The Truth About Trans Athletes

By Jane Latus

Do trans women have an unfair advantage in sports?

If evidence is behind the bans against their participation on women’s teams, then the answer must be yes, right? After all, twenty-three states, as of press time, have enacted laws barring trans girls from competing as girls. In some other states, individual school districts and athletic conferences have adopted bans. Even a U.S. House of Representatives majority declared this year that “sex shall be recognized based solely on a person’s reproductive biology and genetics at birth.” So, it must be scientific.

Not so fast. The problem is … Well, according to medical professionals, there are several:

• There is essentially no scientific evidence supporting these bans: research is insufficient, inconclusive, or irrelevant to the athletes in question.
• A few top-name extremist groups are behind these bans and many of the lawsuits filed in the name of cisgender girls claiming ostensibly to be put at a disadvantage.
• Biological sex is so complex that there is no standard definition for the terms “biological male” and “biological female”.
• If fairness is the goal, there are bigger, proven problems to tackle, such as income and racial inequalities that hamper access to equipment and training, and general deprioritization of girls’ sports. These result in fewer opportunities and lower budgets.
• A certain result of these bans is that trans youths are unable to play sports: 300,100 of them ages 13-17 alone, the Human Rights Campaign estimates. That doesn’t include kids in states with local bans.

Given the above, LGBTQ+ advocates conclude the goal of these bans is exclusion, not fairness. Furthermore, they call them demeaning to all girls, inferring girls are fragile and need protection. Worse, some states (including Florida and Idaho) adopted laws allowing anyone to challenge a player’s gender, requiring a subsequent genital inspection. All girls, especially those who perform highly or look “masculine”, are vulnerable to having their identity challenged and privacy invaded.

The American Civil Liberties Union (ACLU) has called these laws “ripe for abuse.” Satire site The Onion, however, “quoted” Rep. Jim Jordan (R-OH) as saying “It’s great training for the sexual violations they’ll endure at the college level.”

Bluntly put, advocates say all girls are being exploited as part of a long-reaching, national legal strategy.

Gillian Branstetter, ACLU communications strategist, tells Connecticut Voice, “The motivation is quite clearly to limit the reach of court precedents recognizing anti-transgender discrimination as sex discrimination, including the 2020 ruling from the Supreme Court in Bostock. Because athletics already relies on broadly held assumptions about sex and gender, groups like Alliance Defending Freedom and the American Principles Project identified it as their chosen arena for promoting transgender exclusion more broadly.”

The Alliance Defending Freedom (ADF), designated a hate group by the Southern Poverty Law Center (SPLC), was also behind the lawsuit that challenged Connecticut’s inclusive interscholastic sports policies. [See “A Question of Fairness,” Fall 2019 Voice] Others include The Heritage Foundation, Family Policy Alliance, Family Research Council and the American College of Pediatricians (intentionally named to cause confusion with the real professional organization the American Academy of Pediatrics.)

These groups’ goal is to encode conservative Christian beliefs on gender and sexuality into American law, says R.G. Cravens, PhD, a research analyst for SPLC’s Intelligence Project, which works to identify and counter hate and extremist groups. ADF is on record as saying, back in 2017, that it plans to use trans people as a wedge to roll back LGBTQ+ rights, Cravens says.

“ADF has written model legislation banning trans athletes from competitive school sports,” says Cravens. Legislators have acknowledged coordinating their bills with ADF. Cravens says ADF is also the chief group responsible for suing school boards.

The lawsuits and laws are designed to appear initiated by individuals, particularly cisgender girls. “I wouldn’t imagine most folks realize there’s a concerted campaign to challenge LGBTQ+ rights at different levels,” says Cravens.

Several legislators, when testifying for bans, have come right out and said it: they want to “eradicate” (their word) transgender people (or, as they put it, “transgenderism”). The foundation of bills like Idaho’s “Fairness in Women’s Sports Act” is the proponents’ belief that trans women are not really women.

But what about that powerful hormone testosterone? How can it be possible that it doesn’t confer inherent advantages to people born male? Doctors, including the American Medical Association, say there is no evidence that testosterone leads to higher athletic performance. Just like trying to pin down what gender itself is, it’s complicated. We’ll get into it.

The level of competition is another issue. Experts tell Connecticut Voice that all students should be welcome to participate in sports as the person they are. At the elite level, they agree that after a year or two, trans and cis women’s bodies are as equal as any two bodies can get. But they say more data is needed and disagree on whether there should be any restrictions at the elite level until more is known.

Still to be answered: does it only become “fair” for a trans woman to compete after she has suppressed testosterone? And for what length of time? Is it only “fair” if she didn’t go through male puberty, as some international organizations require? If she’s intersex and has a naturally high testosterone level, must she suppress it to an “acceptable” level? And where does that leave nonbinary athletes? Again, it’s complicated, and we’ll get into it.

Even if research ever does demonstrate an advantage for those who go through male puberty, experts say it’s important to ask: does it matter?

“The most valuable studies show what sports give to people when they play them,” says Kathryn Tierny, APRN, medical director of the Transgender Medicine Program at Middlesex Health. “Sports are inherently unfair,” she adds. “The answer is, all kids should be allowed to compete in sports. These are human beings who live in our community.”

Ironically, or by design, policies that elite sports governing bodies have adopted are increasingly impossible to meet. The states banning trans athletes have also criminalized gender affirming medical care for youths, and in some states also for adults.

“It’s not a reasonable thing to put on kids to expect them to avoid a male puberty. It isn’t possible in many states,” says Tierney.

WHAT WE KNOW 

• Kids, not adults, are primarily impacted by restrictions on trans participation. Trans women are statistically underrepresented in elite competitions, but as ESPN’s Bruce Kelley and Carl Carchia wrote, “Youth sports is so big that no one knows quite how big it is.”
• There is no test or exam to determine gender (see sidebar, “What is Gender?”).
• For many trans women, the question of testosterone-endowed advantages is moot because they took puberty blockers, so didn’t go through male puberty.
• Not all trans people want, or are able (financially, medically, or legally) to opt for, all available types of gender affirming care.
• “People assume that men transition hormonally to female to gain a competitive advantage in sports. This is literally not true. No one does this,” says Tierney. Eric Vilain, MD, pediatrician and geneticist from UCI Health Affairs in Irvine, CA, tells Connecticut Voice, “This is fearmongering, not based on reality.”
• There are isolated bans, but no movement to prevent trans boys from playing on boys’ teams.
• The Trevor Project reports that LGBTQ+ kids are half as likely to play sports as straight kids, citing fear of bullying and harassment. Psychologist Derek Fenwick, assistant director of the Center for Gender Health at Hartford HealthCare, says discriminatory policies cause higher rates of depression and school absenteeism in LGBTQ+ youths. “Exclusion perpetuates the stigma and discrimination that one’s identity is invalid, and it outright legitimizes the claim around rejection of gender identity,” he says.
• Backing the charge that trans sports restrictions are rooted in chauvinism and transphobia rather than science, this past summer the chief international chess organization announced that trans women can’t compete as women, but can keep any titles they won before transitioning. Trans men, however, must relinquish titles they won playing in women’s categories. (Stacy, maybe a pullquote, though it’s long. CB)
• Outsports reported that 44 states use pre-participation forms asking about menstrual periods, purportedly because non-menstruating girls are at increased risk of stress fractures. Lisa Rapalyea, Ph.D. of UC-Davis refuted this, telling Outsports, “The only form any high school athletic association needs is clearance by a physician. They don’t need all this medical history.”
• This summer the Human Rights Campaign declared a “National State of Emergency” for LGBTQ+ Americans because of the record number of legislative anti-LGBTQ+ attacks: 567 bills in 49 states (the exception: Delaware) at press time, according to Trans Legislation Tracker.

ONE-SIZE-POLICY DOESN’T FIT ALL (ESPECIALLY KIDS)

Women can be over 6 feet tall; men can be tiny. LA Clipper Kawhi Leonards’s hands are 11.5 inches wide. Michael Phelps has a wingspan unlike any other Olympian. Those born with predominantly fast-twitch muscles are faster sprinters; those with more slow-twitch ones are gifted at endurance.

We all know bodies differ dramatically, yet we somehow still stereotype men–and boys–as larger and stronger, and females as smaller and weaker. Not all of them, we say, but most.

Doctors tell Connecticut Voice it’s especially problematic to apply these assumptions to youths, whose sizes and rates of development are nowhere near consistent or constant. The American Medical Association’s position on trans youth in sports is to let them play.

“Playing on sports teams helps youth develop self-esteem, correlates positively with overall mental health, and appears to have a protective effect against suicide. These bills not only ignore these recommendations, they undermine them. Forcing transgender children to play on teams according to their sex assigned at birth, rather than the gender they live in, also puts their physical and mental health at risk,” reads the AMA policy.

WHAT THE SCIENCE SAYS

Higher levels of testosterone are associated with increased muscle mass, red blood cell count and oxygen delivery, bone size, and speed. Trans women who went through male puberty and who suppress testosterone lose those attributes (except for bone size, which does not revert). They presumably also lose athletic advantages. What little data exists doesn’t suggest otherwise, experts say. They agree more data is needed, including on how long it takes for testosterone’s results to dwindle and disappear.

Pull quote?

Doctors and gender researchers say there is no evidence that trans women have an athletic advantage over cisgender women. They even speculate (although again, they say more research is needed) that in some cases trans women may be at a disadvantage. 

The most common inaccuracy about trans athletes, says Dr. Vilain of UCI Health Affairs, is the assumption “that trans women have a biology that is identical to cis men.”

Joshua Safer, MD, is executive director of the Mount Sinai Center for Transgender Medicine and Surgery. He testified in 2020 on behalf of Lindsay Hecox, who was banned by Idaho law from running on the Boise State University women’s track team.

“That those who suppressed testosterone still have an absolute advantage is an assertion based on speculation and not born out by evidence,” said Safer, cautioning that the assumption must particularly not be applied to youths, whose levels of testosterone vary widely.

“Dr. Safer tells Connecticut Voice that in the two years since his testimony, “The data have not changed much. It still seems that after a couple of years on typical feminizing hormone therapy, trans women are pretty similar to cis women in middle distance running (1.5 mile run along with 5K and 10K runs), push-ups, and sit-ups.”

“The main caution when regulating the participation of trans women with other women in sport is to avoid using fear instead of data,” he adds. “For example, it’s true that trans women who have gone through a typical puberty before beginning gender affirming hormone treatment are bigger than cis women. However, it’s possible that a trans woman who has larger bones but who has slightly smaller muscles may be at a disadvantage athletically. Also, trans women who have not gone through a typical male puberty would not be predicted to be any different athletically relative to cis women.”

As for elite athletes, Dr. Vilain tells Connecticut Voice that success depends on many unequal factors (including body type, and access to the best nutrition and coaches). “So, the real question is whether trans women have an athletic advantage that is disproportionate to all other competitive advantages. And the answer to this question is: we don’t know. There is very little data about trans women athletes in real life competition. Bans to exclude these athletes result in preventing the collection of data that would actually help answer the question.”

“Exclusion of trans youth is even less sensible, physiologically, than excluding trans adults,” adds Dr. Vilain.

There is one study that trans-exclusion advocates point to as in their favor, and its author wishes they wouldn’t. The British Journal of Sports Medicine in 2020 published a study by Christina Roberts, MD, testing trans members of the U.S. Air Force at sit-ups, push-ups, and timed runs. Roberts found that after two years, trans and cis women were equal at sit-ups and push-ups, but trans women still ran 12 percent faster.

Roberts criticized legislators who cited the study when arguing for bans, saying “I feel my data is being misrepresented. They’re cherry-picking the one number that agrees with their pre-existing notions,” she said.

Right-wing Breitbart’s headline about the study was all caps and all wrong: “MALE ATHLETES TRANSITIONING TO FEMALE RETAIN MASSIVE STRENGTH ADVANTAGE DESPITE HORMONE THERAPY.”

Roberts’s study contradicted a previous one, by medical physicist Joanna Harper, that found that after testosterone suppression, trans women ran 10 percent slower than cisgender women.

Last year, the AMA came out against requirements to suppress testosterone levels in intersex and transgender athletes, even in elite competitions, saying there is no evidence of performance advantages.

Also last year, the Canadian Center for Ethics in Sport conducted a review of scientific literature on trans women in elite competitions. Its conclusions: there is no evidence that trans women have an advantage from testosterone after a year of suppression. Physical factors from male puberty like bone density and lung size “do not predict athletic performance.” More data is needed, and sports policies overvalue biomedical factors in comparison to social factors.

Still, legislators keep proposing bans. In Connecticut this year, State Representative Doug Dubitsky (R-47) introduced “An Act Prohibiting Student Athletes Who Were Born As Males From Participating In Women’s Interscholastic Athletic Events.” State Senator Robert Sampson (R-16) proposed civil immunity for youth sport governing agencies that require participants to play on the team of the gender cited on their birth certificate. Neither bill progressed.

Dubitsky’s bill states that its purpose is “to eliminate unfair competition in women’s interscholastic sporting competition.” Dubitsky did not reply to multiple requests from Connecticut Voice, and Sampson’s prepared response did not address the issue. Neither was able to provide any of the evidence they relied on to draft their bills.

The Women’s Sports Foundation, the advocacy group founded by Billie Jean King, in 2021 issued a list of “well known, documented” challenges to girls’ sports, like abuse of athletes, unequal pay, and incompliance with Title IX, concluding, “These are some of the real challenges to opportunities for girls and women, not the inclusion of transgender girls and women.”

What Is Gender?

The science is clear: it isn’t what’s between your legs, or even what organs are inside you. For starters, 1.7% of people are born intersex, a term that encompasses multiple conditions outside of the typical binary. [See interview with Liat Feller, this issue.] So, what is it? The best definition we’ve seen is this one that went viral online, from biologist Rebecca Helm, PhD, of Georgetown University.

I see a lot of people are talking about biological sexes and gender right now. Lots of folks make biological sex seem really simple. Well, since it’s so simple, let’s find the biological roots, shall we? Let’s talk about sex… If you know a bit about biology you will probably say that biological sex is caused by chromosomes, XX and you’re female, XY and you’re male. This is “chromosomal sex” but is it “biological sex”? Well…

Turns out there is only ONE GENE on the Y chromosome that really matters to sex. It’s called the SRY gene. During human embryonic development the SRY protein turns on male-associated genes. Having an SRY gene makes you “genetically male”. But is this “biological sex”? Sometimes that SRY gene pops off the Y chromosome and over to an X chromosome. Surprise! So now you’ve got an X with an SRY and a Y without an SRY. What does this mean?

A Y with no SRY means physically you’re female, chromosomally you’re male (XY) and genetically you’re female (no SRY). An X with an SRY means you’re physically male, chromosomally female (XX) and genetically male (SRY). But biological sex is simple! There must be another answer… Sex-related genes ultimately turn on hormones in specifics areas on the body, and reception of those hormones by cells throughout the body. Is this the root of “biological sex”?

What does this all mean? It means you may be genetically male or female, chromosomally male or female, hormonally male/female/nonbinary, with cells that may or may not hear the male/female/nonbinary call, and all this leading to a body that can be male/nonbinary/female. Biological sex is complicated. Before you discriminate against someone on the basis of “biological sex” and identity, ask yourself: have you seen YOUR chromosomes? Do you know the genes of the people you love? The hormones of the people you work with? The state of their cells? Of course you could try appealing to the numbers. “Most people are either male or female,” you say. Except that as a biologist professor I will tell you…

The reason I don’t have my students look at their own chromosomes in class is because people could learn that their chromosomal sex doesn’t match their physical sex, and learning that in the middle of a 10-point assignment is JUST NOT THE TIME.