Active duty service members are required to take a physical readiness test every six to 12 months. Roberts, Smalley and another co-author, Dr. Dale Ahrendt, realized they had access to robust data on service members before, during and after they started hormone replacement treatment.
The three physicians conducted a retrospective review of medical records and fitness tests for 29 transgender men and 46 transgender women from 2013 to 2018. The Air Force’s fitness assessment includes the number of pushups and situps performed in a minute, and the time required to run 1.5 miles.
They also had records on when the subjects started testosterone or estrogen, the type of hormone used and the number of days from when treatment began to when their hormone levels reached the normal adult range for a cisgender person.
For the first two years after starting hormones, the trans women in their review were able to do 10 percent more pushups and 6 percent more situps than their cisgender female counterparts.
After two years, Roberts told NBC News, “they were fairly equivalent to the cisgender women.”
Their running times declined as well, but two years on, trans women were still 12 percent faster on the 1.5 mile-run than their cisgender peers.
Joanna Harper, a medical physicist in Portland, Oregon, has conducted research into the effect of testosterone blockers on transgender women runners like herself.
In 2015, she published
the first study of transgender women and athletic performance and found that trans women ran at least 10 percent slower after beginning hormones. And, relatively speaking, they did no better against cisgender female runners than they had previously done against cisgender men.
Harper said Roberts’ methodology is solid, but she sees some limitations in the study. In an assessment shared with NBC News, she questioned the lack of data on participants’ individual training habits. She also noted there was no coordination between when subjects started hormones and when they took their annual fitness test.
“The tests were placed into three bins,” Harper said. “One bin of tests that took place in the first year after the start of hormone therapy, one bin of tests that took place between one to two years of hormone therapy, and a third bin that took place between two and two and a half years after the initiation of hormone therapy.”
Lumping the data together could blur out changes that occurred within a 12-month period “and might distort the results notably,” she theorized.
The fact that the trans women were still faster after two years could be due to differences in training intensity, she speculated. But the pushup and situp tests involve muscular strength, technique, muscular endurance and cardiovascular endurance, and “are probably good proxies for success in many team sports.”