it's a it's a it's a magnifying glass over the issue itself because the sport as you put it is you're trying to beat the other person up in the ring right it's a very physical collision type of sport we call it we used to call it a collision sport we used to call you know hockey and football collision sports and basketball contact sport this is a very hyper example of a sport where physical harm is kind of the outcome it's kind of the desired outcome and i bring it up from the get-go because whenever we come up

with these you know kind of absolutist statements for everybody needs to play ball or we're going to exclude everybody you can always come up with hyper examples on one side of the fence or the other to justify those those those positions and all too often in running we think about policy as just pertaining to running but it really but but it really doesn't and so i want to use that as a little bit of a launch point to the research paper that you wrote in conjunction with tommy lumberg who i have a tremendous amount of respect for his work uh over the years i've followed his work for a number of years and i've used it uh in my in my coaching practice i'm gonna put a link to the the research paper in the show notes so everybody can access it it's open access um nobody should have a problem it's actually quite readable but was that the launch point for you to go into this from a perspective of hey i'm actually going to write a review article on this or was there a couple of other steps that you initially took in order to like start that part of the process so um i had started with this fallon fox like you say capture the attention focuses this lens and and had started then to dig around into other sports and i'm a scientist so you know i sit there in front of excel sheets and make graphs and start to calculate percentages here and there and that kind of thing and i was starting to collect not just case

stories because there are several case stories where we could you know you couldn't talk about uh particular trans women who are successful not just in um like a combat sport where where the results are particularly kind of visual and visceral if you like and but also in things like weightlifting and cycling and and that you know across across the board so you've got these case reports but that that's not necessarily so satisfying to me i wanted to try and find out kind of systematically how you know how males were performing relative to females and whether um you know what what were the hormone treatments that trans women are undertaking and how that might affect their performance so i started kind of digging into look here are these advantages over a variety of sports and you know from from something that's a very individual non-contact if you're injured it's probably very individual you're not taking someone else out in the in the process something like running cycling rowing those kinds of things maybe less so cycling because you might collide but all the way through these kinds of um contact collision through to combat sports where you can start mapping things like punch difference or you know the force through a punch patient so starting to map these differences and starting to build a database i suppose almost almost like what i consider to be a resource that i i hadn't really thought about

um necessarily using um in terms of policy guidance and then um it became obvious that there were there was this gap in knowledge about how to understand how trans women might be performing in sports and and and i started getting requests for for my data and then i started to you know i'm a scientist i'm thinking i you know is there do i publish this how do i publish this what what really is that what really are the questions that need to be answered here and digging into things like the international olympic committee policy and and that kind of thing and then tommy and i actually met we both were asked to and consult for world rugby who uh in 2020 took undertook a review of their their inclusion policy for trans women and we were both independently asked i'd seen tommy's work um but but then we kind of have like you know linked up it turns out he'd done a lot of the same kind of digging around the stats that i had and it just became very obvious that we could you know review these and try and formulate some recommendations or try and create a framework that that sports federations might want to have a look at when they're formulating their own policies can you since before we jump into the paper really quick

and you've already gone through this aspect can you briefly go over what you and tommy kind of advised world rugby and then what the outcome of that is because once again the listeners are not going to know they're not rugby followers there might be a small handful of them with all due respect to all the rugby players out there that's not my audience but can you just take the listeners through that really quick so my role in in the world rugby consultation the workshop that they ran was really from a very basic developmental biology point of view here are males here are females the this is how you know on average as a class males are different from females and this is how it translates into sporting differences and i would say that that creates a kind of null hypothesis that is the reason we have separate sports categories is because males and females on average perform differently in sports and and there are very very few sports where males don't outperform females so that that was my role as a developmental biologist and tommy as you will know is an exercise physiologist an exercise clinician he studies people's muscles and how you know how fast they can produce forces and all these kind of physics terms that i faintly remember from 20 years ago at a level physics um and and he has undertaken a study of an you know an original research study of how um trans women in accordance with sports policies which

are standard kind of suppression of testosterone for a year how does that actually change how they can move their muscles what force they can produce what's them you know what's their muscle mass and he he's actually taking this cohort further for some some quite deep molecular analysis of their muscles so so so we had um we had this kind of scientific kind of input here and what world rugby decided from this uh was that first of all the male advantage is very big in rugby you know we're we're talking about a heavy contact sport where mass matters where the speed at which you can shift into a tackle matters we're talking about a sport that has got a particular responsibility to minimize things like head injuries that come out of tackles and what they decided and it wasn't just it wasn't just me and tommy it was a huge number of people talking about various scientific aspects including joanna harper who obviously would be considered on the other side of of my point of view um and and included advocates for um trans inclusion from kind of a social perspective it included advocates for um female athletes that it's a very balanced deliberately balanced deliberately very well kind of um created group of people together and what world rugby came up or you know what they decided at the end was that the risk of

injury and tackle is is big in rugby anyway and and some of these injuries can be quite severe and that the male advantage is simply too big and there isn't enough evidence that it's it's mitigated sufficiently by the standard practice of you know taking down testosterone levels for a year so what what they ended up with and i think a lot of people miss miss the point is that at the moment as the evidence sits we don't think it's safe for an elite competition for trans women to play in female categories but that they will review this you know depending on whatever evidence is coming through and i think from a sporting perspective one and i don't know if you had perspective of this when you're actually going through the workshop and advising world rugby is that became one of the models for other sporting organizations to use since then because for whatever reason we don't need to go through this now they were one of the first to half they were the one of the first that were confronted with this issue and they had to create policy around it and everybody else is kind of playing catch up especially in the contact sports so i think that yes and they were the first to really you know tackle it head-on and of necessity because you know rugby does deliver you know unfortunately some quite severe injuries and and they and rugby has got a really good history of of being very sensible about trying to minimize this and you know mitigate injury risk

and so i think they felt it like i say this kind of special duty to to investigate this because until they did and they came they came back with the idea that the international olympic committee policy wasn't fit for purpose right and until world rugby said that i don't think anyone with authority within the sporting world i mean i've questioned the policy for a while but anyway you know any kind of federation had really questioned what the international olympic committee had set down first of all in 2000 and just about 2003-4 and then kind of refined in 2015 and so to have a major sports federation come out and say look this policy isn't really working and it's certainly not working for rugby right and i don't know i i i i wouldn't want to suggest it's a floodgate opportunity but it it it cut it should rightfully empower other sports federations to rather than follow ioc guidance without their own due diligence to to look at what works best for their sport and whether there are risks or whether perhaps in something like running there's you know less of a safety risk we don't need to think about this and and that kind of thing so hopefully it empowers other sporting federations to to make their own policy and this is always the issue when big you know organizational level policies in sport are adopted by other sports or other organizations and it doesn't matter whether it's

a transgender policy or a doping policy or some other type of rule whenever the ioc sets it which is typically what happens and that's what happened in this case and other organizations just adopt it because of this leadership position that the ioc rightfully has the nuances of each organization are kind of lost and as you said the the kind of the use case or the purpose of the rule in the first place is not directly translatable in all different sports and i'll also say across different levels of sport because there are different uh ideals that each level of sport will have the you know the ioc is looking after a completely different cohort than the michigan state high school athletic association and when they're looking at the ioc to adopt their policies they have to realize that they have a different constituent base to that they have to that they have to serve with those rules that's that's commentary for maybe later on in in the discussion but i hope we do get into it but i want to kind of pivot to this paper and to that that you and tommy wrote and to kind of set the stage of this we can always take transgender policies a ton of different ways you can take it a social way you can take it a scientific way you can take from a competitive standpoint i want to focus on the science first and foremost i know that those venn diagrams are going to overlap in places that's inevitable and i'm and i'm kind of fine with that but my kind of goal with this is to educate the

listeners on the science side of it so that the community eventually can come up with their own decisions because i think that there is a little bit of a knowledge gap between what we what is emerging science and i think you would admit that it is still emerging what still is emerging science on certain aspects and how the community takes that and then ultimately applies it within a particular sport so let's first take like a broad level overview of the paper itself and then we'll try to like drill it down into endurance specifically which is ultimately what we're after so what the first um i guess the the narrative that that we followed was a very what i think is a very ground-up narrative and as i've said i'm a developmental artist so it's it's understanding why male and female bodies are different and they are on average different and understanding how that translates into sports and in different sports and male and female bodies are different on a lot of you know in a lot of on a lot of levels here so we have things like um average difference in height um in adulthood males tend to be about five inches taller than females we have um a much larger muscle mass with males particularly in the upper body so um the you know their legs may be something like

30 percent stronger in the upper body we're looking at something like 60 percent stronger uh so bigger muscles and um different types of fibers uh males have more fast switch fibers which is the type of fiber that gives you explosive power if you're doing something like weight lifting or you're punching um and and and cardiovascular capacity in terms of higher hemoglobin levels they've got males have got bigger hearts they've got bigger lungs they can get more oxygen to the muscles they can you know basically make males can make themselves move more quickly and with far greater force and and that's relevant across an awful lot of sports it's not relevant for every single sports but it is relevant at some level in an awful lot of sports and we can talk about different extremes if you're running a throwing competition the gap is massive if you look at something like they you know how how quickly can men throw a baseball which is essentially rotation through the hips and these much wider shoulders and and bigger muscles kind of making you spin males can throw a baseball over 50 percent quicker than a woman can and if you look at how quickly can make can males punch they can punch with 160 percent greater force than a woman can and but if you look at something like running where it's very lower leg dominant and women tend to have

proportionally more strength in their lower than upper body that doesn't mean they've got absolutely more strength than males but they have proportionally more in their in their lower body the gap is fairly well it's much smaller than it is in these upper body dominant and sports so you're looking at something like 10 to 12 percent in in running disciplines across um distances up to about 10k um and and and actually if you look at longer distances which um you know on various databases you can you can still see these gaps um across across lots of distances so so we see these these performance gaps that are different across sports they're consistent that males are almost always stronger than than females one might argue that you know in female gymnastics females have the advantage because they're more flexible but you could also say that female gymnastics was developed to you know uh complement the female body in that sense and and a female wouldn't be able to compete with a male on the rings because they're not as strong so so this this kind of performance gap across lots of sports and then using that as a baseline this is why females have protected sports because if if they didn't if if sports was just completely mixed and females wouldn't win they wouldn't win in any running races they wouldn't win in any swimming races they wouldn't

win at tennis they wouldn't win in golf they wouldn't win in weightlifting they wouldn't win in a mixed martial art fight and i think this is really well illustrated right off the bat in the paper in figure one where i really appreciated what you and tommy did with this where you not only took whole sports like running and pole vaulting as a sport but you also took components of multidisciplinary sports so like a pitch or a golf drive and you can and you compare those between males and females just to show the difference in between them and i encourage everybody who's listening to to check that figure out as figure it's figure one in the in the reference paper because there is a market difference depending upon the sport and or the activity but there were none that were listed where there is a female advantage and you mentioned there are a few anomalies to which that might be the case gymnastics being one of them but on the whole the performance difference is at least 10 percent yeah so yeah as i say i would say that female gymnastics has been developed as a protected female sport which from which males are excluded and if you there's a really cool youtube video of some elite female gymnasts looking at males doing their you

know their events like the beam for example which males don't typically do and actually the males are pretty good at it it's just they don't you know there are a lot of overlap between male and female gymnastics both uh you know work a floor event and there are some bar movement events there is the vault and actually when you when you start to look at how males do perform in events here there's not this strength component overtakes the the the kind of normal advantage the flexibility that females have and one of the other aspects of the paper because all too often we get caught up in elite athletics and i just mentioned earlier we take the ioc's policy and they're definitely trying to serve an elite athlete constituent and different groups adopt the ioc policy that might not be their constituents might not be elite athletes you spent a couple of different you and tommy spent a couple of different sections in the paper talking about non-elite cohorts and what we know about those non-elite cohorts what can you tell us about that so in in non-elite cohorts so these are you know your average kind of averagely sporty males and females that are coming in and getting all their you know metrics tested in a lab and we see differences of a similar if not larger magnitude and such that so the the statistic i referenced earlier in terms of um the

the increased ability for a male to punch forward that was done in a moderately sporty you know general population rather than in any elite athletes if you look at one of the things i did look at which is not in the paper is is the running gap at my local club i'm in manchester so so you know you know a big city in the uk with a good sporting kind of culture and lots of facilities and that kind of thing lots of funding if you look at manchester 5k or 10k records at the elite level we see a gap of 10 or 11 but actually at club level it starts to run at about 15 or 16 percent the gap there are perhaps social factors that play there that females at club level haven't trained quite so much or or there's some socialization that they haven't had the history of of training that that their peer males have but there's certainly no indication that the gap at what what we in the uk would call club level is is any smaller there's no there's no um well you know at elite level there's these gaps but at club level it goes away that's absolutely not the case so it's relatively similar if anything there's a bigger male advantage it's of a magnitude you know that's the same okay so that paints a broad picture of all of sport and i think we can kind of summarize that as the speed and power sports there's a bigger male

advantage at the endurance sports there's a smaller male advantage but it's still on the order of 10 ish we'll use that 10 ish percent fair fair conclusion there yeah that's fine okay so now here's where the policy rubber meets the road when it comes to transgender in sport where in the strategy that the ioc and many other sporting organizations have adopted is that one of two things need to happen and you're and you're probably gonna have to explain this in much better detail than i'm than i'm going to because i'm going to generalize a lot of different policies into one one or two different things have to happen first thing is testosterone levels have to be below a certain amount and the second thing is they have to be a certain time frame removed from a point in the transition phase i'm trying to generalize this as much as possible without like pointing one specific thing out because there's like several different policies that are out there that all define that point right the ioc guidelines yeah you could start from there which most sports federations not all sports federations but most follow are that and these are 2015 guidelines they they had a slightly different policy when they first formulated it 10 years before that but from 2015 the guidelines are that a a trans woman must have had their testosterone lowered to below uh 10 nanomolar now don't worry too much about the units that's just a kind of measure of the

amount of the concentration the amount of testosterone and you know circulating in their bodies it has to be lower than 10 now the average male testosterone level might be about 20 the average female testosterone level is usually about one 1.5 so the ioc said if trans women are below 10 that's a qualifying kind of you know that's a criterion there they said you have to be below 10 for at least one year throughout that year before you compete and obviously you have to be below that threshold during the time at which you compete within the female category and that you have to make a kind of solemn declaration that you are female and that once you do that in a sporting within a sporting uh environment you're not allowed to switch categories back i think it's four years i think they say once you once you switch into the female category you're not allowed to flip back and so so trying to weed out uh you know kind of a cynical uh you know uh exploitation of this policy so they're the ioc rules as they stand um and and and as you say sporting federations because it's the ioc kind of say well they must be good rules they must be you know they must be decent rules because it's the ioc um and and and so sports

federations and it's always not i don't want to say it's an abdication of responsibility it's always good when a central body that you can defer to gives you this guidance and you can then just say well we're going to follow the ic rules and sure enough that's what an awful lot of sports federations did without necessarily questioning whether they were good rules or not and the the rule that i sent you beforehand to do a little bit of research takes a little bit of that and this is the rule that uh western states uses is the great daddy of all hundred mile races that basically just that basically just says that you have to be under medical supervision for over a year to compete as a trans woman and so what what what what i view that as is they're adopting some part of this ioc language without having to do the actual testing of the athlete and kudos to them for being on the leading edge of it because you go across the rest of the trail and ultra running world and it's a lot of silence in terms of where do these races actually stack up against that so i just wanted to provide that as a point of reference and that a link to that uh uh policy in the show notes as well but here's where the rubber meets the road does that actually remove and this is what everybody wants to know does does the ioc's policy as it's actually written actually remove the male advantage for these athletes once they re-enter

the competition as a trans woman so that was the key question that tommy and i tried to address in our paper um and we took a a particular angle because we felt that strength is a major component of an awful lot of sports and i'm aware we are kind of talking about some kind of ultra distance running events where that becomes perhaps less important but we can we'll get on to that and but we took we took this approach so essentially the male advantage is is mostly driven by superior muscle mass and skeletal metrics you know taller um narrow hips bigger shoulders so so this superior musculoskeletal setup and underpins most of the male advantage in most sports and and so what we did was have a look at you know we tried to find and i think we found them all every paper where trans women had been measured for muscle mass strength and obviously height as a kind of metric and just as a routine part of their clinical kind of transition so so these are things that these are measurements that their clinical team would make in order to measure you know are they losing muscle mass that would be regarded as a kind of feminine aesthetic it's not intended for a sporting it's not intending it

in it for to evaluate some sort of like sporting discipline or anything like that they're just going in for normal health measurements underneath the supervision of their doctor and you're taking that data and presenting it yes so we we we kind of re-interrogated the data with a different question so yes this data was collected to assess the general health and perhaps in some terms the physical appearance of trans women uh particularly things like bone density which is really kind of quite an important health measurement throughout your life and so so these were metric these were measurements that were collected just as general care and what we said was let's grab those measurements and let's see how much muscle mass is being lost in a year how how much strength where those measurements exist are being lost in the year now tommy actually in his his paper in 2020 had already started to ask that question because his was the first paper where these were trans women who were part of you know their normal clinical care but tommy had come in and said hang on i've got a sporting angle on this and so so that you know kind his paper was framed very much to try and answer the sports question and what tommy and i did with this review is grab all the other similar studies to say where where are these cohorts of trans women who's measured their muscle mass who's measured their strength and what is there a pattern is there a kind of general sense

where we can understand the magnitudes of loss the magnitudes of change that trans women undergo within a year which is the sports federation guidelines that come from the ioc and to see whether this really is you know meaningful is it meaningful loss is it a significant loss is it how does that relate to sports so that was the question we asked of data that already existed in in the wider sense and this is table four in the paper so can you summarize that for people who aren't going to actually look the paper up and try to weed through all of the so so what we did was we we basically did a systematic search of the literature you know we're looking for things like uh trans women muscle strength bone density body composition exercise those kinds of things and i think we grabbed everything because the the the body of literature is quite small and there's a lot of cross-referencing we were able to pick up i think pretty much all the data um and someone would have told me by now if we did this one um so what we did was we found 12 studies in the end and 11 of them were within the sports federation guidelines one one of them was only for four months so it's in that table it's the the first one and but that doesn't necessarily meet what the sports federation criteria but we found 11 studies overall they covered around seven seven to eight hundred trans women 790 something trans women who had all just

part of their clinical care been measured for muscle mass being body mass and some of them for strength and we just we just started calculating how much you know how much loss over this these 800 or so trans women how much muscle loss do they see in a year and actually what you find is that they don't experience a huge amount of muscle loss so and i should say most of these trans women almost all of these trans women are part of the general population they're not athletes they're not um exercise in particular we know that trans women generally don't undertake very heavy physical exercise again that's an aesthetic kind of uh decision and we also know that trans women tend to or not tend to but perhaps often have lots of issues with their diet and that kind of thing it you know there are some kind of co morbid uh conditions and so anyway so what we've got is the general population of trans women who are actually slightly unhealthy anyway um and and when you look at how much muscle they lose within a year it's very small it's about five percent of their muscle mass and so you know that's that's a loss and i understand that that feels significant and statistically and i think all the studies almost all the studies it was deemed to be a significant loss but that's a statistical significance loss and what we asked was is that a meaningful loss as we compare it to females and

and that wasn't a question that any of the studies asked because that wasn't what they were trying to look at but when you consider that males have on their legs 30 or 40 percent more muscle mass and on their upper body 60 or 70 percent more muscle mass when you're losing five percent of that muscle mass for sure it's a it it makes trans women slightly weaker than they were before they started you know suppressing testosterone but it doesn't bridge this gap to where to where the male body has has given them a baseline to to create anything that i think is a meaningful parity with females i think the way that i heard you describe it earlier which was really poignant is that the suppression or the removal of testosterone which is kind of the key part in all of this therapy doesn't equate to a symmetrical change in the decline of any of these anthropometric measurements that you're looking at meaning if you want to look at muscle mass males are x percent you know more muscular than women suppression of or removal of that testosterone doesn't symmetrically move the needle from any of those metrics no that's absolutely right and like i say if we if we look at something like in tommy's original research study in 2020 there is a small loss in quad muscle um but when you map that to strength the strength loss was smaller but when you compare to a female

cohort their strength is still 40 percent higher than in those females so so i think that's the the part of the review that a lot that has challenged a lot of people that there's this discussion that the trans woman population as an exercising population and as a you know baseline perhaps not engaged with with sports and and those kinds of things that they're different from control males and i do understand that but we were concerned or interested in looking at how they map to females and even though they experience a loss they still map tens of percents higher in terms of muscle mass and strength of females and so so there's this idea that trans women who are suppressing testosterone can no longer compete against male you know males who aren't doing so and and i would acknowledge that but but the logic is not then that they must compete with females we that's that's a different question to ask an answer well and that's the relative cohort to compare to right are the people that they're actually um that they're actually competing against because that's actually a piece of criticism that i've wanted you to to address that was in my notes that the comparative groups are not the right comparative groups to which i i i'm looking at this through a sporting lens right not through a not solely through a social lens there's a little bit of social lens that you always have to use but i'm predominantly looking at this through

a sporting lens and the sporting lens says we need to compare trans women to women that they're actually going to compete against absolutely and yeah i think it is a like i say i think it's something that people miss when they look at the study and and even people who i think have read you know have read it and kind of perhaps agree with some parts of it even if they don't like the the kind of implications of what we've shown and the the they think i think there's this confusion that we're we're saying trans women are in a sporting sense equivalent to you know what what people would call cis you know men um you know men who haven't avoided sport who who are kind of going out there and doing it and and and and i think they've missed the fact that we're saying like you say they're not competing right in that country now they're they're asking to compete against females and actually the gap between trans women and controlled males is is very small compared to the gap between both of those and females 100 okay so here's where all the race directors need to listen up we've already gone through the fact that ultra running is like super fractured and there's probably i don't know a couple hundred race directors or people that are involved in right in race directing that are that are going to be listening to this in trying to figure out some sort of guideposts and the only guideposts they have right now

is essentially the ioc and maybe western states certainly western states i'd say from an ultra running perspective so let's really drill this down into endurance performance because that's what's going to be the the group of people the group of athletes that they're most interested in serving and creating policy around this is section 4.3 from the paper we've got it right in front of me emma you can take it away what are the key points from an endurance perspective so first of all there aren't that many studies of endurance and parameters in trans women and there are there is one major study um that was conducted by a trans woman middle distance runner and i don't think she'll be offended if i say you know a kind of sub elite club you know good club runner um called joanna harper and so she had conducted this study of how trans women perform in you know middle distance running and well middle just anything from 5k to a marathon and uh after transition and what she what she came up with back in 2015 and actually was this i think was it was a key part of how the ioc formulated their policy formulated their policy in 2015 which was that they think there's no particular advantage um when trans women suppress testosterone what she showed was that in in these trans women

runners that she'd collected data from that it's a bit complicated you you will but you may well be more familiar if you know if you're not in the age graded kind of way um runners as they were racing as males and then you look at their times post-transition within the female category and accounting for age age grades then what she showed was that there was no difference that is that someone who is a 70 percentile male was running as a 70 percentile female and you know uh proportionally around those and and that was so there were a lot of problems with this study and i i i don't know i don't want to speak for it but it wasn't it wasn't a particularly well executed study it was a great idea it's exactly what the kind of studies that we need you know what's actually happening to performance here rather than saying for example well you know muscle mass on the legs get smaller but what does that actually mean in terms of delivering performance so i think it was it was a great idea it was it was quite badly executed but there are limits to how many trans women athletes you can collect and study and and those kinds of things um but but a really small number of athletes um and and a lot of self you know times were self-reported there there weren't i think about 50 percent of them weren't verified so it was essentially a

it was a survey right yeah of people's you know strata times and or just remembering that 10 years ago they'd run a marathon in this time and now as a female it was proportionally kind of slower in a in a what would map to a sex difference um and and and so so it wasn't very well controlled i mean it wasn't controlled at all it's it's eight case reports which is not of no value but to uh form a sporting policy around it is was quite remarkable i think well i so i take it in two ways and i'm really glad you brought up joanna's research and i i respect her tremendously she's given a lot of you know advice and counsel to the same bodies that you've given advice and counsel to but a lot of people in the endurance community have used that research to essentially validate the fact that trans women are on the same playing field as women when it comes to endurance sport but they don't realize the context of how the research was actually conducted which is you you mentioned it was eight people which that's not too that's not too far outside the realm in an exercise science perspective sometimes we're lucky if we get 12 people in a study but to to use a lot of self-reported data and it was not controlled in the best way to then use that study as this blanket argument to say oh well we're going to base all of our policy off of this or

this is why i believe this i think that that part is that part is a stretch because there's so much more that goes into it yeah it's um it's been used as a very kind of iconic i don't know this kind of benchmark it's been used as a benchmark and actually it's very easy to to understand how it's more a preliminary look it's one of those studies where you say look here's eight people and they didn't all become poor or not poorer slower runners one of one of the runners in her cohort actually improved hugely and and that was you know this runner was dismissed as a bit of an anomaly but the reason given was because the runner had started training properly and had started you know actually really going for i think it was a marathon kind of tight distance had actually started training for a marathon and and no acknowledgement then that if you do train whilst you're suppressing testosterone actually there's no there's no necessity that you will become a slower runner and but so these kinds of things were ignored um or you know dismissed as anomalies and and what you what you are left with is a small collection of data that like i say i just find it remarkable that anyone would have used sporting or would have created any sporting rules around it but training is always the confounding variable in any

exercise science intervention if you say okay we're gonna we're gonna have a group of people and we're gonna give this group of people intervention a in this group of this group of people intervention b and there's a time gap between how you're evaluating a and b the training that happens in the middle which can affect performance and all of these other you know physiological variables always confounds things it happens with altitude it happens with nutrition it happens with supplementation all of these different things so in age absolutely so i use that as a little bit of a dialogue to just say this is like that's kind of a normal confounding variable so here's where i come here's here's where i come to this one section of the paper emma it's a lot of mechanistic speculation not mechanistic not speculation but it's a lot of looking at mechanisms and then speculating how those mechanisms could have fit eventually affect performance the way that tommy and i have done yeah exactly yeah well well i think because the the so there are some um there are some reliable measurements about physiology that we do know are very likely to impact performance so the obvious one is that when you suppress testosterone and hemoglobin is reduced now we know that hemoglobin these are the red blood cells that carry oxygen around your body we know that the amount of hemoglobin you have is very testosterone sensitive in males and females

and so when when you reduce testosterone it's it's well known that hemoglobin shifts to kind of map this loss of testosterone and there is no doubt that hemoglobin the amount of oxygen in in your blood that you can get around your body is providing an input into your performance and so when you lower hemoglobin it's absolutely intuitive and i i i would not question i have no you know it's almost certainly true that if you lower hemoglobin you're going to suffer an oxygen deficit compared to you know your kind of higher hemoglobin state so so i think that that's quite a an argument you know i have no uh real uh real need to reject that this is this is almost certainly true so there'll be a performance penalty in that sense when you lower testosterone hemoglobin is gonna you know flatten or drop and you will suffer you'll feel like you're not kind of um you don't have quite as much kind of cv capacity and what i would argue is that we know hemoglobin isn't the only thing that contributes to your cv capacity um and that it's not just about how much oxygen you can transport around your body but it's also how much oxygen you can get across your lungs which if your lungs are bigger you've got a bigger surface area so you can get more oxygen across if your heart is bigger you can pump more blood volume around

your body and and how your individual muscles respond in their own kind of metabolic environment to the amount of oxygen you're getting so hemoglobin loss is going to impact your cv capacity i don't think that's controversial um i don't i don't think it's going to be a major impact but i think but i think it will be an impact and here's what people want to know right we started out with the premise that in an endurance sports the male advantage is about 10 and then we went on to the premise that using some sort of testosterone uh suppression is going to remove not all of that advantage certainly across the speed and power disciplines but do you think and i always hate to ask scientists this because they hate speculating on things but do you do you think that in an endurance discipline that asymmetrical aspect still exists meaning that 10 to 10 10 to 12 advantage is reduced by 10 to 12 percent and in a symmetrical way or is it reduced less than that what would be your speculation if we could actually do the research and you can feel free to say no comments because we haven't done that research i absolutely wouldn't i genuinely for anyone listening i genuinely want dialogue on this i want you know we

can get all ideas out there we can talk about everything and we shouldn't need to pretend that some things don't exist you know or some scientific relationships say this and so so do i think that that in an endurance sense that if you lose testosterone that that will create parity with females no i think it will it has the potential to create more parity than in weight lifting or in boxing and ignoring the safety aspects of those things but i think it i think it has because the gap is smaller and because endurance running in terms of the the body systems that you use it relies less on explosive power through the muscle it relies less on fast twitch fibers that drive that explosive power the way that you know i've i've run a couple of marathons but that's as far as my kind of running career goes the way it works on your tendons and your ligaments is very different than it you know works if you're trying to lift weights and so so it's when you when you weight a sport away weight a sport away from muscular force the gaps are smaller and they may be closer to parity there are still some very fundamental advantages that males as a class will possess over females when it comes to running i think the cue angle the the width of the hip how that

um how you move force through your legs how you travel forwards in a more efficient gait is going to be something that is absolutely irreversible right and and it will there's no way that we understand skeletal um levers and you know skeletal metrics change with with suppression of testosterone these things don't change so the favorable running gait you know men have got straight legs women have got knees that bow inwards and and and that means we have to put more effort in to to move forward in a straighter direction so those things won't change um so will it deliver parity in the sense that you know it's that you're creating a trans woman who is as if they've never developed as a male as a hypothetical do you understand what i mean as if they've never developed as a male then then no it won't i i really appreciate you indulging that question i understand that that that is a hard one because we don't have a lot of good concrete evidence to look one way or the other but i think the the picture i wanted to paint across all of the sports and the differences in the male advantage across all the sports and how those might be removed with testosterone uh uh removal or suppression um that's the point that i wanted to get across to the listening audience that it's not a universal blanket that we can apply to every single sport which i think has kind

of been uh haphazardly thrown around the other thing that i want to have some dialogue with you about and i'm i'm really curious to hear your thoughts on it i'm a coach that's my profession and i i know as a coach if i give if i if i work with an athlete for a year and i get to train that athlete and give them workouts and put them through their paces and things like that for a year i know that the effects of that year of work are going to show up four years down the line five years down the line six years down the line maybe for forever irrespective of what they do in the meantime it has a long term especially when we're talking about endurance sports it has a long-term chronic effect and one of the things i think about with this issue is that you have you have trans women that are born in training as men for a certain portion of their life the who knows how long that is 10 years 15 years five years whatever but they're training underneath different underneath a different biology than women for a significant portion of their lives and that doesn't go away instantaneously there's a long-term training effect and the analogy i always make is that everybody wants stiffer doping penalties because we know that the effects from doping last far longer than the acute effects of taking the drug themselves through training there's a compounding

effect that happens through the actual training intervention while the athlete is actually taking the illicit substance that shows up four years five years 60 years down the road and that's why all the athletes want stiffer penalties because they realize that the advantage is not lost once the doping suspension is over and i'm not making the analogy that trans women are doping let's stop that because i'm going to get a lot of hate mail after this if i don't make that clarification but the the mechanism is very similar because you're training in a different way you're training with different biology and that training has lasting effects for far longer than any sort of acute time frame can really take into account and that's what makes policy so hard because we don't know what the length of that is we want to say it's a year okay it's a year i don't think it's a year that's me as a coach right i just mentioned that i know that those effects last more than a year but should we hold people out for sport for longer than that i mean that so i wanted to have some dialogue with you about that in terms of what do you think like the training effects of going through those paces with a certain biology are we ever going to be able to track that down or do you have any thoughts on it it's such a hard question i can't even eloquate it no no and it's an analogy i've made before and i would absolutely reiterate that when i make this analogy i am not accusing trans women of cheating or doping or

anything like that i want to make i want to make that clear again too because i will get more hate now if i don't do it i've made the analogy and and because i am going to talk about females who dope and cheat and and so so if you think about a trans woman in terms of just their development and biology under elevated testosterone now now that's not necessarily elevated for their natural physiology but we'll we'll call it elevated for for the purposes of the analogy and then you think about a female who would naturally have far lower testosterone who boosts their testosterone to perhaps match that male and and is therefore dopey and and let's say they do that for the first 18 years of their life or for five years or like you say for 10 years but when when when a when a female stops taking testosterone how how how where where is that time where you think that like you say under training and it's not it's not necessarily the things that testosterone does to you in a physical muscle mass sense although that's obviously part of it but but resistance to injury the ability to keep on going for another you know sprint when you you know you're you're kind of powering through where is your mental wall where is your aggression where is those kinds of things the ability to train harder rather than you know just physically

what what is happening with you know with your muscles or that kind of thing and so so there is an analogy and i i i think it's reasonable to say when when would we forgive or when when do we recognize that a female who is doped for 10 years or 15 years when do we think she is able to compete fairly with other females and my answer would be and there's probably a feminist kind of social aspect coming my suggestion is she'd probably never be allowed to compete again i think if a female is doping for 15 years she's never going to be allowed to compete again and that tells you that there is an underlying understanding of what 15 years 10 years of testosterone can do to a body that you simply can't ever be assured that the trajectory you know the trajectory has changed from this line to this line you can never be assured that either it's going to reach parity or even that it where it would have ended up if they hadn't have done that right it's kind of a bit high it's a bit hypothetical you're trying to understand how how quickly would that female have run if she hadn't have taken testosterone i mean the answer is we don't know right but but what we do know is testosterone does this and we you know to to bodies and and i don't know what the answer is

if you look at if you look at long cohorts of trans women and so by that i mean uh trans women who are kind of 10 years post-transition and and often surgically transition so full-on no testosterone at all um small amount from the adrenal glands but that's negligible if you look at those cohorts and you don't have comparisons from the start and we we talk about cohort in the paper that tommy and i wrote a cohort where we don't have starting measurements all we have are end measurements and after about eight years of trans uh of transition and and they are you know these trans women are a bit weaker than they probably would have been after one year if we'd have had those measurements but still when you go back to comparing with like a like for like female cohort they're still a lot stronger they're like 25 stronger on their group strength and so it still it seems that there isn't i think that's an average of eight years some of the trans women in that cohort were a lot a lot further past transition but it seems that there is a very long-term effect and like you said whether it's is it ever reversible it doesn't seem that likely and as a developmental biologist that doesn't feel particularly intuitive that it would be completely um reversible but that's uh that's my own kind of opinion on that well and the other thing that you touched on a little bit is there's likely to be a tremendous amount of individual variability on those aspects

i just happen to have access to because our our lab here in colorado uh tested people uh both both trans men and trans women before and after their transition and i could take those case studies that we have and let me just say this from the get-go we're really fortunate to have access to that data because it was not intentional from the get-go i mean this was several years ago before a lot of this started to to come into the spotlight i could take that small the very very small sample of people and not make any conclusion from it at all because it doesn't align with anything that i've ever seen ever because all of these individual all these things are at such an individual level that it would be impossible for me to conclude based on those very narrow specific examples all this person's going to do this and this person's going to do this you're really fortunate that you've got access to and you've analyzed you said seven or eight hundred trans women and and can draw some general conclusions but i use that as an example just to say that that there are enough trans men and trans women who we've been speaking about predominantly in the community that we will hear all of these different flavors of stories in terms of how their individual performances and how their individual running or whatever was different pre during post whatever at whatever point during that during uh during that journey and we can't always take those

individual anecdotes to be representative of the whole no i think it's um so yes i i absolutely agree i i think sports works generally on on you know kind of class level performances um if one wants to start investigating individual level performance then you you're making an argument not you personally but one is making an argument to remove categorization that if you know this person runs a marathon in this time and this person runs a marathon at this time then you put them in a race together and it doesn't really matter how that person you know what kind of um disadvantage physical or otherwise that person is overcoming um and so so the the idea i think that at the individual level things vary is true it's not always true in the uh in in one direction there are some trans women who become stronger right there are uh 100 yeah um and and if you want to argue for individual assessment that opens up so many more questions and and fundamentally i think becomes just impractical to to regulate i don't because i could i could give you a list of six and a half thousand gene differences between males and females and tell you that you need to score all of those and you know we it kind of like falls into an almost like some

solipsism kind of you know everyone's different let's just send everyone down a track or around a course it so let me ask you this since this topic is incredibly complicated and there are all there are all these individual differences and there are tremendous differences across all of the different sports do you think that that is part of the reason or maybe a lot of the reason that has led a lot of society to take these polarizing views to inclusion should be the default or protection should be the default just because we can't make sense of it so you see so i think an awful lot of if you're involved in a particular sport it's very clear to you within your own sport you know what are the kind of key metrics what are the things that make someone better than someone else if you are a kind of more social commentator who doesn't particularly have an interest in sport i can i agree it can all just look like it's a bit of a mess that you know i read an article um today that was in newsweek um arguing that nothing in sport is fair because um basketball is a tall and baseball is a great eyesight and and and almost this sent a pate of manning's

dad is famous so that's why he got a bit of a leg up you know in nfl and and so so this idea that because nothing is fair and it's all such a mess that we should really kind of stop trying to to make it fair and and i kind of i i mean i really reject that we we can we can have some clear ideas of fairness or uh what i would call kind of unjustness rather than unfairness and we can have clear ideas about what is fair and what isn't fair and what we can regulate and and what we can't but i i do think that a lot of people particularly those who aren't engaged in any sports just view it as as a social problem to be solved rather than if you're within a sport thinking about the competitive you know needs and and the different people who are competing and how you uh include them in particular categories or if you have to exclude them from a particular category how do you open up a new race for you know this this group of people so so i think there was a bit of a ah we can't we can't solve this so why should we try and i've i find that remarkable there were you know competitive sport is not only a really valuable thing for a lot of individuals it's a major economic force it's you know i don't know the gdp of like must be massive it's important for a lot of people and on an individual level and you know from a spectator point of view and stuff so i don't really i don't really buy the whole

it's too difficult it's not let's you know let's just let's just let everyone have fun this is i mean maybe i i've always been regarded as quite a competitive person maybe that's that personality coming out but well i think i think some of the friction point comes from when we try to apply i mentioned this a little bit from the onset when we try to apply policy that's meant for the most elite of the elite whose values are centered around fair competition into what i'm going to call participatory sport so your club runs right that you just mentioned in in the uk and you go to you know your back you know your backyard 5k and marathon and things like that which are largely there are a lot of elite athletes that go there certainly but are largely participation types of events when we try to down feed those and we see this going back to a doping example i just now remember this we see this in cycling and triathlon here in the us with usada's uh what i'm going to call their club programs so they can usada uh uh the us anti-doping agency for for usa cycling and usa triathlon events they will test at random a certain selection of the age group competitors so your 50 year old male that's fourth place in the local criterium they'll come and pluck them out of a crowd and go and test them inevitably what happens is some you know 45 year old dude gets popped for the heart medication that

his doctor prescribed him and he just doesn't care to look it up on the dro because he doesn't think that he's going to get you know randomly drug tested his weekend triathlon or something like that i mean that and that and that actually happens a lot that's an example of elite level rules that are getting pushed down to a community or participatory level that kind of go afoul that person's not trying to cheat he just doesn't know what the rules are now that's not the same as what we're talking about here but when we when we take transgender policy that's developed at the elite level and there's certainly flaws with that but we try to force feed it down in the community level that's eventually where a lot of the friction points come because the value set is different right the value set isn't necessarily hinged on fairness and competition which it tends to be more so at the elite side so i'm gonna that's my commentary i'm gonna give you the last word though emma because you've got a fascinating perspective on this and i i appreciate you uh indulging us in some of your opinions that go kind of along with uh the research that you've done what would you advise the how would you advise the community to look at this issue in the community being the race directors who ultimately have to figure out how they orchestrate their race rules the competitors who have to navigate it from a competition standpoint as well as social standpoint and then the community at large who's also participating in these events what are some of like the big things that you would counsel people

on if you were to come into the community of ultra running like you've done for rugby and other organizations what would that look like so i think there are so if we start with rugby and as an example of a sport where there are concerns outside of safety outside of participation they are when people participate they're taking on things like risk and you know for their kind of personal safety and if you if you are regulating a sport as running almost always is you're regulating sport where those safety risks go away you only have to consider fairness and so you know the safety fairness inclusion i would argue safety is something that you don't compromise on fairness inclusion starts to become like you say particularly a kind of recreational level something that you might feel you can balance a bit more and you might feel that the social purpose of sport is more important than the competitive aspect of sport so if you if you don't have any safety issues then you're you're just kind of balancing up fairness and inclusion and i i do think if you feel if if any regulator feels that they can run their races at the level at which they operate in a way that is inclusive everyone runs together say and i gather that is that the case in kind of ultra you know the two marathons i ran i was running in a mixed field

now the females were kind of separated in terms of their results of which obviously i was nowhere near as scoreboard but but you're running together and it's all kind of you know a kind of fun time it is a fun time we do have a good time at trail in old trotter you should come and do more of them because it's a hoot well i i have messed up me someone said to me that maybe trail running would be a solution for this you know rather than just pounding on a road for four hours but um if you if you if you're not you know if by including a trans woman within a female kind of category you're not popping a female out of the bottom there's no female losing a place if you can record female data in a way that you can analyze and continue to keep records for females then sending 50 or 80 people along a trail and telling them to get on with it is is far less of an issue than it is you know when you're regulating the 100 meter race at the olympic final i absolutely acknowledge that i i would say that if the sport involves contact or pollution or something like that you do have to consider that it's not just always about an individual's participation but i absolutely acknowledge that that that those things don't always feed into something like running and then what about at the elite level because you're right in participatory sports most of it is everybody going

around the trails having a good time but in mass partition mass participation mass participatory sports whether it's triathlon or marathon running or in this case trail and ultra running there is a small sliver that is an elite cohort that is is going to be more concerned about the fairness of competition as compared to the rest of the population at large within that sport are there any nuances within that group that they can take under consideration my position is that if a sport has a strength or skeletal component i don't see any justification to include trans women within a female category now that is slightly different from perhaps running races at the same time perhaps you know sending everyone out together like i said but recording differently but i i don't see an argument for inclusion of trans women in female sports and i definitely think that that's the way the burden of proof lies female sports are a protected category and if you want to open and and they're a protected category from males and if you want to open that up to trans women who have gone through an awful lot of male development for for sometimes a you know an informative part of their life the burden of proof is to say that this is fair and there are

burdens of proof with that position that haven't ever been met and so so when when we're talking about elite competition and not always you know lower level kind of participatory sports do lead to competitive opportunities so so there is a bit of a balance the idea that it doesn't matter in schools and all schools are where people find you know which sports they're good at and where they might be able to develop something that is a competitive um prospect for them uh so so i think it's a fine it's a fine difference between trying to understand when a when an event is just genuinely everyone having fun maybe people don't really care apart from the top five men the top five women and you know maybe there's no there's not trans women anywhere you know anywhere around that doesn't you start to you start to not have to worry too much about it but i think where there are competitive benefits where it where it benefits a person to finish in a particular place either because it accesses something in the future for them or they win some money or you know whatever i think that we really have to be um uh quite cautious here because as far as i'm concerned there's no there's no evidence that it can be a fair thing to include transfer emma i cannot tell you how much i

i appreciated this dialogue and satiating our curiosity on this you did it in a very intellectual and balanced way and put up with my bumbling types of questions brilliantly you're always welcome back on this podcast to discuss it even more and if you want to uh get into trail running i can definitely point you in the right direction in your area and if you're over here in the states you're welcome to come out on trail run with me um i'm gonna put links to all of your uh research that we referenced in the show notes is there any way anywhere else that you want people to get a hold of you or any way that they can uh learn more about some of the things that you've done some of the research that you published so i'm i'm quite active on twitter my handle is at haunted beetles um and um our paper contains our emails and those kinds of things so i'm always happy to answer questions i'm always happy to talk to people even those who you know we might not reach the same conclusions but i think sports is something that is you know can be dealt with quite scientifically so talking is good and if anybody else wanted another vouch for emma i can see an 8-bit nintendo system in the background yeah it's right there i remember that from my childhood i just noticed it five minutes ago i'm gonna give you a huge shout out for holding on to that for i don't know 30 years maybe so and game boys and smezes and i don't

know what's on that cupboard it's not mine that's brilliant wow you get to you should take credit for it because it's pretty darn cool thank you emma like i said you're welcome back anytime yeah absolutely all right and there you have it folks there you go much thanks to emma for coming on the podcast today i have to tell you i found that conversation very balanced and enlightening and insightful on many different aspects not just the strict scientific ones but also some of the extrapolative ones and some of the policy ones that are always hard to pin scientists like emma down on so i appreciate her entertaining some of those well what if types of questions because that is certainly not something that they're trained or accustomed to or even like answering i appreciate everybody that listened to this podcast with open ears and an open mind you are more than welcome to send me any feedback my twitter handle is at Jason Koop instagram handle is at Jason Koop i always love hearing from everybody on what you thought about any of the episodes in this one in particular i do hope that you take something away from this and something that helps form your future opinions on it because this is this is an aspect of sport that is staring us in the face right now and it's going to continue to stare us in the face for the long run appreciate the heck out of everybody listening today and as always we will see you out on the trails

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