Why Women Are Still Playing by Men’s Rules

Sims directly criticizes the absence of cycle-phase differentiation in established protocols. She states that the data exists — women hit in the high-hormone phase experience worse outcomes — but it hasn’t been codified because the research it’s built on didn’t make it into the 'bell curve of normality.' The consequence is that female athletes are subjected to guidelines designed for men, risking premature return to play and prolonged recovery. This protocol is, therefore, a call to clinicians and sports organizations to bridge the gap between what is scientifically known and what is actively practiced. Until the guidelines themselves change, individual practitioners can begin incorporating this layer of assessment into their concussion care.

Sims presents nitrates as the standout example from a broader supplement audit. Most sport supplements, like beta-alanine, have no demonstrated benefit for women because they were never properly studied in female populations. Creatine is finally accumulating female evidence only in the last two to three years. Nitrates, however, have been studied and reveal a stark estrogen-dependent split. She warns that unless athletes and coaches check whether the supplement recommendations they follow are founded on female-specific data, they risk not just neutral effects but outright harm. For premenopausal athletes, beetroot shots — commonly marketed as performance boosters — could actually compromise their session. For postmenopausal athletes, the same shot becomes a reliable ergogenic aid. This example, she argues, should prompt a wholesale re-examination of supplement protocols in female sport.

Sims ties this small linguistic shift to a much larger project of dismantling gendered conditioning in fitness. She describes walking into a generic gym: women are asked how much weight they want to lose and pointed to cardio, while men are asked how much weight they want to gain and directed to the lifting platforms. The language used, she says, creates an immediate gendered funnel that limits perception of what’s possible. Calling a modification a 'girl' version does the same micro-level steering. By switching to mechanical descriptors, institutions can signal that strength and ability are not predetermined by sex. Sims frames this as part of creating a 'safe environment' where women can simply exist as athletes without the overhead of gendered judgement.

Sims acknowledges that many people still feel awkward when topics like menstruation arise. She observes that if a coach stands there visibly uncomfortable, it reinforces the notion that these subjects are shameful or unwelcome. By deliberately opening up one’s stance, the coach shifts the dynamic: the athlete reads the physical cue as permission to continue. This simple, somatic practice is one of the 'things we do in our day-to-day life' that can catalyze a sea change in how female athletes are supported — moving from a culture that treats the menstrual cycle as a fallibility to one where it’s a normal, discussable aspect of health and performance.

Sims’ supplement audit serves as the backbone of this protocol. The fact that creatine only recently acquired a credible female evidence base and beta-alanine has virtually none underscores how normalized it is to treat male research as the default human evidence. She argues that every athlete should internalize a skeptical reflex: Is this product recommendation based on studies that included women? Where was she in her cycle or life stage? If those answers aren’t available, treat it with caution. This applies not just to elite sport but to recreational gym-goers who are routinely offered pre-workouts and stacks designed with male biology in mind.

Stacy Sims relays a sociological study conducted with New Zealand rugby sevens Olympians. To succeed at their sport, they must carry significant muscle and embody a powerful, aggressive on-field presence — traits that fans celebrate during competition. Yet award night arrives, they wear a cocktail dress, and those same fans turn hostile, hurling insults about looking 'like a man'. This instant reversal encapsulates what Sims calls a 'dyotic switch' — the public’s inability to hold two images of the same woman. It illustrates the persistent misconception that a female athlete’s body should oscillate between masculine-performance and hyper-feminine-social modes, and the backlash when it doesn’t. Sims argues this isn’t a niche frustration but a barrier that discourages women from pursuing high-performance sport and maintains a culture where women’s bodies are never fully accepted as they are.

Sims points out that while researchers know the high-hormone phase of the menstrual cycle predisposes women to worse outcomes after concussion, this knowledge hasn't moved into practice. The guidelines remain undifferentiated, leaving clinicians and coaches unaware that a woman concussed during a particular week of her cycle may need a longer, more cautious return-to-sport plan. She suggests this illustrates a broader failure: sports medicine still operates on the 'bell curve of normality' that excludes female physiology. As long as research isn’t specifically designed to capture these differences, guidelines will continue to default to the male prototype, and female athletes will be systematically underserved.

Sims stresses that when she and colleagues audited supplements routinely used in high-performance sport — including nitrates, beta-alanine, and creatine — the efficacy for women was almost completely absent. Beta-alanine, for instance, showed nothing meaningful for female athletes. Creatine has only accumulated a reasonable female evidence base in the last two or three years. Nitrates were the exception that proved the rule: their divergent effects depending on menopausal status demonstrated how badly women’s physiology can alter outcomes. Sims uses this to argue that every supplement recommendation, from gym floors to elite programs, must be scrutinized: Was it tested on women? At what hormonal status? The default of extrapolating from male studies is not benign — it may actively undermine female performance or health.

Sims explains that 20 years ago, if a female athlete stopped menstruating, coaches and peers interpreted it as a signal that she was ‘ready to go,’ sufficiently fit to succeed at the next event. Today we know that amenorrhea signals an energy deficit that can harm bone density, cardiovascular health, and performance itself. Yet the cultural residue remains: a menstrual bleed is still framed as a ‘fallibility,’ something inconvenient that women prefer to ignore, often by taking the oral contraceptive pill to eliminate it entirely. Sims calls this a pernicious holdover that prevents honest conversations about female health and normalizes a profoundly unhealthy state. The implication is that sport must reframe menstruation not as a weakness but as a vital sign of physiological wellbeing.

Sims uses this example as a linguistic lever for broader cultural change. A push-up done by a girl is a push-up; the modification should be described mechanically — on the knees or with a band — not tagged with a gender. This shift, she argues, is part of creating a safe environment where women aren’t already pigeonholed before they start moving. Combined with the observation that commercial gyms still ask women about weight loss and men about weight gain, the micro-aggression of 'girl push-up' illustrates how language quietly channels people into gendered fitness trajectories. She advocates that everyone — coaches, trainers, participants — become conscious of these terms and replace them, because language shapes perception and, ultimately, who feels entitled to be strong.

Sims recounts that early in CrossFit’s rise, the prescription—RX—applied identically to men and women. No scaled-down expectations; equal prize money. This stance, she contends, shattered the old narrative that women weren’t strong enough. It opened the door for Olympic lifting to become popular among women in regular gyms, creating small pockets where gender norms were contested. She doesn’t gloss over the complexities (hence the love-hate), but she presents CrossFit’s structural approach — equal challenge, equal reward — as a tangible model that other sports and fitness businesses can replicate. In her view, it demonstrates that when the rules themselves refuse to differentiate by gender, cultural expectations can shift rapidly.