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Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport’s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete’s unique makeup.

The benefit of training at altitude to enhance exercise performance remains equivocal although the most widely accepted approach is one where the athletes live and perform lower-intensity running at approximately 2300 m with high-intensity training at approximately 1250 m. The idea is that this method maintains maximal augmentations in total hemoglobin mass while reducing the performance impairment of high-intensity sessions performed at moderate altitude and thus preventing any detraining that can occur when athletes live and train at moderate altitude. This training regimen, however, is not universally accepted and some argue that the performance enhancement is due to placebo and training camp effects. Altitude training may affect an athlete's hematological parameters in ways similar to those observed following blood doping. Current methods of detection appear insufficient to differentiate between altitude training and blood doping making the interpretation of an athlete's biological passport difficult. Further research is required to determine the optimal method for altitude training and to enhance current detection methods to be able to differentiate better blood doping and altitude exposure.

Introduction: The issue of integrating transgender athletes into sport is becoming more prominent with the rising numbers of those identifying as transgender in society. Whether it is fair for transgender athletes to be included in their affirmed gender category across all levels of sport from grassroots to elite is the crux of the debate. Previous studies have shown muscle mass loss in transwomen and muscle mass and strength gain in transmen after 1 year of gender-affirming treatment (GAT). Wiik et al., 2020 found that transmen retain a strength disadvantage over cisgender men and transwomen retain muscle mass and strength advantages over cisgender women after 1 year of GAT. Roberts et al., 2020 also found that running performance in transwomen was maintained but not baseline muscular strength. However, very little data on sports performance measures outside muscular strength and running times exist, nor has any of the previous data been compared with a comparative control group. Aim: To investigate the effect of “muscle memory” in transgender athletes and investigate changes in physiology after 2 years of GAT such as bone mineral density, lean muscle mass, and fat mass, coupled with sports performance measures in transwomen and transmen athletes and compare them with a cisgender female athletic cohort. This will elucidate what advantages/disadvantages transgender athletes gain/retain after 2 years of GAT over their cisgender counterparts and this will better inform policymakers who control their integration into their affirmed gender category in sport.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

Exertional rhabdomyolysis may occur when an individual is subjected to strenuous physical exercise. It is occasionally associated with myoglobinuria (i.e. "cola-colored" urine) alongside muscle pain and weakness. The pathophysiology of exertional rhabdomyolysis involves striated muscle damage and the release of cellular components into extracellular fluid and bloodstream. This can cause acute renal failure, electrolyte abnormalities, arrhythmias and potentially death. Exertional rhabdomyolysis is observed in high-performance athletes who are subjected to intense, repetitive and/or prolonged exercise but is also observed in untrained individuals and highly trained or elite groups of military personnel. Several risk factors have been reported to increase the likelihood of the condition in athletes, including: viral infection, drug and alcohol abuse, exercise in intensely hot and humid environments, genetic polymorphisms (e.g. sickle cell trait and McArdle disease) and epigenetic modifications. This article reviews several of these risk factors and proposes screening protocols to identify individual susceptibility to exertional rhabdomyolysis as well as the relevance of proteomics for the evaluation of potential biomarkers of muscle damage.

Introduction: High altitude acclimatization is a process that involve several physiological adjustments, which may increase glucose metabolism because of acute hypoxic exposure. Native highlanders like Tibetans show an increased anaerobic glucose metabolism and a higher proportion of type I muscle fiber than lowlanders. Actin filaments are anchored to the Z line of the sarcomere by a protein called alpha-actinin that exist in two isoforms in the muscle (ACTN2 and ACTN3), however ACTN3 is present only in type II fibers, especially in type IIx. Homozygous individuals for a 577X polymorphism in the ACTN3 gene do not express ACTN3 and seem to be more type I muscle fiber than homozygous individuals 577R. The aim of this study was to compare the glucose consumption response of individuals with different ACTN3 genotypes at simulated 4,500 m altitude. Materials & Methods: Twenty-three volunteers spent four hours exposed to a simulated altitude of 4,500 m inside a normobaric hypoxia chamber. Lactate and glucose concentrations, SpO2 and heart rate were analyzed immediately before entering the chamber and at each hour during the exposure. Results: Glucose after four hours of exposure to hypoxia was different between groups, with RX (68.1 ± 11.7 mg/dl) and RR (71.7 ± 14.4 mg/dl) showing a decreased blood glucose compared to XX (88.7 ± 14.1 mg/dl), indicating an increased dependence on glucose metabolism in individuals with at least one R allele after exposure at 4,500 m simulated altitude. Conclusions: We concluded that individuals with at least one R allele of the ACTN3 R577X gene polymorphism consume more glucose than the ones with XX genotype.

Experimental and cross-sectional study. To assess the immediate effect of exercise on heart rate (HR), oxygen uptake (VO2), pulmonary ventilation (PV), oxygen pulse (OP), glucose and lipids of wheelchair basketball players with spinal cord injury (SCI). Center of Studies in Psychobiology and Exercise—Sao Paulo, Brazil. In all, nine wheelchair basketball players with SCI and nine able-bodied controls (C) performed three exercise sessions at different intensities: ventilatory threshold 1 (VT1), 15% below VT1 and 15% above VT1 with a duration of ~24–34 min. HR, VO2, PV, OP, glucose and lipids were analyzed. VO2, PV and OP were significantly lower in the players with SCI compared to C during the same intensity exercise sessions. However, the individuals with SCIs demonstrated increases in HR, PV and OP at similar rates to C. Triglycerides of the SCI group were elevated 30 min after the exercise session at VT1 compared to values before the exercise session (P=0.017); this elevation was not observed in group C. For the exercise sessions 15% above VT1, only glucose (P=0.040) and low-density lipoprotein (P=0.012) 30 min after the exercise were elevated in the SCI group compared to group C. We conclude that the SCI group demonstrated increases in HR, PV and OP but not VO2 with increased intensity of exercise at similar rates as in group C.

BACKGROUND Physical exercise may contribute to changes in eating behavior. AIMS to investigate eating behavior and reported energy intake in physically active individuals. METHODS Thirty-nine healthy adults of both sexes, who were involved in physical fitness training, were enrolled to participate in the study. A food diary and the TFEQ-21 was used for energy intake measurementandeating behaviors identification. RESULTS All participants showed acceptable levels of all evaluated behaviors: Cognitive restraint (46.58±16.4 and 49.5±20.0), Emotional eating (8.12±12.5 and 40.8±26.7),and Uncontrolled eating (21.6±15.1 and 35.6±20.9) in men and women, respectively. Uncontrolled eating was associated with increased carbohydate intake for women, andfat-free masscontent was associated with less Emotional eating only in men. There were no differences in energy and macronutrient consumption between training and non-training days. CONCLUSION Regular physical exercise is associateto bettereating behaviors, but women mayfind it harder to maintain or lose weight due to higher levels of emotional eating.