For young people who come through the doors of our clinics and operating rooms, sports from dancing to wrestling offer opportunities to get the physical benefits of exercise, develop the social skills involved in teamwork and competition, and strive for goals that may have once seemed unattainable. Experiences like these can have positive benefits that last a lifetime. But now legislators across the country are trying to take that opportunity away from some of these youth because they are transgender.
Lawmakers in 27 states, including Pennsylvania, introduced bills to ban transgender children from sports participation. Some of these proposed laws even go as far as requiring unnecessary and invasive physical exams for children who identify as or may be transgender. These bills represent an unjustifiable overreach of the state into the lives of children. If enforced, these intrusions would have negative consequences for all children, but it is clear that they would be devastating for children who are transgender, nonbinary, or questioning their gender identity — including children who have already come out to their friends or family, and those who have not.
Transgender children who identify their gender as different from the sex they were assigned at birth are at risk for many poor health outcomes. They are more likely to struggle with both mental and physical health challenges like depression, anxiety, eating disorders, and HIV. Most upsetting of all is that research indicates that more than 40% of transgender adults who have not received support for their identity report having attempted suicide in their lifetime. These poor outcomes are not due to a young person’s gender identity, but rather to the discrimination, shame, and stigma they face from their schools, families, and communities. We’ve seen this firsthand as clinicians.
The single most protective factor in any young person’s life is whether they have a connection to at least one caring and competent adult who affirms who they are. Ideally, parents play this role. When they do, other caring adults including coaches, teachers, and physicians can provide added protection. When parents do not fulfill this role — a circumstance that is a reality for transgender youth more often than their peers — these other caring adults move to center stage and a young person’s connection to them becomes essential.
And so for transgender kids, opportunities to play sports can offer the same benefits that they offer other kids — but with a greater chance that these opportunities will literally offer a lifeline. The positive benefits of sport and recreation programs are clear. Participation can promote physical health and skill development, while also helping young people cultivate resilience, learn to balance multiple responsibilities, and work (sometimes competitively) toward meaningful goals with both intention and integrity. That was the experience of Matthew Dawkins, a Marlton teen who moved with his school and community’s support from the female to male track teams after he came out as trans. Dawkins continues to rely on supportive care at CHOP and remains an athlete and public advocate for the trans community.
Sports programs like Students Run Philly Style help young people — 19% of whom identify as LGBTQ — to train in safe, developmentally appropriate and supported ways for laudable athletic goals, like running the Broad Street Run or the Philadelphia Marathon, while centering the pursuit of these goals around lifelong values.
Students Run Philly Style explicitly names those values: courage, effort, and respect. This year SRPS launched the OUTpace mentoring and support program for LGBTQ youth and they are a critical partner in bringing back the Philadelphia Distance Run with a nonbinary gender category. Such programs welcome students without exclusion based on gender, gender identity, sexual orientation, or even athletic skill. The success of such organizations — and more important, the individual successes and happiness of their student-athletes — provides strong evidence that all young people benefit from participating in sport and recreation programs that are inclusive and fundamentally pro-youth.
In fact, in a recent evaluation of SRPS led by Dr. Renjilian and colleagues, we learned that all youth are poised to benefit from participation in a mentored running program — demonstrating increased levels of grit (a marker of resilience) and reduced levels of depression and anxiety.
Recent analysis of soon-to-be-published data also suggest that LGBTQ+ youth and youth who have experienced higher levels of adversity — who often arrive with higher levels of anxiety and depression at the start — may experience the greatest benefits. By the end of a single season with Students Run Philly Style, their levels of depression and anxiety decline to look more like their peers. These changes didn’t come from an intervention specifically tailored for “at-risk’' youth — they happened organically in a mentored after-school sports program that simply aims to be inclusive.
Just like cisgender children, not all transgender youth will enjoy or seek out the same sports. For this reason, it is critical to ensure that transgender youth have opportunities to participate in the full, broad array of sport and recreation opportunities available to other children.
The vast majority of transgender youth do not desire to become elite-level athletes. They just want the chance to play.
The authors of bills to deny trans youth these opportunities say they want to protect other children and, particularly, prevent transgender girls from having what they say is an unfair advantage over other girls. But these claims are based on misunderstandings of biology and hormones, have not been backed by any concrete examples of unfair athlete advantage, and are irrelevant to K-12 school sports. Like cisgender children, the vast majority of transgender youth do not desire to become elite-level athletes. They just want the chance to play.
For kids, sports can be a refuge as well as a source of joy and strength that just might save their life. In addition to organizations like the American Academy of Pediatrics, the NCAA has opposed such discriminatory policies and announced that they will not hold events in states with such legislation in place. Not only could this harmful legislation prevent transgender children from playing sports, but it also sends the message that they are somehow less deserving than others to fully participate in life and have the same rights.
In Pennsylvania, our governor is clear in his support of transgender kids and that state representatives’ proposed bill will never be signed into law. But trans kids and their families should not have to endure the hate, stress, and bullying that will arise as a result of this legislation even being introduced. Instead, we should be focusing on providing all kids, and especially trans kids, more opportunities — not fewer — to play sports in a healthy and supportive environment.
Nadia Dowshen is the codirector of the Gender and Sexuality Development Program and faculty member at PolicyLab at Children’s Hospital of Philadelphia. Chris Renjilian is an adolescent medicine and sports medicine specialist at Children’s Hospital of Philadelphia. Alfred Atanda Jr. is a pediatric sports orthopedic surgeon at the duPont Hospital for Children.