The International Olympic Committee framework on fairness, inclusion and nondiscrimination on the basis of gender identity and sex variations does not protect fairness for female athletes.

The International Olympic Committee (IOC) recently published a framework on fairness, inclusion, and nondiscrimination on the basis of gender identity and sex variations. Although we appreciate the IOC's recognition of the role of sports science and medicine in policy development, we disagree with the assertion that the IOC framework is consistent with existing scientific and medical evidence and question its recommendations for implementation. Testosterone exposure during male development results in physical differences between male and female bodies; this process underpins male athletic advantage in muscle mass, strength and power, and endurance and aerobic capacity. The IOC's "no presumption of advantage" principle disregards this reality. Studies show that transgender women (male-born individuals who identify as women) with suppressed testosterone retain muscle mass, strength, and other physical advantages compared to females; male performance advantage cannot be eliminated with testosterone suppression. The IOC's concept of "meaningful competition" is flawed because fairness of category does not hinge on closely matched performances. The female category ensures fair competition for female athletes by excluding male advantages. Case-by-case testing for transgender women may lead to stigmatization and cannot be robustly managed in practice. We argue that eligibility criteria for female competition must consider male development rather than relying on current testosterone levels. Female athletes should be recognized as the key stakeholders in the consultation and decision-making processes. We urge the IOC to reevaluate the recommendations of their Framework to include a comprehensive understanding of the biological advantages of male development to ensure fairness and safety in female sports.

SARS-CoV-2 prevalence and transmission in swimming activities: Results from a retrospective cohort study.

There is an urgent need for research on the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19), as the transmissibility differs between settings and populations. Here we report on a questionnaire-based retrospective cohort study of the prevalence and transmission of SARS-CoV-2 among participants in swimming activities in Denmark in the last 5 months of 2020 during the COVID-19 pandemic. Eight of 162 swimming activities with a SARS-CoV-2 positive participant led to transmission to 23 other participants. Overall, the percentage of episodes leading to transmission was 4.9% (competitive swimming 8.9%; recreational swimming 1.3%). Overall, the incidence rate of transmission was 19.5 participants per 100 000 pool activity hours (corresponding values: 43.5 and 4.7 for competitive and recreational swimming, respectively). Compliance with precautionary restrictions was highest regarding hand hygiene (98.1%) and lowest in distancing personal sports bags (69.9%). As a result of low statistical power, the study showed no significant effect of restrictions. Insight into the risk of transmission of SARS-CoV-2 during indoor swimming is needed to estimate the efficiency of restrictive measures on this and other sports and leisure activities. Only when we know how the virus spreads through various settings, optimal strategies to handle the COVID-19 pandemic can be developed.

Recreational Athletes' Use of Performance-Enhancing Substances: Results from the First European Randomized Response Technique Survey.

BACKGROUND AND AIM: Measuring the prevalence of doping in recreational sport is difficult. However, to fit their initiatives, National Anti-Doping Organizations are interested in knowing the numbers, so their scarce resources are not wasted. The present study aimed to estimate the prevalence of doping and over-the-counter medicine use for performance enhancement among recreational athletes in eight European countries. DESIGN: A survey covering + 200 sports aimed at recreational athletes 15 years and older was distributed via social media to sports clubs and individuals in eight European countries. To overcome social desirability bias, we applied indirect questioning by using the Randomized Response Technique and asked for the use of over-the-counter medicine and doping for the year 2019. RESULTS: The prevalence of the use of over-the-counter medications for performance enhancement was estimated at 10.4%. We differentiated between the concept of "doping" as the behavior to enhance performance in a certain sport and the concept of "a doper" as a property of a person. The prevalence of dopers in recreational sport was found to be 0.4%, with 3.1% male and 0% female dopers. Responses were separated into four categories: "Artistic sports," "Combat sports," "Games," and "CGS sports" (i.e., sports measured in centimeters, grams, and seconds). The overall prevalence of doping in recreational sports was found to be 1.6%, and the results from Artistic and CGS sports did not differ significantly from this. However, in Games we found an estimated doping prevalence of 6.9%. DISCUSSION: The estimates for the prevalence of dopers and doping in this study do not equal Anti-Doping Rule Violations as stipulated by the World Anti-Doping Agency. Still, while doping is not absent in recreational sport in Europe, it appears to be a low frequent phenomenon. Also, the differences in doping prevalence between the sports categories might reflect structural and competition-related differences, rather than differences in the logic of the sporting competition or discipline-related subcultures. CONCLUSION: While few recreational athletes appear to use illegal drugs to enhance performance, those who do use them are more often men than women. Yet, 1 in 10 recreational athletes uses over-the-counter medication for performance enhancement and more than 4 out of 10 use medication for other reasons than performance enhancement when doing sports. The highest doping prevalence was found in the sub-category of Games, which can likely be attributed to competition-related differences between the categories. Therefore, research on doping in recreational sports needs tailored approaches to come to a better understanding of the phenomenon.

Do you get what you see? The illicit doping market in Denmark-An analysis of performance and image enhancing drugs seized by the police over a 1-year period.

This study examines doping products seized by the police in three regional police districts in Denmark from December 2019 to December 2020. The products, often referred to as performance and image-enhancing drugs (PIEDs), are described in relation to the country of origin, manufacturing company, and the active pharmaceutical ingredient (API) stated on the packaging versus the one identified by subsequent chemical analysis. The study also includes a description of the degree of professionalism by which the products appear according to EU requirements. A total of 764 products were seized during the study period. The products originate from 37 countries, mainly located in Asia (37%), Europe (23%), and North America (13%). One hundred ninety-three different manufacturing companies could be identified from the product packaging. The most frequent compound class was the androgenic anabolic steroids, found in 60% of the products. In 25%-34% of the products, either no or an incorrect API relative to the one stated on the product was found. However, only 7%-10% contain either no API or a compound from a different compound class than the one stated. Most products had a professional appearance fulfilling most EU requirements for packaging information. The study shows that many different companies supply PIEDs to the Danish market and that counterfeit and substandard products are widespread. Many products do, however, appear professional to the user giving an impression of a high-quality product. Although many products are substandard, they most often contain an API from the same compound class as the one labeled.