IMMAF began working on its transgender policy two years ago, with a working group exploring the issues and holding discussions with experts from other sports.

At present the women's category is protected - meaning transwomen cannot compete - but the online event explored the possibility of an "open" category being created and transmen competing in men's categories.

The issue is particularly complex in MMA, which as a combat sport has obvious risks.

Safety and welfare is seen as the organisation's number one priority, and not just involving transgender athletes.

While IMMAF sets rules for its international events - national governing bodies have been asked to determine their own policies.

These will reflect the laws and cultures in particular countries, and again must ensure a safe environment.

In November 2021, an International Olympic Committee framework encouraged sports to develop their own transgender policies and rejected testosterone levels as the basis for eligibility. 

However, this was later rejected by the International Federation of Sports Medicine.

The meeting heard that transmen could potentially take testosterone to compete in male categories, although this would require a therapeutic use exemption from the World Anti-Doping Agency as it is a banned substance.

Another issue is the eligibility of people who transition before puberty.  

"It's a serious challenge, it's a relatively under-researched field," said Andrew Moshanov, IMMAF's director of development, on the range of issues.

"We need to continue to look closely at this subject, follow up and examine the examples of best practice.

"When it comes to competition I can foresee it would be a struggle for us to go further.

"We have member federations from various cultures and they will be very strict for example with mixing up females and males in the training sessions.

"We are a multicultural organisation, we want the sport to be fully inclusive. 

"We want our sport to be seen as modern and fully compliant with the Olympic Charter, where's there no room for homophobia or transphobia. 

"It's all about being inclusive but we may come across serious resistance from some national federations, largely due to different cultures."

Fallon Fox, a transwoman, has competed against female fighters in the United States, ending with a 5-1 record in 2014.

She lost a bout to Ashlee Evans-Smith but also reportedly fractured another woman's skull.

"This is not exclusive or new to MMA, this happens a lot," said Marc Goddard, IMMAF's director of regulatory affairs, on this incident. 

"But because it was a transwoman competing against a born female it hit all the headlines.

"If you go to any gym session, mixed gender sparring happens all the time, but that's a controlled setting.

"I don't think it's a realistic view to say that is what could potentially transpire in a match, professional, amateur or otherwise."

Goddard said canvassing of IMMAF officials had overwhelmingly revealed that referees would not want to officiate a transwoman's fight in a female category.

"We're a combat sport, the sole objective of our sport, under the confines of the rules, is to render our opponent unable to continue," he said.

"It's not a team sport, it's not running round a track or on a cycle, the consequences that we face as a combat sport and the added pressure that brings on the responsibility of all involved, that's an insurmountable hurdle that will take a lot of deliberation."

Dutch fighter Germaine de Randamie, who fights in the Ultimate Fighting Championship, is a biological woman who competed against a male in an unsanctioned kickboxing bout and won.

"If you had a female compete with a male, and they won, it would almost be celebrated," said Goddard.

"If you had a female compete with a male and lost, that's when the frowning would start, that's when the questions would start."

Randa Bascharon, a member of IMMAF's Medical Commission, said that an open category would still cause issues.

"We still have to ensure a fair playing field, and a safe playing field, even in an open category," she said.

"It's not just throw in anyone that doesn't want to be identified as someone else - that doesn't solve our problem.

"You're not going to have a transgender male who is a heavyweight competing against a transgender male who is a lightweight."