On Friday, the Senate Special Committee on the Protection of Women’s Sports will hold its final hearing. This panel of lawmakers intends 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. As pediatricians who care deeply for children and adolescents of all gender identities, we must speak out in opposition to this legislation which would certainly cause harm to our patients.
According to the American Academy of Pediatrics, children engaged in sports develop motor skills that facilitate physical activity throughout their lives, have improved academic performance and foster critical life skills, including self-regulation, goal setting and teamwork. Additionally, participation in sports enhances self-esteem and protects against feelings of hopelessness and suicidality. These benefits associated with sports participation should be available to all children and adolescents regardless of a child’s sex or gender identity.
Credit: Handout
Credit: Handout
Credit: Handout
Credit: Handout
Credit: Handout
Credit: Handout
We must also consider the potential risks associated with sports participation, including bullying, and how these risks would be exacerbated if this legislation were enacted. 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, 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 and psychological harm is tremendous in this scenario. Laws that ban transgender sports participation are often touted as legislation that protects cisgender youth, but in reality, they increase the risk of harm to transgender children and adolescents.
In 2019, a survey involving transgender and nonbinary U.S. adolescents in grades 7-12 identified a higher risk of sexual assault among transgender and nonbinary youth impacted by restroom and locker room restrictions compared with youth without restrictions. Also, transgender girls were twice as likely to be sexually assaulted in this setting. These restrictive laws that discriminate against gender diverse youth are not just ill-conceived and unnecessary, they are also dangerous and increase the risk of harm to youth who are already vulnerable to peer victimization.
Laws intended to ban transgender athletes from participating in sports are solutions to a problem that does not exist. In 2022, the Republican governor of Utah, Spencer Cox, vetoed a bill that would ban transgender students in kindergarten through 12th grade from participating in sports aligned with their gender identity, citing that he found only four transgender students participating in high school sports throughout the state of Utah and only one who played girls’ sports. In a letter explaining his decision, Cox acknowledged these transgender athletes were not dominating in sports or taking scholarships from cisgender athletes. He also recognized the mental health burden experienced by many transgender young people and the need for these students to find connection and acceptance.
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 2017 systematic review of studies focused on sports and the participation of transgender people, there were no consistent findings to suggest transgender athletes had an advantage at any stage of their medical transition. Yet, despite these findings and the rarity of a transgender athlete excelling to the level of elite sports competition, these few examples have been used to stoke fear and mistrust of transgender people.
In truth, differences in height and body sizes might 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. 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. Lawmakers are capitalizing on these concerns for political gain, and they are unfairly imposing extreme and far-reaching sports bans that would impact children as young as kindergartners.
Numerous medical and psychological associations 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 and American Psychological Association. In a 2022 survey involving 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 their physical safety and increase their mental health burden. Importantly, every provider surveyed believed this type of legislation should be stopped.
As pediatricians, we oppose any law 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 implore leaders in our state to champion greater access to sports participation for all youth. Transgender and nonbinary 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 is an internal medicine and pediatrics physician and infectious diseases specialist in Atlanta. Chelsea Marion is a pediatrician in Atlanta. Ronnye Rutledge is an internal medicine and pediatric hospitalist in Atlanta.
