Experts: Bills targeting trans people get the science wrong

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Politics and ideology, not facts, drive claim that transgender women have an unfair athletic advantage

When Republican lawmakers filed a bill last month to bar transgender women from competing against other women at schools and universities in North Carolina, LGBTQ advocates called it part of a new national wave of anti-transgender bills.

Scientists and doctors who study and treat transgender athletes are calling it anti-science.

North Carolina’s House Bill 358, like bills in more than 30 states pushed by the conservative Christian group Alliance Defending Freedom, is predicated on the premise that transgender women are simply men pretending to be women.

“From what I’ve seen in patients I work with, it doesn’t make sense,” said Dr. Deanna Adkins.

Adkins is a pediatric endocrinologist who helped establish Duke Child and Adolescent Gender Care at Duke University Hospital in 2015; she is one of the state’s most sought-after experts on gender transition. She has been working with transgender patients, primarily under the age of 21, since 2012, and has treated more than 425 people in gender transition.

Dr. Deanna Adkins

A number of assumptions in the bill about transgender youth and sports are wrong, Adkins said, because they begin from a fundamental misunderstanding of who transgender people are, how and when they transition, and how that impacts their biology. 

To make the case for the sports superiority of men and transgender women even after transition, HB 358 cites studies of transgender people that rely on data from more than two decades ago, when the understanding and science of gender transition was very different. 

Those studies also cite data on the effects of testosterone in adult elite athletes and subjects ranging from 18 to 37, far outside the range of most of the student athletes who would be affected by the bill.

Today, many transgender young people elect to begin a course of hormone blocking treatment that forestalls puberty, Adkins said. This eases their gender transition by preventing the development of many of the secondary sex characteristics associated with the gender they were assigned at birth — including things such as height, muscle development and bone density — that are often cited as advantages in sports.

Not all transgender people choose to have that treatment, hormone therapy or gender confirmation surgery. But the wave of new legislation fails to take into account many of the modern scientific realities of transition, Adkins said.

Most of the concern in sports is over testosterone, which is often cited as helping to build muscle more quickly and carry oxygen more efficiently in the blood.

“When we talk about muscle development, if you lower the testosterone level to normal female level, you can’t build muscle anymore like you could when that testosterone was there,” Adkins said. “It really only takes a year or at most two, probably less time, for all of that advantage to disappear.”

This is an area in which transgender women regularly face greater scrutiny in sports. Many cisgender women, or women assigned female at birth, can have naturally occurring high levels of testosterone. But if they are designated female on their birth certificates, this isn’t generally taken into account or cited as an unfair competitive advantage.

Adkins said she has seen patients who are also athletes, and whose athletic performance has decreased as a result of their transitioning. But whatever the impact of their treatment, most are simply eager to follow the guidelines that allow them to compete on teams that match their gender identity.

“They don’t complain,” Adkins said. “They just want to play.”

Similarly, Adkins said, concerns about height and reach advantages are misplaced. The average height difference between men and women is about 5 inches. Transgender women tend to lose somewhere in the neighborhood of 2 to 2 1/2 inches in height through transition, Adkins said.

“But the concern about height doesn’t make much sense anyway,” Adkins said. “There are tall women who may have a height advantage over smaller women in sports. But no one says they can’t compete with one another. There is such a diversity of size and height among women in general.”

WNBA player Margo Dydek was 7’2’’ in her competitive prime, taller than most male NBA players. Current WNBA star Brittney Griner is 6’9’’ and renowned for her ability to dunk better than many men. Both women are cisgender, or designated female at birth.

Nor does bone density give transgender women a competitive edge. “There’s actually a lot of data that shows that transgender women have low bone density,” Adkins said. “We have to monitor to make sure their bone density stays at a good level as they get older.”

The only inherent advantage those assigned male at birth might have is in growth plates, Adkins said — areas of new bone growth. “When you’re born your growth plates have a certain lifespan of when they’re going to close,” Adkins said. “But even that does change when you go through puberty. Like all of these things, you can alter that according to your gender identity, to match it to your identity’s puberty rather than your endogenous puberty.”

The scientific consensus has led major sports organizations like the North Carolina High School Athletic Association, the National Intramural-Recreational Sports Association, the NCAA and the International Olympic Committee Medical Commission to draw up their own guidelines allowing transgender athletes to compete alongside the gender with which they identify. Most of those policies involve proof of transition treatment, including any hormone therapy and accounting for testosterone levels.

The International Olympic Committee has allowed transgender athletes to compete at the highest level of international athletic competition since 2003. The NCAA has had a policy on inclusion of transgender athletes since 2011. In 2019, World Athletics — the international body governing sports competitions like track and field and cross country running — revised its policy to become even more inclusive.

None of those organizations use the standard set forth in the House Bill 358 (“reproductive biology and genetics at birth”). That standard had, until the recent wave of new legislation, been widely abandoned since U.S. and international courts began ruling against its use in the late 1970s in favor of more scientifically sound policies.

Renée Richards, the openly transgender professional tennis player who successfully sued to compete in the U.S. Open in 1977, is a key historical example of the problem with oversimplifying the competitive advantage transgender women are supposed to have. 

Richards transitioned after 40, having already reaped all of the lauded physical advantages of male puberty. But after winning the right to compete and enduring protests that her inherent biological advantages would give her insurmountable advantages, Richards and her doubles partner Betty-Ann Stuart were defeated by two cisgender women, Martina Navratilova and Betty Stove.

Richards would go on to oppose transgender women competing in women’s sports unless, like her, they had gender confirmation surgery — an opinion that reflects a persistent controversy even within the transgender community.

But reality has continued to dog the persistent conservative narrative of transgender women as inherently superior ever since Richards’s legal win and athletic loss.

Though the Olympics has had ever evolving trans-inclusive participation policies for nearly two decades, no openly transgender athlete has yet to even qualify. No transgender athletes now dominate professional or collegiate sports leagues with transgender inclusion policies, in the U.S. or internationally.

In February, the families of a group of high school girls in Connecticut filed a lawsuit over their daughters having to compete against what they argued were inherently superior transgender young women in high school track competition. Two days later, one of the cisgender young women won the state championship against one of the transgender athletes named in the lawsuit.

“A solution in search of a problem”

Without support from the mainstream scientific community or examples of transgender women actually dominating women’s sports, what is driving the new wave of legislation targeting them?

“It is a solution in search of a problem,” said Dr. Rebecca Kreitzer, assistant professor of Public Policy at UNC-Chapel Hill. “It’s a political push not founded in medical science or need. But it’s one we’ve seen before.”

Dr. Rebecca Kreitzer

Kreitzer’s work concentrates on gender and sexuality in politics. She said the current push against transgender athletes is part of the same cycle in conservative politics that produced HB2 in North Carolina five years ago, leading to boycotts of the state and billions in lost revenue.

“A number of these bills have been written by the Alliance Defending Freedom, which also helped craft HB2,” Kreitzer said. “There are a lot of similarities between in the push for ‘bathroom bills’ a few years ago and the push for these sports bills now.”

Once HB2 passed in North Carolina, a number of large companies and athletic organizations pulled out of the state, Kreitzer said. Other states took note and the push for such bills essentially died.

Now, as Republicans face a federal government helmed by Democrats who support transgender rights, Kreitzer said Republicans are betting a new version of the same argument can serve as a wedge issue in the mid-term elections.

“This is a more narrow take on it, but it essentially gets down to the same thing — this fear of transgender women, this idea that they are in some way harming women who are not transgender women,” Kreitzer said. “And Stephen Miller, the former advisor to President Trump, said in his speech at CPAC that this is an issue that is going to help Republicans win in 2022.”

(In addition to HB 358, North Carolina Republican lawmakers this week introduced a separate bill which states that gender transition is impossible, and transgender young people will simply grow out of gender dysphoria over time.)

That’s a position that defies decades of research, mainstream medical consensus and federal law. The bill, which would outlaw medical transition for people under 21, is similar to the one passed in Arkansas this week over the veto of Republican Governor Asa Hutchinson.)

Identifying and scapegoating a group as a threat to an established way of life is a very old political play, Kreitzer said. As Republicans lost both the legal and the cultural argument over preventing same-sex marriage, their focus gradually shifted to an even more marginalized group that may seem more exotic and threatening to its base: transgender people.

“There are a lot of people who have never met a transgender person, or who don’t know that they know a transgender person,” Kreitzer said. “That is changing, especially among younger people. But right now they are betting that this is an argument that is going to rally people, even if they are unable to point to examples of this being a real problem or a real threat.”

Using transgender rights as a political wedge issue is particularly harmful to transgender youth, who studies show are at a much greater risk than their peers for discrimination and violence and report suicidal thoughts at a much larger rate.

“The truth is that transgender youth deserve the same access as any other student to the many benefits of participating in school sports, including the physical, social, and emotional impacts,” said Allison Scott, Director of Impact & Innovation at the Campaign for Southern Equality.

Allison Scott

Scott, who is transgender, said trans youth have experienced this cycle of targeting in election cycles for years. Bills further singling them out and cutting them off from opportunities to be part of their community are irresponsible and dangerous, she said.

“To categorically deny transgender students the freedom to play alongside their peers is at odds with lawmakers’ duties to care for and protect our youth,” Scott said. “To all of the transgender youth feeling attacked by this bill and others like it nationwide, I want to be sure you understand that you are loved, you are seen, and we are fighting with you.”

Dr. Adkins said she has seen the difference something like youth sports can make for her own transgender patients in both mental and physical health.

“Our goal is to have healthy young people,” Adkins said. “And sport is all about that. If we are going to make people compete according to their assigned sex at birth, there will be many fewer people who take up sports and adopt those things.”

“We don’t need another thing to discourage any child from playing sports or doing physical activity,” Adkins said. “I think it’s a huge disservice to our kids.”

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