essay on transgender athletes

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The fight for the future of transgender athletes

A group of influential women’s sports advocates say their proposals are about fairness. but lgbt activists say their plans would endanger transgender rights — and transgender lives..

The women timed their announcement carefully, holding it the day before National Girls and Women in Sports Day, created three decades ago to promote female athletes.

Among them were trailblazers: Donna de Varona, the Olympic swimmer who lobbied for Title IX’s passage in 1972; Donna Lopiano, the former chief executive of the Women’s Sports Foundation; and Nancy Hogshead-Makar, Olympic swimmer and law professor who wrote a book on Title IX.

Before that day in early February, they were universally respected as pioneers in the long fight for women’s equality in sports. Then they unveiled their project: changing the way transgender girls and women participate in women’s sports. Almost immediately, their proposal drew bitter criticism in the fraught debate over transgender rights.

For starters, they said, they planned to lobby for federal legislation requiring transgender girls and women, in high school sports and above, to suppress testosterone for at least one year before competing against other girls and women, making universal a policy already in place in some states and some higher levels of sports. For transgender girls in high school who do not suppress testosterone, they suggested “accommodations,” such as separate races, podiums or teams.

They called themselves the Women’s Sports Policy Working Group .

“To give girls and women an equal opportunity to participate in sports, they need their own team. Why? Because of the biological differences between males and females,” said Hogshead-Makar, CEO of Champion Women, a women’s sports advocacy organization.

They portrayed their proposals as a science-based compromise between two extremes: right-wing politicians seeking wholesale bans of transgender athletes and transgender activists who argue for full inclusion — and who even dispute what some view as settled science about the relationship between testosterone and athleticism. They quickly drew fierce backlash, illustrating how the issue of transgender athletes has become the most vexing, emotionally charged debate in global sports and why it may prove impossible for schools and sports organizations to craft policies that are both fair to all female athletes and fully inclusive of transgender girls and women.

Transgender and women’s equality activists denounced their proposals as transphobic and accused the women of having a myopic focus on sports at a critical time for the transgender equality movement — as the Biden administration fights to expand federal anti-discrimination protections for transgender people and as conservative lawmakers push bills in more than 20 states seeking to ban transgender athletes and criminalize gender-affirming hormone therapy for transgender youth.

Critics also pointed to members of the working group with reputations of engaging in anti-trans rhetoric, including Martina Navratilova, the tennis champion whose commentary on transgender athletes has stoked outrage, and a Duke law professor whose work calling transgender girls and women “biological males” is cited in anti-transgender legislation.

Inside the world of sports — where careers are built on split-second wins and governed by rules that measure testosterone by the nanomole — these women’s proposals have gained some surprising voices of support. They have drawn endorsements from the first openly transgender Division I cross-country runner in NCAA history as well as a leading transgender scientist researching the effects of hormone therapy on athleticism. With enduring credibility in the sports world and on Capitol Hill, they have begun meeting with state and federal lawmakers grappling with this issue.

But even advocates who view their proposed policies as sensible for collegiate and professional athletes wonder whether these women have truly grappled with the impact their policies would have on the lives of hundreds, perhaps thousands of transgender girls across the country.

“The folks who are pushing these anti-trans bills … they don’t believe transgender people exist. They think they’re faking it for an advantage in sports,” said Cathryn Oakley, state legislative director at the Human Rights Campaign. “I don’t know how you find a middle ground between a hate group and people pushing for equality.”

A patchwork of policies

Before 2010, few college or high school athletic associations had policies on transgender athletes, according to a report published that year by the Women’s Sports Foundation and the National Center for Lesbian Rights.

Noting that “an increasing number of high school and college-aged young people are identifying as transgender,” the report proposed a set of policies: In college sports, transgender women should undergo one year of hormone therapy before competing against other women, a rule rooted in scientific research that suggested such an approach would mitigate any athletic benefits. The NCAA quickly adopted the policy.

For high schools, the report recommended letting transgender girls compete in sports as soon as they transition socially and begin dressing and acting in accordance with their gender identity. Requiring hormone therapy for adolescents is potentially harmful, experts said in interviews, because not all transgender teens have supportive families or access to gender clinics. Ones who do may not want to undergo hormone therapy, which for transgender girls typically involves puberty blockers that pause developmental changes followed by a combination of testosterone suppressors and estrogen.

According to information compiled by transathlete.com and the ACLU , 10 states let transgender girls compete in high school sports after undergoing some treatment. Twelve states prohibit them entirely, including four that passed new laws and executive orders this year. Nine states have no policies at all. And 19 states, as well as the District of Columbia, let them compete regardless of testosterone level.

For the past decade, this policy patchwork has developed largely without controversy. Transgender youth are a very small minority of the U.S. population — 1.8 percent of high school students, according to a 2019 CDC report — and the number of those transgender girls likely to play sports and compete at an elite level is even smaller.

But then, a few years ago, a transgender runner took the Connecticut track scene by storm, catching the attention of politicians, pundits and advocates — including Lopiano, a Connecticut resident and Title IX champion.

Running on the boys’ team as a ninth-grader in suburban Hartford, Terry Miller was an average track athlete, online records show, failing to qualify for any postseason events. But in 2018, Miller came out as a transgender girl. In her first season running against other girls, as a sophomore, Miller dominated. She won five state championships and two titles at the New England championships, beating the fastest girls from six states.

The next fall, as a junior, Miller won another four state titles and two more all-New England titles. In several races, she was followed closely by Andraya Yearwood, another transgender girl who had also won three state titles.

In interviews, Miller and her supporters discussed how important track was for her confidence and stability as she transitioned.

“Track helps me forget about everything, and I love it,” Miller said in a 2019 story on DyeStat, a website that covers high school track and field. (Miller and her parents declined an interview request for this story.)

Support for Miller, however, was not unanimous. Girls who lost to her and their coaches complained that she had an unfair advantage. Parents of other girls started online petitions demanding state high school officials add a testosterone suppression requirement for transgender girls.

I’m not saying transgender girls are going to take over women’s sports. I’m saying that the law protects girls and women, and they shouldn’t have to compete against someone who has an immutable testosterone-based advantage. — Donna Lopiano, Title IX advocate

A lawyer representing a few mothers contacted Lopiano and asked for help. Believing Connecticut’s policy violated Title IX, Lopiano met with state officials and attempted to broker a compromise that would allow the results of transgender runners not to affect the results of cisgender girls.

Title IX doesn’t define what it means to be a girl or a woman. But Lopiano argues Congress intended to restrict female sports to girls and women who haven’t gone through male puberty, when testosterone in boys surges to between four and 10 times the levels found in girls and women.

She points to the 1975 testimony of Bernice Sandler, an activist known as “the godmother of Title IX,” who told Congress that, because of physical advantages men acquire during puberty, any effort to integrate sports between the sexes “would effectively eliminate opportunities for women.”

“I’m not saying transgender girls are going to take over women’s sports,” Lopiano said. “I’m saying that the law protects girls and women and they shouldn’t have to compete against someone who has an immutable testosterone-based advantage.”

Lopiano’s compromise never materialized. The mothers decided instead to work with the Alliance Defending Freedom, an Arizona-based conservative Christian advocacy organization that supports anti-trans lawsuits and legislation across the country. The Alliance helped three girls who lost races to Miller and Yearwood sue Connecticut high school authorities, arguing their policy on transgender athletes violated Title IX. The case is pending in U.S. District Court in Connecticut.

The ACLU has intervened on behalf of the transgender runners. In an interview, Chase Strangio, deputy director for transgender justice at the ACLU, said courts already have found Title IX protections apply to transgender girls and women in cases involving access to women’s restrooms. He views restrictions on transgender athletes in high school, such as hormone requirements, as discriminatory and probably a violation of the law.

Miller did not begin suppressing testosterone until her junior year, Strangio acknowledged, but Yearwood was on hormone therapy throughout high school. Regardless, Strangio emphasized that his clients didn’t win every race they competed in and they quit the sport after high school.

“Their careers were sabotaged by the rhetoric and the attacks on them,” Strangio said.

In early 2019, Lopiano began meeting regularly with de Varona and Hogshead-Makar to discuss what they believe are looming collisions between the transgender equality movement and Title IX. To them, the Connecticut controversy illustrated what they view as the two extreme positions between which they are trying to navigate.

The Alliance Defending Freedom argues that transgender girls and women always have physiological advantages in sports, even if they have suppressed testosterone. Their advocacy has inspired a wave of legislation across the country targeting transgender athletes since 2019.

“You can’t change a person’s biological sex,” said Christiana Holcomb, an Alliance lawyer working on the Connecticut case. “Nothing can undo the physiological advantages that come from being born biologically male.”

Strangio and the ACLU dispute whether transgender girls and women have advantages in sports, even if they’re not suppressing testosterone. Other prominent transgender activists, making this same argument, have called for the NCAA to remove its testosterone suppression requirement.

“The truth is, transgender women and girls have been competing in sports at all levels for years, and there is no research supporting the claim that they maintain a competitive advantage,” a 2019 ACLU article noted.

“Athleticism is complex,” Strangio said. Referring to Lopiano and her colleagues, he added, “I’m not a scientist, and neither are any of them.”

A growing research field

Benjamin Levine, a professor of cardiology at the University of Texas Southwestern Medical Center, is one of the world’s leading experts on the science of athletic performance. The founder and director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, one of the largest institutes of its kind in the world, Levine has published hundreds of peer-reviewed papers and consulted for the NCAA, the NFL, World Athletics and NASA.

In an interview, Levine said he understands why this topic stirs intense emotions. But, he said, there is no debate over whether post-pubescent transgender teenage girls and women have advantages in sports until they suppress testosterone.

Regardless of gender identity, Levine said, people who go through puberty with male levels of testosterone, on average, will grow taller and stronger than cisgender girls and women, with more muscle mass, larger hearts and advantages in several other physiological factors that affect athleticism. Puberty in boys typically begins by 12 and ends by 18.

“This is why, for every single record that you see in athletic competitions, boys and girls before puberty are about the same, and then everything diverges afterward,” said Levine, whose scientific research is cited by the women’s policy group.

Transgender advocates dismiss Levine’s research as irrelevant because he studies cisgender athletes. But several small-scale studies have found transgender women do have physiological advantages until they suppress their testosterone for at least one year.

The first was published in 2004 by Louis Gooren , a Dutch endocrinologist and founder of the Center of Expertise on Gender Dysphoria in Amsterdam, one of the largest transgender health clinics in the world. “Testosterone exposure has profound effects on muscle mass and strength,” wrote Gooren, who reported that as he gave more testosterone to 19 transgender men, they saw marked increases in muscle growth, as well as hemoglobin and insulinlike growth factor levels, both relevant in athletic performance. As he suppressed testosterone in 17 transgender women, the opposite occurred: Their muscles shrank, and their hemoglobin and IGF levels dropped.

Gooren’s findings were essentially replicated in November by a study published in the British Journal of Sports Medicine examining how 29 transgender men and 46 transgender women in the Air Force performed on routine fitness tests — push-ups, sit-ups and a 1½-mile run — as they transitioned hormonally.

After a year of treatment, transgender men were performing better and the transgender women worse. The transgender women were still running slightly faster than cisgender women, however, so the authors concluded elite sports organizations might need to lengthen testosterone suppression requirements beyond one year. In interviews, two of the study’s authors cautioned against drawing conclusions about high school athletes because their research subjects were all 18 or older.

Other recent research has been conducted by a transgender athlete herself: Joanna Harper, a medical physicist and runner. In 2015, Harper published an analysis of what happened to her and seven other transgender women runners as they transitioned hormonally. Seven of the eight women, including Harper, saw their times slow considerably.

After that, Harper left her job in Portland, Ore., and moved to England to research the effects of hormone treatment on transgender athletes at Loughborough University.

In February, she published a systematic review of 24 studies of the effects of hormone treatment on transgender women. Harper found some athletic benefits — such as higher hemoglobin levels, vital in endurance sports — dissipated after only four months of suppressing testosterone. But other advantages, such as increased muscle area and strength, remained even after 36 months.

Harper has consulted for the International Olympic Committee, World Athletics and other elite sports organizations, where she advocates for allowing transgender girls and women to compete after one year of hormone therapy. She also has signed on as a public supporter of the women’s policy group.

In a recent interview, Harper said she has been called both “the destroyer of women’s sport” and “a traitor to transgender people.”

“My agenda is to pull people toward the middle,” Harper said. “The science leads me there.”

My agenda is to pull people toward the middle. The science leads me there. — Joanna Harper, transgender athlete and researcher

When asked for experts to support his belief that it’s unclear whether transgender girls and women have competitive advantages in sports, the ACLU’s Strangio mentioned two people: Katrina Karkazis and Joshua Safer.

Karkazis is a cultural anthropologist and bioethicist. She has not conducted original research on testosterone and athleticism, but she has written extensively on the subject, including the book, “Testosterone: An Unauthorized Biography.”

In an interview, Karkazis emphasized many complexities in scientific research of testosterone and athleticism — testosterone alone doesn’t build a better athlete, researchers have found — but did not dispute that transgender girls and women who do not suppress testosterone have advantages in sports.

“Yes, on average … there will be performance differences that will be better,” she said when pressed on this point. “Whether that’s an advantage or not … I actually think that’s a normative statement that involves a value judgment about what is advantaged.”

Safer is an endocrinologist and the director of a transgender health clinic who has served as an expert witness for the ACLU. In court filings, Safer has acknowledged transgender girls and women with higher levels of testosterone will have advantages in sports. But, he has noted, these advantages are less pronounced in high school.

“Testosterone begins to affect athletic performance at the start of puberty, and those effects increase each year until about age 18,” Safer wrote in a statement challenging a law barring transgender athletes in Idaho. “As a result, testosterone provides less of an impact for a 14-, 15- or 16-year-old than it does for a 17- or 18-year-old.”

In an interview, Safer emphasized that, despite the advantages conferred by testosterone, the list of known examples of transgender girls and women succeeding in sports, at any level, is vanishingly short.

There has never been an openly transgender athlete in the Olympics ; the first three, all women, could compete this summer in Tokyo. There has been one openly transgender woman champion in the history of NCAA: CeCe Telfer, a Franklin Pierce University runner who won the Division II 400-meter hurdles in 2019. On the high school level, there are just Miller and Yearwood in Connecticut.

Said Safer, “The important thing to consider here, as it relates to high school sports and teenagers, is are we addressing a problem that actually exists, or are we simply addressing a fear?”

‘Sports does discriminate’

At their opening news conference, Lopiano spoke first and stressed that the group’s proposals represented “respectful inclusion” of transgender athletes.

“These are our kids. And we have to take care of all of them,” she said.

A few minutes later, the women turned the news conference over to one of their lesser-known colleagues: Doriane Lambelet Coleman, a Duke law professor and former elite runner who, in the late 1970s, was one of the first women to receive a track scholarship to Villanova University.

Over the past few years, Coleman has published law review articles and essays defending the preservation of girls’ and women’s sports for athletes with female levels of testosterone.

“I’ve tried to make clear that I support a science-based approach to inclusion, not categorical exclusion,” she said.

But as the debate moves beyond sports and into mainstream politics, more people have begun to see “science-based inclusion” as a form of exclusion. Which is why, to her dismay, her writings are routinely cited by right-wing politicians promoting wholesale bans of transgender athletes. It’s also why some transgender advocates say her and her colleague’s proposals are not only unfair but dangerous.

Research shows that transgender youth struggle with alarmingly high rates of anxiety, depression and suicidality. Emerging research has suggested affirmative transgender care — letting children transition socially for a period of time and then, if prescribed, start hormone therapy — can significantly reduce those mental health problems. A key to affirmative care, experts said, is to avoid situations where a transgender child is treated in any way that invalidates their gender identity.

When briefed on the women’s policy group’s proposals, several experts sharply criticized the idea of transgender-specific sports teams or events as stigmatizing.

“They have to go through so many obstacles just to recognize they are transgender, and for a lot of them, sports is the turning point. … You’d just end up exiling transgender girls from sports,” said Helen Carroll, former director of the Sports Project of the National Center for Lesbian Rights, who co-wrote the NCAA’s policy on transgender athletes.

And even if they do have physiological advantages, some experts argued, transgender teens face a minefield of challenges, including higher rates of bullying, rejection by their families and homelessness.

“The deck is stacked against them in every single way, so, to me, it seems silly to … look at this physiological advantage but not consider all the other substantial disadvantages these kids face,” said Jack Turban, fellow in child and adolescent psychiatry at Stanford University School of Medicine.

De Varona and her peers conceded that their concerns about high school sports are mostly hypothetical. As the legal and social climate for transgender people improves, they believe, more situations similar to what happened in Connecticut may arise.

But when asked to describe the harms that occurred to the girls who lost to the transgender athletes in Connecticut, they struggled to come up with anything concrete. Neither Miller nor Yearwood, the transgender girls, received track scholarships to college, and the women concede they are unaware of any cisgender girls who missed out on a scholarship opportunity as a result of Miller’s and Yearwood’s success.

There was other harm, the women argued, pointing to dozens of girls who lost races or opportunities to advance to postseason meets because they finished behind the transgender girls. Research has shown, they emphasized, that when girls succeed in sports, they’re more likely to go to college and have successful careers.

“Everybody here … has worked their entire lives to make sure that girls and women have equal opportunities in competitive sports,” Hogshead-Makar said.

And in those moments, these women tacitly conceded that, despite their talk of inclusion, they view transgender girls and women as different from the girls and women to whom they have devoted their careers — at least when they’re on the playing field.

“Yes, it’s important for everyone to have that opportunity in athletics,” de Varona said. “But sports does discriminate.”

From the field to the courts

The IOC is revising its guidelines on transgender athletes and is expected to announce them after this summer’s Tokyo Games. The NCAA also is examining its guidelines after hearing concerns from transgender advocates last fall.

The battle over transgender athletes in America’s high schools is likely to be settled, at least in part, in the courts. The ACLU is challenging an Idaho law that banned transgender athletes from competing in any public school, including colleges. The Connecticut lawsuit challenging that state’s policy also must be resolved.

Since its February news conference, the women’s policy group has had conversations with several members of the House and Senate, on both Judiciary Committees, according to Coleman, but they declined to specify whom or how many.

They also acquired a prominent supporter: Juniper Eastwood, one of the first openly transgender women to compete in NCAA Division I sports and the first cross-country runner.

There’s no way it would have been fair. My testosterone levels were so much higher than any of the girls I would’ve been running against. — Juniper Eastwood, the first openly transgender cross-country athlete in NCAA Division I history

In an interview, Eastwood said she never would have competed against girls or women without suppressing her testosterone. In high school, she set a Montana state record in the 800 meters that, had she been running on the girls’ team, would have broken the women’s world record.

“There’s no way it would have been fair,” she said. “My testosterone levels were so much higher than any of the girls I would’ve been running against.”

A closer examination of Eastwood’s personal story, however, spotlights the ramifications of policies that would separate transgender youth from sports.

Eastwood always planned to transition after she finished her track career because she knew she would attract unwanted attention as a transgender runner. But in her sophomore year at the University of Montana, Eastwood got hurt and had to sit out the season. Running had always been her way of coping with gender dysphoria. Without it, Eastwood began drinking excessively and struggled with depression.

Eastwood decided to transition and then continue running track on the women’s team. As she had expected, she got considerably slower as she suppressed her testosterone. And, as she had dreaded, her performances were closely analyzed by right-wing news sites, track and field obsessives and transgender activists.

Eastwood’s senior track season ended abruptly because of the coronavirus . She’s in graduate school at Montana, studying environmental philosophy, and would like to work somewhere outdoors. Even though she feels a little out of shape lately, Eastwood said, she enjoys running now more than she ever did in high school or college.

She lives not far from several secluded trails where she can run for miles without seeing another person. When she runs now, she said, she feels free from the worry about what someone will write online the next day about her performance.

“It’s just me, the trails and no one else,” Eastwood said. “And I can just run.”

Correction: An earlier version of this article described Juniper Eastwood as the first openly transgender athlete in NCAA Division I sports history. Eastwood is o ne of the first openly transgender women to compete in Division I sports and the first to run cross-country. The story has been corrected.

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I’m Transgender. Here’s How Playing Sports Saved My Life

By Shane Diamond

It would not be an exaggeration to say that sports saved my life.

I grew up in a small town in the American Southwest known as an offbeat refuge for artists and skiers. Locally, the area had a reputation for heroin overdoses, drunk driving fatalities, and high school drop-outs. But after school and on the weekends, my friends and I all played youth sports like soccer and basketball together. Athletics kept us occupied, supervised, and generally out of trouble. We also learned lifelong lessons about accountability, hard work, and time management.

When soccer season ended and the boys started playing ice hockey, I was one of the only girls who was eager to join them; I wanted to do what my friends did. Throughout my youth and into high school, I was often the only girl on the ice, and one of only a handful statewide, but I was welcomed and accepted by both my team and the league. Looking back, it makes sense that I was “one of the boys” because I was a boy, but we didn’t have language or resources to support transgender youth in the early ’90s the way we do today.

After high school, I played varsity women’s ice hockey at Bowdoin College in Maine. I can’t tell you what our record was during my four years of playing college hockey, which team won the league championship, or how many goals I scored, but I can say with absolute assurance that my hockey teammates are still some of my best friends. And that didn’t change after I came out as transgender in 2016 and started transitioning.

We’ve supported each other during marriage and divorce, while caring for ill parents and starting families, and through experiences of racism and discrimination. During the pandemic, we have remained connected online and debated whether or not we’re going to wear pants with elastic waists forever. We share a bond that can only be forged through long hours at the rink and grueling lifting schedules at the gym. We all remember the collective joy of celebrating a win and the shared grief after a loss.

As a kid who didn’t quite fit in, I always found safety and stability among my teammates. When the weight of the outside world felt like it was too heavy for a teenager struggling with identity, I knew that for an hour each day, I could leave it all outside the rink and just play hockey. Then in my 30s, while fighting for sobriety and battling depression, outreach from my college teammates saved my life: They made overt gestures, like flying to Maine when I was approaching rock bottom just so we could lie in a hotel bed, eat Thai food, and watch trashy reality TV. They messaged me on the daily group text where we offer support and accountability.

Only a person who has spent years working out with you can call you up and say, “I love you but you’re being an idiot,” with the sort of bluntness that you know comes from a place of love.

I’m not alone in my experiences. For transgender youth, having access to sports is quite literally life-saving; according to a study recently published by the Center for American Progress, the mere existence of transgender-insluive sports policies lowers the risk of poor mental health and suicidality for trans youth. Even if trans youth don’t participate in sports, the fact that they are able to reduces their risk of depression and attempted suicide. As a community, we need the mental health benefits that sport can offer. The largest survey of transgender people, the 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality, reports that transgender people are nine times more likely to attempt suicide over our lifetime than our cisgender peers. And almost 75% of transgender people who attempt suicide are under the age of 18. Even without harmful and invasive laws, it is dangerous to be a young trans person .

But lawmakers in 31 states are preying on this already vulnerable population by trying to pass laws to ban trans kids from playing sports . Politicians are targeting young children who are already coping with trauma after a year of wearing masks and only seeing their classmates on Zoom. They are going after teenagers who, like each of us, miss spending time with their friends without being afraid for the future. They are harming college students who are preparing to enter an economy grappling with unemployment and low wages.

It’s important to note that the majority of these attacks are not coming from cisgender athletes. They overwhelmingly welcome their transgender teammates. Earlier this month, over 550 current student athletes from over 85 U.S. colleges and universities recently — and for the second time — sent a letter to the NCAA in support of transgender student athletes. They know that trans athletes just want to be included. I played hockey as a kid because that’s what my friends were doing and I didn’t want to be left out. These laws and policies don’t just leave out trans kids, they intentionally exclude us.

Transgender athletes are not a new trend: the NCAA has allowed transgender athletes to participate since 2011 and the International Olympic Committee since 2004. But trans kids are still facing pushback. In 2018, transgender Texas wrestler Mack Beggs was forced to compete against girls despite wishing he could wrestle with other boys. The story of his fight to participate and show up as himself, along with the stories of Connecticut runner Andraya Yearwood and New Hampshire skier Sarah Huckman, are featured in the documentary film Changing the Game , for which I am the Impact Change Coordinator. Their stories are powerful examples of what happens when we let kids be themselves, participate fully as students, athletes, friends, and family members. Trans athletes aren’t asking for special treatment, nor do we want to be stigmatized for our transness. We simply want the opportunity to play.

Because of the wave of anti-transgender legislation sweeping the country, trans youth are hearing consistently false and harmful messages about themselves: that our inherent identities are deceptive and unfair, that there’s not enough room for us, that we don’t belong. But I am living proof that there is no better lifeline for trans kids than ensuring they are able to play sports with their peers. We owe it to kids, transgender and cisgender alike, to make sure they have the same opportunities to participate in, fall in love with, and be saved by sports the way so many of us have.

James Factora

Abby Monteil

Call your local schools’ athletic directors and demand that athletic policies allow trans youth to participate as themselves, contact legislators in these 31 states — many of whom have never met a trans person — and tell them why this matters to you and your family. Every young person deserves the chance to learn and grow through the transformative power of sports. Many of these bills and laws will likely make their way to the Supreme Court and hopefully be ruled unconstitutional, but the damage being caused to trans kids in the process will have lasting effects.

When I say that I don’t know where I’d be without sports, I mean it quite literally; without the support networks that have lasted well beyond my time on the ice, I would likely have joined too many of my transgender siblings who felt isolated and excluded enough to end their lives. Trans youth need our support now, loud and proud and in unison, before it’s too late to fight for them.

Shane Diamond is a media and communications maverick. Previously the communications manager at TLDEF, he is now the impact campaign coordinator for the film Changing the Game, a transgender advocate, and former college athlete.

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Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies

Bethany alice jones.

1 Nottingham Centre for Gender Dysphoria, 3 Oxford Street, Nottingham, NG1 5BH UK

2 School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK

Jon Arcelus

3 Division of Psychiatry and Applied Psychology, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK

Walter Pierre Bouman

Emma haycraft.

Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation.

To the authors’ knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature.

Eight research articles and 31 sport policies were reviewed.

In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport’s policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based.

Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.

Introduction

Transgender people are those who experience incongruence between the gender that they were assigned at birth (based on the appearance of their genitals) and their gender identity/experienced gender. Gender identity, or experienced gender, can be defined as a person’s internal sense of gender, whether this be male, female, neither or somewhere along the gender continuum. Some transgender people, but not all, will choose to affirm their gender identity by socially transitioning (i.e. living as their experienced gender socially, at work or at an educational institution, with friends and family, outside the home) and some, in addition, will choose to medically transition with cross-sex hormones and gender-confirming surgeries [ 1 , 2 ]. Although over time various different terms have been used, the term ‘transgender female individual’ will be used to describe individuals assigned male at birth, based on their genital appearance, but who later identify as female. ‘Transgender male individual’ will be used to describe people who are assigned female at birth, based on their genital appearance, but later identify as male. ‘Cisgender’ will be used to describe people who do not experience incongruence between their gender assigned at birth and their gender identity.

Recent reports indicate that the number of transgender individuals who attend transgender health services has increased substantially over the years in many European countries [ 3 – 5 ]. There has also been a significant increase in the number of people who self-identify as transgender and do not necessarily attend transgender health services [ 6 ]. For example, Kuyper and Wijsen [ 6 ] found that 4.6 % of people who were assigned male at birth and 3.2 % of people who were assigned female at birth in their Dutch population sample reported an ambivalent gender identity (equal identification with the other gender as with the gender they were assigned at birth). The authors also reported that 1.1 % of the people who were assigned male at birth and 0.8 % of the people who were assigned female at birth identified as transgender. It remains unknown how many of these people will seek treatment through a transgender health service. The increase in people who identify as transgender may be at least partly explained by the increase in visibility of transgender people within Western society [ 4 , 5 ]. For example, Caitlin Jenner, a former athlete and current television personality, recently came out as transgender during a television interview that was viewed all over the world [ 7 ]. Increases in visibility may have prompted some people to reflect and question their gender identity [ 8 ].

Some transgender people experience stigma, transphobia, prejudice, discrimination and violence as a consequence of their gender identity [ 9 – 11 ]. Ellis et al. [ 12 ] found that transgender people were more likely to avoid situations when they were afraid of being harassed, identified as transgender or ‘outed’, such as in clothes shops, public toilets and gyms. Gyms are a popular outlet to engage in sport-related physical activities (i.e. gym fitness exercises) and therefore it is important to create an inclusive environment given the established mental and physical health benefits of physical activity and sport [ 13 , 14 ]. This is particularly important for transgender people as they have been found to report a high prevalence of depression and anxiety [ 15 , 16 ], which could be managed with physical activity. Furthermore, physical activity and sport can also contribute towards maintaining the appropriate weight necessary to undergo gender-confirming surgery, acknowledging that not every transgender person will wish to do so [ 1 , 2 , 17 ].

The premise of competitive sport is fairness (i.e. inclusion in the absence of advantage) and, owing to fears surrounding the perceived athletic advantage of transgender people, the question of whether transgender people should be permitted to compete in accordance with their gender identity has been raised and greatly contested within the literature, among sport organisations, fellow competitors and spectators. It is a commonly held belief that androgenic hormones (especially testosterone) confer an athletic advantage in competitive sport. Therefore transgender female individuals, because of high endogenous testosterone levels, are perceived to hold an advantage in sport (when testosterone has not been blocked to a cisgender female level). Transgender men are not thought to possess an athletic advantage, despite being injected with testosterone if they chose to medically transition with cross-sex hormones. However, there has been a paucity of research that has directly explored how androgenic hormone levels are associated with athletic competence in both cisgender and transgender populations (e.g. running time).

To facilitate the inclusion of transgender competitors, in 2004, the International Olympic Committee (IOC) [ 18 ] announced that transgender people could participate in all future Olympic games providing they had fully medically transitioned (i.e. had been prescribed cross-sex hormone treatment for 2 years and undergone gender-confirming surgery). Although the requirements of this policy appear to concur with the commonly held belief that transgender people hold an athletic advantage, they have been criticised for not being underpinned by an evidence-based rationale [ 19 ]. The IOC [ 20 ] has recently updated its policy to be more inclusive of transgender athletes (i.e. fewer restrictions); however, the 2004 policy has been extremely influential on other sport organisations’ policy development. The new (2016) IOC policy will be considered in Sect. 3 .

In an attempt to draw a consensus as to whether transgender people should be able to compete in accordance with their gender identity, in 2005 Reeser [ 21 ] conducted a review of the literature pertaining to gender identity issues in competitive (elite) sport. Reeser paid particular attention to the evolution of gender verification in competitive sport and whether current competitive sport policies for transgender people are fair. He concluded that, while gender verification has made significant advances, there is a lack of physiological performance-related data in transgender people. This is preventing an overall consensus from being made as to whether transgender sport policies are fair or not (i.e. fairness in the absence of advantage). Reeser’s review, although important, has some limitations. He did not adopt a systematic methodology and therefore did not include the majority of transgender sport policies. Additionally, Reeser only considered the implications of such policies in relation to elite competitive sport and did not consider the experiences of transgender people who engage in sport or sport-related physical activity for leisure or fitness (e.g. gym fitness activities, jogging).

With the intention of addressing the limitations of the previous literature review, this systematic review has two aims. First, to systematically analyse and critically review the available literature regarding transgender people’s experiences in relation to competitive sport (elite and recreational) and sport-related physical activity participation (e.g. jogging, gym fitness activities). Second, to systematically review the available transgender competitive sport policies with regard to their fairness (i.e. competition in the absence of advantage). It is hoped that this systematic review will further enhance the understanding of sport participation and competition amongst transgender people. It may be expected that as more people define themselves as transgender, the issues that transgender people experience in competitive sport and sport-related physical activity will become more pronounced. It is therefore important that those who work to facilitate and promote sport and develop policies for their own sport organisations (e.g. sport medicine specialists, sport policymakers) are informed about the issues that this vulnerable population face. This will allow for a non-discriminatory atmosphere in sport, whilst ensuring a fair system for all participants and competitors (regardless of their gender identity).

Search Strategy

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to undertake this systematic review [ 22 ]. To obtain relevant peer-reviewed articles, an electronic search of literature published between January 1966 and August 2015 was conducted using the following search engines: ScienceDirect, Web of Science, Scopus and PubMed. Within each search engine, the following search terms were entered: gender dysphoria, gender identity disorder, trans people, trans individual, transgender and transsexual. These terms were combined with three terms relating to sport (physical activity, exercise and sport) using the “AND” operator. The reference lists of eligible papers were searched for potentially relevant publications. Sport policies were obtained through a Google search using the above search terms with the addition of “policy” at the end of all sport-related terms.

Inclusion and Exclusion Criteria

To address the first aim, articles that were selected were concerned with the experiences and issues surrounding physical activity and sport participation for transgender people. This systematic review only considered articles eligible if they were research articles, as opposed to discussion papers. Case studies were also considered eligible, as research articles were limited. Peer-reviewed articles that were written in English only were included. For the second aim, all available national and international policies on competitive sport in transgender people were selected and reviewed.

Study Selection

Thirty-one research articles were considered potentially relevant to the remit of this review. The search also identified 31 competitive sport policies for transgender people. After screening the abstracts, ten research articles were excluded as six were concerned with lesbian, gay, bisexual and transgender sport, one was a Scottish non-academic survey, one was a book chapter, one was concerned with an irrelevant topic and another focused on cisgender participants. The remaining 21 articles were downloaded for full-text review and 13 papers were excluded as they were discussion papers, as opposed to research articles. Therefore, eight research articles fulfilled the inclusion criteria and were consequently included within this systematic review (Fig.  1 ). All 31 competitive sport policies for transgender people were reviewed and included within this systematic review.

Process of identifying eligible research articles. LGBT : lesbian, gay, bisexual, transgender

This section presents the findings from the research articles and sport policies included within this systematic review. First, the findings from the research articles that explored participation in sports (both elite and recreational standards) and sport-related physical activities (i.e. gym fitness activities, jogging) are provided. Second, findings from the reviewed competitive sport policies relating to transgender inclusion are given.

Transgender People and Sport Participation

Characteristics of the eligible research studies.

The oldest research article included was published in 2004 [ 23 ] and the most recent publication was from 2015 [ 24 ]. The majority of the studies were qualitative in nature, all of which employed interviews [ 24 – 29 ]. The remaining two research articles included an experimental study [ 23 ] and a cross-sectional survey [ 30 ]. Most of the studies were concerned with transgender people who participated in sport competitively, at an elite or recreational level [ 21 , 23 , 25 – 29 ]. Some authors focused on a specific sport; ice hockey, netball and softball [ 26 , 28 , 29 ] while others were concerned with transgender people engaging in any sport [ 25 , 27 , 29 ]. Broadly, across all sports, Gooren and Bunck [ 23 ] explored whether transgender athletes have a physiological advantage in competitive sport. One study explored participation in competitive sports and sport-related physical activity [ 24 ] and another study discussed participation in sport-related physical activity only [ 30 ]. Details of all of the research articles included within this systematic review can be found in Table  1 .

Table 1

Study characteristics of research articles included within the review

Review of Transgender People and Competitive Sport Participation (Elite and Recreational): Research Articles

The same data were extracted from all research articles reviewed (Table  1 ). Below, we provide the most prominent findings in relation to competitive sport participation from each of these articles. Six research articles were concerned with competitive sport participation within this systematic review [ 23 , 25 – 29 ]. The only experimental study was by Gooren and Bunck [ 23 ] who aimed to explore whether transgender people taking cross-sex hormone treatment can fairly compete in sport. The authors measured transgender people’s muscle mass (via magnetic resonance imaging) and hormone levels (via urine and blood analyses) before and 1 year after cross-sex hormone treatment. They found that 1 year after transgender male individuals had been administered cross-sex hormone treatment, testosterone levels significantly increased and these levels were within a cisgender male range. They also found that 1 year after cross-sex hormone treatment, transgender male individuals’ muscle mass had increased and was within the same range as transgender female individuals (assigned male at birth) who had not been prescribed cross-sex hormone treatment. In relation to transgender female individuals, Gooren and Bunck found testosterone levels had significantly reduced to castration levels after 1 year of cross-sex hormone treatment. Muscle mass had also reduced after 1 year of cross-sex hormone treatment. However, muscle mass remained significantly greater than in transgender male individuals (assigned female at birth) who had not been prescribed cross-sex hormone treatment.

Therefore, Gooren and Bunck concluded that transgender male individuals are likely to be able to compete without an athletic advantage 1-year post-cross-sex hormone treatment. To a certain extent this also applies to transgender female individuals; however, there still remains a level of uncertainty owing to a large muscle mass 1-year post-cross-sex hormones. While this study was the first to explore, experimentally, whether transgender people can compete fairly, the sample size was relatively small ( n  = 36). Additionally, they did not explore the role of testosterone blockers and did not directly measure the effect cross-sex hormones had on athletic performance (e.g. running time). Many, but not all, transgender female individuals are prescribed testosterone blockers to help them to reach cisgender female testosterone levels, when administration of oestrogen alone is not enough to reduce testosterone levels. This is particularly important if the person aims to undergo gender-confirming surgery, as 6 months of testosterone suppression is a requirement for such procedures. However, if a transgender woman does not wish to undergo surgery or does not wish to have their testosterone blocked to cisgender female levels (e.g. as they wish to use their penis), their testosterone levels will be above cisgender female levels. Differentiating not only between those taking cross-sex hormones and not taking cross-sex hormones, but also transgender female individuals taking testosterone blockers, may be necessary when discussing an athletic advantage.

The remaining studies considered within this section are qualitative, and although they have provided insight into the experiences of transgender people participating in competitive sport, the findings cannot be generalised. Semerjian and Cohen’s [ 27 ] narrative account provides a good overview of how diverse and individual the issues and experiences of transgender people participating in competitive sport can be. Some participants felt anxious when engaging in sport because they felt their genitals may be revealed (e.g. when changing). In contrast, one participant used sport as a safe space to escape from the harassment he received at school. It must be considered though, that participants within the study engaged in different sports and their experiences could therefore be associated with the specific sport (i.e. some sports could be more inclusive then others).

Three qualitative studies described the implications that sport policies had on the experiences of transgender people who engaged in sport [ 26 , 28 , 29 ]. Cohen and Semerjian [ 26 ] published a case study about a transgender woman (pre-gender-confirming surgery) who was playing in the women’s national ice hockey tournament, but who was eventually banned from playing in the tournament because it was felt she had an athletic advantage. She described how she felt under constant surveillance when she was playing and at times felt ambivalent about what gendered team she should play on. It was apparent that although teammates were supportive, the issues she experienced in relation to inclusion in the tournament were primarily related to constraints put in place by competitive sport policies. Similarly, the discussions held by two former New Zealand transgender female netball players in Tagg’s [ 28 ] study gave the impression that although transgender sport policies were supposedly implemented to increase the inclusivity of transgender people, this was not always the case. They discussed how policy would allow a pre-gender-confirming surgery transgender woman to compete in a male or mixed-gender netball team only and they must obey male dress codes. However, the participants in this study were former netball players and therefore their discussions may not have been based on the current state of netball in relation to transgender participation. In contrast to the previously mentioned studies, the majority of participants ( n  = 12) in Travers and Deri’s [ 29 ] study discussed the positive experiences they had in relation to transgender participation in competitive sport. However, some of the transgender men did discuss how they had hostile experiences (e.g. incorrect pronoun use). Several of the participants in this study also felt that testosterone gave transgender women (endogenous) and men (when injected) an athletic advantage.

For the two young transgender male individuals in Caudwell’s [ 25 ] study, the stage of transition appeared to be instrumental in disengagement from participation in competitive sport. The discussion held by the participants highlighted how accessing sport during their transitional period was difficult as they would not be accepted or feel comfortable on either a male or female team during this period. However, this study again discussed sport very broadly and therefore it is unknown whether the participants’ experiences were associated with specific sports or whether they are generalisable across other sports.

In summary, there is limited research from which to draw any conclusion about whether transgender people have an athletic advantage in competitive sport or not. The limited physiological research conducted to date has informed the development of transgender sport policies that are implemented by sporting organisations all over the world. It is these sport policies that appear to be instrumental in transgender people’s experiences with competitive sport, most of which are negative.

Review of Transgender People and Sport-Related Physical Activities: Research Articles

Within this systematic review, only two studies explored sport-related physical activities [ 24 , 30 ]. Muchicko et al. [ 30 ] set out to quantitatively explore the relationship between gender identity and physical activity. They compared levels of physical activity between cisgender and transgender people. The study found that self-identified transgender participants ( n  = 33) reported engaging in less physical activity than cisgender participants ( n  = 47). Social support and self-perception were found to mediate the relationship between gender identity and physical activity. The authors suggested that their study highlights how leisure centres need to be more inclusive, and transgender people need to be given more social support to encourage physical activity. However, this study was limited by the sampling methods employed. The cisgender participants were recruited from a university campus where they potentially had more opportunity to walk around campus, and opportunity for discounted gym memberships, whereas the transgender participants were recruited from a support group for transgender people and were not associated with the university.

As with transgender people who engage in sport at a competitive level, transgender people who engage in sport-related physical activity also appear to experience a range of different barriers. Hargie et al. [ 24 ] found in their qualitative study that transgender people prefer to engage in individual, as opposed to group, sport-related physical activities. This was reportedly owing to their fear of being ‘outed’. Regardless of whether sport-related physical activities are engaged in individually or in a group, changing rooms appeared to be a significant barrier. Being excluded from sport-related physical activities was distressing for participants, as they could not maintain physical fitness, which they felt was important in preparation for gender-confirming surgery. Despite these interesting findings, the study is limited by the lack of sociodemographic information provided about participants. Within qualitative research, because of the small sample size, it is often desirable to provide a large amount of sociodemographic detail about participants so that the findings can be interpreted in relation to this information. For instance, in the context of sport-related physical activities, the stage of transition may be an important factor when interpreting the individuals’ current experiences of sport-related physical activities.

The limited research studies concerned with sport-related physical activities suggest that inclusive environments are not created for transgender people engaging in such activities, which may deter engagement.

Transgender-Inclusive Sport Policies

Characteristics of the eligible sport policies.

Of the 31 transgender inclusive policies reviewed, 13 were from the USA [ 31 – 43 ]. Ten of the policies reviewed were from the UK [ 44 – 53 ]. One policy was from Australia [ 54 ]. The rest of the policies ( n  = 7) were international [ 18 , 20 , 55 – 59 ]. Details of all of the sport policies included within this review can be found in Table  2 .

Table 2

Transgender-inclusive sport policies included within this systematic review

GCS gender-confirming surgery, CHT cross-sex hormone therapy, IOC International Olympic Committee, TUE therapeutic use exemption, n.d. no date

a Gender dysphoria is the diagnostic name included within the Diagnostic and Statistical Manual for Mental Disorders , Fifth Edition, for people who experience an incongruence between their gender assigned at birth and gender identity [ 60 ]

Review of the Sport Policies

Policies within this section were systematically reviewed in relation to their inclusiveness of transgender competitors (i.e. maintaining fairness in the absence of advantage for all competitors). The fairness of the policy requirements was judged against the available physiological research that has explored athletic advantage. The time restrictions associated with each requirement were also reviewed (e.g. cross-sex hormones must have been administered for at least 2 years prior to competition). The requirements from each policy are summarised within Table  2 and the most salient points of these policies are then presented in the section that follows.

In 2004, the IOC [ 18 ] announced that transgender people who transition after puberty are permitted to compete in sport in line with their experienced gender identity providing they have had gender-confirming surgery, can provide legal recognition of their gender, have been prescribed cross-sex hormone treatment for at least 2 years and have lived in their experienced gender for the same amount of time [ 18 ]. Additionally, transgender people who had undergone gender-confirming surgery pre-puberty are eligible to compete in sport in line with their experienced gender identity [ 18 ]. This is an international policy and has been adopted by sport organisations all over the world.

While the 2004 IOC [ 18 ] policy has been praised for its efforts to address the inclusion of transgender athletes [ 61 ], several flaws have been identified [ 61 ]. First, the policy excludes transgender people who choose not to have gender-confirming surgery owing to a lack of genital dysphoria (distress), medical reasons, fears about risk during operations, and/or because of other personal reasons [ 28 , 62 , 63 ]. The 2004 IOC [ 18 ] policy also excludes transgender people who are in the process of transitioning. For instance, a transgender athlete may be prescribed cross-sex hormone treatment, but be yet to undergo gender-confirming surgery. The 2004 IOC policy [ 18 ] therefore adopts a very narrow definition and excludes a large proportion of transgender people [ 19 ]. In addition to this, the policy appears to have been developed with only transgender female individuals in mind, possibly as transgender male individuals are not thought to possess athletic advantages in the majority of sports, and therefore the policy discriminates against transgender male individuals [ 21 ]. Moreover, the 2004 IOC [ 18 ] policy fails to take into consideration the regional, national and international differences in accessing cross-sex hormone treatment and gender-confirming surgery [ 18 , 63 – 65 ]. Within this policy, there also appears a lack of an evidence-based rationale as to why a period of 2 years was chosen as the length of time cross-sex hormone treatment must be administered prior to sport competition and why individual differences in blood hormone levels are not considered [ 66 ]. As mentioned previously, the role of testosterone blockers in transgender women is also not considered. Although the rationale for the 2-year time period is not made explicit, it may be related to the fact that this time period was imposed by the IOC in 2004, when banning athletes from competitive sport to discipline them for doping violations. The evidence-based rationale for gender-confirming surgery is also not clear [ 61 ]; whether an athlete has a penis or vagina appears irrelevant, as this will not change the physiology of the body or the physiological advantage of the person [ 63 ].

Approximately 200 days before the 2016 Rio Olympic Games, the IOC announced changes to their competitive sport policy for transgender people. The new 2016 IOC [ 20 ] policy suggests that transgender male athletes are able to compete in a male category without any restrictions. Transgender female athletes may compete in a female category if they have declared their gender as female for at least 4 years and their blood testosterone levels are below 10 nmol/L for at least 12 months prior to competition. However, the latter requirement is a general guideline, and each case will be reviewed individually to determine whether 12 months is a sufficient amount of time to suppress testosterone levels to an appropriate level. If transgender female athletes do not meet these requirements, they will be able to compete in a male category. This is a great improvement in sport policy, which considers gender assigned at birth and individual difference in relation to bloody hormone levels and moves away from the requirement of surgery to compete in their experienced gender category. However, we could not find any evidence to support the requirement for testosterone levels to be below 10 nmol/L for at least 12 months.

Despite its flaws, the 2004 IOC policy [ 18 ] has been adopted by several other sport organisations. Within this systematic review, 11 sport organisations adopted the policy outlined by the IOC in 2004 [ 33 , 36 , 38 – 40 , 45 , 46 , 48 , 49 , 51 , 57 ]. All but one (the International Tennis Federation) of these sport organisation policies are employed at a national level. Not only is it problematic that other sport organisations adopted the 2004 IOC policy, but elements of the 2004 IOC policy concerning children pre-puberty are not applicable to sport organisations in the UK and many other countries. Within the UK (and many other countries), children presenting with gender incongruence cannot undergo gender-confirming surgery before the age of 18 years, by which time puberty has usually started.

Three policies stated that it is only necessary to provide legal recognition of gender and to be prescribed cross-sex hormone treatment for a ‘sufficient amount of time’ (international policy) [ 56 ] or so that hormone blood levels are within cisgender female or male ranges (national policy) [ 44 , 52 ]. Policies from the National Collegiate Athletic Association [ 32 ] and British Rowing [ 50 ] also state that only cross-sex hormone treatment is required; however, the specifics of this requirement differ for both transgender male and female individuals. With both of these policies, transgender female individuals have to provide more evidence of cross-sex hormone treatment and their blood hormone levels in comparison to transgender male individuals. Similarly, the Association of Boxing Commissions [ 31 ] in its national policy has different cross-sex hormone treatment requirements depending on gender assigned at birth and how the athlete identifies themselves (transgender or transsexual). The language used within the Association of Boxing Commissions’ policy [ 31 ] may be seen as offensive by some transgender people and the difference between “transsexuals” and “transgender” people remains unclear. Policies held by the Ladies Professional Golf Association (international policy) [ 43 ] and the International Association of Athletics Federations [ 55 ] differ dramatically in relation to gender and gender-confirming surgery as a requirement. In both cases, it is necessary for transgender female individuals to have undergone this procedure, but not for transgender male individuals. Although some of the requirements of these policies are unreasonable and not evidence based (e.g. gender-confirming surgery), the gender difference in relation to the amount of evidence that is required about their gender change seems acceptable considering that only transgender female individuals (and not transgender male individuals) are currently seen to potentially have an athletic advantage [ 23 ].

The more inclusive sport policies reviewed here only required legal or medical recognition or do not ask for any evidence of gender; thus they encourage competition in line with the experienced gender (five were national policies and two were international) [ 34 , 35 , 41 , 42 , 53 , 54 , 59 ]. The Fédération Internationale de Volleyball [ 58 ] had the most invasive policy considered within this systematic review; they ask players to provide a birth certificate to verify gender. Additionally, female players may be asked to provide a gender certificate or submit themselves to a medical examination if the medical evidence is not sufficient. Both British Universities & Colleges Sport [ 47 ] and USA Triathlon [ 37 ] do not have their own policies, but suggest the adoption of other policies (i.e. those relevant to the sport in question or guidelines of the US Anti-Doping Agency, respectively).

Currently, the majority of sport policies unfairly exclude transgender people from competitive sport, as the requirements they place on them are not underpinned by evidence-based medicine. Until (and if) there is consistent and direct evidence to demonstrate transgender people have an athletic advantage, it seems unreasonable to exclude them on any basis.

The first aim of this systematic review was to explore the experiences of transgender people in relation to competitive sport participation (elite and recreational) and sport-related physical activity. The majority of the studies within this body of literature are qualitative in nature, which may be at least partly a reflection of the low numbers of transgender people in the general population. It is therefore difficult to draw any definite conclusions because of the lack of quantitative research. By its very nature, the findings from qualitative research cannot be generalised but the findings can be used to form a platform from which generalisations can be made. The research articles reviewed here described a generally negative experience of sport participation and sport-related physical activity for transgender individuals. It was evident from these studies that transgender people are facing barriers when engaging in competitive sport and sport-related physical activity. In relation to sport-related physical activity, lack of accessibility to an inclusive and comfortable environment appeared to be the primary barrier to participation. Charities and support organisations working with transgender people should consider developing campaigns to raise awareness about different gender identities. Leisure centres should also be made more aware of potential gender differences (i.e. via training and greater information provision) and be given advice on how to make such environments more inclusive of transgender people (e.g. gender neutral changing facilities with cubicles). In relation to competitive sport participation, the findings from this systematic review suggest that the requirements that transgender competitive sport policies place on competitors were instrumental in transgender athletes’ negative experiences.

While a distinction needs to be made between the issues and experiences transgender people have with regard to participation in sport and competitive sport, it also needs to be acknowledged that there is an overlap. Transgender male and female individuals have anecdotally discussed that access to sport participation (such as becoming part of the local football team) is restricted as even community and local sport organisations who play at a recreational level implement transgender competitive sport policies.

The second aim was to review the available sport policies regarding the fairness for transgender people in competitive sport (i.e. fairness in the absence of advantage). Owing to overinterpretation and fear of the athletic advantage in transgender athletes, the majority of the policies reviewed were discriminatory against transgender people, especially transgender male individuals (i.e. exclusion in the absence of advantage). Although the updated IOC policy may be perceived as more inclusive then the 2004 version, there are still flaws. The requirement for a transgender female individual to have declared their gender as female for at least 4 years is excessive. In the UK and many other countries, once a transgender person has accessed a transgender health service, it is likely to be less than 4 years before a person legally changes their name, undergoes irreversible treatments and, hence, fully commits to their experienced gender. There appears to be a lack of rationale regarding the 4-year time period for transgender athletes, although this time restriction is consistent with the current disciplinary action for cisgender athletes when a doping incident occurs [ 67 ]. The 2016 IOC policy [ 20 ] also states that to avoid discrimination against transgender female individuals, they are allowed to complete in a male category if they do not meet the requirements for transgender female athletes. For most transgender female individuals, competing in a male category, when their experienced gender is female, would be distressing and may deter engagement in competitive sport altogether. This particular requirement may be promoting exclusion of transgender female individuals in competitive sport, rather than avoiding discrimination.

Several sport policies, including the recently updated IOC 2016 [ 20 ] policy, have based their requirements for transgender competitors on indirect, inconsistent and unambiguous evidence. Physiological research involving cisgender people has shown that testosterone deficiency in young men is associated with a decrease in muscle strength [ 68 ] and testosterone injections in cisgender men are associated with an increase in some aspects of muscle strength [ 69 ]. However, this research did not determine whether these decreases and increases in muscle mass are within ranges for cisgender female and male individuals and the time required to reach cisgender male or female levels. Elbers et al. [ 70 ] expanded on this research by exploring the effects of oestrogen supplements and androgen deprivation on fat distribution and thigh muscle mass (by using magnetic resonance imaging) in 20 transgender female individuals. They found that 12 months after cross-sex hormone treatment, transgender female individuals had a more feminine pattern of adiposity and their thigh muscles had decreased. Other research has found that transgender female athletes who have hormonally and surgically transitioned have reported feeling weaker and their testosterone levels tend to be lower than average compared with cisgender women [ 19 , 71 ]. However, this research does not tell us anything about the relationship between androgenic hormones and athletic ability.

To date, Harper’s study [ 72 ] is the only one to directly explore androgenic hormones and athletic ability. The aim of the study was to explore the long-distance (5–42 km) running times of eight transgender female individuals pre- and post-testosterone suppression. It was found that post-testosterone suppression running times were significantly slower in comparison to pre-testosterone suppression. Harper stated that owing to reductions in testosterone and haemoglobin, transgender female individuals post-transition would have the same endurance capabilities as a cisgender female individual. However, the sample size was very small ( n  = 8) and participants were asked to self-report their race times, which might have been subject to recall or social desirability bias.

On average, men perform better than women in sport; however, no empirical research has identified the specific reason(s) why. Based mainly on indirect research with cisgender people, it is commonly believed that androgenic hormones (specifically high testosterone levels) confer an advantage in competitive sports (i.e. enhance endurance, increase muscle mass) and, while this belief has informed several sporting policies, testosterone may not be the primary, or even a helpful, marker in determining athletic advantage [ 73 ]. Karkazis et al. [ 73 ] have argued that there is no evidence to suggest that endogenous testosterone levels are predictive of athletic performance (apart from doping), as there is variation in how bodies make and respond to the hormone. Testosterone is only one part of a person’s physiology and there are other important factors (both biological and environmental) that should be considered if fairness (the absence of advantage) is the aim in competitive sport. For instance, having large hands is key for manipulation in some sports (e.g. basketball), but this is not seen as an unfair advantage. Establishing what an athletic advantage is in competitive sport would facilitate inclusion of all athletes (regardless of their gender identity) on the premise of fairness.

The Canadian Centre for Ethics in Sport [ 74 ] recently released a document offering guidance to sport organisations on how to develop inclusive competitive sport policies for transgender people. An expert panel maintained the viewpoint that everyone has the right to compete in accordance with their gender identity at a recreational and elite level. Cross-sex hormones and gender-confirming surgeries should not be a requirement at any level of sport. If any sport organisation requires transgender competitors to take cross-sex hormones for a specified time, they will have to provide evidence to support that this is reasonable. The panel suggests that when sporting organisations are concerned about safety, based on the size or strength of competitors, such organisations should develop skill and size categories, such as in wrestling.

The issues and challenges that transgender people experience when engaging in competitive sport and sport-related physical activity will undoubtedly become more prominent as the visibility and prevalence of transgender people become more pronounced. Consequently, health professionals working in sport will need to become more familiar with the specific issues and challenges that a transgender person may experience when engaging in sport. By doing this, these professionals will be able to ensure transgender people can start or continue to engage in sport in a safe and inclusive manner. The most common question of people working within the sport domain will likely be: When it is safe and fair to permit a transgender person to compete in sport in line with their experienced gender? At the current time, this is a difficult issue to address considering that there is a lack of direct and consistent physiological performance-related data with transgender people, which is preventing a consensus from being made as to whether transgender people (especially transgender female individuals) do or do not have an athletic advantage. It may be sensible to suggest that until there are direct and consistent scientific data to suggest that transgender competitors have an advantage, transgender people should be allowed to compete in accordance with their gender identity with no restrictions (e.g. no requirement to have cross-sex hormones, gender-confirming surgery). The athletic advantage transgender female individuals are perceived to have (based on indirect and ambiguous evidence) may be no greater than widely accepted physiological (e.g. large hands) and financial (e.g. training opportunities) advantages that some cisgender people possess in competitive sport. Sport organisations wanting to exclude a transgender person from competing in their experienced gender category would need to demonstrate that the sport is gender affected and that exclusion is necessary for fair and safe competition [ 74 , 75 ]. At the current time, this would be difficult considering there is no evidence to suggest that androgenic hormone levels consistently confer a competitive advantage [ 74 , 75 ].

Limitations of the Area and Directions for Future Research

Within the area of sport, physical activity and transgender individuals, research is limited and mainly qualitative. More quantitative research needs to be conducted to increase the applicability and generalisability of the research findings and so that conclusions about transgender people and sport can be drawn. At a medical level, more physiological research is needed with the transgender population to accurately determine whether transgender people have an advantage in competitive sport or not. Future studies should investigate when a person can be considered physiologically as their experienced gender. This in turn should aid more inclusive (i.e. inclusion in the absence of advantage) sport policies for transgender individuals and a fair system for all. To date, the few studies exploring the experiences of transgender people have mainly been concerned with exploring experiences in relation to competitive sport. This research now needs to be extended to those who participate in sport-related physical activity for leisure and fitness. It is also important to understand transgender people’s experiences in the context of different sports. The barriers to, and facilitators of, football participation, for example, may greatly differ to those experienced when engaging in gymnastics, athletics, swimming or aquatic activities. For the latter four sports, clothing may be revealing and an indication of one’s gender. For example, feeling comfortable in swimwear may be an issue for transgender people, especially when they are in the process of transitioning, as the body is often more exposed than in other sportswear (e.g. a football kit) and swimwear is heavily gendered (i.e. swimming trunks are worn by male individuals and swimming costumes by female individuals). In light of this, it would be interesting to explore the experiences of transgender people who have previously participated, or are currently participating, in aquatic activates, gymnastics and/or athletics.

Overall, it appears that the majority of transgender people have a negative experience of competitive sport and sport-related physical activities. Accessibility to sport-related physical activity needs to be improved. Within competitive sport, the athletic advantage transgender athletes are perceived to have appears to have been overinterpreted by many sport organisations around the world, which has had a negative effect on the experiences of this population. When the indirect and ambiguous physiological evidence is dissected, it is only transgender female individuals who are perceived to potentially have an advantage as a result of androgenic hormones. Within the literature, it has been questioned as to whether androgenic hormones should be the only marker of athletic advantage or, indeed, if they are even a useful marker of athletic advantage. Given the established mental and physical health benefits of engaging in physical activity and sport [ 13 , 14 ], the barriers transgender people experience are a significant limitation to the promotion of healthy behaviours in transgender individuals. There are several areas of future research required to significantly improve our knowledge of transgender people’s experiences in sport, inform the development of more inclusive sport policies, and most importantly, enhance the lives of transgender people, both physically and psychosocially.

Acknowledgments

We sincerely thank Prof. Barrie Houlihan for his helpful advice and feedback on an early draft of this systematic review.

Compliance with Ethical Standards

Bethany Jones was supported by a PhD studentship co-funded by Leicestershire Partnership NHS Trust and Loughborough University. No other sources of funding were used to assist in the preparation of this article.

Bethany Jones, Jon Arcelus, Walter Bouman and Emma Haycraft declare that they have no conflicts of interest relevant to the content of this review.

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Opinion article, transgender athletes in sports competitions: how policy measures can be more inclusive and fairer to all.

• 1 Princeton University, Princeton, NJ, United States
• 2 Plastic and Reconstructive Surgery Department, Rush University Medical Center, Chicago, IL, United States

Introduction

Recently, there has been much debate over the inclusion of transgender athletes in elite athletic competitions. Since the transgender population in the United States and worldwide is increasing every year ( Meerwijk and Sevelius, 2017 ) and with it the transgender athletic population, it's important to establish athletic policies that are both inclusive and fair to avoid future conflicts. In this article, environmental and social barriers to transgender athlete participants as well as biological differences related to athletic performance are examined. A review of the current athletic policies and suggestions for potential policy updates are provided. We acknowledge that this is a relatively under-researched field and that there is no clear-cut solution. However, we believe this topic is important and we hope to contribute to the ongoing discussion.

Barriers to Participation

It's important to first address some of the barriers transgender athletes face to participate in sports competitions before examining the current policies behind their participation. A recent study showed that transgender men (TGM) are significantly more likely to participate in team sports than transgender women (TGW) but that this difference is not apparent for individual sports ( López-Cañada et al., 2020 ). Transgender women have previously stated that the primary barrier to their participation is the lack of an environment that is both inclusive and comfortable ( Jones et al., 2017 ), and this could contribute to their decreased participation in team sports. More specifically, TGW perceive their voices to be a contributing barrier in their lack of participation ( Stewart et al., 2020 ). Sports that are strongly gendered create an environment for these athletes that makes them feel anxious that speaking out or cheering for their teammates could result in them not being identified as women ( Stewart et al., 2020 ). Similarly, sports clothing may serve as a barrier to participation because it can be physically revealing. For example, a TGW who has not had bottom surgery might use a “tucking” technique to hide the bulge of the penis and testicles. Sports bras can relatedly impact transgender athletes: TGW might add padding to their bras and TGM might bind their chests. Any of these actions could be uncomfortable to the athlete and/or hinder performance in sports competitions. Additionally, locker rooms and other team spaces are often strongly segregated by gender and transgender athletes may be excluded from areas that match their gender identity. Restricting athletes from such areas, regardless of whether they are allowed to participate, may have the effect of causing athletes feeling separated from their teammates and their gender identity invalidated ( Cunningham et al., 2018 ).

There is certainly an additive effect of the numerous barriers to participation discussed, but one of the most important and in some cases least understood barriers is stigma. Although stigma is not a novel concept, stigma in how it impacts transgender athletes is more of a recent phenomenon. The numerous roles of stigma are often under-recognized ( Hatzenbuehler, 2017 ), and acknowledging it prior to developing new policies could help to combat some of its negative effects. Transgender stigma, in general, limits opportunities and can have extremely negative effects on mental and physical health ( Hughto et al., 2015 ). Stigma acts at numerous levels (e.g., structural, interpersonal, and individual), and adopting interventions to address and combat the negative effects of stigma at all of these levels is an important aspect of developing any new policy ( Hughto et al., 2015 ), especially when this policy aims to include transgender athletes. This is especially significant in developing sports policy that addresses youth athletes, as transgender stigma can be heightened when geared toward transgender youth and adolescence is a critical point to target interventions ( Hatzenbuehler and Pachankis, 2016 ; Hatzenbuehler, 2017 ).

To add to these social and environmental barriers, athletic policy restrictions have also contributed to a decrease in participation of the transgender individuals in competitive sports ( Jones et al., 2017 ). The lack of consensus among the various athletic governing bodies makes it even more difficult to determine the exact policies to include transgender athletes in sports competitions. Acknowledging these barriers to participation is an extra element that should be included in the adoption of new athletic policies regarding transgender athletes.

Biological Differences Related to Athletic Performance

The current debate over including transgender athletes in sports competitions (in their current state) is centered on biological differences, most notably those between transgender and cisgender women. Performance disparities based on “assigned sex at birth” vary across sports—they are known to be the lowest for swimming and highest for track and field events ( Bassett et al., 2020 ). These differences in athletic performance don't appear until after puberty and are thought to be most likely due to increased circulating testosterone levels in the “male” assigned sex at birth athletes when compared to the “female” assigned sex at birth athletes ( Handelsman et al., 2018 ). However, there is a general lack of data showing that higher testosterone levels are correlated with improved athletic performance ( Karkazis, 2019 ).

Despite the lack of evidence, hormone therapies are currently being employed by TGW to suppress their testosterone levels to those more similar to cisgender women to comply with competition regulations. Interestingly, the muscular advantage of TGW over cis-gender women is only minimally reduced after testosterone suppression ( Hilton and Lundberg, 2021 ). This suggests that in certain athletic competitions which rely on muscles mass and explosive strength, TGW will still have a physical advantage even if they are able to lower their testosterone levels to the officially requested threshold. Other hormone therapies have been successful at decreasing hemoglobin levels in TGW after only 4 months, but remain unsuccessful at decreasing strength, lean body mass, and muscle area even if undergone for 36 months ( Harper et al., 2021 ). Although only slight changes are seen in TGW after hormone therapies, this is not the case for TGM. After only 1 year of gender-affirming hormone treatment, TGM were able to significantly increase muscle mass and strength ( Wilk et al., 2020 ). Without a scientific evidence that testosterone levels are mainly responsible for athletic performance discrepancies between transgender and cisgender women, TGW could be undergoing unnecessary treatments. More research is needed to show this link before athletic governing bodies can enforce decreased testosterone policies as a requirement for TGW to attend competitions.

While proposed methods for categorization may be considered as a “commonsense and clear-cut assessment” by many, they have all failed as they were not scientifically driven ( Karkazis, 2019 ). Authorities have used physical examination in 1960's, chromosomal testing in 1970's, and testosterone measurements in 2010's and 2020's for “sex testing” athletes to allow them to participate in competitions ( Karkazis, 2019 ). “Physical examination of genitals,” “chromosomes,” “gonads,” and more recently “hormones” have all been used in “sex testing” and as evidence for categorization in sports through the history albeit without success; mostly due to the fact that they were not scientifically based and only considered “common sense.”

Current Athletic Policies

A fundamental issue regarding the current sports policies on transgender athletes is that the governing bodies of different athletic organizations have very different policies these athletes must follow to be included in sports competitions. In 2019, the International Olympic Committee (IOC) restricted all athletes from competing in the female category unless they lowered their natural testosterone levels below 5 nmol/L ( Harper et al., 2018a ). This level was recently increased in 2021 to 10 nmol/L and the additional requirement of these levels being maintained for at least 12 months prior to competition was added ( Hilton and Lundberg, 2021 ). Unlike the IOC, the National Collegiate Athletic Association (NCAA) has much less explicit guidelines for the inclusion of transgender athletes. They only require that TGW must complete at least one year of hormonal suppressive therapy to participate on a women's team, but do not require natural testosterone levels to be below a specific level ( NCAA Office of Inclusion, 2011 ). The NCAA's policies have not been updated since 2011, suggesting that there could be room for improvement based on new and more updated research.

As touched upon previously, the center of the debate over the inclusion of transgender athletes in sports competitions is the physical advantages that TGW could have. However, the “female” category for sports in general is ambiguous and not established in the same manner universally ( Ingram and Thomas, 2019 ). In order for competitions to remain fair, universal rules need to be created regarding the inclusion or exclusion of transgender athletes. Currently, policies and perceived fairness of inclusion vary immensely at the level of sporting competition ( Tanimoto and Miwa, 2021 ), meaning that there is a large difference in how transgender athletes are perceived at professional and non-professional levels. Setting the standards for their inclusion at the professional level, may result in other levels of sporting competitions (e.g., recreation leagues, high school athletics, sports clubs, etc.) following suit. However, it has also been argued that the aim of athletics at these non-professional levels is mass participation, and therefore more restrictive guidelines should be avoided ( Cunningham et al., 2018 ; Buzuvis, 2019 , 2021 ; Tanimoto and Miwa, 2021 ).

Both the medical and the scientific communities need to provide input to help guide the creation of such rules ( Ingram and Thomas, 2019 ), especially with hormone therapy expansions as well as increased research into the link between testosterone levels and increased athletic performance. While physicians will play an influential role in developing new sports policy, it is important to also acknowledge the roles of sports managers and others who have experience in sport governance and development. Opening conversations among all of these individuals is the first step to ensuring the success and implementation of new policies at all levels of sporting competitions.

Proposed Solutions

Numerous solutions have been proposed to include transgender athletes in sports competitions while being fair to all athletes. Since numerous nations around the world already allow a “third legal gender,” some have proposed extending this idea to elite sports as a separate category for athletes who identify as this gender ( Harper et al., 2018b ). A problem with this idea that it still excludes athletes who don't identify as the third legal gender, leaving some athletes without a category in which they can compete. Others suggest employing an algorithm that includes all athletes and divides them into categories based on both physiological and social parameters ( Anderson et al., 2019 ). This idea is still relatively new, and more research is needed to determine how inclusive this approach is and how effective it would be to enact.

Others suggest reforming sports policies to favor participation based on gender identity and not on biological sex ( Buzuvis, 2019 , 2021 ). This solution argues that in general, U.S. policies are on the side of inclusion and that this can readily extend into athletic policies, especially for youth athletes ( Buzuvis, 2019 , 2021 ). While there are certainly merits to this argument in terms of inclusion, it is difficult to completely ignore the biological arguments discussed previously. Thus, a solution that balances both inclusivity and fairness is the best approach to this problem in particular.

The most important parameters when assessing methods to improve current sports policies are determining how inclusive a policy is to transgender athletes and how fair it is to all athletes involved in competitions. Many suggest adding more categories under which athletes can compete ( Knox et al., 2019 ), upholding inclusivity without compromising fairness. However, it is unclear how many categories would need to be added to accomplish this feat and if athletic organizations can financially support a large number of athletic categories competing under each sport. For this reason, we suggest adding a third category to elite sports similar to that suggested above, but without the legal third gender requirement. This category would be considered “open,” meaning that any athlete can compete regardless of their gender identity. Male and female sports categories would still be included in this idea but adding an “open” category is more inclusive to all athletes who wish to participate. As we believe that gender is a no longer a binary concept, having an open category supports the inclusion of non-binary, transgender, and genderqueer groups of individuals in sports competitions. While this idea has its advantages and disadvantages, we believe that the language used in naming a third category is especially important and the term “open” is more inclusive than previous suggestions.

The population in the United States, similar to the rest of the world, is constantly changing and it's imperative that elite athletics mirrors these changes. This is especially relevant for the community of transgender athletes as they should be included in sports competitions in a fair and inclusive manner. It is clear that more research is needed to determine what advantages transgender athletes, particularly TGW, could have in athletic competitions. This needs to be accomplished prior to making definitive policy statements regarding the inclusion or exclusion of transgender athletes ( Johnston, 2020 ). In the meantime, current policies need to be careful in the language used in order to promote inclusivity.

Author Contributions

AH conceptualized the paper and AR wrote the first edition of the manuscript. AR and AH contributed to the manuscript with their expertise, read, edited, and approved the submitted version. Both authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: transgender athletes, athletics, sports policy, inclusivity, fairness

Citation: Reynolds A and Hamidian Jahromi A (2021) Transgender Athletes in Sports Competitions: How Policy Measures Can Be More Inclusive and Fairer to All. Front. Sports Act. Living 3:704178. doi: 10.3389/fspor.2021.704178

Received: 01 May 2021; Accepted: 22 June 2021; Published: 14 July 2021.

Reviewed by:

Copyright © 2021 Reynolds and Hamidian Jahromi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Alireza Hamidian Jahromi, alirezahamidian@yahoo.com

This article is part of the Research Topic

Highlights in The History, Culture and Sociology of Sports: 2021/22

All the Arguments You Need: To Prove It’s Fair for Trans, Intersex Athletes to Compete in Consistence With Their Gender Identity

Bodies and gender identities aren’t binary, so why are sporting competitions?

Nowhere is the struggle between maintaining the traditional status quo of the gender binary, and moving forward toward greater inclusivity, more pronounced than in competitive sports, due to the differences in male and female physiology. But, there is enough science and data out there to suggest these differences aren’t nearly as stark as we’ve been led to believe — which means any argument against allowing trans and intersex people and people with differences in sex development (DSD) to compete against ciswomen is queerphobic at best. Here are all the arguments you need to fight for greater gender inclusivity in sport.

“Biological males have physical advantages over women such as more stamina, larger bones, and more muscle, so it’s unfair for trans women to compete with ciswomen.”

The science on what women’s bodies can do is flimsy at best. But consider what the female body can do better than a male body: “Women’s bodies have a lower center of gravity and therefore better balance; they tend to be more flexible, and their bodies more efficiently convert calories into energy giving them greater endurance,” Liesl Goeker writes for The Swaddle , while arguing for equal pay in sports. This gives women the upper hand in ultra-endurance running and gymnastics — just as male bodies have the upper hand when it comes to sports such as the shotput and 100m sprint that require speed and brute strength. But zero trans women who are gymnasts are complaining about the advantage cis women have, or saying they want to compete in the men’s category for endurance running or gymnastics — because they just want to participate in the sports category congruent with their gender identity.

Besides, sports isn’t ‘fair.’ It never was. Genetics isn’t either. Many elite athletes are genetically blessed in a way the average person isn’t. Basketball players have the advantage of height, and Michel Phelps’s very peculiar anatomy gives him the upper handin swimming. Privilege isn’t fair either — athletes of color are at a disadvantage when it comes to exposure, opportunities, and resources to even begin pursuing sports competitively, compared to Caucasian athletes. So, what is this “level playing field” argument but a myth spun by those allowed to play and win in the field, to maintain the status quo?

Related on The Swaddle:

New Report Outlines Scale of Homophobia, Transphobia in Sport

“Biological males have the advantage of testosterone that enhances performance so it’s unfair for trans women to compete with ciswomen.”

The science on physiological advantages male athletes have over female athletes is in a nascent stage. It’s important to preface this argument by pointing out that very little research and conversation is around, say, the advantages of estrogen (the hormone responsible for many physical characteristics of a typical female) or prolactin (the breastfeeding hormone) on athletic ability. The obsession is entirely with testosterone (T) — the hormone responsible for many glorified physical characteristics of a typical male — and the absurd question of at what level of testosterone does a female athlete become too good to be a woman.

For every credible study and statement out there that proves greater testosterone is linked to greater athletic ability in men and women, there are equally credible studies that prove testosterone is just one of the many factors that affect sporting ability — sometimes even negatively. Take the International Association for Athletics Federation’s data on elite women athletes. Its initial analysis of two world championships showed that women with higher T levels performed better in only five out of 21 events.

After an independent group of researchers took an issue with the research methodology to reach even this finding, the sports body was forced to issue a correction. In the corrected results, in three of 11 running events, the group with the lowest levels of T did better. Across all events, the association between T and performance was the strongest (and the most surprising) in the 100m sprint: athletes with lower T ran 5.4% faster than those with the highest levels of T. The independent group of researchers who objected to the results earlier concluded it’s “impossible” to discern the real relationship, if any, between T and performance. Clearly, though, neither this study nor the broader sports science literature supports the IAAF’s claim that targeted trans, intersex athletes  “have the same advantages over [other] women as men do over women.”

Then there’s the stuff outside of the binary that science is nowhere close to explaining clearly, like Chand’s and Semenya’s hyperandrogenism (a medical condition where a typical female body produces higher testosterone than usual). Or, as Faryal Mirza, a clinical endocrinologist at the University of Connecticut Medical Center, tells Scientific American , sometimes high T simply means that a person isn’t very efficient at using T: the body is producing more precisely to arrive at “typical” function of someone producing T in the “typical range.”

IAAF’s Caster Semenya Decision Arbitrarily Dictates What Is Female

A review of 31 national and international transgender sporting policies, including those of the International Olympic Committee, the Football Association, Rugby Football Union and the Lawn Tennis Association by researchers at the Scool of Sports Exercise and Health Sciences, Loughborough University concluded : “After considering the very limited and indirect physiological research that has explored athletic advantage in transgender people, we concluded that the majority of these policies were unfairly discriminating against transgender people, especially transgender females” by overinterpreting the “unsubstantiated belief” that testosterone improves athletic performance.

Thousands of trans athletes have been competing at national and international competitions who you just don’t hear about simply because they don’t all win or qualify for the Olympics even with all their apparent unfair advantages. This also proves the non-cisgender athletes who do go ahead and win medals owe their success more to their training, skill, perseverance, resilience, and a host of other reasons apart from their gender or sex, and especially from the myth of testosterone.

“Letting trans and intersex women compete in women’s sports will lead to many male athletes pretending to be women just so they can easily win.”

Yikes. Are we really suggesting there are numerous male athletes who will declare they identify as women, go through exhausting transition processes such as hormone replacement, gather the required medical and psychological proof of their fake gender dysmorphia (prolonged distress caused a mismatch between their biological sex and gender identity), go through their entire lives living under the pretense of being female, all while facing prejudice that trans people face on a daily basis — only for a few gold medals and some cash? Notwithstanding the paranoia (looking at you Martina Navratilova ), this argument is the literal definition of transphobia . This idea — that we should ban all innocent and real trans and intersex women based solely on the fantastic hypothetical of the fraudulent cis man — has roots in an irrational fear of the other (in this case, non-cisgender people) based on prejudice or ignorance.

Laws and rules can always be misused, irrespective of gender. But, we can’t deny people’s rights simply because a few could, in theory, game the system. Look at it this way: are some people falsely framed for murder? Yes. Does that mean we don’t have any rules to punish the crime? Of course not.

This debate doesn’t even have to be esoteric; there is actual data to prove male athletes aren’t queuing up to declare a new gender identity. In 2003, the International Olympic Committee adopted the Stockholm Consensus (SC) allowing the inclusion of trans athletes who had undergone sex reassignment, making it possible for trans athletes to compete in the Olympics from 2004. The IOC modified these guidelines in 2015 to put a cap on testosterone levels for trans womenathletes. And yet, despite the fact that more than 50,000 athletes have participated in the Olympics since 2004, no trans athlete has ever been a part of the Olympics until now, real or fake. So, clearly including trans athletes in sports won’t make the sky fall.

Explaining the Vocabulary of the Gender Spectrum

“If not men’s and women’s sports categories, then how do we organize sports fairly?”

Creating a third, mixed category for trans, non-binary, cis men and women to compete against each other can be an earnest, motivating place to start making sports more inclusive. Mixed-gender sports teams are a widely debated topic and have been for many years, just not in relation to opportunities for transgender people. But, introducing more mixed-gender sports teams would also facilitate accessibility for transgender people. The IOC did well, when in June 2017, it added mixed-sex events in athletics, swimming, table tennis, and triathlon to the upcoming Summer Olympics schedule in Tokyo 2020 , in addition to the traditional categories. This not only allows trans and intersex athletes to compete in the sports category congruent with their gender identity based on their athletic ability alone, Tokyo 2020’s milestone mixed-sex events are a concrete step towards ungendering sports. (It is important here to note this will all be moot unless the IOC allows trans and intersex athletes to compete — in these mixed events at least — without having to meet any criteria other than being a human adult who’s good enough to qualify.)

Another way to organize sports, as suggested by Alison Heather, a physiologist at the University of Otago in New Zealand, and her colleagues in an essay  published in the Journal of Medical Ethics , would be to create a system that uses an algorithm to account for physiological factors such as testosterone, height, and endurance, and social factors like gender identity and socioeconomic status. Sure it’s a Herculean task, but international sports bodies have enough money to at least begin research into the idea if it means a more inclusive world.

Apart from this, sports can also be organized on the basis of other factors such as weight class, professional/amateur status, and size. The idea is that through a mixture of formats, we redesign sports to make them more inclusive.

It’s going to take fresh thinking and self-awareness that what we believe to be facts about sex and gender are not unquestionable. But every individual must have the possibility of practicing sport, without discrimination of any kind, and in the spirit which requires mutual understanding, with a spirit of friendship, solidarity and fair play. Those are not my words, that’s the Olympic charter.

Pallavi Prasad is The Swaddle's Features Editor. When she isn't fighting for gender justice and being righteous, you can find her dabbling in street and sports photography, reading philosophy, drowning in green tea, and procrastinating on doing the dishes.

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June 16, 2021

The debate over transgender athletes' rights is testing the current limits of science and the law

by Claire Breen, The Conversation

The petition presented to parliament last week calling for trans women to be excluded from women's sport is simply the latest round in a difficult and volatile global debate.

Organised by Save Women's Sport Australasia, the petition challenges Sport New Zealand's " draft guiding principles for the participation of transgender players in sport" for failing to consult widely enough.

Despite the draft principles covering community-level sport , not international competition , former Olympians and elite athletes supported the petition in an open letter to Minister for Sport and Recreation Grant Robertson.

The controversy comes not long after New Zealand transgender weightlifter Laurel Hubbard's Pacific Games victory was criticized due to her alleged physical advantage, and not long before the Olympic Games open in late July.

Overall, this polarizing issue is likely to keep dividing people . Consensus looks increasingly difficult to achieve. With both sides claiming discrimination , can existing laws and principles provide a way forward?

Sports participation as a human right

The wider relationship between sports and human rights is complex and often contradictory. No explicit right to participate in sport exists in international law. However, a number of core human rights are relevant:

• the Universal Declaration on Human Rights says everyone has the rights to freedom of association, health, rest and leisure, and to participate in cultural life
• the International Covenant on Civil and Political Rights says everyone has the right to freedom of association; its sister treaty, the International Covenant on Economic, Social and Cultural Rights recognizes the rights to health and cultural life
• the UN Convention on the Rights of the Child identifies the rights to rest, leisure and participation in cultural life, which include participation in sport , as does the Convention on the Rights of Persons with Disabilities
• UNESCO's International Charter of Physical Education and Sport identifies sport as a fundamental right, as does the International Olympic Committee.

Recognizing trangender athletes

As with all human rights, the right to participate in sport is underpinned by the right to be free from discrimination on grounds of sex, gender or other status . That includes gender identity and the right of trans people to be free from discrimination.

This broad principle informs much of the thinking on the issue. The UN Special Rapporteur on the Right to Health , for example, has said the participation of girls and women in sport should not result in the arbitrary exclusion of transgender people.

The rapporteur has also asked for a consensus by all international sporting bodies and national governments, in consultation with transgender organizations, with subsequent policies ideally reflecting international human rights norms.

The UN's Independent Expert on "protection against violence and discrimination based on sexual orientation and gender identity" has highlighted the negative impact of exclusionary practices in sport, and noted the value of inclusive programs.

The UN Convention on the Elimination of All Forms of Discrimination Against Women calls for equality between men and women in sports and includes gender identity among the forms of potential discrimination.

The devil is in the detail

Beyond these areas of broad agreement, however, the issue quickly becomes more complex.

In Aotearoa New Zealand, the Human Rights Act 1993 prohibits discrimination on the grounds of "sex" and "sexual orientation." These prohibitions have been interpreted to encompass the legal right of trans people to be free from discrimination.

However, the act also says it is not discriminatory to exclude people of one sex from participating in any competitive sporting activity in which the strength, stamina or physique of competitors is relevant.

Unfortunately, this is where the arguments run into the limited help offered by science. There is still strong disagreement about whether transgender athletes have a competitive advantage or not.

The limits of science and the law

Research focusing on testosterone levels to justify the exclusion (or inclusion) of trans athletes has been criticized as an inappropriate oversimplification .

Whether testosterone even provides a competitive advantage is disputed, and commentators point to other factors that may be at play.

One study of the available literature concluded that a consensus could not be reached due a lack of data. That finding was itself challenged, but both sides agreed more research was required.

In the meantime, we need to recognize the limits of science and the law when it comes to setting demonstrably balanced guidelines for trans athletes' participation in sport.

Progress will only come through listening to both sides in the short term, but broad support for the required research is also needed in the longer term.

Ultimately it is in everyone's interests that this hugely complex issue is resolved properly. Given it goes to the heart of human identity, the potential benefits are not confined to the sporting world.

Provided by The Conversation

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Arguments that trans athletes have an unfair advantage lack evidence to support

NPR's Scott Detrow speaks with geneticist Dr. Eric Vilain about a spate of laws targeting trans athletes.

SCOTT DETROW, HOST:

Last week saw a flurry of activity in the ongoing debate about transgender athletes competing in school sports.

(SOUNDBITE OF MONTAGE)

UNIDENTIFIED REPORTER #1: Breaking news - transgender athletes will soon be banned from playing in women's sports in Kansas schools.

UNIDENTIFIED REPORTER #2: The Biden administration has proposed a new rule. This plan essentially bars blanket bans of trans athletes, but it leaves wiggle room for schools to place some restrictions at more elite levels.

UNIDENTIFIED REPORTER #3: The U.S. Supreme Court has denied West Virginia's request to let it fully enforce a state law that bans women who are transgender and girls from participating on public school sports teams consistent with their gender identity.

DETROW: The debate is heated, highly politicized, and it's taking place all across the country. According to the ACLU, 19 other states have enacted similar bans over the past three years. They generally state that only those who are assigned biologically female at birth will be allowed to compete on girls' and women's sports teams within the state. In Kansas and elsewhere, supporters say these bans are all about fairness, ensuring an even playing field for girls in particular.

So what does fairness mean really, and what is the extent that it can be measured? What do we know? We decided to ask a doctor to speak with us, an MD PhD who advises sports organizations on the issue of transgender athletes. Dr. Eric Vilain is a pediatrician and geneticist at the University of California, Irvine. Dr. Vilain, thanks for joining us again on ALL THINGS CONSIDERED.

ERIC VILAIN: Always a pleasure to be here.

DETROW: Let's start just a little bit with those headlines. There was that new law in Kansas, then the Biden administration's proposed rule change to Title IX, which would outlaw broad bans against transgender athletes but give schools discretion to ban specific athletes. Do you think that strikes the right balance?

VILAIN: Well, on one hand, not having an indiscriminate ban suggests that the baseline for eligibility for all athletes, including trans athletes, should be inclusion. And I think that's a good thing. And that's actually what the International Olympic Committee has done in creating a framework for inclusion and fairness that's based on the principle of no presumption of advantage. And if a category is going to be excluded, it needs to be based on evidence. The problem here with the exclusion on a case-by-case basis is that it is likely not to be based on evidence. Who's going to undertake all the necessary research to demonstrate a disproportionate advantage, sport by sport, at so many different ages? Who will fund this? Likely not the school systems.

And the other problem is that the proposed rule will likely create a quite inequitable patchwork of inclusion and exclusion throughout the country, with some states or some cities more likely to include and others not. And the same trans athlete may be eligible in one school and, if they move, may not be in another school, which doesn't make much sense. And finally, all the schools that will ban participation will also prevent the collection of any data on trans athletes, which will further even more the inability to make policy supported by data.

DETROW: Is there a way - I mean, if you put the politics out of it, which, at this point, is a naive view and increasingly impossible because it's an incredibly political issue, but is there a balance that could take people and assess them on an individual basis, like you're saying is important, but also be equitable? Because if we're making different policies for specific people and specific places, it feels hard to have a broader policy in place.

VILAIN: The issue is we lack a lot of data, so we, in fact, know very little about advantages of trans girls and women athletes over their cisgender peers. That's true in elite competitions. That's true in school sports. What we know is that boys and men have an advantage in performance over girls and women, and that disadvantage increases after puberty. So the answer of competitive advantage will vary by class level, and the difference will be much smaller, of course, in elementary school, before puberty, than in high school. So it's a complicated debate. Some are making the argument that the difference between boys and girls should translate directly into concluding that there will be the same difference between trans and cisgender girl athletes. But there is no good evidence for this, in part because many cases are going to be different, some having undergone blocking of puberty at different ages.

I'll end by saying that the larger question really goes beyond a simple competitive advantage. It's whether there is a disproportionate competitive advantage between trans and cis athletes. So there are all sorts of advantages coming into play for athletic abilities - their genetic advantages, metabolic differences, physical characteristics, height, for example, and all the socioeconomic access to better nutrition, better coaching, better training equipment. Does all of these differences that provide some advantage are dwarfed by the fact of being trans athlete? We simply don't know.

DETROW: A lot of people say they're worried about inclusion. A lot of other people say they're worried about protecting female athletes. You're an expert in this field. What are you worried about?

VILAIN: I'm worried that outright bans will prevent inclusion. And it's especially worrying at the school level because there are already so much inequity of sports participation that comes from all sorts of other issues, such as socioeconomic status, access to sports, which are not addressed. So adding layers of exclusion is just not helpful.

DETROW: Dr. Eric Vilain is a pediatrician and a geneticist at the University of California, Irvine. Thanks so much for coming on ALL THINGS CONSIDERED.

VILAIN: Thank you.

Copyright © 2023 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Four Myths About Trans Athletes, Debunked

For years state lawmakers have pushed legislation attempting to shut trans people out of public spaces. In 2020, lawmakers zeroed in on sports and introduced 20 bills seeking to ban trans people from participating in athletics. These statewide efforts have been supported through a coordinated campaign led by anti-LGBTQ groups that have long worked to attack our communities.

Before the COVID-19 pandemic shut down most state legislatures, Idaho became the first state to pass a sweeping ban on trans people’s participation in athletics from kindergarten through college. We, along with our partners, immediately sued . Advocates across the country are gearing up to continue the fight against these harmful bills in legislatures when they reconvene. In Connecticut, the ACLU is defending the rights of transgender athletes in a lawsuit brought by cisgender athletes seeking to strike down the state’s inclusive policy.

Though we are fighting every day in the courts and in legislatures, upholding trans rights will take more than judicial and legislative action. It will require rooting out the inaccurate and harmful beliefs underlying these policies. Below, we debunk four myths about trans athletes using the expertise of doctors, academics, and sports psychologists serving as experts in our litigation in Idaho .

FACT: Including trans athletes will benefit everyone.

Myth: the participation of trans athletes hurts cis women..

Many who oppose the inclusion of trans athletes erroneously claim that allowing trans athletes to compete will harm cisgender women. This divide and conquer tactic gets it exactly wrong. Excluding women who are trans hurts all women. It invites gender policing that could subject any woman to invasive tests or accusations of being “too masculine” or “too good” at their sport to be a “real” woman. In Idaho, the ACLU represents two young women, one trans and one cis, both of whom are hurt by the law that was passed targeting trans athletes.

Further, this myth reinforces stereotypes that women are weak and in need of protection. Politicians have used the “protection” trope time and time again, including in 2016 when they tried banning trans people from public restrooms by creating the debunked “bathroom predator” myth. The real motive is never about protection — it’s about excluding trans people from yet another public space. The arena of sports is no different.

On the other hand, including trans athletes will promote values of non-discrimination and inclusion among all student athletes. As longtime coach and sports policy expert Helen Carroll explains, efforts to exclude subsets of girls from sports, “can undermine team unity and also encourage divisiveness by policing who is ‘really’ a girl.” Dr. Mary Fry adds that youth derive the most benefits from athletics when they are exposed to caring environments where teammates are supported by each other and by coaches. Banning some girls from athletics because they are transgender undermines this cohesion and compromises the wide-ranging benefits that youth get from sports.

FACT: Trans athletes do not have an unfair advantage in sports.

Myth: trans athletes’ physiological characteristics provide an unfair advantage over cis athletes..

Women and girls who are trans face discrimination and violence that makes it difficult to even stay in school. According to the U.S. Trans Survey , 22 percent of trans women who were perceived as trans in school were harassed so badly they had to leave school because of it. Another 10 percent were kicked out of school. The idea that women and girls have an advantage because they are trans ignores the actual conditions of their lives.

Trans athletes vary in athletic ability just like cisgender athletes. “One high jumper could be taller and have longer legs than another, but the other could have perfect form, and then do better,” explains Andraya Yearwood , a student track athlete and ACLU client . “One sprinter could have parents who spend so much money on personal training for their child, which in turn, would cause that child to run faster,” she adds. In Connecticut, where cisgender girl runners have tried to block Andraya from participating in the sport she loves, the very same cis girls who have claimed that trans athletes have an “unfair” advantage have consistently performed as well as or better than transgender competitors.

“A person’s genetic make-up and internal and external reproductive anatomy are not useful indicators of athletic performance,”according to Dr. Joshua D. Safer. “For a trans woman athlete who meets NCAA standards , “there is no inherent reason why her physiological characteristics related to athletic performance should be treated differently from the physiological characteristics of a non-transgender woman.”

FACT: Trans girls are girls.

Myth: sex is binary, apparent at birth, and identifiable through singular biological characteristics. .

Girls who are trans are told repeatedly that they are not “real” girls and boys who are trans are told they are not “real” boys. Non-binary people are told that their gender is not real and that they must be either boys or girls. None of these statements are true. Trans people are exactly who we say we are.

There is no one way for women’s bodies to be. Women, including women who are transgender, intersex, or disabled, have a range of different physical characteristics.

“A person’s sex is made up of multiple biological characteristics and they may not all align as typically male or female in a given person,” says Dr. Safer. Further, many people who are not trans can have hormones levels outside of the range considered typical of a cis person of their assigned sex.

When a person does not identify with the sex they were assigned at birth, they must be able to transition socially — and that includes participating in sports consistent with their gender identity. According to Dr. Deanna Adkins, excluding trans athletes can be deeply harmful and disruptive to treatment. “I know from experience with my patients that it can be extremely harmful for a transgender young person to be excluded from the team consistent with their gender identity.”

FACT: Trans people belong on the same teams as other students.

Myth: trans students need separate teams..

Trans people have the same right to play sports as anybody else. “For the past nine years,” explains Carroll , “transgender athletes have been able to compete on teams at NCAA member collegiates and universities consistent with their gender identity like all other student-athletes with no disruption to women’s collegiate sports.”

Excluding trans people from any space or activity is harmful, particularly for trans youth. A trans high school student, for example, may experience detrimental effects to their physical and emotional wellbeing when they are pushed out of affirming spaces and communities. As Lindsay Hecox says, “I just want to run.”

According to Dr. Adkins, “When a school or athletic organization denies transgender students the ability to participate equally in athletics because they are transgender, that condones, reinforces, and affirms the transgender students’ social status as outsiders or misfits who deserve the hostility they experience from peers.”

Believing and perpetuating myths and misconceptions about trans athletes is harmful. Denying trans people the right to participate is discrimination and it doesn’t just hurt trans people, it hurts all of us.

Learn More About the Issues on This Page

• LGBTQ Rights
• LGBTQ Youth
• Trans and Gender-Nonconforming Youth
• Transgender People and Discrimination
• Transgender Rights

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• Explainer: How bans on transgender athletes protect fairness in women’s sports

In recent years, there has been a growing debate surrounding the participation of transgender athletes in girls’ and women’s sports. After a wave of initial support for making such accommodations, the tide is turning. A Gallup poll finds that a larger majority of Americans now (69%) than in 2021 (62%) say transgender athletes should only be allowed to compete on sports teams that conform with their birth gender. Likewise, fewer endorse transgender athletes being able to play on teams that match their current gender identity—26%, down from 34%.

During this same time period, an increasing number of sports associations and states have recognized that bans on transgender athletes are necessary to protect the integrity and fairness of women’s sports. Here is what you should know about the issue.

What are bans on transgender athletes in sports?

Bans on transgender athletes in sports refer to policies that prevent people who identify as transgender from participating in sports that are consistent with their gender identity. The bans are most commonly applied to biological males who identify as transgender (transgender women). Few biological women who identify as transgender (transgender men) have sought access to competitions against male athletes. 

Why are such bans on transgender athletes necessary?

There are four primary reasons such bans are needed. 

To uphold biological reality.

God created male and female as distinct and complementary sexes. Biological differences between males and females are to be honored and cherished rather than used to gain an unfair advantage. By upholding biological reality, we can ensure that women’s sports remain a space for female athletes to compete on equal footing.

To ensure fair competition.

A key reason why such bans are needed is because biological differences between males and females can provide an unfair advantage in certain sports. Male puberty can result in physiological advantages such as increased muscle mass, bone density, and lung capacity, which can impact athletic performance. By allowing biological males to compete in women’s sports, it is argued that the level playing field for women is compromised. Maureen Collins, writing for Alliance Defending Freedom, has highlighted about a dozen examples of how women have been disadvantaged by competing against men.

To protect women’s opportunities.

Girls and women should have equal opportunities to excel in sports without facing unfair competition. Title IX , a federal law in the United States, was designed to ensure equal athletic opportunities for women. Allowing biological males to compete in women’s sports limits the opportunities available to women, as scholarships, records, and other achievements may be dominated by transgender athletes.

To preserve the integrity of women’s sports.

Maintaining separate categories for males and females is essential to preserve the integrity and essence of women’s sports. Women’s sports have historically provided a platform for female athletes to showcase their skills and achievements, and allowing transgender women to compete undermines this tradition.

Bans on transgender athletes in girls and women’s sports are necessary measures to protect the sanctity, fairness, and opportunities of women’s sports. Christians should uphold biological reality, protect women’s opportunities, and preserve the sanctity of women’s sports by supporting such bans.  

Where are such bans on transgender athletes currently in place?

As of August 2023, 23 states in the United States have enacted laws to ban transgender athletes from participating in sports aligned with their gender identity

These bans apply to both K-12 and collegiate level sports teams. The states with bans on transgender athlete participation in college sports include:

Alabama, Arkansas, Arizona, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Missouri, Mississippi, Montana, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, and Wyoming.

The Supreme Court has declined to intervene in enforcing bans on transgender athletes in West Virginia, affirming the constitutionality of such restrictions.

In April, the U.S. House of Representatives approved legislation that would bar transgender women and girls from participating in athletic programs designated for women. The bill has no chance of passing the Democratic-controlled Senate or being signed into law by President Biden. 

However, Biden’s Department of Education proposed a rule change that—while not allowing a blanket ban—would give universities and K-12 schools the discretion to limit the participation of transgender students if they conclude that including transgender athletes could undermine competitive fairness or potentially lead to sports-related injuries.

Which sports organizations ban biological males from competing against girls and women?

In 2022, the Union Cycliste Internationale, the governing body for cycling, announced a testosterone limit of 2.5 nmol/L for biologically male cyclists who want to compete with women.

Around that same time, FINA, the governing body for swimming, barred biological males from competing in women’s events .

World Rugby also has a complete ban on biological males competing in international women’s rugby “because of the size, force- and power-producing advantages conferred by testosterone during puberty and adolescence, and the resultant player welfare risks this creates.”

Earlier this year, World Athletics (WA), the governing body for track and field and other running competitions, implemented a policy that biological males who went through male puberty can no longer compete in women’s events at international competitions. WA also ruled that to compete as a woman, athletes with differences of sexual development (DSD), who have congenital conditions that cause atypical sex development, must have a testosterone level below 2.5 nanomoles per liter (nmol/L) for at least 24 months before an international competition.

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Sign up for your free reminder for bringing hope to an election year, article 12: the future of ai.

We affirm that AI will continue to be developed in ways that we cannot currently imagine or understand, including AI that will far surpass many human abilities. God alone has the power to create life, and no future advancements in AI will usurp Him as the Creator of life. The church has a unique role in proclaiming human dignity for all and calling for the humane use of AI in all aspects of society.

We deny that AI will make us more or less human, or that AI will ever obtain a coequal level of worth, dignity, or value to image-bearers. Future advancements in AI will not ultimately fulfill our longings for a perfect world. While we are not able to comprehend or know the future, we do not fear what is to come because we know that God is omniscient and that nothing we create will be able to thwart His redemptive plan for creation or to supplant humanity as His image-bearers.

Genesis 1; Isaiah 42:8; Romans 1:20-21; 5:2; Ephesians 1:4-6; 2 Timothy 1:7-9; Revelation 5:9-10

Article 11: Public Policy

We affirm that the fundamental purposes of government are to protect human beings from harm, punish those who do evil, uphold civil liberties, and to commend those who do good. The public has a role in shaping and crafting policies concerning the use of AI in society, and these decisions should not be left to those who develop these technologies or to governments to set norms.

We deny that AI should be used by governments, corporations, or any entity to infringe upon God-given human rights. AI, even in a highly advanced state, should never be delegated the governing authority that has been granted by an all-sovereign God to human beings alone. 

Romans 13:1-7; Acts 10:35; 1 Peter 2:13-14

Article 10: War

We affirm that the use of AI in warfare should be governed by love of neighbor and the principles of just war. The use of AI may mitigate the loss of human life, provide greater protection of non-combatants, and inform better policymaking. Any lethal action conducted or substantially enabled by AI must employ 5 human oversight or review. All defense-related AI applications, such as underlying data and decision-making processes, must be subject to continual review by legitimate authorities. When these systems are deployed, human agents bear full moral responsibility for any actions taken by the system.

We deny that human agency or moral culpability in war can be delegated to AI. No nation or group has the right to use AI to carry out genocide, terrorism, torture, or other war crimes.

Genesis 4:10; Isaiah 1:16-17; Psalm 37:28; Matthew 5:44; 22:37-39; Romans 13:4

Article 9: Security

We affirm that AI has legitimate applications in policing, intelligence, surveillance, investigation, and other uses supporting the government’s responsibility to respect human rights, to protect and preserve human life, and to pursue justice in a flourishing society.

We deny that AI should be employed for safety and security applications in ways that seek to dehumanize, depersonalize, or harm our fellow human beings. We condemn the use of AI to suppress free expression or other basic human rights granted by God to all human beings.

Romans 13:1-7; 1 Peter 2:13-14

Article 8: Data & Privacy

We affirm that privacy and personal property are intertwined individual rights and choices that should not be violated by governments, corporations, nation-states, and other groups, even in the pursuit of the common good. While God knows all things, it is neither wise nor obligatory to have every detail of one’s life open to society.

We deny the manipulative and coercive uses of data and AI in ways that are inconsistent with the love of God and love of neighbor. Data collection practices should conform to ethical guidelines that uphold the dignity of all people. We further deny that consent, even informed consent, although requisite, is the only necessary ethical standard for the collection, manipulation, or exploitation of personal data—individually or in the aggregate. AI should not be employed in ways that distort truth through the use of generative applications. Data should not be mishandled, misused, or abused for sinful purposes to reinforce bias, strengthen the powerful, or demean the weak.

Exodus 20:15, Psalm 147:5; Isaiah 40:13-14; Matthew 10:16 Galatians 6:2; Hebrews 4:12-13; 1 John 1:7 

Article 7: Work

We affirm that work is part of God’s plan for human beings participating in the cultivation and stewardship of creation. The divine pattern is one of labor and rest in healthy proportion to each other. Our view of work should not be confined to commercial activity; it must also include the many ways that human beings serve each other through their efforts. AI can be used in ways that aid our work or allow us to make fuller use of our gifts. The church has a Spirit-empowered responsibility to help care for those who lose jobs and to encourage individuals, communities, employers, and governments to find ways to invest in the development of human beings and continue making vocational contributions to our lives together.

We deny that human worth and dignity is reducible to an individual’s economic contributions to society alone. Humanity should not use AI and other technological innovations as a reason to move toward lives of pure leisure even if greater social wealth creates such possibilities.

Genesis 1:27; 2:5; 2:15; Isaiah 65:21-24; Romans 12:6-8; Ephesians 4:11-16

Article 6: Sexuality

We affirm the goodness of God’s design for human sexuality which prescribes the sexual union to be an exclusive relationship between a man and a woman in the lifelong covenant of marriage.

We deny that the pursuit of sexual pleasure is a justification for the development or use of AI, and we condemn the objectification of humans that results from employing AI for sexual purposes. AI should not intrude upon or substitute for the biblical expression of sexuality between a husband and wife according to God’s design for human marriage.

Genesis 1:26-29; 2:18-25; Matthew 5:27-30; 1 Thess 4:3-4

Article 5: Bias

We affirm that, as a tool created by humans, AI will be inherently subject to bias and that these biases must be accounted for, minimized, or removed through continual human oversight and discretion. AI should be designed and used in such ways that treat all human beings as having equal worth and dignity. AI should be utilized as a tool to identify and eliminate bias inherent in human decision-making.

We deny that AI should be designed or used in ways that violate the fundamental principle of human dignity for all people. Neither should AI be used in ways that reinforce or further any ideology or agenda, seeking to subjugate human autonomy under the power of the state.

Micah 6:8; John 13:34; Galatians 3:28-29; 5:13-14; Philippians 2:3-4; Romans 12:10

Article 4: Medicine

We affirm that AI-related advances in medical technologies are expressions of God’s common grace through and for people created in His image and that these advances will increase our capacity to provide enhanced medical diagnostics and therapeutic interventions as we seek to care for all people. These advances should be guided by basic principles of medical ethics, including beneficence, non-maleficence, autonomy, and justice, which are all consistent with the biblical principle of loving our neighbor.

We deny that death and disease—effects of the Fall—can ultimately be eradicated apart from Jesus Christ. Utilitarian applications regarding healthcare distribution should not override the dignity of human life. Fur- 3 thermore, we reject the materialist and consequentialist worldview that understands medical applications of AI as a means of improving, changing, or completing human beings.

Matthew 5:45; John 11:25-26; 1 Corinthians 15:55-57; Galatians 6:2; Philippians 2:4

Article 3: Relationship of AI & Humanity

We affirm the use of AI to inform and aid human reasoning and moral decision-making because it is a tool that excels at processing data and making determinations, which often mimics or exceeds human ability. While AI excels in data-based computation, technology is incapable of possessing the capacity for moral agency or responsibility.

We deny that humans can or should cede our moral accountability or responsibilities to any form of AI that will ever be created. Only humanity will be judged by God on the basis of our actions and that of the tools we create. While technology can be created with a moral use in view, it is not a moral agent. Humans alone bear the responsibility for moral decision making.

Romans 2:6-8; Galatians 5:19-21; 2 Peter 1:5-8; 1 John 2:1

Article 2: AI as Technology

We affirm that the development of AI is a demonstration of the unique creative abilities of human beings. When AI is employed in accordance with God’s moral will, it is an example of man’s obedience to the divine command to steward creation and to honor Him. We believe in innovation for the glory of God, the sake of human flourishing, and the love of neighbor. While we acknowledge the reality of the Fall and its consequences on human nature and human innovation, technology can be used in society to uphold human dignity. As a part of our God-given creative nature, human beings should develop and harness technology in ways that lead to greater flourishing and the alleviation of human suffering.

We deny that the use of AI is morally neutral. It is not worthy of man’s hope, worship, or love. Since the Lord Jesus alone can atone for sin and reconcile humanity to its Creator, technology such as AI cannot fulfill humanity’s ultimate needs. We further deny the goodness and benefit of any application of AI that devalues or degrades the dignity and worth of another human being. 

Genesis 2:25; Exodus 20:3; 31:1-11; Proverbs 16:4; Matthew 22:37-40; Romans 3:23

Article 1: Image of God

We affirm that God created each human being in His image with intrinsic and equal worth, dignity, and moral agency, distinct from all creation, and that humanity’s creativity is intended to reflect God’s creative pattern.

We deny that any part of creation, including any form of technology, should ever be used to usurp or subvert the dominion and stewardship which has been entrusted solely to humanity by God; nor should technology be assigned a level of human identity, worth, dignity, or moral agency.

Genesis 1:26-28; 5:1-2; Isaiah 43:6-7; Jeremiah 1:5; John 13:34; Colossians 1:16; 3:10; Ephesians 4:24

As a pediatrician, I know Blakeman's transgender sports ban puts vulnerable kids at risk

Nassau County Executive Bruce Blakeman, surrounded by supporters, announces Thnursday a ban on transgender girls competing in Nassau County athletic facilities. Credit: Rick Kopstein

Nassau County Executive Bruce Blakeman recently issued an order that bans teams with transgender girls from using any county sports facility. Blakeman felt this was necessary even though he said he had not heard of specific examples of transgender girls attempting to compete in women's sports in Nassau. This politically motivated act put political expediency ahead of the lives and well being of some of his most vulnerable constituents.

As pediatricians, we support our transgender patients in the challenges they face. Our patients are struggling through a mental health crisis. About half of transgender youth have considered suicide in the past year as they struggle to fit in. Those who are bullied are three times more likely to attempt suicide. Participation in extracurricular activities and living in accepting communities reduce this risk. In addition, regular exercise and participation in sports reduce anxiety and depression. Blakeman’s order effectively eliminates that positive outlet for transgender girls who stand to benefit greatly from the camaraderie, acceptance, and physical activity that come with being on a team.

The order is cloaked in the intent to protect women’s rights in sports. Proponents claim that having transgender girls on teams gives them an unfair advantage and poses a risk to other players.

As a former hockey and soccer mom, I know how hard female athletes work to achieve their goals and to seek scholarships. I also remember fearing injuries as I watched my daughter get checked on the ice or tackled as a soccer keeper.

It’s important, however, to understand a few factual points here. The number of highly competitive transgender athletes is so exceedingly small it makes much of the discussion surrounding the executive order almost theoretical.

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There are approximately 300,000 transgender youth aged 13-17 in the U.S. Less than half identify as female. An estimated 12% of transgender youth choose to participate in sports compared to 68% of their counterparts. As with all youth athletes, only a very small percentage will advance to competitive levels.

Transgender grade school youth or those who initiate puberty blockers before or at puberty have no physical advantage over their peers. For those who have gone through puberty before transitioning, success in sports depends on many factors including tenacity, determination and time devoted to acquiring and perfecting skills.

In the rare instances of high-level competition, sports governing boards should be the ones to weigh in should concerns arise, rather than uninformed politicians.

As a result of Blakeman's order, transgender girls will be further stigmatized and undoubtedly become the target of hateful rhetoric or actions that will place their mental health and physical safety in peril. This is why the American Academy of Pediatrics has joined with all other major health, child welfare and education organizations to oppose legislation that bans transgender youth from participating in sports.

If we truly care about public health and seek ways to allow all our youth to be successful and thrive, would we not strive to teach our children to be welcoming and inclusive? Rather than finding ways to further exclude and stigmatize already struggling and isolated youth, should we not work to create an atmosphere where more of our transgender youth feel comfortable participating in sports with all the benefits that would provide? Instead, the Nassau County executive has chosen to unnecessarily and carelessly put children’s lives at risk, children who will suffer in silence.

This guest essay reflects the views of Dr. Eve Meltzer Krief, a pediatrician from Centerport and legislative advocacy co-chair of the New York American Academy of Pediatrics Chapter 2.

This guest essay reflects the views of Dr. Eve Meltzer Krief, a pediatrician from Centerport who is legislative advocacy co-chair of the New York American Academy of Pediatrics Chapter 2.

Wisconsin governor vetoes transgender high school athletics ban

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Wisconsin Gov. Tony Evers vetoed a bill Tuesday that was passed by the Republican-controlled Legislature to ban high school transgender athletes from competing on teams that align with their gender identity.

Evers had promised to veto the bill ever since it was introduced. Democrats did not have the votes to stop its passage in the Legislature. He vetoed it in the Capitol surrounded by Democratic lawmakers, transgender advocates, the mayor of Madison and others.

Republicans don’t have the votes needed to override the veto.

Evers said in his veto message that this type of legislation “harms LGBTQ Wisconsinites’ and kids’ mental health, emboldens anti-LGBTQ harassment, bullying, and violence, and threatens the safety and dignity of LGBTQ Wisconsinites, especially our LGBTQ kids.”

Evers vowed that as long as he is governor, he will not allow for “radical policies targeting LGBTQ individuals and families and threatening LGBTQ folks’ everyday lives and their ability to be safe, valued, supported, and welcome being who they are.”

Republican Rep. Barb Dittrich, who sponsored the bill, called Evers’ veto “disgusting” and accused him of “misogynistic and hateful position towards actual females.”

“His veto today clearly demonstrates his disrespect for women and girls as well as for protecting their hard-fought achievements,” Dittrich said in a statement.

The bill proposed to limit high school athletes to playing on teams that match the gender they were assigned at birth.

Republicans who backed the bill argued it was a matter of fairness for non-transgender athletes. But bill opponents argued there was no real issue with transgender high school athletes in Wisconsin and said the proposed ban was a form of discrimination and harmful to transgender youth.

The Wisconsin Interscholastic Athletic Association requires transgender athletes to undergo hormone therapy before they can play on the teams of their choice. The association’s policy is modeled after NCAA requirements for transgender athletes.

At least 20 states have approved a version of a blanket ban on transgender athletes playing on K-12 and collegiate sports teams statewide, but a Biden administration proposal to forbid such outright bans is set to be finalized this year after multiple delays and much pushback. As proposed, the rule would establish that blanket bans would violate Title IX , the landmark gender-equity legislation enacted in 1972.

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More than 70 per cent of British elite sportswomen against competing with transgender athletes

T op British sportswomen are overwhelmingly opposed to competing against transgender women but are afraid to say so publicly, the largest survey of its kind has found.

The BBC Elite British Sportswomen’s Study revealed that 104 female athletes were “uncomfortable” or “very uncomfortable” with trans women competing against them, 96 of whom felt the same about speaking out on the subject.

Of the 143 respondents, only 11 were comfortable or very comfortable competing against trans women, 21 were neutral, five did not wish to respond and two did not provide an answer.

The responses will increase pressure on sports bodies to ban trans women from female competitions, many of which have done so in the past four years, while some – such as the Football Association and England & Wales Cricket Board – continue to be slow to act.

Athletes taking part in the BBC survey did so anonymously but were also given an opportunity to provide contact details for further inquiries.

Those who did so included Olympians and Paralympians.

According to the BBC, many of those who responded cited concerns around protecting women’s sport, while others referred to the potential physical advantages transgender women retain from going through male puberty.

“Putting them in women’s sport is literally like going back in time and putting women at the bottom of the pile again and having to rebuild women back up again,” an athlete said.

Other comments included: 

• “It makes it too much of an unfair playing field, regardless of what sport you are competing in.”
•  “We are in a position of just trying to get that momentum and just trying to get female sport on a level playing field with the men, and almost now feel that there’s decisions being made... and we’re being marginalised again.”  
• “I think allowing transgender athletes to compete in women’s sport would be the end. It would be like going back in time.”

Questions about trans women in sport were part of a wider survey sent to 615 athletes, including any applicable transgender athletes, in 28 sports.

The study also found almost 40 per cent of respondents had been trolled on social media, with more than half of those receiving abuse of a sexual nature, while a third of those taking part had considered giving up sport because of the cost of living crisis, with more than three-quarters earning less than £30,000 a year from being an elite athlete.

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Transgender athletes face growing hostility: four tell their stories in their own words

USA TODAY’S “In Their Own Words” is a video project that interviewed four transgender athletes who told their own stories about living in an America that is increasingly hostile to gender diverse people. We’re using a video format so you can hear from the athletes directly.

This project is needed now more than ever. Increasing numbers of states are attempting to prohibit transgender athletes from participating on teams that align with their gender identities.

One of the main goals of supporters of these bills, the trans athletes interviewed for this project say, is to both demonize and spread misinformation about the trans community. They’ve identified sports as a vehicle to attack trans people, the athletes said.

These athletes tell a different story. It is a story of hope, self-expression, and sports competition. It’s their story…told in their own words.

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Name-Calling and Calling the Police: How N.Y.C. Parent Meetings Got Mean

In school districts across the city, families are fighting over transgender athletes and how race and discrimination are taught in the classroom.

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By Troy Closson

New York City has never been immune to heated education fights, but in recent months they have taken on a new level of vitriol and aggression, and expanded to a broader menu of divisive issues.

The battles reflect the nation’s growing political divide even in this deep blue city, as parents layer old debates — how issues of race and discrimination are taught in schools, for example — over newer ones, such as the role of transgender students in sports and how schools should address the Israel-Hamas war.

Parents have shouted over each other, called each other bigots and made formal complaints about behavior at meetings traditionally focused on issues like school improvements and student achievement . Some parents have filed police reports against each other for harassment. One woman said she was mailed a parcel with feces inside.

The battlegrounds have also multiplied, from a few notoriously quarrelsome parent councils to traditionally peaceful spots around the city.

In other districts around the country, changes in school board policy can transform what happens in classrooms. In New York City, the parent councils where many of the fights are occurring — and which represent the public school system’s 32 districts — have little power, because the mayor controls the schools.

But the new battles — about issues that don’t always break cleanly along party lines — have created a challenge for an administration trying to manage what is perhaps the nation’s most diverse school district.

The city’s schools chancellor, David C. Banks, has previously shown a willingness to listen to families’ worries over the direction of the system, including its handling of desegregation at elite schools. But the tenor of the new debates has families demanding that officials do more to intervene.

As the fighting continues, Mr. Banks suggested last week that city education leaders would soon have more to say about “the nonsense we’ve seen.”

“It is the thing that in this role as chancellor I find most disappointing,” he said. “Adults behaving badly.”

Perhaps nowhere are tensions more evident than in District 2, a sprawling and diverse section of the system weaving through the heart of Manhattan — from the West Village and Hell’s Kitchen to the Upper East Side.

The district’s parent meetings have always been contentious, but families there had mainly sparred over efforts to loosen admissions at selective schools. Recently, though, they have argued over books with more diverse story lines and whether to disavow the right-wing advocacy group Moms for Liberty, among other issues.

And last month, parents there passed a proposal asking the city’s Department of Education to review its gender guidelines, which currently allow students to participate on sports teams based on their gender identities, regardless of the sex they were assigned at birth.

The effort was led in part by Maud Maron, one especially vocal parent leader whose rhetoric has come under fire from school officials. At a remarkably tense March meeting, held in person and online, she and other parents said that the current policies presented “challenges to youth athletes and coaches,” and that they failed to consider the “well-being of girls.”

During the meeting, parents attending remotely argued over whether their children would be unsafe if transgender athletes joined girls’ teams. Several elected officials called the discussion “disgraceful.” Mr. Banks later asked, “Won’t you just leave the kids alone?”

The proposal, a nonbinding recommendation to officials, ultimately passed in an 8-3 vote. In a post on X , Moms for Liberty called the vote “a huge step for NYC!” This year the organization held its first major local event , which some District 2 parent leaders attended as panelists, and the group now has a small chapter in Queens.

It is unclear how much the parent council represents broader views within District 2. The council’s members recently won their spots with several hundred votes, and the district has more than 24,000 eligible voters.

Still, Mark Levine, the Manhattan borough president and a progressive Democrat, said “the MAGA movement has come to Manhattan.”

Other neighborhoods are also becoming battlefronts.

In District 14 — which includes Williamsburg, Brooklyn — some parent leaders have vocally called for a cease-fire in Gaza, and say they have faced threats for their stances. At the same time, other parents filed a federal lawsuit last week over the council’s policies, arguing that those who “dissent from official orthodoxy” face unfair scrutiny from school officials.

Even students have joined the battles at times. At the city’s most prestigious high school, teenagers launched a campaign to expel Ms. Maron from their school leadership team for “deeply hurtful” rhetoric toward minority groups on social media.

The safety of the “most vulnerable students is at stake,” they wrote. Ms. Maron did not return a request for comment.

The conflicts are arising after some parents formally organized in recent years over their anger at a proposal to overhaul admissions at the city’s specialized high schools. When moderate or conservative parents feel like their concerns are not being heard in more progressive places, experts said, the messages of a group like Moms for Liberty can resonate.

Rebecca Jacobsen, an education policy professor at Michigan State University, said that the increasingly charged environments could reflect a lasting change. “It is not going back to the way it was,” she said, referring to the national landscape.

Others who study political fights in education pointed to school closures during the coronavirus pandemic. “They galvanized a certain kind of conservatism in New York City which we hadn’t seen in a while,” said Natalia Mehlman Petrzela, an associate professor of history at the New School.

Now, she added, “it’s taken hold in other issues.”

In recent months, Mr. Banks, the schools chancellor, has begun to criticize parents for their behavior more often.

But the fighting has prompted questions over how far officials should go. The president of the city’s teachers’ union, Michael Mulgrew, wants them to do more. He said in a recent letter that some parent leaders had used their platforms to “denigrate and endanger students,” raising concerns that children could suffer.

Still, Kenita Lloyd, a top school official overseeing family engagement, said at a press briefing last week that removing elected parent leaders could set a “dangerous precedent.”

But some parents remain disappointed. “The adults in the room at the Department of Education really need to step in,” said Gavin Healy, a parent leader in District 2.

In New York, several recent chancellors have encouraged schools to expand the type of teaching — on issues like identity and discrimination — that some other cities have restricted. That too appears to be drawing fresh dissent in at least one neighborhood.

The news site Gothamist reported last month that books on topics like Native American history and the Black Panther superhero were found in the trash at a Staten Island elementary school. Some were labeled with notes, including “Not approved. Discusses dad being transgender. Teenage girls having a crush on another girl in class.”

At the recent unveiling of new lessons on the African diaspora, Mr. Banks said that the teaching of Black history was “under attack all across America.” He said that students would be exposed to diverse stories “whether folks like it or not.”

As the State Legislature considers whether to renew mayoral control of the city’s public schools, the abstract parent fights could have more resonance. Some want state lawmakers to give elected school boards power to make real policy.

Brad Hoylman-Sigal, a Democratic state senator who represents much of Manhattan’s West Side, said “we need to be mindful of how” both school boards and parent councils “can be hijacked.”

Still, experts note that voter turnout — which sits at around 2 percent in parent council elections — would likely rise if the stakes were higher.

Whatever lawmakers decide, John Rogers, a U.C.L.A. professor who has studied education fights, said national political conflict over school issues was likely to grow in the lead-up to the presidential election.

“I think it’s only going to be heightened in the months to come,” he said.

Troy Closson reports on K-12 schools in New York City for The Times. More about Troy Closson

Our Coverage of the Israel-Hamas War

News and Analysis

A deadly Israeli strike  on an aid convoy run by World Central Kitchen  in Gaza is already setting back attempts  to address a hunger crisis in the territory, with aid agencies saying they are being more cautious and at least two suspending operations.

​​The Biden administration is pressing Congress to approve a plan to  sell $18 billion worth of F-15 fighter jets to Israel , as President Biden resists calls to limit U.S. arms sales to Israel over its military offensive in Gaza.

The Israeli police clashed with antigovernment protesters  outside Prime Minister Benjamin Netanyahu’s home in Jerusalem, on the third day of demonstrations  calling for early elections.

Internal Roil at TikTok: TikTok has been dogged for months by accusations that its app has shown a disproportionate amount of pro-Palestinian and antisemitic content to users. Some of the same tensions  have also played out inside the company.

Palestinian Detainees: Israel has imprisoned more than 9,000 Palestinians suspected of militant activity . Rights groups say that some have been abused or held without charges.

A Hostage’s Account: Amit Soussana, an Israeli lawyer, is the first former hostage to speak publicly about being sexually assaulted  during captivity in Gaza.

A Power Vacuum: Since the start of the war, Prime Minister Benjamin Netanyahu of Israel has done little to address the power vacuum that would appear after Israeli forces leave Gaza. The risks of inaction are already apparent in Gaza City .