As a physician who cares for hundreds of patients who identify as trans or intersex, I am deeply disturbed by the recent flurry of bills and laws that would prevent school sports participation for transgender youth. On March 30, Montana’s Senate advanced such a bill that now awaits passage in the House. Restrictive laws have already been signed by the governors in Idaho, Mississippi and most recently Arkansas. In fact, more than 25 states have proposed such bills to restrict youth from participating in sports by their gender identity, and some aim to restrict health care for trans youth as well.
It appears that state legislatures and school boards are trying to oversimplify biological sex into male or female, as if they were two discrete categories. In fact, science supports that human anatomy, as well as gender identity, are on spectrums. The process of sex differentiation is unbelievably complex and involves the interaction of dozens of genes, enzymes, hormones and cell receptors.
Not surprisingly, there is a very wide spectrum of anatomy and hormone levels, with most people appearing masculine or feminine enough that no one questions their sex assigned at birth. As least 1 in 200 people have an intersex condition. Although some babies are identified with ambiguous genitalia at birth, many people are not diagnosed until later in life, either when a child has a hernia, a teen doesn’t start their period or an adult is infertile.
I have had patients figure this out only when they sent their DNA to be tested by 23andMe. If I, an experienced physician, cannot tell by physical exam whether someone has “male or female” hormones, genes or gonads, how could I expect to know by looking at someone what their gender identity “should” be? The best way for me to understand their gender identity is to listen to what they tell me.
Parents, it is highly likely that a kid with an intersex condition has been on your child’s sports team. There was likely nothing about them that would have made you suspect it. Their participation on your team was not unfair to their teammates or opponents.
People who identify as trans or intersex are not born with gold medals in their hands. They, like other adolescents, may or may not excel at sports. Some are practicing hard, playing year-round on travel teams, and hoping to start on their high school teams. Some are warming the benches and cheering on their teammates. All of them want to be included, respected and accepted for who they are.
We as a nation have the opportunity to appreciate the spectrum of human biology and gender identity. We have the opportunity to embrace each person on this planet as unique and valuable. We have the opportunity to promote inclusion and to practice true sportsmanship. We have an obligation to promote the physical and mental health of all children, especially the most vulnerable. I hope state legislatures and school boards will listen to the science and take the opportunity to do the right thing.
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