Cal Calamia, a 27-year-old high school cross-country coach and runner in San Francisco, has quickly emerged as one of the leaders of the nonbinary running movement.
A transgender runner’s push for inclusion may have changed the sport
Cal Calamia is a nonbinary runner who is taking testosterone as part of his transition and was granted an unexpected exemption from the U.S. Anti-Doping agency
By Kelyn Soong
Updated October 27, 2023 at 8:55 p.m. EDT|Published October 6, 2023 at 2:42 p.m. EDT
“Running is a massive, massive part of my life,” Calamia said.
But for the past three months, Calamia had been anxiously waiting for news about his eligibility to compete. In July, Calamia received an email from the U.S. Anti-Doping Agency learning that he was at risk of being disciplined for his use of testosterone, a prohibited and potentially performance-enhancing drug for runners competing in USA Track & Field-governed events.
Calamia, who uses both he and they pronouns, has been open on social media about taking testosterone since 2019 as part of his gender transition. (Calamia was assigned female at birth.)
This week, Calamia received an email from USADA stating that he has been granted a therapeutic use exemption to compete in male, nonbinary and open categories at USATF-governed events, which are all based in the United States.
It’s believed to be the first such exemption to compete in the nonbinary category in running and is viewed as a victory for nonbinary and trans athletes, some of whom receive gender-affirming hormone treatments that have traditionally been banned from the sport.
“This approval represents a turning point in conversations about trans athletes,” Calamia said. “To have this approval means I’m allowed to be part of this conversation without being sidelined.”
The anti-doping agency allows athletes who have a medical reason for using testosterone or other banned substances to apply for a therapeutic use exemption, also called a TUE. An athlete who uses a prohibited substance for medical reasons but competes without a TUE is at risk of violating anti-doping rules and discipline from the sport.
For Calamia, TUE application requirements from anti-doping officials felt harshly out of step with how the sport is evolving. To create a running division that welcomes nonbinary and trans runners only to disqualify them for seeking gender-affirming medical care would not have made sense, he said.
An ‘invasive’ request
Calamia said it never occurred to him that his use of a medically necessary, gender-affirming treatment would be viewed as doping or that he would need an exemption to compete in a nonbinary division as a result.
Even so, he decided to apply for a therapeutic use exemption after the inquiry from the anti-doping agency. But as he read the application and learned of the necessary paperwork required of him, he grew disheartened.
To start, the application form allows only two options for gender: female and male. Calamia said he left both boxes unchecked.
The agency also asked for a complete medical history, including psychological records and medical notes, establishing a diagnosis of gender dysphoria.
Calamia said he believes USADA’s checklist is unnecessarily invasive. By comparison, athletes who use medically prescribed testosterone to treat hypogonadism, a condition in which the body does not produce enough of the hormone, are not required to submit psychological records when seeking an exemption.
According to the agency’s website, it’s uncommon to ask an athlete for psychological records. The only other applicants asked to provide them are athletes who use certain banned drugs to treat attention-deficit/hyperactivity disorder.
Calamia decided against including all the items listed as essential in his application. “It feels like overstepping,” Calamia said.
Matt Fedoruk, USADA’s chief science officer, said the agency had been waiting for input from World Athletics and the USATF on eligibility requirements for transgender and nonbinary athletes.
The therapeutic exemption process was created to allow athletes who have medical conditions to use medically necessary treatments that might otherwise be banned. In addition to testosterone and muscle building steroids, the list of banned substances includes insulin, stimulants and diuretics, as well as drugs used to treat breast cancer, infertility, high blood pressure and asthma.
While many athletes have legitimate medical reasons to take these drugs, banned substances, including testosterone, also have a long history of misuse by athletes, such as cyclist Lance Armstrong, seeking to enhance athletic performance or mask the use of an illegal substance.
Calamia’s exemption dates from June 17, 2022, and is in effect for 10 years. As part of the approval, Calamia needs to note any changes in medication, dosage or treatment schedule. He is also required to monitor his testosterone levels approximately every six months.
Running since middle school
Calamia began running in middle school and continued to compete in college on the women’s crosscountry and track and field teams at St. Louis University. He said running felt “super gendered” in part because of differences in uniforms; women wore bathing-suit style briefs while men wore longer shorts.
Calamia quit in 2016, halfway through college. Later, he cut his hair and started to have questions about his gender. In July 2019, a few months after he started testosterone therapy, Calamia had “top” surgery, which is a chest masculinization surgery that includes removal of breast tissue. “It was super euphoric because I could run around with just shorts and I felt so like myself,” he said.
In October 2019, Calamia ran the Chicago Marathon in the women’s division because the race did not yet have a nonbinary division. It was the last time he raced in the women’s category. Now he says he will compete only in races with nonbinary divisions.
“I’m not a cisgender man,” Calamia said. “I identify with masculinity, but I’m nonbinary.”
Calamia said he does not know of anyone else in a similar situation as a nonbinary transmasculine runner competing at a high level in the nonbinary category. In the past few years, hundreds of road races around the country have added nonbinary divisions. They were pushed toward inclusion by lifelong runners such as Calamia, who didn’t feel represented when races asked them to register in either a male or female division.
“I recognize I am an activist, but I think it’s important for people to know this activism was born out of desire to be who I am and do what I love,” he said.
Exemptions for athletes who use testosterone
Sloan Teeple, a 52-year-old urologist and amateur cyclist living in Amarillo, Tex., said he was diagnosed with low testosterone at 31. When he applied for a therapeutic use exemption so he could use testosterone treatment and still compete, he was rejected multiple times. He hired an attorney and eventually received a recreational competitor therapeutic use exception.
When the exemption expired, Teeple didn’t reapply.
“I wasn’t racing much anymore, and it was really, honestly so invasive,” Teeple said. “They wanted a test done like every few months, and they could randomly drug test me anytime. I just let it expire and said: ‘Okay, I’m done with this. I proved my point. I got a little win for my patients and for recreational athletes.’ But in hindsight, I wish I’d done more.”
Schuyler Bailar, the first transgender athlete to compete on an NCAA Division I men’s team, was allowed to compete for Harvard University’s swim team from 2015 to 2019 while taking testosterone.
The process required a doctor’s note and regular testing. “The form was something that the doctor had to sign that said, ‘Schuyler is transgender and is taking testosterone for gender dysphoria,’ ” he said.
Calamia has also received support from Nikki Hiltz, a 28-year-old elite nonbinary runner who holds the American mile record in the women’s division in 4 minutes 16.35 seconds.
“I think it’s a big deal. Anytime there’s someone doing it for the first time, there are a lot of hurdles," Hiltz said. "But there is also freedom of being the first and knowing that it’ll be easier for anyone else after them. I think Cal is a trailblazer in a way.”
‘Normal’ levels of testosterone
Testosterone can be a lifesaving therapy for a transgender or nonbinary person, experts say. A Washington Post poll found that nearly a third of trans adults use hormone treatments.
A recent study published in JAMA Network Open found that early access to testosterone reduced gender dysphoria, depression and suicidal thoughts, said Brendan Nolan, the study’s lead author and an endocrinologist at Princess Alexandra Hospital in Brisbane, Australia.
“It is an absolutely crucial part of a transgender person’s health care,” said Shabina Roohi Ahmed, an assistant professor of medicine at Johns Hopkins School of Medicine. Ahmed said the normal range for testosterone in cisgender men can range from 300 up to 1,000 nanograms per deciliter. When Ahmed is treating transgender men, she said the dose will vary depending on how quickly someone wants to transition.
“Some transgender people want to be a little more gradual in their changes,” Ahmed said.
Calamia uses a weekly subcutaneous injection and said his levels now are on the lower end of the “normal” range for cisgender men.
Running as your authentic self
Calamia has over 60,000 followers on Instagram and 41,000 followers on TikTok and works with brands including running apparel company Janji and Zappos and has had modeling gigs with Adidas and Puma.
Last month, despite USADA’s admonishments to stop competing while the TUE was pending, Calamia ran in the nonbinary division of the Philadelphia Distance Run, a half marathon that he completed in a personal best time of 1 hour 20 minutes, placing fourth.
“I realized I’m a runner and I’m trans and I’m not doing anything wrong,” he said. “I’m going to keep doing what I’m doing. Whatever the consequences of that may be, those consequences will ultimately expose a deeper issue that we can then work to fix.”
Aaryn Edge, a 29-year-old nonbinary runner who finished sixth in the nonbinary category of the Philadelphia Distance Run last month, said it doesn’t bother them that a fellow runner may be taking testosterone. Edge does not take testosterone but said everyone who runs should feel their most “comfortable and authentic self.”
“It’s important for folks to feel comfortable in their body, and testosterone therapy and other gender-affirming therapy provides that,” Edge said. “It’s not a factor when I’m lining up against my competitors.”
Last November, Calamia founded a nonbinary run club with regular running meetups in the San Francisco area. One member of the club is Theo Espy, 29, a classical violinist who also uses testosterone for gender-affirming care. He has seen the stress that the uncertainty of the TUE status has caused Calamia. “I’m super relieved that USADA made the decision they did, but I wish there wasn’t this much suspense leading up to the ruling,” Espy said.
Calamia hopes that after the Chicago Marathon, he will have an opportunity to sit down and talk with USADA officials about the TUE process. There’s a lot more left to be discussed, he said.
“Now that this conversation has been opened up and the TUE has been approved, there’s an exponential amount more space for other people to follow my lead in this process and have that opportunity to transition and be themselves and still be able to do their sport,” Calamia said.