We are physicians, public health professionals, scientists, educators, former elite athletes, women, mothers and transgender and pediatric health care providers who are writing in very strong opposition to renewed attempt to exclude transgender children from sports, which is on the agenda for the upcoming meeting of the Utah Legislature’s Health and Human Services Interim Committee meeting.
Rep. Kera Birkeland, R-Morgan, has proposed that bringing this topic to the interim committee can help to make all voices on this issue heard and to adequately discuss the complexity of this issue. We want to provide science and evidence that has been missing or misrepresented in this debate during the last legislative session.
The prior bill purported to “preserve sports for female students” by explicitly excluding 6 to 18-year-old children, who are assigned male at birth but identify as girls (transgender girls — not men, as was incorrectly stated time and time again on the House floor), from participating in all sports in Utah. Unfortunately, as there are currently no known issues of transgender girls participating in school sports at this time, this type of legislation attempts to solve a non-problem, while simultaneously creating a very real problem with real consequences and likely harm to an already vulnerable population.
Most children have developed their gender identity, the internal sense of being male, female, a little of both, or not quite either, by the time they are 4 to 5 years old. This may be consistent or not with the sex that they were assigned at birth. When these do not align, it is referred to as being transgender or gender nonbinary. About 1 in every 100 to 150 people identify as trans or gender nonbinary. Transgender and nonbinary people are at a higher risk for discrimination, abuse, harm, depression, poverty and suicide attempts, especially when they are not included and affirmed.
Evidence has shown that providing affirming care to children, which means using their preferred name and pronouns, referring to them as the gender they identify with, allowing them to wear clothing and hairstyles that align with their sense of self and, once they have reached an appropriate age, allowing for some medical interventions helps reduce their rates of mental illness and improves their quality of life. Significantly, affirming transgender children reduces their risk for suicide to that of the general population.
In Utah, our suicide rate is already too high, especially among children; in 2019 suicide was the leading cause of death for Utahns ages 10-17 and 18-24 and from 2016-2019 more than 170 children between the ages 10-18 took their own lives. Providing an affirming environment for transgender children is lifesaving. This includes participation in sports.
Participating in sports benefits everyone. Children who participate in sports are more confident, have higher self-esteem, are healthier, engage in fewer risk-taking behaviors, like smoking or substance use, and have improved school performance and graduation rates. Sports are also an opportunity to develop important communication, teamwork and sportsmanship skills, as well as grit and resilience. All children should have access to this, regardless of their gender identity or pronouns.
The 47 National Governing Bodies of Sports in the United States have overwhelmingly said that children should participate in sports, due to all of the benefits mentioned above, and they should play on teams based on their gender identity. Physiologically, little kids are really not that different from each other. Once children begin puberty, we recognize that there are potential differences in things like strength and lung capacity, but these differences vary across all youth. Children receiving gender affirming medical care, like puberty delaying medications, are likely at no physiological advantage at all compared to their peers of any gender.
Also, any possible advantage varies by sport, for example track and field is very different than girls’ gymnastics, which is very different than horseback riding, volleyball, curling and bowling. The previously introduced legislation treats all ages and sports the same and punishes anyone trying to provide a space for transgender girls to participate. Specific recommendations for eligibility should be determined at the sport, not the state, level.
During this interim committee meeting, we implore the members to think about how they can protect and improve girls and women’s athletics. This could include protecting our children from predatory adults, providing equal funding and facilities for girls and women and enforcing title IX provisions. We ask them, at the same time, to not harm transgender children by denying them access to lifechanging and lifesaving activities, attempting to solve a problem that does not currently exist, and failing to recognize current scientific evidence.
A complicated issue like this should be addressed at the sport level and we should follow the lead of the NCAA, International Olympic Committee and the National Governing Bodies of Sport. We encourage our state legislators and Gov. Spencer Cox to protect trans children. Allow trans girls the same opportunity to participate in sports and reap the lifetime of benefits of this participate that we, the below signed, were also afforded by title IX. We can work together to improve the health and lives of all Utah children.
Joanne Rolls, master of physician assistant studies, master of education in the health professions, physician assistant-certified; Nicole Mihalopoulos, M.D., master of public health; Jennifer Plumb, M.D., MPH; Johanna Greenberg, MPAS, PA-C; Erika A. Sullivan, M.D., M.S. All practice at the University of Utah, and Mihalopoulos and Plumb also practice at Primary Children’s Hospital. Views expressed here do not necessary reflect those of those medical centers.