Pigozzi, FabioBigard, XavierSteinacker, JuergenWolfarth, BerndBadtieva, VictoriyaSchneider, ChristianSwart, JeroenBilzon, James Lee JohnConstantinou, DemitriDohi, MichikoDi Luigi, LuigiFossati, ChiaraBachl, NorbertLi, GuopingPapadopoulou, TheodoraCasasco, MaurizioJanse van Rensburg, Dina ChristinaKaux, Jean-FrançoisRozenstoka, SandraCasajus, Jose-AntonioZelenkova, IrinaAk, EmreUlkar, BulentArroyo, FranciscoIonescu, AncaPedrinelli, AndreMiller, MikeSingleton, PatrickShroff, MalavWebborn, NickBarrett, JamesHamilton, BlairGeistlinger, MichaelBeltrami, GianfrancoMigliorini, SergioDienstbach-Wech, LenkaBermon, StephanePitsiladis, Yannis P.International Federation of Sports Medicine (FIMS)European Federation of Sports Medicine Associations (EFSMA)2023-11-202023-11-202022-01Pigozzi, F., Bigard, X., Steinacker, J., et al. Joint position statement of the International Federation of Sports Medicine (FIMS) and European Federation of Sports Medicine Associations (EFSMA) on the IOC framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. BMJ Open Sport & Exercise Medicine 2022;8:e001273. DOI:10.1136/bmjsem-2021-001273.10.1136/ bmjsem-2021-0012732055-7647 (online)http://hdl.handle.net/2263/93369The IOC recently published its framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. This framework is drafted mainly from a human rights perspective, with less consideration for medical/scientific issues. The framework places the onus for gender eligibility and classification entirely on the International Federations (IFs), even though most will not have the capacity to implement the framework. The position of no presumption of advantage is contrary to the 2015 IOC consensus. Implementation of the 2021 framework will be a major challenge for IFs that have already recognised the inclusion of trans and women athletes with differences of sexual development (DSD) using a scientific/medical solution. The potential consequences for sports that need to prioritise fairness or safety could be one of two extremes (1) exclusion of all transgender or DSD athletes on the grounds of advantage or (2) self-identification that essentially equates to no eligibility rules. Exclusion of all transgender or DSD athletes is contrary to the Olympic charter and unlawful in many countries. While having no gender eligibility rules, sport loses its meaning and near-universal support.en© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC.FairnessHuman rightsInternational Federations (IFs)International Olympic Committee (IOC)SDG-05: Gender equalitySDG-10: Reduced inequalitiesArticle