Qualitative Research in Sport, Exercise and Health

ISSN: 2159-676X (Print) 2159-6778 (Online) Journal homepage: http://www.tandfonline.com/loi/rqrs21

Bodily changes and performance effects in a

transitioning transgender college athlete

Alexandra Klein, Vikki Krane & Amanda L. Paule-Koba

To cite this article: Alexandra Klein, Vikki Krane & Amanda L. Paule-Koba (2018) Bodily changes
and performance effects in a transitioning transgender college athlete, Qualitative Research in
Sport, Exercise and Health, 10:5, 555-569, DOI: 10.1080/2159676X.2018.1466721

To link to this article: https://doi.org/10.1080/2159676X.2018.1466721

Published online: 03 May 2018.

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Qualitative ReseaRch in spoRt, exeRcise and health
2018, VOL. 10, NO. 5, 555 – 569
https://doi.org/10.1080/2159676X.2018.1466721

Bodily changes and performance effects in a transitioning

transgender college athlete
Alexandra Klein, Vikki Krane and Amanda L. Paule-Koba
School of Human Movement, Sport, & Leisure Studies, Bowling Green State University, Bowling Green, OH, USA

ABSTRACT ARTICLE HISTORY

National Collegiate Athletic Association regulations stipulate that once Received 16 November 2017
collegiate transgender male athletes begin taking hormones, they no Accepted 16 April 2018
longer can compete on a women’s team and can only complete on a men’s
KEYWORDS
team. However, little is known about what happens physically, mentally Transgender; transitioning;
and emotionally during transgender athletes’ athletic transition. This case transfeminism; video diary;
study focused on the physical and athletic changes that occurred during testosterone
the first year of taking testosterone as reported by a trans male US college
athlete in a video diary. Diary entries were recorded approximately once a
month for 12 months. Guided by transfeminism, we employed a narrative
approach to chronicle his transition. The participant described physical
changes as his body adjusted to increased testosterone (e.g. increased facial
hair, body fat redistribution), emotional or mood disturbances, and training
and performance effects. His diary also highlights the challenges of shifting
from a women’s to a men’s athletic team, leading us to question current
regulations regarding inclusion of transgender athletes.

Recently, two transgender male athletes have been in the news: Chris Mosier is the first openly trans-
gender male to be on a US National team; he competes in the duathlon and triathlon. He also broke
ground as the first openly transgender athlete to appear in ESPN magazine’s The Body issue (Kahrl 2016),
which portrays artistically presented naked images of athletes, and was featured in a Nike advertisement
(Unlimited Courage: Chris Mosier 2016). Mack Beggs is a high school wrestler who also identifies as a
transgender male (Domonoske 2017). Despite his request to compete in the boy’s division, initially the
governing body of Texas high school sport ruled that he had to compete in the division consistent with
his birth certificate. It didn’t matter that Beggs had begun physically transitioning and taking testos-
terone, he was only allowed compete in the girl’s division, which was met with much controversy and
contempt. These two examples reveal the widely disparate realities for competitive transgender athletes.
Transgender can be an umbrella term for any individual whose gender identity and/or gender expres-
sion is incongruent with their physical sex (Krane and Symons 2014). Some transgender, or trans, people
will identify and desire to be recognised as a different sex than they were assigned at birth. Others may
identify as genderqueer, non-binary or gender fluid in which their gender expression is a combination
of or shifting among traditionally masculine and feminine traits. Transfeminism (Enke 2012; Scott-Dixon
2006) provides a framework for understanding and critiquing transgender inclusion in sport. Through
a blending of critical feminism and transgender studies, this approach is predicated on the need to

CONTACT  Vikki Krane  vkrane@bgsu.edu

© 2018 Informa UK Limited, trading as Taylor & Francis Group
556    A. KLEIN ET AL.

contest binary sex divisions. It leads scholars to recognise the complexity of sex and gender beyond
the binary categories of male/female and masculine/feminine and to privilege self-defined identity.
Transgender people are obvious proof of the incompleteness of the binary view that sex is comprised
only of male and female people who act in masculine or feminine gendered manners. Yet, society con-
tinues to separate individuals based on sex and judge individuals on the compatibility of their sex and
gender. That is, gender-conforming individuals (feminine females and masculine males) are privileged
while gender non-conforming people face scrutiny and prejudice. Sport, as a social institution, acutely
maintains and reinforces this social hierarchy and sustains the perceived need for social separation based
on sex. The strict sex/gender binary structure of sport is disrupted by transgender athletes. New ways
of being, or lived experiences, in sport emerge from the experiences of transgender athletes. Sport has
the potential to enrich the lives of transgender athletes, yet it also presents numerous challenges for
them (Caudwell 2014; Farber 2017; Lucas-Carr and Krane 2011, 2012).
In sport, athletes must fit into the female or male category to be eligible for competition. Even on
co-ed teams, rules often indicate the number of females and males who can be on the field or court.
Elite sport has very specific rules concerning who is eligible to compete on a female or male team under
the guise of ensuring fair play and protecting female athletes (cf. Krane 2015). This sex division in sport
is predicated on the assumption that male bodies are bigger, taller, stronger, and, hence, more athleti-
cally skilled than female bodies. Therefore, to ensure an even playing field, males and females are kept
separate. This also protects females who presumably can be injured if competing against larger and
stronger male bodies, particularly in collision and contact sports. Although many females are bigger,
taller, stronger and more athletically skilled than many males, this overlap goes largely unrecognised
(Kane 1995). This social construction of sport as a male and masculine domain (Messner 2002) is largely
centred on the presumed effects of testosterone in athletic bodies. Because the average male is larger,
more muscular and stronger than the average female AND the average male has higher endogenous
levels of testosterone than the average female, conventional wisdom assumes that testosterone causes
superior athleticism.
Medical and cultural narratives about testosterone underpin the social treatment of transgender
athletes. As Lucas-Carr and Krane (2011) pointed out, common myths include that transgender female
athletes maintain size and strength advantages of their male birth bodies (due to their pre-transition
high levels of testosterone) while transgender males gain an athletic advantage because they take
exogenous testosterone. Although medical research does not support these presumptions, they still
form the foundation for many sport policies governing transgender inclusion in sport (Krane 2015).
And, although much scholarship focuses on the policing of trans female bodies in sport, these policies
include scrutiny and monitoring of both trans male and trans female bodies. Generally, sport policies
require transgender females, who were assigned male at birth, to undergo hormone therapy for at least
one year before they can compete on female teams. Transgender males (who were assigned female at
birth) typically can compete in the sex category that corresponds with their gender identity unless they
are on hormone therapy. Once they begin taking exogenous testosterone, they typically are required
to compete on male teams.
Transitioning is the process during which a transgender person alters their1 gender expression to
be consistent with their gender identity. This may include changing the type of clothes they wear,
restyling their hair, and/or changing their name and preferred pronouns. Some transgender people
may choose to alter their bodies through hormone therapy during their transition and some may have
surgical interventions. There is not a single way to transition; instead, ‘there are multiple possibilities to
transition and various ways to be and become one’s gender’ (Farber 2017, 257). Transitioning athletes
will develop the path most suited for them and that which best portrays and leads to comfortable sex
and gender presentation.
Since this paper presents a case study of a male transgender athlete, we will focus specifically on
transitioning in transgender male athletes. For those who choose to undergo hormone therapy, one step
in their physical transition is taking exogenous testosterone, which may be regularly injected, ingested
in a pill-form or applied as a gel (Hembree et al. 2009). In a recent review, Irwig (2016) explained, ‘the
 QUALITATIVE RESEARCH IN SPORT, EXERCISE AND HEALTH 557

overall goals of testosterone therapy for transgender men are to obtain secondary sex characteristics
of natal men, to live their lives as men, to improve their well-being, and to decrease gender dysphoria’
(302). Testosterone therapy will lead to increases in lean body mass, muscle mass, strength and bone
density; a redistribution and decrease in body fat; cessation of menses; changes in hair growth; and
deepening of the voice (Dahl et al. 2006; Van Caenegem et al. 2012). These changes typically will occur
within a year of beginning to take testosterone and it is generally accepted that after one year on hor-
mone therapy, transgender male hormonal levels and body composition are similar to their cisgender
male peers (e.g. Devries 2008).
For some individuals who identify as a transgender male, it is important to be recognised as male
and to fit into male social roles. Sport and exercise can assist in this goal. Farber (2017) interviewed
trans males about their engagement in fitness as well as analysed posts by transgender males to a
fitness message board. Through their fitness routines, the transgender men hoped to gain body size
and strength associated with cisgender males. This included developing a masculine physique with
broad shoulders, a tapered waist and a muscular chest. Weight lifting was perceived as an important
supplement to their testosterone therapy to enhance body comfort and satisfaction, and to be gendered
correctly (i.e. recognised as male) by others.
What becomes clear in the research is that transitioning is a process of many changes. It is a journey
towards an authentic self, filled with excitement and challenge. In sport, some transgender athletes face
prejudice and discrimination whereas others find comfort and acceptance and feel that participation
in sport and physical activity benefits their transition and well-being (e.g. Caudwell 2014; Farber 2017;
Hargie, Mitchell, and Somerville 2017; Semerjian and Cohen 2006). Yet, very little is known about what
happens during the transitioning period. What occurs physically, mentally and emotionally during
this year? The purpose of this case study is to investigate this question. More specifically, the research
questions guiding this study are what physical changes occur during the first year of testosterone ther-
apy in a transgender male athlete and how do they impact athletic performance. Although seemingly
clear-cut, these initial research questions led us to explore the complexity of navigating athletic and life
goals during transition, both of which are strongly impacted by the binary sex requirements of college
sport and cultural narratives about the role of testosterone in sport.

Method
This study is part of a larger case study project that followed a transgender male college athlete for
one year during the time he began physically transitioning. Two sets of data emerged from that case
study. Klein, Paule-Koba, and Krane (forthcoming) analysed data from a series of interviews covering
a broad range of topics during the year-long project. In this study, we present data from a video diary
developed by the participant focused on his physical transition.

Participant
Bryan (a pseudonym) was a competitive distance runner for a midwestern university at the time of the
study. He identifies as a white transgender male, was 20 years old when the study began, and uses he/
his/him pronouns to refer to himself. He had been a stand-out cross country and track athlete in high
school and received a scholarship to compete for a National Collegiate Athletic Association (NCAA)
Division I university. In his words:
I competed on the women’s team for the first two years that I was here. I came in as a freshman, competed on the
women’s team, was still identifying as a lesbian for the fall of my freshman year. Then March of my freshman year
I officially came out as trans. During that time, I started identifying as male. I came out to my teammates and the
guys’ team was a part of that conversation as well. Then [I] came back in the fall [with] a fresh start, went by [male
name] 100% of the time, fully identified as male, just kind of lived my life as a dude 100% of the time. So, fall of my
sophomore year, I really started to fully embrace living life as a male and obviously that is challenging at times,
especially being on a female team. Cross-country season ended in November and I ended up visiting my gender
therapist for the first time in December, the first week of December. I went back and visited him one more time,
558 A. KLEIN ET AL.

and then he cleared me [to begin hormone therapy]. So, we were in indoor track season at the time and we had
kind of completed my transition there, from ‘ok, you’re not really on the women’s team anymore,’ but obviously I
was just starting hormones so like I wasn’t going to jump in and compete with the men’s team either. So it was a
really weird time for me just to kind of be in limbo there, like I didn’t compete for the women’s team, but I wasn’t
like actually on the men’s team, I was just kind of like … there, but I was still practicing with the women’s team, it
was really kind of weird.
To contextualise Bryan’s experiences, it is important to frame them within the policy that structured
the sport environment for him. As a US college athlete, his university was bound by NCAA policy. At
the time he was competing, the policy stated: ‘a trans male (FTM) student-athlete who is not taking
testosterone related to gender transition may participate on a men’s or women’s team’ (Griffin and
Carroll 2011, 13). The policy further included,
A trans male (FTM) student-athlete who has received a medical exception for treatment with testosterone for diag-
nosed Gender Identity Disorder or gender dysphoria and/or Transsexualism, for purposes of NCAA competition
may compete on a men’s team, but is no longer eligible to compete on a women’s team without changing that
team status to a mixed team.
Because exogenous testosterone is on the NCAA Banned Drugs List, transgender males need to request
an exemption to gain approval to take the drug without it being considered as doping. Exemptions
will be granted for ‘student-athletes with a documented medical history demonstrating the need for
treatment with a banned medication’ (NCAA, n.d.). If the team status were to be changed to a mixed
team, that means that they no longer are eligible to compete as a women’s team (in this case). The only
mixed team sports that have an NCAA national championship are rifle, fencing and skiing (NCAA). As
such, if Bryan remained an active member of the women’s cross country and track teams once he started
taking testosterone, his teams would have become ineligible to compete as an NCAA women’s team.

Procedure
Upon receiving institutional review board approval, Bryan was approached by the lead author and
asked if he would participate in this case study that would involve a series of interviews and maintain-
ing a personal journal throughout a year. After discussing the purpose and methods of the study with
Bryan, she emailed him an informed consent form. At the time of the first in-person interview, Bryan
signed the consent form and commenced the first of eight interviews. Also, Bryan and the lead author
often communicated informally, usually at the track or in other athletic settings. Additionally, during
his transition, Bryan maintained a video diary that he shared with the researchers, which began shortly
before he began taking testosterone. Diary entries specifically were focused on his physical transition
and were recorded approximately once a month for 12 months. Bryan was alone during the videoing
and he usually was in his bedroom at his apartment or his parents’ home. The entries ranged from 4:29
to 18:16 min with an average of 9 and a half minutes. The video diary entries were transcribed verbatim.
Video diaries created by trans people can be a mechanism for self-exploration, autobiographical
story-telling and ‘constructing and archiving bodily changes’ (Raun 2015, 366). When creating them,
the diarist has an imagined audience which provides a context for their comments. Bryan wanted to
document his transition in a way that had the potential to help others in similar positions. This led him
to post his videos online. He hoped that the video diaries would be an educational tool for others. He
also wanted others to be aware of what his experiences were as a trans person and a trans athlete.
Unfortunately, the demands of school and work proved too much to continue posting after one year.

Data analysis
Consistent with the broader study, our analysis is guided by transfeminism and we employed a nar-
rative approach (Sparkes and Smith 2014) to present complete stories of Bryan’s transition. Because
the chronology of events is central to chronicling his transition and understanding various issues that
arose, we present the data in diary format. As such, we do not present a series of emergent themes, but
 QUALITATIVE RESEARCH IN SPORT, EXERCISE AND HEALTH 559

rather focus on the flow of experiences showing the physical, emotional and psychological progress
through the first year of Bryan’s physical transition. It is important to note that transition experiences
are not a simple linear progression of changes; there will be starts and stops, backtracks and jumps
forward. The chronology presented refers to the sequence in which Bryan recorded the diary entries.
The title of each entry is the title used by Bryan in the video diary. Using creative non-fiction (Caulley
2008), each entry was shortened, and occasionally rearranged, to best present a concise representation
of the primary story in that entry. All of the data presented are Bryan’s words, consistent with the pro-
cedure used by previous sport researchers (e.g. Bruce 1998; Waldron, Lynn, and Krane 2011). Among
the diary entries, we layer discussion and theoretical explanation of the data. This format allows us to
alternate between presenting Bryan’s voice and the researchers’ voice (Ely et al. 1997).

Results
First video: Welcome to my channel! 19 January 2015
I’m currently a 19-year-old trans man living in [City]. I go to school at [University], I’m a sophomore [and]
I’m also an athlete, I do cross country and track and field, so, I run a lot. It’s been a difficult journey and it’s
only probably going to get just a little more difficult as time moves on. I am excited though, I’m excited to
document this transition. I’m currently pre-t [testosterone]. I will be starting testosterone, hopefully, this
week. I’m going to do Androgel. There was a little bit of a problem with that. I was at my endocrinologist
last week, had a little bit of a set back with that, I wasn’t able to purchase Androgel just because it was not
approved by my insurance, super expensive $550, and obviously I’m a broke college student, but I found
some ways around that.

Finally started T! 30 January

I finally officially started testosterone. I was supposed to start on the 15th, but couldn’t because of the money
issue, but, finally worked it out. So, started on the 27th, so this is day 3 with Testim 1%. It’s 15 mg tubes that
I apply once a day to my shoulders. The ease of use is definitely really high. I like it way better than needles
which was, for a while, going to be my only option. It makes me feel good about myself. I’m really excited that
I was finally able to f***in’ start testosterone, jeeze it took way longer than it should have. I have officially
started my transition.

FTM life update: Almost 2 weeks on T + other stuff 7 February

Today is my 12th day on testosterone. Not too much changed so far, but I have experienced slightly more
aggression when responding with things. I definitely have noticed that I do get a little bit more aggressive
with the way that I respond with stuff or, just the way I express anger, or like a negative emotion. Also, I have
experienced some growth down there, not much, but it is a little bit of enough of a difference where I can
tell sometimes if I’m sitting or running, doing some sort of activity, it can rub a little bit and I’ll like sense that
it’s actually there, so that’s… weird, definitely an interesting change. Never really knew how I was going to
feel about that sort of thing but it is what it is. I also got a haircut, [I’m] keeping it a little bit shorter. This is
only day 12 of taking testosterone. I feel like the days actually do go by pretty fast now that I have actually
started the transition, now I’m actually closer to becoming who I am, or who I think I should be.

FTM life update: 1 + month on T, 9 March 2015

Today is day 42 on testosterone, I’m still taking Testim, at the 1 tube a day dose right now. The veins in my
arms are definitely starting to like, come out a little bit more, especially on the inside of my arm. I’ve had a
little bit more, I guess, bottom growth, I guess that would be the term for that. I don’t think I’ve really had too
many other physical changes other than the fact that I did miss my last period and I didn’t experience any
560 A. KLEIN ET AL.

PMS either that went with that. So I may be done with PMS and just menstruation in general at this point
so that’s pretty exciting.

FTM: 2 months on T!
This is my 2-month update for T. Some changes I have experienced: slightly more facial hair above my upper
lip, it’s kinda hard to see unless you’re like right up close and my hair line receded a little more. I used to defi-
nitely have a very rounded hairline, which is typically associated with more like a feminine hairline. That’s
really cool because, I honestly get pretty dysphoric about that, because I feel like people are gonna notice that
when I’m out in public they’re going to be like, ‘yo that kid has a really round hair line, probably not a dude’.
I dunno, but I’m glad it’s started to change though because I feel a lot better about it. My appetite has also
increased a lot. I didn’t think that being a collegiate athlete my appetite could go up anymore, it did. Hunger
is a serious struggle for me. I get hungry late at night and I’m craving food at like 10–11 pm. That’s crazy, but
definitely I’ve noticed I’m starting to eat some more and get hungry more often. My energy is still kind of low,
sometimes I’ll just feel sluggish, but I mean it’s still fairly early on. It takes time for peoples’ bodies to adjust to
hormones and whatnot. I’m not like dead tired or anything. I play a sport so obviously if I’m doing that and
some days I don’t feel like amazing, that’s a little unfortunate but that’s alright though. The veins in my arms
have also clumped a little more and my face got a little bit fuller. I can’t really see these things all the time
because like I’m always looking. Slight fat redistribution, wow, yay, isn’t that exciting!? I noticed it last week
that where I usually wear my pants, it felt a little bit more snugs there, it felt like the fat was kind of starting
to creep up my back a little bit there, kind of redistribute. Pretty minor, can’t say I’ve noticed it anywhere else,
but, then again I’m also like an incredibly small kid, it’s pretty much the only fat I got.
Probably the coolest, most exciting thing that I really wish I didn’t actually have to bring up, but periods:
I skipped my period last month so I was like yeah done with Mother Nature! But I’m not. Still on my period
right now, definitely makes me feel terrible about myself. I can definitely tell that I feel different due to the
fact that my oestrogen levels are like [points in an upward trajectory] along with my T levels, I mean my T
levels are already really high right now, so the fact that oestrogen is also just like [upward motion again]
going way up is just like not good, and I can tell it’s kind of messing with me mentally a little bit. Another fun
thing to talk about, tampons, definitely those hurt a lot more to deal with this at this point, which is not a
fun time. This is like a really awkward conversation, but that’s happening.
I’ve started working out a little bit [flexes arms]. I’m a distance runner so I mean it’s not like I’m going to
be frickin’ huge or anything. I can only build so much muscle. I’m attempting to maybe get some kind of
build, so maybe at some point I can actually look like kinda decent, you know. Also, I feel like maybe every
now and then my voice will sound a little bit lower than what I’m used to hearing. Or like I’ll start talking
and it’ll sound like a little bit different.
My emotions are definitely changing, for sure. I’m starting to definitely feel different. I have a hard time
explaining this to other people, just because it’s such a weird feeling, but I feel like an emotional distance or
disconnect from myself. I just feel different about stuff, certain situations I just feel like different about myself,
like the way things are happening emotionally with me, definitely different than what I’m used to. I would say
pretty much [I have] generally been in a good mood, other than the fact that I’ve had these weird emotional
disturbances that I can’t really understand like what they mean and why they are happening [pause]. I used
to experience a lot of negativity and just like general terrible emotion, because my life is really hard.2 Things
have been good so, [I’m] taking each day as it comes. I’m excited, I’m pleased with the changes I’ve got so far.
In a relatively short amount of time, Bryan is experiencing discernible physical changes. He has
noticed increased facial hair, veins being more prominent, body fat redistribution, menstrual irregularity,
appetite increase, and emotional or mood disturbances. Essentially, these changes are similar to what
young males experience during puberty. However, contrary to the average boy going through puberty,
much time and mental, physical, financial, and emotional effort was needed to begin this transition.
During the lead up to beginning testosterone therapy, Bryan needed to obtain permission or approval
from a gender therapist before an endocrinologist was able to treat him. This description of transgen-
der transition is permeated in medical jargon that pathologises the transition, often called a medical
 QUALITATIVE RESEARCH IN SPORT, EXERCISE AND HEALTH 561

transition with hormone therapy and/or sex reassignment surgery (also referred to as gender affirm-
ing surgery). The current Standards of Care Standards of Care for the Health of Transsexual, Transgender,
and Gender Nonconforming People (Coleman et al. 2012) require, ‘initiation of hormone therapy may
be undertaken after a psychosocial assessment has been conducted and informed consent has been
obtained by a qualified health professional’ (181). Although no longer requiring a diagnosis of gender
identity disorder as required in the previous standards (published in 2001), one criteria that needs to
be verified is ‘persistent, well-documented gender dysphoria’ (201). This standard of care, embedded
within medical ethics and which must be followed before a physician will treat a transitioning person,
still is grounded in the presumption that transgender people are not capable of deciding for themselves
whether or not to make changes to their bodies. Consider that people who want breast augmentation
or other body-changing surgeries, are not required to receive prior psychological counselling and
approval. While therapy is not necessarily without value, it is an added expense which can cause hard-
ship for some transgender people (and, tangentially, one may wonder why people wanting cosmetic
surgery are not required to engage in it).
Many transgender people who decide to take hormones and/or have gender affirming surgery
consider the processes as medically necessary rather than as elective or cosmetic. As such, the need
for a psychological approval may be questioned. The use of medical language and medical framing
of sex has been explored in transfeminist scholarship on people with intersex conditions through the
concept of biological citizenship (Davis 2015; Query and Krane 2016). Good biological citizens have
the appropriate biological characteristics to be approved and supported by the state (Fitzgerald 2008).
As Query and Krane (2016) wrote in their case study of an athlete with an intersex condition, ‘applied
here, preferred biological citizens are those who neatly fit into binary categories of sex and gender’
(10). In other words, a good transgender biological citizen obtains a diagnosis of gender dysphoria,
follows the advice of the medical professionals, and adheres to binary sex and gender categories. For
some transgender people, this approach works well; their gender identity is comfortably (trans) male
and the diagnosis and hormone therapy provide the avenue to feel, appear and present as a masculine
male. Though it is important to reiterate, there is not a singular path for transitioning.
Ultimately, what is important is how transitioning transgender people respond to their hormone
routine and bodily changes. Previous research shows that testosterone therapy is associated with good
mental health and a higher quality of life in male-identified transgender people taking hormones versus
those not taking them (Newfield et al. 2006). As Bryan stated, beginning testosterone therapy brought
him ‘closer to becoming who I am, or who I think I should be’. As such, transitioning is an exciting and
optimistic time, and this is reflected in how he talks about the physical changes he is experiencing.
There is a sense of awe about some changes, satisfaction with others and anticipation for his continued
progression.

FTM 4 + months on T, experiences as a collegiate trans athlete so far: 8 June 2015

This is a 4-month update. I’ve been on T for 132 days. I’ve had some pretty interesting experiences so far. [My]
voice is definitely a lot lower now, so that’s amazing. I definitely never get misgendered, I don’t even know
the last time I was misgendered by somebody, so that’s really good. And I’ve got kind of a trash-stache on
my upper lip, there’s definitely some darker facial hairs working their way into my face there. Not too much
with like muscle mass, I don’t really lift on a regular basis. But, I guess my muscles are decent for a kid that
runs a lot of miles. Kinda some neck thickness and the face kind of changing a little still, my veins are still
relatively prominent in my arms, especially when it’s warm outside. My energy I think has actually been pretty
good, [I] used to kind of struggle a little there the first couple months I was on T, but energy has actually been
pretty good so that’s really exciting. I’ve gotten some more bottom growth. I haven’t really had too much fat
redistribution and I’m obviously still hungry as always. I mean I play a sport and I’m a man, so lots of food
consumption, lots of good things, I’m very positive.
I’m still struggling with the running; there’s a lot of shit going on in my body right now and to kind a
throw a college sport on top of that is pretty tough on my body. When March rolled around and I was still
562 A. KLEIN ET AL.

practicing with the women’s team and the men’s coach actually suggested, ‘Hey, why don’t you try to run
with the men’s team?’ I had plans to run with them later on, I felt like I needed some time to adjust to the
transition, like what it was doing to my body. But [men’s coach] was like go ahead and run with them on
some easy days, see how you feel. Obviously, the guys definitely run a lot faster than the girls do, even just
on an easy run. So for me, it was kind of intimidating to switch gears. Since the men’s and women’s [prac-
tices] overlap a little bit I could only practice with the men’s team one day a week. I practised with them on
Mondays from March throughout the rest of the semester. They were actually really cool about it; you know,
obviously I did the best that I could. If I couldn’t stay with them for an entire run then so be it. The fact that I
was just out there running with the men, being read as male, that was probably what was most important
for me, to just know that I was out there running with dudes and that other people who saw me out there
running with them didn’t think anything else of it. That was a very empowering experience. It was amazing.
The first time I ever ran with the guys’ team – it felt way different to run with the girl’s team – I felt like I really
belonged there, I wasn’t really being seen as an outsider, it was really awesome, it was really awesome. It was
a great experience and made me really excited to kind of join the men’s team in the fall. I’m in my summer
training right now, but I’m still struggling a little bit. It’s to be expected, at least I’m out there doing what it
is that I want to do. I’m about to make history come fall, be the first trans athlete, first transitioning athlete
at [University] to have successfully competed on both the women’s and men’s team. So that’s really exciting.

FTM life update. Where have I been!

I’m closing in on my nine month. Today is 22 October, my nine month will be 27 October. Life in general has
just been going really well. In terms of actual updates with my transition, I’ve got a lot more facial hair now
and it’s coming in darker. I feel like it really helps me pass, helps me look a lot better. Still got a ways to go I
feel like, but I can’t complain. And my clothes are starting to hug my shoulders a little bit more, they are not
quite so loose-fitting on my body, they are a little more snug. I’ve been doing a lot of strength training with
my teammates. We got a new cross-country coach back in August. And the guy loves strength training, so
we’ve been doing a lot of that. I’ve been getting a significant amount of muscle growth, but I still got a ways
to go. Obviously, running is going to keep me small, so I mean there’s only so much I can do about that. It is
nice to know that I have seen some progress with myself, and I’ve been able to tell that even if the changes
are kind of minute. I’m really happy with how life is progressing; there haven’t been really too many huge
downfalls at this time. I’m just kind of glad to be alive, I’m glad I made it this far.

FTM life update: Why I publicly came out + important things

The biggest life thing that’s going on right now is [working towards] my official name change. So I’m excited
to finally get that changed. It costs a decent amount of money to do it, so I mean not every day that you can
casually just shell out more than $100. I can finally fully detach myself from my current legal name [and]
live my life a little more comfortably.
I’ve definitely started to take up lifting; I lift on a regular basis, several times a week. I have a good routine
down so that certainly helps my confidence in my dysphoria. Really working to kind of destroy as much chest
fat as I possibly can. I’ve seen some gains, I feel like I filled out a little bit more. Still have a ways to go but I
can comfortably wear a tank top without binding. I’m not binding at all.

FTM happy new year! 2016 life updates

Today is day 355 on my testosterone, so 10 days, 10 days until I am in the one year. My 21st birthday will be
at the end of this month as well, just after my one year on T. I can be a full adult now, across all aspects of
life. I’m looking forward to actually updating my licence too, get the new pic on there, I’m gonna have my
gender marker changed. I don’t have my name legally changed, still working on that right now. Still trying
to figure out when I want to do that, just because it’s time-consuming and it costs a lot of money. Visiting
my endocrinologist on 10 February, I’ll have my 1-year check up with him. I’m going to try to switch over to
 QUALITATIVE RESEARCH IN SPORT, EXERCISE AND HEALTH 563

injections; there’s a couple of reasons I want to switch but mainly for cost. My insurance does a pretty good
job right now of covering my Testem gel that I’m using. It’s only 30 dollars a month. But it really adds up
over time and that’s expensive. So I’m going to switch over because it’s a little more cost-effective, it’s going
to cost $10 or $15 for a little vile and then of course the needles are pretty cheap, like cents not even dollars.
As well, my changes with the gel have kind of plateaued. I’m looking for a little bit more, and sometimes I
struggle with having a good internal sense of self as a male just because I feel like my [testosterone] levels
are not quite as high as they should be. It’s really like a mental thing, but it’s not a thought, not emotional. I
feel like it just has a lot to do with the chemicals in my brain. I think that’s what’s causing me to feel that… I
think my dose needs to increase a little bit. . . . So [at work] people have just been asking questions, or they’ll
ask about my sports, ‘so how are things going with sports’ and I’m like ‘oh well you know, I don’t really do
anything, I haven’t really competed, because you know … I’m not good enough to compete’. But of course
I don’t tell people that.
In these passages, we see Bryan’s progress in his physical transition. Many of the physical changes
are consistent with what is documented in medical research: in the first six months of taking testos-
terone there is a redistribution of fat, cessation of menses and clitoral enlargement (Hembree et al.
2009). By 12 months, typically one will experience muscle gain, change in hairline, deepening of the
voice and increased facial hair (Hembree et al. 2009). Where Bryan’s experience adds to our knowledge
is concerning the sport performance effects. He talks about his vacillating energy levels and that he
often felt sluggish during this time period, making training difficult. Policy mandates that as soon as
one begins taking testosterone, he is only eligible to complete on the men’s team. This leads to the
presumption that there will be a quick and linear increase in strength, stamina, musculature and hence
athletic performance, as one transitions. However, this clearly is not the case. Chris Mosier, mentioned
in the introduction to this article, began his transition in 2010, and it was not until 2015 that he earned
a spot on the national team.
A year after beginning to take testosterone, Bryan still is struggling to train at the same levels as
the other runners on the men’s team. In cisgender males, puberty lasts between 2 and 5 years. Bryan
is going through these same changes in a much shorter time. It makes sense that his body is fatigued
as it acclimates to its new hormonal balance. And truly, Bryan probably has not reached his ultimate
hormonal equilibrium as he still is experiencing bodily changes. Further, the average age cisgender
males complete puberty is between 16 and 17. That means the men on the cross-country team have
had at least two or more years to acclimate to and train their bodies after their hormones levelled off.
Bryan is trying to train at the same level as these cisgender males while his body is in flux and while he
is not yet accustomed to his new normal. It is no wonder he is frustrated and struggling. In addition, it
is psychologically challenging as Bryan has gone from being one of the best runners on the women’s
team to not competing on the men’s team. This is a difficult adjustment for an elite athlete. While Bryan
didn’t overtly mention this challenge (he does talk about it in the interview data; Klein, Paule-Koba,
and Krane, forthcoming), you can sense his frustration when he stated that ‘I’m not good enough to
compete’. Conversely, Bryan expressed an emotional lift of running with the men’s team, feeling a sense
of belonging and being recognised as a male runner. His experiences highlight the need for sport
administrators and coaches to provide social support for transitioning transgender student athletes.

FTM life update: Injections and sports (27 January)

I wanted to just kind of talk about where I am in sports right now. So for a long time I was kind of struggling
to just feel good about running, feel good about myself running, to feel like I was able to balance being an
athlete with my transition which is really hard because my sport is really demanding. So it’s really hard on
my body. I made it through the first semester, but it was really tough. My pace never got too much better
from what I was running, my endurance didn’t really get much better. So it’s hard to take that in and accept
that. Personally I felt shitty, you know I wasn’t really having fun, I don’t feel good about it anymore. I was
struggling with dysphoria and just generally being smaller than everybody else. You know I don’t have top
surgery, so that was a problem for me. I’ve been considering all of these things that are affecting me ever
564 A. KLEIN ET AL.

since I started my transition and wanting to move towards the men’s team. So this past summer was really
hard for me to feel good about running and I found it hard to feel motivated. It was a long time coming, I
made this decision based on some stuff that had been affecting me for a really long time. Earlier this week
I officially signed the papers to quit my sport.
I’ve always wanted to be able to build muscle, feel a little more solid about myself because I’m pretty
small. So quitting is definitely going to help with that, not having to do cardio, not having to run anymore.
It’s going to help me, allow me to have more time to focus on lifting, focus more attention on my body,
and building my body and essentially transitioning. I always tell people that the point of transitioning is to
transition. So basically, if I’m out here running constantly to keep my body really small and I’m not gaining
any muscle, I’m not helping my body transition to the way that I want to look. If I’m not building my body
from a feminine body to a masculine body, for me personally, I don’t feel like I’m doing myself justice. If I’m
out here taking hormones and my body is not changing at all, that was really hard for me to deal with. My
body is really important to me, I need to build it in a way that’s going to make me feel good about myself.
I’m already seeing great results now that I don’t do cardio and haven’t for a while. It was a tough choice,
but I can’t sacrifice my transition. If it comes down to being an athlete or my transition, I have to choose my
transition over everything else. So unfortunately, I never thought my athletic career would end like that,
never thought I would sit down in front of my coaches and have to sign a piece of paper that says sorry this
didn’t work out the way that all of us wanted it to. But like I said they were supportive, so it helped out in the
end. You know I really like running, I like being on the team, and I would not trade my time as a college athlete
for anything. But I need to be happy, what’s important to me in the end is I need to me happy with myself.
Gaining congruence between one’s internal and external sense of self is a powerful life experience
for transgender people (Austin 2016). One reason transgender men take testosterone is to gain this
congruence. Bryan, however, also was trying to negotiate his athletic identity while transitioning and
his particular sport, running, became a hindrance to his physical progress. Other college athletes who
publicly transitioned from the women’s team to the men’s team (e.g. Taylor Edelmann in volleyball
and Schuyler Bailar in swimming) were in sports where strength training and being muscular were
beneficial (Buzinski 2015; Zeigler 2013). As Farber (2017) found, gaining muscularity ‘enables some
transgender men to achieve a more harmonised sense of self in accordance with their ideals of male-
ness and masculinity’ (264).
The tug-of-war between Bryan’s athletic identity and trans identity was an unexpected finding.
Paving the path as the first openly transgender athlete in his sport was a strong source of athletic
pride. Though, as a trans male who identifies within the sex binary, obtaining a body consistent with
hegemonic masculinity also was an important goal. As Bryan alludes to, gaining muscle and strength
are outward signs of his (trans) male identity whereas running high mileage interfered with his ability
to develop this body. As Farber (2017) found with trans exercisers, many transgender men want ‘to
achieve size, strength and a bodily structure traditionally associated with cisgender men’ (5) which
includes broad shoulders, strong upper body and visible muscles. In his study of trans peoples’ video
blogs, Raun (2015) noted that the trans men tended to ‘track the changing appearance of their bodies,
focusing on the growth of muscles and development of “masculine” features’ (370). For some trans
men, development of strength and muscles enhances embodied self-comfort and sense of self within a
masculine identity (Elling-Machartzki 2017; Farber 2017). Perhaps being a university athlete compounds
this aspiration as Bryan was surrounded by people who value muscular bodies often in conjunction
with a hypermasculine temperament. Bryan was able to solidify his trans male identity and gender
expression, bolstered through body changes and muscular development, the more he was read as
male, which led to feeling better about himself. At the same time, his muscular growth plateaued,
which Bryan attributed to his running. Training at the level expected of a college cross-country runner
became counterproductive for Bryan and forced a decision between being true to his authentic self or
continuing as a college athlete.
What also is important to point out is that not all bodies react to testosterone in the same way.
Grounded in common sport and medical narratives, sport policies are predicated on the belief that tes-
tosterone always will lead to athletic advantages. Research generally supports that exogenous androgen
 QUALITATIVE RESEARCH IN SPORT, EXERCISE AND HEALTH 565

use (including testosterone) is correlated with increased muscle mass and strength, quicker recovery
after workouts, and increased aggressiveness and/or motivation (Mazzeo and Ascione 2013). This has
led to the common discourse that people with higher levels of testosterone will be better athletes than
those with less testosterone. Yet, as Karkazis, Jordan-Young, Davis and Camporesi stated, ‘despite the
many assumptions about the relationship between testosterone and athletic advantage, there is no
evidence showing that successful athletes have higher testosterone levels than less successful athletes’ (2012,
8, emphasis in original). In fact, a study of college cross-country runners found no correlation between
athletes’ testosterone levels and finishing time (Casto, Elliott, and Edwards 2014). Some research sug-
gests that androgens such as testosterone will have more impact on athletic skills based in strength
compared to endurance activities (Hartgens and Kuipers 2004).
The role of testosterone in athletic performance has been called into question regarding the current
controversy about the inclusion of female athletes with certain intersex conditions in elite international
sport. An international athletic court of arbitration ruled that there currently is insufficient evidence
that testosterone is the primary determinant of successful athletic performance (CAS 2015). While the
focus on athletes with intersex conditions is endogenous testosterone, the current scholarly debate (e.g.
Karkazis et al. 2012; Viloria and Martínez-Patino 2012) reveals the limited understanding of the effects
of testosterone in elite athletes, especially relevant given the strong policy implications. Regarding
transgender male college athletes, the NCAA rules reflect a belief that upon the first ingestion of tes-
tosterone, trans male athletes will gain an unfair advantage over cisgender female athletes. Bryan’s
experience refutes this absolute stance. Instead, there seems to be a lengthy period of transition in
which the body acclimates to a new hormonal climate. While a single case study will not provide strong
evidence of how trans male bodies react to exogenous testosterone, this case study does point to the
limits of our knowledge, the need for more research on this topic, and the need to revisit policies about
trans male inclusion in sport.

Conclusion
One of the paradoxes for transfeminist scholars is the desire to transgress binary perspectives of sex
and gender balanced with the desire by some transgender people to fit into binary sex and gender
categories. Here, we turn to Krane and Barak’s (2012) notion of sex and gender as a prism, which recog-
nises the complexity of transgender identities and that ‘there are countless permutations of gender, sex,
identity, and expression’ (41). Transgender people have a wide range of gender identities and expres-
sions. Privileging one’s self-defined identity is an important component of transfeminism (Nagoshi
and Brzuzy 2010). This case study focused on an athlete who identifies as trans male; his trans identity
fits into the sex binary. Bryan’s experiences likely are very different from genderqueer, gender fluid or
non-binary trans athletes.
Sport tends to cling to normative views of sex and gender and is slow to adjust to inclusive social
movements. Elite sport policy seems focused on sustaining cultural narratives about binary sex and
gender in which masculine males and feminine females are privileged (Kauer and Krane 2013). As
such, current policies favour transgender sportspeople who can fit into a binary sex category. Further,
commonly accepted discourse about testosterone appears to guide policy regarding inclusion of trans-
gender athletes which leads to policing and monitoring trans male bodies (Krane 2015). Transgender
female athletes need to suppress testosterone levels whereas transgender males can supplement testos-
terone with special dispensation. In other words, NCAA policy generally accommodates good biological
citizens. Transgender athletes who fit binary sex categories, fulfil medical directives, and have their
hormone levels monitored become eligible to compete. While on the surface this seems to be a step
towards a more inclusive sport for transgender athletes there are several overlooked issues. For one, to
gain approval to participate, the onus is on the athlete to initiate the process, disclose their transgender
identity and follow medical guidelines. For example, a transgender male taking testosterone must dis-
close this status to at least some athletic personnel, apply for a medical exemption and share medical
records detailing their testosterone levels. Unfortunately, not all university athletic departments provide
566 A. KLEIN ET AL.

a supportive and inclusive environment for athletes with diverse sex and gender, and some transgender
athletes may be met with obstruction. Although NCAA policy disallows discrimination based on sex
and gender (among other characteristics), not all universities adhere to this policy (Zeigler 2016). Even
when athletic departments are trans inclusive, following policy for athletes like Bryan means they have
to seek approval to participate.
Often conflated in the discourse about trans male athletes is the use of testosterone to achieve coher-
ence between gender identity and sex versus doping or using testosterone to gain an unfair advantage
(i.e. cheating) (Lucas-Carr and Krane 2011; Teetzel 2006). Transgender men taking testosterone aim to
have levels consistent with average cisgender males (Bhasin et al. 2001). Individuals who use testos-
terone for doping, ingest amounts of 250–3200 mg (Evans 2004) whereas the dose for transgender
males is typically less than 50 mg (e.g. Olson et al. 2014). Clearly, the amounts and motives for taking
testosterone under these divergent circumstances differ widely. If there is reason to believe that an
athlete is using testosterone for illicit means, then drug testing and doping protocols can be put in play.
Put differently, why not let athletes compete in the sex category consistent with their gender identity.
One may voice concern that cisgender male athletes will claim a female gender identity and flock to
women’s teams where it may be perceived that they can more easily gain distinction and win. Yet during
the decades of sex-testing elite international female competitors, no cisgender male interloper had
been identified (Heggie 2010). Further, women’s sport receives far less media attention and, often, less
athletic department support compared to men’s sport, which would be an impediment to one seeking
attention. Conversely, a gender identity inclusive policy would reduce the policing of trans bodies and
lessen the burden on transgender athletes. Still, this would only support transgender athletes fitting
into binary sex categories.
Non-binary, genderqueer and gender fluid athletes are challenged to fit into many sport systems.
Trans people who do not want to identify within male or female categories are forced to ‘choose a side’
in order to complete. They then may have to wear uniforms incongruent with their preferred gender
expression or possibly face stigma and bigotry based on their appearance. Gender non-conforming
athletes report more hostile sport climates compared to gender conforming LGBT peers (GLSEN 2013).
Sport policy also does not address how to work with transitioning transgender athletes. Bryan’s story
clearly shows the difficulties encountered while trying to continue elite level training while transitioning.
Perhaps trans males should not be required to immediately compete on a men’s team upon beginning
testosterone therapy. One dose of testosterone does not prepare one to begin training and competing
with cisgender males. Popular press articles about other trans males describe similar challenges when
moving from competing on a college women’s team to a men’s team (Buzinski 2015; Zeigler 2013). Trans
male athletes like Bryan are seeking to be true to their gender identity and live an authentic and com-
plete life (cf. Austin 2016). That is the point of transitioning, to gain congruence between their gender
identity and physical body. Yet, being an athlete also is an important component of their identity. While
there are stories of athletes who delay their transition until they no longer are competitive athletes or
who quit sport when they transition, many trans athletes will want to do both: be their authentic self
and be an athlete. Sport administrators should consider how we can help these athletes.
One possibility is to offer a red shirt year3 as transgender college athletes acclimate to their transi-
tioning bodies. During this period, they could split time training with the women and the men, as did
Bryan, or they could spend part of the year with one team and then shift to the other. It is important to
recognise that it would be difficult to institute a single process that would work for all trans athletes as
transitioning will be experienced differently by different people. Though, the NCAA could allow tran-
sitioning student-athletes to have one year in which they would not compete, but they could practice
with either the women’s or men’s team and, importantly, keep their scholarship. This would allow time
for the student-athlete to adjust to their new body without competitive pressures. It also would allow
the trans athlete to remain with their team(s) and benefit from social support received in the athletic
environment during the transition.
In all, Bryan’s experience points to the challenges of transitioning while being a college athlete. He
was in a highly supportive setting in which female athletes, male athletes, men’s and women’s coaches,
 QUALITATIVE RESEARCH IN SPORT, EXERCISE AND HEALTH 567

and administrators worked to provide an inclusive and compassionate climate, yet still he struggled.
Being different always will be challenging. Yet, sport can offer protections and support. Krane (2015)
espoused commitment to compassionate inclusion, which ‘begins with questioning and countering the
taken for granted narrative grounded in the social construction of the binary sex and gender categories.
… In such an environment, policing of athlete bodies is replaced with a celebration of accomplishments’
(58). This can occur when commitments to fair play prioritise inclusion and support for minoritised
athletes, and centre what is best for the transgender athlete, not what is perceived to support fair play
for others (CCES 2012). Compassionate inclusion, consistent with our transfeminist approach, celebrates
sex and gender diversity and will welcome athletes across the sex and gender spectrums (CCES 2012).

Notes
1. 
We use ‘they’ and ‘their’ as singular, non-binary, gender-neutral, and inclusive pronouns.
2. 
Bryan went through a tumultuous time before and during his transition due to lack of family support and financial
and emotional struggles (see Authors, in review for more detail).
3. 
An athlete who takes a red shirt year does not participate in competition that year and defers eligibility until the
following year. Red shirt athletes may practice with their team and receive financial aid.

Disclosure statement
No potential conflict of interest was reported by the authors.

Notes on contributors
Alexandra Klein recently earned a master’s degree from Bowling Green State University in Sport Administration. Her research
interests include the intersection of sport and LGBTQ topics. She currently works for Big Ten Network as the company’s
Studio Production Coordinator.
Vikki Krane is a professor in the School of Human Movement, Sport, & Leisure Studies at Bowling Green State University.
Her research focuses on sex, gender and sexuality in sport.
Amanda L. Paule-Koba is an associate professor of Sport Management in the School of Human Movement, Sport, and
Leisure Studies. Her research focuses on issues in intercollegiate sport (such as academic clustering, athlete rights, and
the recruitment process), gender equity policies, and Title IX.

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