How Fallon Fox became the first known transgender athlete in MMA

Fallon Fox revealed that she had transgender surgery, making her the first such athlete in MMA history.

/Photo courtesy of Championship Fighting Alliance

There wasn't going to be an easy way for Fallon Fox to do this. She knew it. Her family knew it. Her manager knew it. The biggest battle would come outside the cage.

A fighter, born male and now anatomically a female, wanting to climb into a cage to punch, kick and choke out other women? It would raise a lot of questions. It would bring on a flood of criticism. But to keep Fallon's dream of fighting professionally alive, the price would be her anonymity.

On Tuesday, amidst whispers from snooping journalists and licensing issues looming with two athletic commissions, Fallon bravely stepped forward as the first on-record transgender female athlete to compete in MMA.

Fallon already had three amateur and two professional victories on her record, but her admission quickly shined a light on how an athlete with a unique medical history such as Fallon's should be handled moving forward.

It might be an unfamiliar concept for MMA fans, but transgender athletes are nothing new to professional sports. Such athletes have flourished for decades in boxing, motor racing, track and field, tennis, skiing and muay Thai, to name a few. MMA now joins that growing list.

SI FLASHBACK: THE TRANSGENDER ATHLETE

It wasn't a decision the 37-year-old Fallon took lightly. She'd discussed it with family, friends and mentors for over a year. It was an idea that filled her with fear and anxiety, but in the end it was a necessity.

"This wasn't something that I wanted to come out," said Fallon. "I consider it my personal business, part of my medical history. It's not something I like to discuss with people, but I've been bracing for this for years, thinking when was the phone call going to come?"

In a perfect world, Fallon would not have been obligated to reveal her transsexuality beyond the state athletic commissions that license her. In 2012 the Association of Boxing Commissions drafted a transgender policy for the sport. It just hasn't been needed until now.

What happens to Fallon next will set the groundwork for others to follow, a small consolation as she wades through the misconceptions and misnomers and rises to tackle the discriminatory reactions she'll get in the coming weeks. That's the problem with being first. Trailblazers are usually not revered until that treacherous road snakes long behind them.

When the dust settles, Fallon hopes fans will see that MMA is as much a part of her as it is for Anderson Silva, Georges St.-Pierre or Ronda Rousey. It's as much a part of her identity as her transsexuality is. Fallon has struggled for years to find her identity and she doesn't want to let it go. Should she really have to?

Fallon's Story

If one can get past the preconceived notions that the word transgender conjures up for so many, Fallon's story becomes not that different from any other professional fighter's journey. Like many of her MMA peers, she's already dedicated years to perfecting her craft in multiple combative sports disciplines. By 2008, she was dreaming about wrestling and Brazilian jiu-jitsu moves. She'd eventually graduate to purple belt status, competing and placing in regional and national grappling tournaments. In 2010, Fallon added muay Thai and other striking arts to her arsenal. She made her amateur debut in June 2011. She went pro less than a year after that.

Like many of her fighting peers, Fallon was not without her own set of challenges growing up the middle child of a conservatively Christian, ethnically-mixed family in Toledo, Ohio. The ability to overcome great obstacles is one of the key characteristics that all fighters share. It's what gives them their backbone and the courage to pursue a dream that offers no guarantees. Fallon Fox has courage to spare.

It's difficult for Fallon to verbalize what it feels like to be born one gender and know in your heart that you were truly meant to be the other.

"It's hard because the phrase 'woman trapped in a man's body' is thrown around a lot, but that's like shorthand," she says. "It's deeper than that. There's so much more to it."

From as early as age five or six, Fallon recognized that there were these feelings churning inside of her.

"At that age, I didn't understand the subconscious force that was pushing me toward wanting my body to be female," she said. "I didn't know what that meant, so I was always confused and I felt that every other person that was born male was like me and had these same feelings, but knew it was something they weren't supposed to talk about."

As a child, Fallon would steal her mother's and sister's clothes to play dress-up when no one was looking. It felt right, though she didn't yet know why.

When she reached adolescence, these feelings grew more intense. At first, Fallon suspected she might be gay. Transgender didn't enter her vocabulary until age 17, when she watched an episode of Donahue featuring a transsexual woman.

"She talked about her feelings and there was this big exclamation point," recalls Fallon. "That's when I really started to realize that this was a big possibility of what I was."

Still, Fallon had to keep her suspicions to herself. To everyone else, she was a heterosexual man, and was expected to act accordingly. (Years later, when she finally came out to her family, their response would be to send her to a gay conversion therapist. )

"I did experiment, trying to figure out what I did and didn't like," said Fallon. "Around 19, I got a girl pregnant. I really didn't want to get married, but I was raised with the belief to marry that person and take care of our child."

To support her family, Fallon entered the Navy and served as a operations specialist 2nd class for the U.S.S. Enterprise. But after the military and during a brief stint that followed at the University of Toledo, Fallon said everything came crashing down.

"The feelings of gender got so bad that I had to figure out what I was going to do," said Fallon. "My hair was falling out, which wasn't good for my psyche, and I knew I couldn't wait because the longer you spend not transitioning the more the effects of aging make the transition not so pleasant."

Fallon sat her four-year-old daughter down and explained that she was going to make her transition.

"She took it well. I think when kids are younger, they don't have these preconceived notions of what a transsexual person is," she said. "I told her that I felt I should have been born a woman and that it was really, really important to me. I told her the doctor was going to help me become a woman. I told her that and she said, 'Oh cool. Can we do something else now?'"

To raise enough money for gender reassignment surgery, Fallon quit college and became a trucker for the next four years, making her way from coast to coast, and back again. When she visited home, she spent time with her daughter and went to therapy sessions.

Fallon eventually moved to Chicago to make a fresh start away from what she describes as her less-than-supportive parents. In 2006, she made the 8,000-mile, 17-hour trip to Thailand alone. She underwent gender reassignment, breast augmentation and hair transplant surgeries at the Bangkok National Hospital. Six weeks later, when she had recuperated enough to travel, she flew back home as the woman she always knew she was meant to be.

After her first MMA fight in 2011, Fallon had facial feminization surgery, which de-emphasized her brow bones and jaw line, and fixed her receding hairline.

Though athletic and fit-conscious, Fallon hadn't played sports as a kid. She stumbled upon MMA when she walked into a gym looking for a way to shed some unwanted pounds. Like many of her peers, MMA was the final missing piece.

Today, Fallon's 16-year-old daughter lives with her, having witnessed her entire transition from struggling man to confident woman. Now she gets to watch her trailblaze the very first road paved by a professional transgender fighter.

The Science

The biggest question raised from Fallon competing in women's MMA is what advantages her remaining birth-given gender characteristics give her against her opponents. Even if an individual who started as a man underwent successful gender reassignment surgery, wouldn't some aspects of her original physiology remain? Wouldn't she still have stronger upper-body strength? Would she still be inherently faster or retain the ability to cut weight easier?

Helen J. Carroll, the Director of the National Center for Lesbian Rights' Sports Project and an advocate for transgender athletes, said the "competitive equity" among transwomen and the rest of the field is always a glaring, and often misunderstood, topic.

"[The common thinking is] it's impossible for a transgender woman, who was born a man, to play women's sports and [have] it be fair," said Carroll, a former athlete, national championship basketball coach, and collegiate athletic director with over 40 years of sports-related experience. "The short answer is the transgender woman is a woman, and when she transitions, she takes testosterone-blocking hormones, so when she does end up competing, she has less testosterone in her system than her competitors do."

Because of this, Carroll said a transgender female athlete has to work harder to keep muscle mass and strength than a female-born woman athlete. That lack of testosterone would also affect speed and weight retention, added Carroll.

"You remember that she's carrying a lot of estrogen at this point, which will make it difficult to cut weight," said Carroll.

In Fallon's case, she was required to take copious amounts of estrogen and testosterone blockers in preparation for transition surgery in 2006.

"Even before I had my surgery, my muscle mass was way lower than your average male," said Fallon. "The testosterone levels of a normal male can be anywhere from 300-1,000 nanograms. For the average female, it's 10-70. Mine is around 7."

Today, Fallon continues to take oral estrogen (which has never been considered a performance-enhancer). If she were to stop, her body would enter a post-menopausal state, but her testosterone levels would remain the same.

Conclusive supporting data on the subject of competitive equity has only increased as the transgender community grows among all ages. Carroll has worked with 26 transgender female athletes, including Fallon, ranging from middle school to the professional level, in both the public and private arenas since 2005. And Carroll said that number continues to rise, aided by sports regulatory bodies like the International Olympic Committee (IOC) and the NCAA, who added transgender policy to their guidelines in recent years.

Transgender policy has also been adopted by the World Tennis Association, LGPA/PGA and U.S. Track and Field. Additional professional sports leagues are currently examining policy that will soon be needed.

OutSports.com co-founder Cyd Zeigler, who has covered transgender issues in sports for a decade, said it's nearly impossible to pinpoint how many transgender athletes are competing across the U.S.'s wide spectrum of sports, "given the barriers in sports that are put up for transgender participation," but they are there.

Zeigler has written extensively about numerous transgender athletes, including George Washington University's Kye Alumms, who came out as the first openly transgender NCAA basketball player, in 2010. Zeigler has his hand on the pulse of the trans community and is familiar with Fallon's story.

"That fact that Fallon has gone to the extent that she has gone through, she's eliminated, medically, any benefit to being born male that she had. With the blockers they give male and female transfolks, the muscle atrophies very fast," said Zeigler. "Fallon would be able to compete in the Olympic Games at this point. The IOC would deem her eligible to compete as a woman."

The Politics and the Future

When Fallon came out Tuesday as a transgender female fighter, it was prefaced by the fact that she'd already fought two times as a professional without the overseeing athletic commissions or her opponents knowing she was a transwoman.

Part of the confusion between athlete and commission came from an honest mistake. Fallon and her management had mistaken an application receipt mailed to her by the California State Athletic Commission (CSAC) and used it to get licensed in Florida. Fallon fought last weekend for the Championship Fighting Alliance in Coral Gables, knocking her opponent out with a knee in 39 seconds.

Fallon's was an honest mistake. CSAC Executive Officer Andy Foster has reviewed his commission's receipt and said the form itself needed to, and would be, changed, as it could be misconstrued as something more than what it is. It's unclear if the Florida Boxing Commission requested this document of Fallon when she listed herself as having a combatant's license, but with or without it, the Florida commission could have called the CSAC to verify this and did not.

The DBPR has verified that Fox didn't need the California license to obtain a license in their jurisdiction. A DBPR representative said that applicants are required to attest to the truthfulness of all the information provided on the application.

There is also the fact that Fallon chose not to inform the Florida commission of her transgender history, though it should be noted that there was no area on her two-page form that asked her to list surgeries, procedures or other medical information of that ilk. It's also unclear what other forms Fallon might have been asked for, if any. From Fallon's point of view, she was completing what was asked of her and didn't want to be treated differently than any other fighter applying for a license in Florida. If she'd revealed her status, there was a chance she could have been asked to sit out the March 2 fight to give the commission more time to review her application. After months of grueling training and sacrifice, Fallon simply wanted to fight. She wanted to seize the opportunity she felt she'd earned.

Since Tuesday, the Dept. of Business and Professional Regulation, which oversees Florida's athletic commission, has rightfully placed Fallon's license on hold, not only to request more medical information of her for review, but also to evaluate their own practices and how they can handle a transgender fighter's application both speedily and fairly with both athletes' health and safety in mind. Asking Fallon to provide additional medical documentation is not only Florida's right, and something it would ask of any athlete with an extraordinary medical history, but also its responsibility.

There was no clear-cut system in place this time -- something the DBPR readily admitted it was looking into. That doesn't mean there won't be one in the near future.

In July 2012, the Association of Boxing Commissions (ABC) took a very proactive step in combat sports at its annual convention when its Medical Advisory Board presented policy for transgender athletes.

The policy was co-authored by Sherri Wulkan, the ABC's medical advisory chairwoman and a seven-year veteran ringside physician in New Jersey, and Eric Vilian, an Associate Professor in the Departments of Human Genetics, Pediatrics and Urology at UCLA and one of the foremost experts in the field of sexual development genetics. (Vilian also helped author the transgender guidelines implemented by the IOC and the NCAA.) The proposed ABC guidelines were then reviewed and accepted by the medical board's 42 members before being presented to the 83 North American state and tribal regulatory bodies that make up the ABC.

The guidelines set clear definitions as to what constitutes a transsexual athlete (a transgender having undergone the surgeries necessary for anatomical change), as well as minimum requirements for the hormone therapy appropriate to their assigned sex to maintain competitive equity among the athlete pool.

For instance, a female transgender athlete like Fallon would be required to produce medical documentation of the relevant surgeries and procedures she underwent during transition (it should be noted that it is not a requirement for the athlete to undergo complete gender reassignment surgery), as well as detailed paperwork from a board certified endocrinologist or internist showing that she underwent hormone therapy for a minimum of two years following a gonadectomy and the levels have been within acceptable range for a female.

"Based on the research of Valian and others, we know it takes approximately two years to negate the emotional behavior and muscle mass difference that would be based on the natural testosterone of a male," said Wulkan. She added that transgender athletes would also not be exempt from performance-enhancing testing, meaning levels must be kept within acceptable ranges to ensure there is no unfair advantage being obtained.

A transgender athlete's medical privacy is also a continuing concern, though this falls more into the legal realm. Most specifically, is a commission required to notify a transgender athlete's opponent of their medical history prior to a bout? The answer is no.

"Discussions involving the medical history of the opponent would not typically take place, and would not be legally required to take place," said Nick Lembo, Legal Committee Chair for the ABC.

With transgender policy in place, implemented thoroughly and correctly, it is the athletic commission's responsibility to ensure a level playing field without having to impede on an athlete's privacy.

On Tuesday, as Fallon's circumstances came to light, sources confirmed that regulators in Florida and California reached out to ABC officials to revisit this proposed policy. It's also fair to conclude that other commissions will quickly follow suit and move to adopt this policy in their jurisdictions.

In Fallon's case, granted she can provide the required documentation these guidelines request, it means she'll likely be able to resume her professional career that much quicker.

That brings Fallon and other transgender fighters who follow her to their next challenge. Now that Fallon has come out as transwoman, will her opportunities with other promotions dry up? Will other female fighters decline to fight her for fear she has an advantage, no matter what evidence a commission presents to the contrary?

"I have that concern, but I'm confident in the industry, that they won't hold it against her," said Fallon's manager, Brett Atchley, the founder of Addison Sports. "This shouldn't take away from the decisions she's made for herself. She has to live in her own skin and I support her 100 percent."

At least one promoter has already taken a stand. CFA co-founder Jorge De La Noval, who promoted Fallon's fight on March 2 in Florida, has opted to postpone the April 20 event that Fallon would have fought on next to give her the time to resolve licensing issues with the commission. Fallon's last victory had advanced her into the semifinals of the CFA's eight-women featherweight tournament, and De La Noval said he refuses to deny Fallon the opportunity to compete for the $20,000 grand prize.

"We're not going to turn our backs on her," said De La Noval. "Fallon's not only a woman, she's a sweet woman. She also a great fighter and has the potential to win this tournament. As long as she's licensed, she's always welcome in our promotion. We stand behind her and we give her all of our support."

If more promoters are willing to be as open-minded as De La Noval, Fallon stands a chance. Other female fighters will also play a big role in Fallon's future. How they react to Fallon -- whether it be to accept her as a worthy competitor or shy away for whatever reason -- will be one of the deciding factors in her ultimate success. It wasn't that long ago that women's MMA as a whole was asking for its chance. Now Fallon is asking for hers.

"I'd really like to fight for Invicta [the all-women's fight league], maybe in the UFC if they would take me." said Fallon. "I want to go as far as I can go, just like the other female fighters. I just want the same opportunities."