Global review reveals complex governance challenges for transgender athletes across diverse sporting contexts and regions

As gender diversity and gender identity have become increasingly central to contemporary public debate, the participation of transgender athletes in competitive sport has emerged as a highly contested issue at the intersection of science, law, governance, media, and human rights. Rather than treating this controversy as a simple opposition between fairness and inclusion, this article offers an integrative review of the major tensions shaping current debate. Drawing on academic studies, policy documents, media analyses, and first-person accounts published between 2015 and 2026, the article examines the issue through four interrelated dimensions: medical and physiological evidence, policy and legal developments, media and social narratives, and lived experience. The review shows that while testosterone, pubertal development, and related physiological factors remain relevant to certain aspects of athletic performance, the evidence remains limited, uneven, and highly variable across sports and performance indicators. It further demonstrates that sport policy is shaped not by science alone, but by the interaction of governance priorities, legal culture, political climate, and public discourse. In particular, the policy trajectory from the IOC's 2015 testosterone-based threshold model, to its 2021 principle-based framework, and further to its 2026 shift toward a more centralized and explicitly sex-based eligibility rule illustrates the instability of current governance approaches. The review also shows that mainstream and social media actively shape the public legitimacy of transgender athletes, while first-person accounts reveal embodied pressures, institutional exclusion, and forms of agency often overlooked in abstract policy debate. This article argues that transgender athletes’ participation should be understood not as a narrow eligibility issue, but as a complex governance problem involving knowledge translation, institutional design, procedural justice, and lived experience. A more sustainable policy direction requires interdisciplinary evidence, procedural transparency, sport-sensitive governance, and the meaningful inclusion of transgender athletes’ voices.