Can transgender men play men's rugby?

Transgender men who have transitioned pre- or post-puberty can play men's rugby subject to the following conditions:

• Transgender men who have transitioned pre- or post-puberty can play men's rugby subject to certain conditions (currently: confirmation of physical ability and a Therapeutic Use Exemption (TUE) where necessary, see 1 & 2 below).
• Transgender men who have transitioned pre- or post-puberty cannot play women's rugby, irrespective of the obtaining of a TUE
• Transgender men can play mixed-gender non-contact rugby

1. Confirmation of physical ability which must include:
   1. Written acknowledgement and acceptance by the player of the associated risks of playing contact rugby with males who are statistically likely to be stronger, faster and heavier than them, given the predictions this combination of variables makes for injury risk, as described
   2. Written confirmation from a medical practitioner or qualified coach with an understanding of the demands of rugby, to whom the player is known, that the player is in a physical condition to play and that this view is supported by a musculo-skeletal evaluation and/or other appropriate assessments. The Union/ competition can adopt the spirit of the guideline and make it fit the laws/realities of that particular
   3. A template confirmation is attached here.

2. Therapeutic Use Exemption (where necessary, to play men's rugby)
   1. It is important for transgender men to consider whether any medical treatment that they are undergoing requires them to obtain a TUE for the use of a substance on the WADA Prohibited List. Treatment with testosterone would require a TUE and playing without a TUE may result in an Anti-Doping Rule Violation which might result in a significant suspension from rugby
   2. Nothing in this Guideline would be deemed to permit, excuse or justify non­ compliance with any of the WADA requirements so it is very important that the player fully understands their obligations
   3. Further information can be found by contacting your Union and in the WADA Transgender Player TUE Physician Guidelines, available at wada-ama.org.

Why is confirmation of physical ability required?

As described previously, males are typically significantly heavier, faster, stronger, and more powerful than typical females. Thus, when comparing typical males to females, there are large and meaningful differences, with similar or even larger differences present when the extreme cases (heaviest male player vs heaviest female player) are compared.  This does not necessarily preclude some men from being lighter, less strong and less powerful than many women, but the frequency distributions of, for example, elite rugby players suggests than when matched for performance level, there is small overlap between these variables (see Figure below, which shows the mass and height overlap and spread in elite rugby players). Biomechanical modelling suggests a similar frequency distribution for injury risk factors such as neck forces and moments, and head linear and angular accelerations, where the smaller and slower player experiences larger outcomes suggestive of increased injury risk, as described previously.

Similarly, grip strength, a proxy for upper body strength, is 30 to 40% greater in men than women, while still allowing for overlap, and performance outcomes such as countermovement jump and running speed are significantly different, with males outperforming females by approximately 30% and 15%, respectively.

The principle is thus that transgender men, who have not benefited from the biological changes created by testosterone's effects at puberty, will typically have mass and strength variables that fall into the range of those belonging to biological females in the above­ mentioned studies, and will therefore be smaller and less strong, on average, than the men whose data are included in the above studies.

It is therefore prudent, for the purposes of welfare and safety, to request certification to ensure that imbalances are not so large as to create a safety risk to that player. This is done for  various other scenarios in  Rugby Union, including in permitting a youth or junior  player to play adult rugby, where the differences in size, strength and speed are in fact very similar to those documented between men's and women's rugby players at any given age after puberty.

Similarly, World Rugby's guideline for age-grade participation recognizes that permission may be given to girls to continue playing rugby against boys after the age of 13 (when puberty begins to create physiological differences as a result of testosterone) provided certification is given. Finally, players are assessed and deemed competent to play in the front row positions, also for their own safety.

How do I provide the confirmation?

The confirmation of physical ability should be provided to the player's Union's Chief Medical Officer.

Why might a therapeutic use exemption (TUE) be required?

Some transgender men may be undergoing medical treatment  that  includes  the prescription of testosterone (or other drugs) which are "Prohibited Substances"  on the WADA Prohibited List (i.e. they are considered to be performance enhancing substances) and they are not permitted without a Therapeutic Use Exemption (TUE). A TUE provides a player with authorisation to use a Prohibited Substance whilst continuing to play rugby. Players who medically require the use of a Prohibited Substance are required to obtain a TUE.

Without a TUE, players whose treatment include Prohibited Substances risk committing an Anti-Doping Rule Violation, an offence that may result in a sanction (regardless of the player's circumstances or reasons for such treatment). That could result in a four-year suspension from sport and therefore it is very important that players understand their obligations to obtain a TUE.

How do I stay involved in rugby if I can no longer play in the category that I want to?

World Rugby acknowledges that the introduction of this Guideline will mean that some players can no longer play in the  category that they want to.  It  is possible that will change in the future and World Rugby is funding research to  try  to  find out if there are ways to allow that safely and fairly (see here for details).  In the meantime, there are many other ways to stay involved with rugby:

• Other forms of the game: Many forms of non-contact Rugby exist such as: Tag; Touch; Flag etc all have open
• Coaching: Coaching can be hugely rewarding and can provide players with life lessons, engender a love for the sport and provide an enjoyable vehicle for World Rugby and its member Unions offer several courses  for coaches of children, adolescents, and adults. All courses are open to any participant.
• Refereeing: For many people who may not be able to play, refereeing is a viable alternative to stay close to the game. World Rugby and its member Unions offer several introductory courses and a pathway exists in all Unions for fast-tracking talented
• Administration: All clubs rely on volunteer administrators. As individuals enter the latter stages of the long-term participant model, then administration becomes a realistic outlet for many. A number of Unions have dedicated support resources for individuals who wish to pursue this path of staying involved.

World Rugby is currently exploring the possibility of an "open category" of rugby in which any player could play, regardless of gender identity. World Rugby has committed to exploring this option with its Unions, Associations, International Rugby Players, and trans­ advocate groups including Gendered Intelligence and International Gay Rugby.

What if I have concerns about safety or fairness relating to someone I am playing with or against?

It is important to note that many people do not meet cultural or local norms or stereotypes related to the expression of gender identity. All players and Unions ought to take care to consider this when raising any concerns about another player. In the event that a player or Union has a genuine concern about safety or fairness in relation to another player, the concern should be dealt with as follows:

1. The concerned person should raise their concerns with their Union's Chief Medical Officer (CMO).
2. The Union's CMO should carefully consider the concerns raised, in the context of all of the known facts and if having done so, the CMO determines that the concerns are not frivolous or vexatious, the CMO should contact the World Rugby CMO setting out the basis for the
3. The World Rugby CMO will engage with the CMO of the Union of the player about whom the concerns have been raised, ensuring confidentiality for the player and involved team-mates and opponents throughout the
4. The World Rugby CMO and the relevant player's CMO will discuss the situation and agree on the most appropriate actions, based on the specific circumstances
5. In some circumstances, such appropriate actions may include a recommendation that a standardised endocrinological assessment be performed [Appendix].
6. For the avoidance of doubt, no player should or would be forced to undergo any medical or other assessment. It  is a player's responsibility to decide on whether he or she wishes to proceed with any assessment. However, it should be noted that deciding not to participate in an assessment, having been requested to do so, may have consequences in terms of the player's eligibility to participate in the category of competition that is consistent with his/her/their gender identity, since it may not be possible to determine whether issues of safety or fairness arise without such assessment.