Boxing’s highest national governing body added a transgender athletes policy to its rulebook that requires genital reassignment surgery and stringent hormone testing before competition, making it among the strictest policies for trans athletes.

The guidelines, dated August 2022 and released as part of USA Boxing’s 2024 rulebook Friday, are facing criticism for including trans women at all, bucking a recent streak of sports governing body decisions that have excluded trans women entirely if they have undergone male puberty. 

The policy states that minors under the age of 18 “must compete as their birth gender” in weight classes outlined in the rulebook. Transgender women over 18 can only compete in the female category if they undergo genital reassignment surgery and submit quarterly hormone tests for at least four years following surgery. The guidelines — which define normal ranges of testosterone as less than 3.1 nanomoles per liter for women and more than 10 nanomoles per liter for men — mandate transgender women demonstrate that their total testosterone serum level has been below 5 nanomoles per liter for at least four years prior to their first competition and throughout the time they desire to be eligible to compete.

Transgender men over 18 have to meet similar requirements. They must undergo genital reassignment surgery, submit quarterly hormone tests for four years following surgery and demonstrate that their testosterone level in serum has been above 10 nanomoles per liter for at least four years prior to their first competition and throughout the entire time they desire to be eligible to compete. It was not immediately clear when the policy took effect. USA Boxing did not immediately return a request for comment.

The guidelines are a departure from policies typically put forth for transgender athletes. 

Athlete Ally, a group that advocates for trans athletes, has long argued that surgery requirements and testosterone testing like those put forth by USA Boxing “jeopardize athletes’ dignity and autonomy” and may harm their health. The group has also said research into transgender athletes and potential advantages is limited and that restrictions based on advantages don’t take into account the many nuanced factors that affect competitive advantage.

Many sports have made an effort to be more inclusive of trans athletes in recent years. The International Olympic Committee, for example, rolled out a new framework in November 2021 that declined to offer specific guidelines for each sport, and, rather, encouraged sports governing bodies to develop their own sport-specific guidelines that take into account advantage in that sport. The IOC had previously required testosterone limits, testing and treatments, but the new framework described those as “medically unnecessary.” The IOC stopped requiring surgery in 2016.

However, since the IOC introduced its framework, some sports governing bodies have announced some of the most restrictive policies to date, in part due to public pressure after Lia Thomas, a trans University of Pennsylvania swimmer, set national records in multiple events and went on to win an NCAA championship. The NCAA, which oversees collegiate athletics, announced in the middle of her season that it would get rid of its previous trans athlete policy and instead adopt a sport-by-sport approach, similar to the IOC. 

A few weeks later, USA Swimming, the national governing body for competitive swimming in the United States, released a new policy for trans athletes that requires testosterone testing for trans women and requires athletes to provide evidence that going through puberty as their sex assigned at birth “does not give the athlete a competitive advantage over the athlete’s cisgender female competitors.” 

In the months following, more sports governing bodies announced more restrictive policies. In June 2022, World Aquatics, the international governing body for swimming, banned trans athletes from competing in women’s events. In March, World Athletics, which oversees track and field internationally, banned transgender women who have gone through male puberty from elite female competitions, and the International Cycling Union released a similar policy in July. 

Though USA Boxing’s policy is among the most strict for trans athletes, some critics said it didn’t go far enough. Australian professional boxer Ebanie Bridges called the policy “wrong on so many levels.”

“I will never agree to this… it’s bad enough having trans women breaking records in other sports like track and field, swimming and power lifting but it’s a bit different to them breaking our skulls in combat sports where the aim is to HURT YOU not just break a record,” Bridges wrote on X.