Males competing in MMA is the accepted standard. Females have begun to gain widespread acceptance in MMA. Now, what happens when an openly transgender (male–>female) fighter wants to compete at the professional level? 37-year-old Fallon Fox was born a male, but underwent gender reassignment therapy and hormonal treatment beginning in 2006 to become a female. As such, she has applied to fight as a professional female MMA fighter.
The main questions that seem to arise is not whether transgendered fighters should fight, more specifically will the male–>female transgendered fighter have an advantage over female fighters that were born as females. While the Fight Doctor is not an endocrinologist, I will attempt to analyze this issue on a medical and scientific basis.
The key question is whether Fox, being born a male, has a distinct physical advantage over her genetically female opponents. A cornerstone of muscle physiology is that a muscle strength, or the force it can generate, is directly proportional to its cross sectional area. In other words, bigger muscles can generate stronger forces. Therefore, if Fox had bigger muscles, than theoretically she would be able to generate more force than her opponents. This concept, however, simplifies the biologic make-up of a gender-specific muscle. It’s not just a question of muscle size, but also composition.
A simple equation in physics in Force = Mass x Acceleration. More specifically, the lean muscle mass a person has theoretically can determine how much force and damage they can inflict on their opponent. Genetic males tend to have higher amounts of lean muscle mass, less fat, and more dense bones than their genetic female counterparts. So, if Fox was born a male, then she should be bringing those tools with her into the fight. However, a major part of gender re-assignment surgery is not just the physical act of the surgery itself, but also subsequent hormonal therapy. The effects of this hormonal therapy helps the transgendered male–>female person look more female. In the process, lean muscle mass decreases; total body and muscle fat increases, and bone density decreases. This has been studied in male–>female transgender individuals compared to male controls. After treatment, all of these things the transgender females have less lean muscle mass, more fat, and thinner bones than their male controls. This, however, has not been studied against female controls. The reason being is that medical doctors are performing these studies, not to compare the transgender patients to females, but to study if the hormonal therapy can lead to diseases such as osteoporosis, or thin bones.
Before the 2004 Olympic Games, the International Olympic Committee ruled that transgendered athletes may compete as their re-assigned gender provided they have undergone hormonal therapy for more than 2 years, or the surgery occurred before puberty. The Transgender Athlete Policy has also been adopted by the World Tennis Association, LGPA/PGA and U.S. Track and Field.
The effects of hormonal therapy over time, in this case testosterone deprivation and estrogen supplementation, are not completely understood. However, what is clear is that transgender individuals that underwent surgery after puberty will retain some male features, such as increased height. Male–>Female transgender patients tend to retain more muscle mass than female–>male transgender patients gain, suggesting that some gender-specific attributes remain. Whether effects such as height will prove beneficial in MMA like they do in other sports such as basketball remains to be seen. Another question is if the fighter is completely transgendered. Taking estrogens without castration will leak out testosterone that can maintain muscle mass. Furthermore, how much estrogen is being taken? If it’s not enough, then muscle strength can be closer to male levels
Ironically, with all the recent talk of Testosterone Replacement Therapy, this certainly falls into the opposite category! This is obviously a controversial issue with no clear answers. What is clear, however, is Ms. Fallon’s desire to compete. No scientific or medical analysis will question her dedication to the sport of MMA.