The Medical Implications of Banning Transgender Youth From Sport Participation

Abstract

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

Perspectives of US Youths on Participation of Transgender Individuals in Competitive Sports

“…26 Transgender youths are also disproportionately affected by obesity, 27 , 28 which has also been increasing over the past decades, especially among adolescents. 29 Physical activity is an important tool to improve health 30 and may be particularly important for transgender youths 31 , 32 to support their metabolic health, improve bone mineral density, and reduce feelings of loneliness and anxiety. The youths in our study recognized that increasing inclusion and participation of transgender youths could improve both mental and physical health outcomes.…”

Sex Differences in Athletic Performance: Perspectives on Transgender Athletes

“…There are also several other factors that may limit transgender individuals from participating in sports, which may impact physical and/or mental health (116). At baseline before any hormonal interventions, transgender individuals are more likely to be overweight or obese (117,118) and have lower bone mineral density than their cisgender counterparts (89,(119)(120)(121).…”

Position statement: IOC framework on fairness, inclusion and non-discrimination on the basis of gender identity and sex variations

“…13 15 16 Those who do find ways to participate in sport can face harassment, violence and even sexual assault. 17 In recognition of both the values embedded in the Olympic Charter and the enormous potential of sport-from the grassroots to the elite level-to support the health, well-being and social integration of trans people and people with sex variations, [18][19][20][21] the Framework asks that IFs consider the important role of inclusion when developing their policy approach in this area.…”