Now imagine how hard it is for professional athletes, who are competing in real events and vying for gold medals and championships, to be attacked for their gender — or attributes related to it. As the transgender revolution continues to break barriers throughout society, the sports world is also in the midst of an evolution, as more trans and intersex athletes are coming out into the open and facing obstacles related to their gender identity and expression in the process.

But despite the many challenges trans and intersex athletes continue to face, the sports world has witnessed major changes since the days when athletes were forced to remain closeted in order to compete in the sport they loved. Few know this experience better than Caitlyn Jenner, out and proud transwoman, activist, television personality and retired Olympic gold medal-winning decathlete. In 1976, Caitlyn, who was then living as Bruce Jenner, won the Olympic decathlon event at the Montreal Olympic Games and set the world on fire as an All-American hero, while also being known as arguably the world's greatest athlete.

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In the 1970s, there was virtually no transgender visibility or awareness to speak of in the sports world. "It was just something you shut up about," Caitlyn says. "I needed sports to prove to everyone, but most of all to myself, my masculinity, or at least the masculinity society says I should have had." But the pressure to live up to whatever it meant to be an All-American hero, combined with Caitlyn's own internal battle with her gender identity and the social mores of the time, made it nearly impossible to speak out about who she really was. The exuberance she initially felt after having won the greatest award an athlete can be decorated with became dulled — burdened, even, by reality.

"I needed sports to prove to everyone, but most of all to myself, my masculinity, or at least the masculinity society says I should have had." — Caitlyn Jenner

"It dawned on me then that I was now at a level where I'm seen as the best in the world at something," Caitlyn recalls. "I went through that whole experience, and after it was over, the next day, I'm in the bathroom without a stitch of clothes on. The medal is sitting on the counter. I pick it up, I look into the mirror, and I go, 'Holy crap, what did I just do? Did I make this image so big that I'm stuck with it for the rest of my life?' It really kind of scared me. So what did I do? I got into family, I got into work, distractions. Not that my family was a distraction, but it was a distraction from who I really am."

Today, arguably fewer athletes have to face what Caitlyn did in the 1970s, and part of this change comes from something as simple as greater visibility. Trailblazers such as American duathlete and triathlete Chris Mosier, Canadian hockey player Harrison Browne, American volleyball player Tia Thompson, Brazilian volleyball player Tiffany Abreu, American MMA fighter Fallon Fox, American boxer Patricio Manuel and several others around the world are moving the needle forward in their respective sporting categories, whether going for Olympic gold or not. Caitlyn Jenner's story can be seen as a benchmark for the progress the sports world has made in recognizing the presence and ability of transgender athletes.

At the same time, a parallel battle for acceptance is being waged by intersex athletes like South African middle-distance runner Caster Semenya and Indian sprinter Dutee Chand. Both women have faced very public scrutiny for possessing natural, but atypical, sex traits characteristic of intersex individuals. The designation encompasses a broad range of traits that may include chromosomes, gonads, sex hormones or genitals that, according to the UN Office of the High Commissioner for Human Rights, "do not fit the typical definitions for male or female bodies."

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Alongside out transgender and intersex athletes are countless others who are silenced and kept closeted because of the numerous obstacles, from locker room insults to persistent misogyny and transphobia, that remain in their path. Take, for example, the case of the two unnamed male-to-female trans athletes from Team Great Britain who were set to compete in the 2016 Rio Olympics but were afraid of exposure and ridicule in the spotlight, according to Delia Johnson, a transwoman who was once an ambassador for the 2012 London Olympics and currently works as an adviser on transgender issues to several UK sporting bodies. Back in 2016, Johnson told the Daily Mail that these Olympic hopefuls, who had completed their gender confirmation surgeries, hoped to be "selected [for the Olympic team], but they fear they will be deemed too tricky — too many issues, too much negativity." Worse still is that, according to Johnson, had the hopefuls been in the running for gold or silver medals, "they would probably drop back because their fear of ridicule and total humiliation is so massive." Their gender status was reportedly known by their sport governing bodies but not to rivals from other nations. Their situation illustrates the double bind many athletes are confronted with: On the one hand, visibility has been shown to reduce prejudice and lead to real change, but on the other, athletes who reveal their trans identities face very real costs and risks when doing so.

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And sometimes they don't even have a choice about whether to keep their identities private in the first place. 1968 was the first year the International Olympic Committee began conducting the controversial practice of gender and sex testing in sporting competitions, something that has disproportionately affected male-to-female transwomen and intersex women. Other sport governing bodies over the years have also required athletes to undergo the multi-step "verification process" that, in the name of keeping sports equitable and fair, often includes a physical exam (which some accounts say can look like women parading around nude before doctors); a chromosomal test to detect the SRY gene (the gene responsible for the determination of male sex in humans); and hormonal testing. All of the above procedures, some researchers and anthropologists argue, act as types of gender policing.

But over the years, steps have been taken to try to create a more equal and inclusive playing field. In 2003, the International Olympic Committee appointed their Medical Commission to organize a meeting to discuss growing awareness and participation of transgender athletes. Widely known as the Stockholm Consensus, the meeting resulted in recommendations largely concerning the eligibility of trans athletes who had undergone gender confirmation surgery in hopes of competing under their identified gender. Under those guidelines, both transmen and transwomen athletes were required to have met three conditions: hormone replacement therapy (HRT) for a "sufficient length of time to minimize gender-related advantages in sport competitions," legal recognition of their gender and "surgical anatomical changes," including "external genitalia changes and gonadectomy." While some followed the logic that this policy at least opened the door for transgender athletes to compete, it also received blowback for its mandate that trans athletes must have undergone gender confirmation surgery. Not only are the procedures under the gender confirmation surgery umbrella often prohibitively expensive, and often not covered by private insurers, but they can also pose a safety risk, particularly for athletes from countries where trans visibility and acceptance is nearly if not entirely nonexistent.

In many ways, this new consensus felt like a step backward... creating more punitive and draconian environments for intersex athletes than ever.

Chris Mosier remembers confronting this difficult decision about whether to undergo surgery he did not want or risk not being able to compete. Although Mosier's sport, duathlon, is not part of the Olympics, it follows IOC regulations when it comes to trans athletes. "Not every athlete can or wants to change their body," Mosier says. "Adding or removing an extra body part isn't going to make me a faster runner or a better cyclist."

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The issue of intersex athletes, particularly those with female hyperandrogenism — a medical condition present in women and characterized by an excess of androgens, male sex hormones like testosterone — became the next frontier for the IOC to tackle. Sex-testing came under scrutiny during an episode involving the aforementioned Semenya. After the South African runner gained attention for major improvements in her time when she won the gold in the women's 800-meter race at the 2009 World Championships, as well as her muscular appearance, the IAAF (the International Association of Athletics Federation, the international governing body for the sport of athletics, which includes track and field) reportedly felt "obligated to investigate," as these records represented "the sort of dramatic breakthroughs that usually arouse suspicion of drug use." Barred from competing for several months, Semenya was subjected to ridicule from other athletes and insensitive leaks about her test results to the press. The incident and its aftermath shed more light on what The New York Times, in an investigation, would call a "humiliating practice" and a breach of human rights.

Katrina Karkazis, a cultural anthropologist and senior visiting fellow with the Global Health Partnership at Yale University, who has written extensively about the practices of sex testing in sports, argues that many policies that target trans and intersex athletes are rooted in fear and a lack of understanding. "The term 'intersex' is hard for people to understand, because [we] tend to use it often to talk mostly about the complexity of sex, but one of the things I believe is that sex is always complex," she says. "People with intersex may be born with atypical traits, but there is not one single characteristic we can definitively use to categorize people as either male or female. It's hard for laypeople to understand this, but medicine has known that for a really long time."

The IOC held another consensus meeting in 2010 with the Medical Commission, and in June 2012, just five weeks before the 2012 London Summer Olympic Games, they implemented updated regulations on female hyperandrogenism to say that "only men" could compete in men's competitions, and "only women" could compete in women's competitions. For intersex athletes, these designations — and whatever it meant to be "only" male or "only" female — further sowed confusion as to how they were perceived by sport-governing bodies and the athletic community at large. In addition, the consensus report suggested that athletes concerned about the sex of their competitors could report those suspected of possessing traits of female hyperandrogenism to Olympic authorities, and the IOC pledged to "actively investigate any perceived deviation in sex characteristics." In many ways, this new consensus felt like a step backward from 2003, creating more punitive and draconian environments for intersex athletes than ever.

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Around the same time the IOC held their consensus meeting, the IAAF decided to reverse the primary way they conducted sex testing. Though, like the IOC, the IAAF had previously relied on chromosome tests, they decided in 2011 to switch to testing for hyperandrogenism and elevated testosterone levels. One athlete who got caught in the sex-testing crosshairs as a result was Dutee Chand. Like Semenya, it was her prodigious running ability and string of wins (as well as, arguably, jealousy from competitors) that spurred officials to test her sex. In addition to the standard hormone testing, doctors conducted a physical examination, chromosome analysis, MRI and an ultrasound. After her hyperandrogenism was discovered, Chand was banned from competing and dropped from the Indian national team. Rather than accept the rulings, Chand decided to take the IAAF to the Court of Arbitration for Sport (CAS), claiming that she was being discriminated against because of her high testosterone levels.

The IOC held another consensus meeting in 2010 with the Medical Commission, and in June 2012, just five weeks before the 2012 London Summer Olympic Games, they implemented updated regulations on female hyperandrogenism to say that "only men" could compete in men's competitions, and "only women" could compete in women's competitions. For intersex athletes, these designations — and whatever it meant to be "only" male or "only" female — further sowed confusion as to how they were perceived by sport-governing bodies and the athletic community at large. In addition, the consensus report suggested that athletes concerned about the sex of their competitors could report those suspected of possessing traits of female hyperandrogenism to Olympic authorities, and the IOC pledged to "actively investigate any perceived deviation in sex characteristics." In many ways, this new consensus felt like a step backward from 2003, creating more punitive and draconian environments for intersex athletes than ever.

Experts like Karkazis testified that the dividing line between male and female athletes when it came to testosterone — and the impact it had on their athletic performances — wasn't as clear as the IAAF suggested. Some elite male athletes had testosterone levels in the female range, for instance. Ultimately, the court awarded a temporary victory to Chand in 2015 and she went on to compete in the 2016 Rio Olympics. It also ordered the IAAF to suspend its sex-testing policy for two years until the organization could provide evidence showing a clear difference between male and female testosterone levels and how big an advantage the extra testosterone gave hyperandrogenic women. The IOC also paused their sex-testing program as a result of the CAS ruling.

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Just this past April, the IAAF revealed new regulations that, in the words of The New York Times, attempt "to reinstate rules governing female athletes with elevated testosterone levels" like the ones they had before Chand's case. Once again, female athletes with hyperandrogenism will come under scrutiny, and they may be compelled to lower their testosterone levels with medication. It is not entirely clear what effect these new regulations may have on the practice of sex testing, but the implications that these hormone regulations bring indicate that the IAAF may be trying to reinstate hormone testing as well.

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When it comes to hormones, some male-to-female trans athletes, whose participation has long hinged on hormone regulation, dispute the notion that their biological history automatically confers an advantage over cisgender women. "That was the biggest issue I had come up as a trans female athlete — my presumed advantage over cisgendered women," volleyball player Tia Thompson says. Whatever performance edge testosterone may have once given a trans athlete, Thompson argues, may be lost during the transitioning process. "Hormone therapy changes a trans athlete's life," Thompson says, continuing, "Before I started hormone therapy, I was on top of my game. I didn't play professional ball then, but I was very good. I started transitioning at age 18 and I started hormone therapy at 21, so it's been over 10 years that I've been on consistent hormone therapy. I lost muscle mass, I can't jump as high as I used to, and of course there's a difference in physical appearance.

"The biggest difference in terms of the sport is how I played before HRT and how I play now," she continues. "[Trans athletes] don't have an advantage over cisgendered women that can be 'proven,' and I'd say that some of that has to do with the therapeutical physical changes we are going through. It affects you mentally, too."

Relative to the attention given trans and intersex women, there is much less scrutiny directed towards male trans athletes. For instance, in 2015, 12 years after their initial ruling about trans athletes, the IOC's Medical and Scientific Commission convened to review available scientific and clinical evidence on gender confirmation and hyperandrogenism in female athletes, and found that female-to-male transmen could compete without restriction, but male-to-female transwomen must have identified as women for four years, while also demonstrating that their testosterone levels are at or below 10 nanomoles per liter. "Male athletes aren't being gender tested or having the same sort of regulations as female athletes; let's call it what it is," boxer Patricio Manuel says. He goes on to call out both the misogyny and the transmisogyny — or discrimination against transwomen — that can be lurking beneath the surface of many of these policies.

But despite all of the "one step forward, two steps back" progress, there has been one major restriction loosened that affects male and female athletes alike: During that same 2015 meeting, the IOC decided to remove gender confirmation surgery as a requirement for would-be transgender competitors, which provides a wider opening for more trans-identified Olympic athletes to participate. Even as debates over competitive advantage and testosterone levels undoubtedly and rightfully rage on, one has to admit: The Olympics has come a long way since Caitlyn Jenner had to hide out in her Olympic training village as Bruce.

Today, in a statement provided to PAPER about their policies, the IOC says that "The IOC approach aims to balance inclusivity, fairness and safety for all athletes and is based on medical and expert consensus. We are constantly reviewing our guidance in a process led by the Medical Commission, informed by inputs from the Athletes Commission and outside experts."

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Though the Olympics might be seen as the pinnacle, advocates like Hudson Taylor, the executive director and founder of Athlete Ally, a nonprofit New York-based organization that provides education to sports institutions and advocacy for LGBTQ athletes, believe that maybe they shouldn't get all the attention if more change is to occur in how the public views transgender and intersex athletes. He cites the National Women's Hockey League (NWHL) and how they embraced transman Harrison Browne as an example of how other sports leagues can serve as trailblazers in the trans equality movement.

Browne, who recently retired, played for the Metropolitan Riveters, based in Newark, New Jersey, and says that he "was one of the reasons why hockey adopted one of its first trans policies, to help accommodate me, and have something in writing that they wanted me to feel included. That was a big step to have transmen and transwomen in a very traditional sports league." He continues that he hopes his experience "opens people's eyes to the fact that there are more Harrison Brownes out there, and we need to make sure we accommodate them."

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While it may take time before more professional sports leagues follow the NWHL's lead, Taylor thinks it's LGBT sports leagues that should start doing more to promote the inclusion of trans and nonbinary athletes. In the United States alone, Taylor says, there are over 300,000 people who are competing on LGBT sports teams, but most leagues, like the Gay Games, are predominantly sex-segregated (and therefore very binary in how they approach gender). "I'm trying to ask people I'm in contact with, 'How do we invest in more mixed-gender opportunities, more nonbinary opportunities?'" Taylor ponders. "And it may not be as big of a win as an IOC policy change, but it may actually serve the foundation for what sport looks like 50 years from now."

It seems that even the IOC is looking ahead towards the future of mixed-gender competitions: The 2020 Tokyo Olympic Games will, for the first time in Olympics history, feature 18 mixed-gender events, including a mixed 4x4 relay for track and field categories, with two men and two women. In swimming categories, the same is true: Two men and two women will be competing in different relay legs. Other mixed-gender competitions include archery and shooting.

Rather than focusing on testosterone and how it creates an elusive divide between trans and intersex athletes and their cisgendered peers, Taylor also imagines an environment where competition is not about presumed advantage, but instead fostering a better understanding of how men and women relate to each other.

And if we do that, who knows? Maybe comments like "You throw like a girl" will cease to be an insult.

Language

Cisgender: A term for people whose gender identity matches the sex they were assigned at birth.

Gender Confirmation Surgery: The preferred term for what used to be known as sex-reassignment surgery, these are processes that some transgender individuals undergo to confirm a gender identity that is at odds with the sex they were assigned at birth. They may include procedures such as facial feminization or masculinization surgeries, top surgeries (the removal or addition of breasts) and bottom surgeries (the transformation and reconstruction of genitalia). Though surgery is not a requirement in order for a person who identifies as trans to be seen as such, for some it's considered a necessary step.

Hormone Replacement Therapy: Also known as HRT, this is a therapeutic process and medical treatment by which patients take hormones like estrogen or testosterone to induce physiological changes as part of the transitioning process.

Hyperandrogenism: A medical condition characterized by excessive levels of androgens — male sex hormones like testosterone — in the female body.

IAAF: Also known as the International Association of Athletics Federation, this is the international governing body for the sport of athletics (think: track and field events).

Intersex: A term describing people born with atypical sex traits and characteristics that encompass a variety of conditions, including differences in the appearance of external genitalia, the development of reproductive organs, chromosome makeup and more.

IOC: The International Olympic Committee, based in Switzerland, is a non-profit organization in charge of presiding over the Olympic Games.

Sex testing: A multi-step "verification process" dating back to 1968 that includes a physical exam, chromosomal testing and hormone testing.

Pat Manuel Photography: Clay Stephen Gardner
Grooming: Fallon Toni Chavez