> For better or worse nor is our medical science sophisticated enough to swap out the systems to be true comparables

The problem is that it isn't a hard binary. All the relevant metrics are going to fall on a spectrum, and there is a significant overlap between the male and female spectra.

The real question is: do you consider it fair if a top 1% male spectrum transitions to a top 1% female spectrum, or it only fair if that top 1% male spectrum ends up at the 50% percentile on the female spectrum?