Regular physical activity is essential for the health and well-being of children, adolescents, and adults. Participation in physical activity during childhood and adolescence has a positive impact on physical health throughout the life span. Moderate to vigorous aerobic exercise has been demonstrated to improve metabolic health in adolescents and to contribute to improved bone mineral density (BMD) during a period of critical growth. Exercise impacts mental health, leading to a decrease in depressive symptoms, with team sports participation specifically associated with lower rates of loneliness and social anxiety, effects that are more pronounced for those at greater psychologic risk. 1 Adolescence is a period of rapid social development and athletic participation can offer an important opportunity for developing social connections. The emotional, social, and physical benefits of exercise and sports participation are indisputable: physical activity during childhood and adolescence has lifelong positive impacts on both physical and mental health.Transgender and gender-diverse youth (TGD) are particularly vulnerable to mental and physical comorbidities that are mitigated by physical activity. Thus, the benefits of exercise may be particularly significant for TGD youth. The past year has seen widespread legislative efforts to exclude TGD youth from organized sports, even though organized sports represent one of the most important opportunities for youth to engage in regular physical activity. Nine states have passed legislation banning TGD youth from participating in athletic teams concordant with their gender, and more bills are currently under consideration. 2 Notably, collegiate and professional athletic associations have not supported banning transgender athletes from participation in sports. In fact, the recent Olympic games featured several transgender athletes. Restricting sports participation threatens to worsen physical activity engagement among TGD youth, who already have lower rates of exercise than their cisgender peers. 3 Fear of discrimination and violence are major barriers to physical activity participation for TGD individuals. Gender-segregated spaces, such as bathrooms, locker rooms, and sports teams are frequently cited by TGD individuals as feeling unsafe, with more than half reporting avoiding these spaces. 4 Forcing TGD youth to use spaces discordant with their gender exacerbates perceptions of difference and will lead to further avoidance of physical activity for these children and adolescents. The health impact of such bans is likely to be significant. Specifically, these bans could have substantial impacts on the cardiovascular health, bone health, mental health, and cognitive development of TGD youth.Restricting sports participation threatens to worsen existing risk factors for poor cardiovascular outcomes in
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