Many transgender (trans) individuals utilize gender-affirming hormone therapy (GAHT) to promote changes in secondary sex characteristics to affirm their gender. Participation rates of trans people in sport are exceedingly low, yet given high rates of depression and increased cardiovascular risk, the potential benefits of sports participation are great. In this review, we provide an overview of the evidence surrounding the effects of GAHT on multiple performance-related phenotypes, as well as current limitations. Whilst data is clear that there are differences between males and females, there is a lack of quality evidence assessing the impact of GAHT on athletic performance. Twelve months of GAHT leads to testosterone concentrations that align with reference ranges of the affirmed gender. Feminizing GAHT in trans women increases fat mass and decreases lean mass, with opposite effects observed in trans men with masculinizing GAHT. In trans men, an increase in muscle strength and athletic performance is observed. In trans women, muscle strength is shown to decrease or not change following 12 months of GAHT. Haemoglobin, a measure of oxygen transport, changes to that of the affirmed gender within 6 months of GAHT, with very limited data to suggest possible reductions in maximal oxygen uptake as a result of feminizing GAHT. Current limitations of this field include a lack of long-term studies, adequate group comparisons and adjustment for confounding factors (e.g. height and lean body mass), and small sample sizes. There also remains limited data on endurance, cardiac or respiratory function, with further longitudinal studies on GAHT needed to address current limitations and provide more robust data to inform inclusive and fair sporting programmes, policies and guidelines.

中文翻译：

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性别肯定内分泌护理对体育参与的影响。

许多跨性别者利用性别确认激素疗法 (GAHT) 来促进第二性征的变化，以确认自己的性别。跨性别者参与体育运动的比例极低，但考虑到抑郁症发病率很高和心血管风险增加，参与体育运动的潜在好处是巨大的。在这篇综述中，我们概述了 GAHT 对多种表现相关表型的影响的证据，以及当前的局限性。虽然数据明确表明男性和女性之间存在差异，但缺乏评估 GAHT 对运动表现影响的高质量证据。12 个月的 GAHT 导致睾酮浓度与确认性别的参考范围一致。跨性别女性的 GAHT 女性化会增加脂肪量并减少瘦肉量，而在具有男性化 GAHT 的跨性别男性中观察到相反的效果。在跨性别男性中，观察到肌肉力量和运动表现的提高。在跨性别女性中，经过 12 个月的 GAHT 治疗后，肌肉力量出现下降或没有变化。血红蛋白是氧气运输的一种量度，在 GAHT 后 6 个月内会改变至确定性别，但非常有限的数据表明，女性化 GAHT 可能会导致最大摄氧量减少。目前该领域的局限性包括缺乏长期研究、充分的群体比较和混杂因素（例如身高和去脂体重）的调整以及样本量较小。关于耐力、心脏或呼吸功能的数据仍然有限，需要对 GAHT 进行进一步的纵向研究，以解决当前的局限性，并提供更可靠的数据来为包容性和公平的体育项目、政策和指南提供信息。