What does this mean?
In elite level or collegiate athletic competition, where a 1-2% advantage in speed or strength is often the difference between victory and defeat, governing bodies need to re-examine guidelines for inclusion of transgender and other women with elevated testosterone levels and determine what evidence-based changes are required to ensure a level playing field. They will need to stand up to legal scrutiny. In youth and recreational sports there is such a broad range of ability, training, and development that differences from prior testosterone after 12 months of suppression may not have a meaningful competitive impact and the benefits of inclusion of all athletes should take priority. When establishing guidelines for youth and recreational sports, the question has to be: “What is the best thing for all our athletes?”