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Expert: Transgender Athlete Bills Get Science Wrong

Paul Steinbach

Scientists and doctors who study and treat transgender athletes have characterized as unscientific the wave of legislation aimed at keeping trans girls out of girls' sports.

As reported by NC Policy Watch, 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 Deanna Adkins, a pediatric endocrinologist who helped establish Duke Child and Adolescent Gender Care at Duke University Hospital in 2015. Atkins, who has been working with transgender individuals primarily under the age of 21 since 2012, is one of the state’s most sought-after experts on gender transition, having treated more than 425 people in gender transition.

Bills focused on transgender youth and sports begin from a fundamental misunderstanding of who transgender people are, how and when they transition, and how that impacts their biology, according to Atkins. HB 358, for one, 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, NC Policy Watch reported.

Today, many transgender young people elect to begin a course of hormone blocking treatment that forestalls puberty, Adkins told NC Policy Watch's Joe Killian. 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.

“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 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.

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, according to Atkins. “But the concern about height doesn’t make much sense anyway,” she 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.”

Bone density does not give transgender women a competitive edge either. “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.”

According to NC Policy Watch's report, the only inherent advantage those assigned male at birth might have is in growth plates — 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, NIRSA, 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. As NC Policy Watch reported, most of those policies involve proof of transition treatment, including any hormone therapy and accounting for testosterone levels.

The IOC has allowed transgender athletes to compete at the highest level of international athletic competition since 2003, and the NCAA forged a transgender-inclusive policy in 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”), according to NC Policy Watch. 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.

NC Policy Watch cites additional experts on this topic. To read Joe Killian's entire article, click here.

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