No Simple Answers: When Hormones, Cancer and Sport Collide
By Leann Rossi
I’ve learned more about hormones in the past few weeks than I ever expected to in my lifetime. When my biopsy results came back, the explanation was both simple and devastating: my estrogen was feeding the cancer. Suddenly, something I never thought about — a hormone quietly doing its job in the background — became the center of my treatment plan and the reason everything in my life was about to shift.
Part of that plan is hormone suppression. And like any athlete who trains with intention and purpose, my mind immediately went to the same place it always does: How is this going to affect my swimming? I had goals for 2026. I had meets circled on my calendar. I had been building toward something for over a year. Now I’m staring at this new reality and trying to understand what it means for my body, my training, and the future I thought I was stepping into.
Will I be able to train the way I’m used to? Will fatigue take over? Will I need to pivot entirely? These questions don’t come from fear — they come from the discipline of someone who has always planned, prepared, and pushed.
Then came a question I never imagined would be part of a cancer diagnosis: Will the medications I need to survive put me at risk for a doping violation? Tamoxifen — a standard treatment for estrogen‑driven breast cancer — is prohibited in competitive sport unless an athlete secures a Therapeutic Use Exemption. Testosterone therapy, if it ever becomes part of a treatment plan, requires the same. It’s surreal to think that fighting cancer and following the rules of my sport can collide like this, but here I am, navigating both at the same time.
This whole experience has cracked open a world I didn’t know I was living inside of.
I always thought of hormones as something abstract — background chemistry quietly doing its job while I focused on splits, stroke counts, and training cycles. But now I’m seeing how much sport, medicine, and identity is built on assumptions about hormones that we rarely question out loud.
Take prostate cancer. When men are treated for certain types of prostate cancer, their testosterone is often suppressed. Their estrogen levels rise. Their bodies change. They lose muscle mass, gain fat, feel fatigue, experience hot flashes, mood shifts, and changes in libido. In other words, they go through a hormonally induced transition, too — but we don’t talk about it that way. We call it “treatment,” not “transition.” We frame it as survival, not identity.
And yet, physiologically, there are parallels.
If it weren’t for the recent wave of lawsuits and debates over transgender athletes in United States Masters Swimming, I might never have connected these dots: hormones, cancer treatments, performance, and doping regulations are all part of the same ecosystem. The same hormones that are central to gender debates are also central to cancer care. The same medications that save lives can trigger anti‑doping flags. The same bodies we categorize so confidently on paper are, in reality, far more complex.
My mind keeps spinning out questions.
What about women who’ve had complete mastectomies because of breast cancer — how are they seen on the pool deck? As “less female?” As “inspirational survivors?” As something else entirely?
What about women who naturally have higher testosterone levels? They exist. They’ve always existed. How are they perceived when they step onto the blocks? Are they quietly judged as having an “unfair advantage,” even if they’ve never taken a single banned substance? Are they asked to prove their womanhood in ways others never are?
And now I’m in this strange intersection myself: a woman with breast cancer, on hormone‑suppressing treatment, navigating anti‑doping rules, thinking about testosterone and estrogen not as abstract markers of gender, but as levers in my medical chart and variables in my training.
It’s fascinating and absolutely mind‑boggling.
What I keep coming back to is this: we talk about fairness in sport as if it’s simple, as if bodies can be neatly sorted and regulated. But once you start looking at hormones, cancer, surgeries, natural variation, and medical treatments, the picture gets a lot more complicated.
There are men whose testosterone is medically suppressed.
There are women whose breasts have been removed.
There are people whose hormone levels sit outside the “normal” range their whole lives.
All of them are still showing up, still swimming, still trying to belong in lanes that were never designed with this complexity in mind.
Maybe the real question isn’t just who fits the rules, but who the rules were written for in the first place — and who gets left out of the conversation when we pretend bodies are simple.
I don’t have all the answers. I’m still learning, still adjusting, and I’m still figuring out how to train while my hormones are being rewritten by medicine. But I do know this: I’m not alone. There are countless athletes navigating cancer, surgeries, hormone therapies, and bodies that don’t fit neatly into categories.
And maybe if we talked about it more — openly, honestly, without fear — we’d build a sporting world that reflects the real diversity of human bodies, not the simplified version we’ve been taught to believe in.
This is not the season I planned for. But it’s the one I’m in. And I’m trying to hold space for both truths: that I am a person fighting breast cancer, and I am still an athlete with goals, discipline, and a future worth fighting for. My path may change. My training may look different. But I’m still here, still asking the hard questions, still imagining the lane lines and the water and the possibility that I can come back stronger — not because of what I’ve lost, but because of what I’ve learned.
About the Author
Leann Rossi is an elite United States Masters Swimming (USMS) athlete, coach, and advocate for inclusive, evidence‑based conversations at the intersection of sport, health, and identity.
This article crosses a line.
As a breast cancer survivor who underwent a double mastectomy and hysterectomy, I find the comparison between life-saving cancer treatment and gender transition profoundly offensive.
A woman who loses her breasts, ovaries, uterus, or hormonal function because cancer is trying to kill her has not undergone a “transition.” She has endured devastating medical trauma to stay alive. Suggesting there are meaningful parallels beyond basic hormone biology diminishes the reality of what cancer patients and survivors experience.
Cancer does not affirm an identity. Cancer destroys healthy tissue, robs people of fertility, alters their bodies permanently, and forces impossible choices under the threat of death. There is no informed, voluntary choice involved.
The issue of anti-doping exemptions for cancer medications is legitimate and deserves discussion. But using a cancer diagnosis as a vehicle to blur the distinction between involuntary, life-saving treatment and elective gender transition is insensitive and unnecessary.
Cancer survivors deserve better than to have their suffering repurposed to advance someone else’s ideological argument. They deserve to have their experiences recognized for what they are: acts of survival, not examples in a political debate.
There is room for compassion toward every person facing serious medical challenges. There is not room for equating circumstances that are fundamentally different.
This story made me consider that sports are essentially unfair and that’s just part of the reality of competition. Many competitors have physical advantages. It’s rare for a short player to star in basketball, but it happens. It’s rare for a short swimmer to be a top sprinter at the national level.
I was just a smidge under 6 feet and when I qualified for the finals at the Eastern Intercollegiate Championships in 1970, my teammates told me I was the shortest of the six swimmers on the starting blocks. I finished 6th. I didn’t consider myself a victim then. I was happy to do a good time.
Some men are more “blessed” with testosterone than others and the same for some women compared with others. But it’s not all roses. Some of those high testosterone people are more aggressive in a way that is not good for their jobs or their marriages. Younger men who take “T” for athletic performance will probably shut off sperm production and if taken long enough develop testicular atrophy (small testes). You don’t hear about that from the proponents of taking testosterone, do you?
That’s ironic for sure.
In my opinion, it’s great to set ambitious goals in our sport but with the wisdom of age you discover the value of swimming is in the thrill of the journey more than getting to the destination. In other words, only a few get the gold medals, but everybody can gets the benefit of the struggle.
If you are interested in this topic please email me at robert.sinsheimer@gmail.com