Read the op-ed as published by the AJC – There is space for trans youth in sports
By Cassie Grimsley Ackerley, Chelsea Marion and Ronnye Rutledge
On Friday, December 13th, the Senate Special Committee on the Protection of Women’s Sports will hold its final legislative hearing. This panel of lawmakers has stated their intention to put forward legislation that would ban transgender students from playing on sports teams or using locker rooms with other students who share their gender identity. This policy is being considered amid an onslaught of legislation in many states, including Georgia, intended to restrict the rights of transgender youth. As pediatricians who care deeply for children and adolescents of all gender identities in our state, we must speak out in opposition of this type of legislation which would certainly cause harm to our patients.
In August 2024, Lt. Governor Burt Jones announced the creation of the Georgia Senate Special Committee on the Protection of Women’s Sports stating that the purpose was to “ensure that female athletes across Georgia have the right to compete on a fair and level playing field.” While this sentiment may appeal to many Georgians, it is critical to view this legislation within the context of Georgia’s political climate. In 2022, Governor Brian Kemp signed HB1084, a bill authorizing the Georgia High School Association to amend its bylaws and require that high school students must play on sports teams according to the sex listed on their birth certificates. The following year, Governor Kemp signed SB140 into law, which prohibits transgender youth from accessing lifesaving, evidenced-based medical care. During the legislative session in 2024, there were 14 anti-LGBTQ+ bills introduced in Georgia that if enacted would have had serious and detrimental consequences to transgender people and others within the LGBTQ+ community. The clear intent of the leadership in Georgia is to discriminate against gender diverse people, particularly transgender youth, and to restrict their right to safely participate in civic life.
Sports Participation should be safe and accessible for all youth
As physicians who provide pediatric care, we value the benefits afforded to children and adolescents who participate in sports activities. Children consistently engaged in sports develop fundamental motor skills that facilitate physical activity throughout their lives, have improved academic performance in school, and also develop critical life skills, including confidence, self-regulation, goal setting, and teamwork. (1) Additionally, there are psychological benefits as participation in sports enhances self-esteem, lowers the risk for depression, and protects against feelings of hopelessness and suicidality. (2, 3) These benefits associated with sports participation should be available to all children and adolescents regardless of a child’s sex or gender identity.
We must also consider potential risks associated with sports participation and how these risks would be exacerbated by forcing transgender youth to play on sports teams that do not align with their gender identity. Even in a state with no restrictive laws, transgender students are less likely to participate in sports compared to cisgender youth.4 Bullying and hazing are social issues that impact youth sports, and disability, gender identity, and sexual orientation have all been identified as risk factors for harassment. (5) As an example, let’s consider that a transgender girl in middle school is now legally forced to play on the boys’ soccer team. In every aspect of her life, until now, she has been seen and accepted as a girl by her family, friends, teachers, and her teammates on the girls’ soccer team. Now, she will be the only female playing on the boys’ team and forced to change in the boys’ locker room. The potential for physical and sexual assault, as well as psychological harm is tremendous in this scenario. While laws that ban transgender sports participation are often touted as legislation that protects cisgender youth, the reality is they markedly increase the risk of harm to transgender children and adolescents. In a study among transgender and non-binary U.S. adolescents in grades 7 through 12, there was a higher risk of sexual assault among transgender and non-binary youth impacted by restroom and locker room restrictions compared to those youth without restrictions. Also, transgender girls, specifically, were twice as likely to be sexually assaulted in this setting. (6) These restrictive laws that discriminate against gender diverse youth are not just ill-conceived and unnecessary, they are dangerous and increase the risk of harm to youth who are already vulnerable to peer victimization.
Bans on sports participation for transgender youth are unjust solutions seeking a problem
Laws intended to ban transgender athletes from participating in sports are essentially solutions to a problem that does not exist. As an example, lawmakers in Utah passed legislation in 2022 that would ban transgender students in K-12th grade from participating in school sports aligned with their gender identity. The Republican Governor of Utah, Spencer Cox, identified only 4 transgender students participating in high school sports throughout the state of Utah and only one played girls’ sports. In a letter explaining his decision to veto the law, Governor Cox acknowledged that these transgender athletes were not dominating in sports or taking scholarships away from cisgender athletes. He also highlighted the mental health burden experienced by many transgender young people and the need for these students to find connection and acceptance. (7)
The concern that transgender women possess an “athletic advantage” compared to cisgender women has stemmed from a few highly publicized cases involving competition at elite sporting levels. Notably, in a systematic review of medical studies focused on sports and the participation of transgender people, there were no consistent research findings to suggest that transgender females or males had an athletic advantage at any stage of their medical transition. (8) Yet, despite these findings and the rarity of a
transgender athlete excelling to the level of elite sport competition, these few politicized examples have been used to stoke fear and mistrust of transgender people.
In truth, differences in height and body sizes may be advantageous or disadvantageous depending on the sport involved. For example, professional gymnast Simone Biles at 4 feet, 8 inches tall and professional basketball player Brittney Griner at 6 feet, 9 inches tall have markedly different heights, and yet, both are considered elite athletes in their respective sports and have earned Olympic gold medals. (9) There are variations among athletes’ bodies regardless of sex and gender, and policing these differences is likely to result in more gender stereotyping and discrimination. At elite sporting levels, there are multiple sports regulatory agencies, including the International Olympic Committee (IOC) and the National Collegiate Athletic Association (NCAA), that already have established guidelines that address participation of transgender athletes.10 These organizations and other sports federations are the entities best suited to hold discussions relative to individual sports and participation requirements. State legislatures are not the right place for these nuanced conversations given their lack of expertise and partisan biases.
Sports bans that impact transgender students are generally not supported by the medical community
Lawmakers are capitalizing on concerns about the participation of transgender athletes in sports for political gain, and they are unfairly imposing extreme and far-reaching sports participation bans that would prevent children even as young as kindergarteners from playing on sports teams with children whose sex assigned at birth does not align with theirs. While there is little data on sex-based differences in athletic performance for children before puberty, the differences are thought to be minimal and do not justify imposing such a ban on young transgender and gender diverse children.11 For most young people, the greatest advantages to participating on a sports team are the social aspects, including attaining a sense of belonging and comradery. While “winning and losing” may be critical factors that motivate politicians, this aspect of sports competition is far less important than the physical, social, and psychological benefits garnered through participation in sports.
Numerous professional medical and psychological organizations oppose legal bans that would prohibit transgender athletes from participating on sports teams with others who share their gender identity, including the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Psychiatric Association, American Psychological Association, the National Association of School Psychologists, and the Association for Applied Sport Psychology. In a survey conducted among 103 pediatric providers from all 50 states, nearly every provider believed that legislation preventing sports participation by transgender youth was likely to worsen discrimination and stigmatization, negatively impact the physical safety of these children, and would likely increase their mental health burden. (12) Importantly, every pediatric provider surveyed believed that this type of legislation should be stopped.
We, as pediatricians, oppose any legislation that restricts the rights of transgender people to play on sports teams and use facilities with others who share their gender identity based on peer-reviewed research demonstrating the potential harms associated with these types of restrictions. We urge state legislators to focus their time and attention on solving problems that impact the health and well-being of millions of children and adolescents in Georgia, including the risk of gun violence, limited access to mental health services and healthcare coverage, and the health-related consequences of climate change and global warming. We also implore leaders in our state to champion greater access to sports participation and physical activity for all youth. Transgender and non-binary youth and their families are valued members of our communities in Georgia and should not be targeted to advance an uninformed political agenda.
– Cassie Grimsley Ackerley, MD – Internal Medicine-Pediatrics physician, and Infectious Disease specialist
in Atlanta, Georgia
– Chelsea Marion, MD – Pediatrician in Atlanta, Georgia
– Ronnye Rutledge, MD – Internal Medicine and Pediatric Hospitalist in Atlanta, Georgia
References:
1. Logan K, Cuff S, Council On Sports M, Fitness. Organized Sports for Children, Preadolescents, and Adolescents. Pediatrics. 2019.
2. Harrison PA, Narayan G. Differences in behavior, psychological factors, and environmental factors associated with participation in school sports and other activities in adolescence. J Sch Health. 2003;73(3):113-20.
3. Taliaferro LA, Rienzo BA, Miller MD, Pigg RM, Jr., Dodd VJ. High school youth and suicide risk: exploring protection afforded through physical activity and sport participation. J Sch Health. 2008;78(10):545-53.
4. Kaja SM, McGuire JK. Gender-Related Disparities in Sport, Physical Activity, and Physical Activity Lessons in Minnesota From 2016 to 2019. J Adolesc Health. 2024;75(4):683-5.
5. Stirling AE, Bridges EJ, Cruz EL, Mountjoy ML. Canadian Academy of Sport and Exercise Medicine Position Paper: Abuse, Harrassment, and Bullying in Sport. Clin J Sport Med. 2011;21:385-91.
6. Murchison GR, Agenor M, Reisner SL, Watson RJ. School Restroom and Locker Room Restrictions and Sexual Assault Risk Among Transgender Youth. Pediatrics. 2019;143(6). PMC8849575.
7. Cox SJ. Governor’s News Blog2022. [cited 2024]. Available from: https://governor.utah.gov/press/gov-cox-why-im-vetoing-hb11/.
8. Jones BA, Arcelus J, Bouman WP, Haycraft E. Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies. Sports Med. 2017;47(4):701-16. PMC5357259 have no conflicts of interest relevant to the content of this review.
9. Facts on Trans Inclusion in Athletics. National Women’s Law Center [Internet]. 2019 November 27, 2024.
10. Safer JD. Fairness for Transgender People in Sport. Journal of the Endocrine Society. 2022;6(5):1-2.
11. Hunter SK, S SA, Bhargava A, Harper J, Hirschberg AL, B DL, K LM, N JN, Stachenfeld NS, Bermon S. The Biological Basis of Sex Differences in Athletic Performance: Consensus Statement for the American College of Sports Medicine. Med Sci Sports Exerc. 2023;55(12):2328-60.
12. Hughes LD, Dowshen N, Kidd KM, Operario D, Renjilian C, Gamarel KE. Pediatric Provider Perspectives on Laws and Policies Impacting Sports Participation for Transgender Youth. LGBT Health. 2022;9(4):247-53. PMC9271330.