Transgender student athletes: What parents should know

a group of cis and transgender athletes running
From elementary schools to the Olympics, questions abound about trans athletes, fairness, and equality. (Adobe Stock)

Last summer, three Connecticut girls who have run high school track filed a federal discrimination complaint stating that the state’s policy on transgender athletes has affected their ability to win races and potentially qualify for college scholarships. They claim that transfeminine athletes have an unfair advantage when competing against cisgender girls.

The lawsuit is characteristic of the current misinformation and confusion surrounding this controversial topic. From elementary schools to the Olympics, questions abound about trans athletes, fairness, and equality. And the uncertainty is leading many trans and non-binary kids to forgo sports altogether, says Dr. Jeremi Carswell, director of Boston Children’s Gender Multispecialty Service (GeMS). Here, she and GeMS psychologist Col Williams offer more insight into the issue.

1. Rules for elite athletes don’t apply.

You may have heard about a recent ruling by the International Olympic Committee, which requires female athletes to have testosterone levels below a specific level. This ruling is controversial, and was developed to address athletes with differences of sexual differentiation, who may have naturally high levels of testosterone. But the rules for elite athletes don’t — and shouldn’t — apply to kids and teens, says Dr. Carswell.

“Before a child transitions medically, it’s generally fine to have them play on the team that aligns with their affirmed gender,” she explains. That’s because boys and girls generally have the same muscle mass before puberty.

The available research supports that higher levels of testosterone is correlated with greater strength and stamina, although studies are primarily in adult men. There is almost no data about transgender athletes. “We just can’t say whether young trans athletes have an advantage,” says Dr. Carswell. In fact, they might even be at a disadvantage: Some transmasculine athletes who use testosterone may still have lower levels of this hormone than cis males. And some transfeminine athletes who have suppressed their testosterone levels through gender-affirming medical intervention may have less testosterone than cisgender women, who naturally have some of this hormone. It’s also important to keep in mind that different body types are better suited to different sports: Being shorter is an advantage in power lifting, for example, while being tall can confer an advantage in rowing.

“We assume that kids who are on puberty blockers alone — which reversibly pause pubertal development — will continue to have bodies that are more similar to their pre-pubertal counterparts,” says Dr. Carswell. From an athletic performance perspective, this is something that could be a disadvantage to gender diverse kids when they are compared to their pubertal, more developed cisgender peers.

On the other hand, pubertal suppression may assist gender-diverse kids in exercise and sports because it allows them to continue to feel comfortable and connected to their bodies and physical selves, notes Williams. That said, more research is needed to understand how pubertal suppression might affect athletic performance.

2. It’s not just about hormones.

Medical transition aside, young trans or non-binary athletes may feel hesitant to play sports for other reasons, too. For instance, non-binary or transmasculine kids and teens may not feel comfortable wearing athletic uniforms that don’t align with their gender, such as skirts for field hockey. Athletic uniforms — such as bathing suits for swimmers — can often be revealing, contributing to gender dysphoria. Student athletes and their parents should talk with their coach about finding uniform options that work for them. (For more on coaching gender-diverse athletes, see our upcoming story on this subject.)

3. Kids need advocates.

Currently, rules for trans student athletes vary widely. Some states follow NCAA guidelines, applying college rules to high school and junior high athletics. Others have sweeping all-inclusive policies, while others determine “fairness” on a case-by-case basis. For example, Massachusetts and most New England states have inclusive policies that allow student athletes to play on the team that aligns with their identified gender, while Maine decides eligibility by individual case.

All of this means that kids need adults in their corner who can advocate for them, says Williams. “We want to encourage kids to be physically active, but it can be difficult for us to advise them as clinicians,” they say. “You really have to have dedicated people in your life to look into state policy on it and advocate for you.”

4. Research is key.

“We understand why parents and coaches have so many questions about this issue,” says Williams. “If we had a better evidence base, we could help everyone make better decisions.” To that end, Dr. Carswell, Williams, and their colleagues are laying the groundwork for a survey that they hope will give a clearer picture of gender-diverse student athletes and their concerns. In the future, the group hopes to study physiological changes, such as in muscle mass and strength, in trans kids pursuing gender-affirming medical interventions compared to their cis peers. “It’s a huge endeavor and will require a lot of funding,” admits Dr. Carswell. “But we believe that we have the resources and the expertise, and we should try.”

Learn about the Gender Multispecialty Service and look for the second story in this series next month on Discoveries.

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