The fight for the future of transgender athletes

A group of influential women’s sports advocates say their proposals are about fairness. But LGBT activists say their plans would endanger transgender rights — and transgender lives.

(Jarred Briggs for The Washington Post)

The women timed their announcement carefully, holding it the day before National Girls and Women in Sports Day, created three decades ago to promote female athletes.

Among them were trailblazers: Donna de Varona, the Olympic swimmer who lobbied for Title IX’s passage in 1972; Donna Lopiano, the former chief executive of the Women’s Sports Foundation; and Nancy Hogshead-Makar, Olympic swimmer and law professor who wrote a book on Title IX.

Before that day in early February, they were universally respected as pioneers in the long fight for women’s equality in sports. Then they unveiled their project: changing the way transgender girls and women participate in women’s sports. Almost immediately, their proposal drew bitter criticism in the fraught debate over transgender rights.

For starters, they said, they planned to lobby for federal legislation requiring transgender girls and women, in high school sports and above, to suppress testosterone for at least one year before competing against other girls and women, making universal a policy already in place in some states and some higher levels of sports. For transgender girls in high school who do not suppress testosterone, they suggested “accommodations,” such as separate races, podiums or teams.

They called themselves the Women’s Sports Policy Working Group.

“To give girls and women an equal opportunity to participate in sports, they need their own team. Why? Because of the biological differences between males and females,” said Hogshead-Makar, CEO of Champion Women, a women’s sports advocacy organization.

They portrayed their proposals as a science-based compromise between two extremes: right-wing politicians seeking wholesale bans of transgender athletes and transgender activists who argue for full inclusion — and who even dispute what some view as settled science about the relationship between testosterone and athleticism. They quickly drew fierce backlash, illustrating how the issue of transgender athletes has become the most vexing, emotionally charged debate in global sports and why it may prove impossible for schools and sports organizations to craft policies that are both fair to all female athletes and fully inclusive of transgender girls and women.

Transgender and women’s equality activists denounced their proposals as transphobic and accused the women of having a myopic focus on sports at a critical time for the transgender equality movement — as the Biden administration fights to expand federal anti-discrimination protections for transgender people and as conservative lawmakers push bills in more than 20 states seeking to ban transgender athletes and criminalize gender-affirming hormone therapy for transgender youth.

Critics also pointed to members of the working group with reputations of engaging in anti-trans rhetoric, including Martina Navratilova, the tennis champion whose commentary on transgender athletes has stoked outrage, and a Duke law professor whose work calling transgender girls and women “biological males” is cited in anti-transgender legislation.

Inside the world of sports — where careers are built on split-second wins and governed by rules that measure testosterone by the nanomole — these women’s proposals have gained some surprising voices of support. They have drawn endorsements from the first openly transgender Division I cross-country runner in NCAA history as well as a leading transgender scientist researching the effects of hormone therapy on athleticism. With enduring credibility in the sports world and on Capitol Hill, they have begun meeting with state and federal lawmakers grappling with this issue.

But even advocates who view their proposed policies as sensible for collegiate and professional athletes wonder whether these women have truly grappled with the impact their policies would have on the lives of hundreds, perhaps thousands of transgender girls across the country.

“The folks who are pushing these anti-trans bills … they don’t believe transgender people exist. They think they’re faking it for an advantage in sports,” said Cathryn Oakley, state legislative director at the Human Rights Campaign. “I don’t know how you find a middle ground between a hate group and people pushing for equality.”

A patchwork of policies

Before 2010, few college or high school athletic associations had policies on transgender athletes, according to a report published that year by the Women’s Sports Foundation and the National Center for Lesbian Rights.

Noting that “an increasing number of high school and college-aged young people are identifying as transgender,” the report proposed a set of policies: In college sports, transgender women should undergo one year of hormone therapy before competing against other women, a rule rooted in scientific research that suggested such an approach would mitigate any athletic benefits. The NCAA quickly adopted the policy.

For high schools, the report recommended letting transgender girls compete in sports as soon as they transition socially and begin dressing and acting in accordance with their gender identity. Requiring hormone therapy for adolescents is potentially harmful, experts said in interviews, because not all transgender teens have supportive families or access to gender clinics. Ones who do may not want to undergo hormone therapy, which for transgender girls typically involves puberty blockers that pause developmental changes followed by a combination of testosterone suppressors and estrogen.

According to information compiled by and the ACLU, 10 states let transgender girls compete in high school sports after undergoing some treatment. Twelve states prohibit them entirely, including four that passed new laws and executive orders this year. Nine states have no policies at all. And 19 states, as well as the District of Columbia, let them compete regardless of testosterone level.

For the past decade, this policy patchwork has developed largely without controversy. Transgender youth are a very small minority of the U.S. population — 1.8 percent of high school students, according to a 2019 CDC report — and the number of those transgender girls likely to play sports and compete at an elite level is even smaller.

But then, a few years ago, a transgender runner took the Connecticut track scene by storm, catching the attention of politicians, pundits and advocates — including Lopiano, a Connecticut resident and Title IX champion.

Running on the boys’ team as a ninth-grader in suburban Hartford, Terry Miller was an average track athlete, online records show, failing to qualify for any postseason events. But in 2018, Miller came out as a transgender girl. In her first season running against other girls, as a sophomore, Miller dominated. She won five state championships and two titles at the New England championships, beating the fastest girls from six states.

The next fall, as a junior, Miller won another four state titles and two more all-New England titles. In several races, she was followed closely by Andraya Yearwood, another transgender girl who had also won three state titles.

In interviews, Miller and her supporters discussed how important track was for her confidence and stability as she transitioned.

“Track helps me forget about everything, and I love it,” Miller said in a 2019 story on DyeStat, a website that covers high school track and field. (Miller and her parents declined an interview request for this story.)

Support for Miller, however, was not unanimous. Girls who lost to her and their coaches complained that she had an unfair advantage. Parents of other girls started online petitions demanding state high school officials add a testosterone suppression requirement for transgender girls.

I’m not saying transgender girls are going to take over women’s sports. I’m saying that the law protects girls and women, and they shouldn’t have to compete against someone who has an immutable testosterone-based advantage.
— Donna Lopiano, Title IX advocate

A lawyer representing a few mothers contacted Lopiano and asked for help. Believing Connecticut’s policy violated Title IX, Lopiano met with state officials and attempted to broker a compromise that would allow the results of transgender runners not to affect the results of cisgender girls.

Title IX doesn’t define what it means to be a girl or a woman. But Lopiano argues Congress intended to restrict female sports to girls and women who haven’t gone through male puberty, when testosterone in boys surges to between four and 10 times the levels found in girls and women.

She points to the 1975 testimony of Bernice Sandler, an activist known as “the godmother of Title IX,” who told Congress that, because of physical advantages men acquire during puberty, any effort to integrate sports between the sexes “would effectively eliminate opportunities for women.”

“I’m not saying transgender girls are going to take over women’s sports,” Lopiano said. “I’m saying that the law protects girls and women and they shouldn’t have to compete against someone who has an immutable testosterone-based advantage.”

Lopiano’s compromise never materialized. The mothers decided instead to work with the Alliance Defending Freedom, an Arizona-based conservative Christian advocacy organization that supports anti-trans lawsuits and legislation across the country. The Alliance helped three girls who lost races to Miller and Yearwood sue Connecticut high school authorities, arguing their policy on transgender athletes violated Title IX. The case is pending in U.S. District Court in Connecticut.

The ACLU has intervened on behalf of the transgender runners. In an interview, Chase Strangio, deputy director for transgender justice at the ACLU, said courts already have found Title IX protections apply to transgender girls and women in cases involving access to women’s restrooms. He views restrictions on transgender athletes in high school, such as hormone requirements, as discriminatory and probably a violation of the law.

Miller did not begin suppressing testosterone until her junior year, Strangio acknowledged, but Yearwood was on hormone therapy throughout high school. Regardless, Strangio emphasized that his clients didn’t win every race they competed in and they quit the sport after high school.

“Their careers were sabotaged by the rhetoric and the attacks on them,” Strangio said.

In early 2019, Lopiano began meeting regularly with de Varona and Hogshead-Makar to discuss what they believe are looming collisions between the transgender equality movement and Title IX. To them, the Connecticut controversy illustrated what they view as the two extreme positions between which they are trying to navigate.

The Alliance Defending Freedom argues that transgender girls and women always have physiological advantages in sports, even if they have suppressed testosterone. Their advocacy has inspired a wave of legislation across the country targeting transgender athletes since 2019.

“You can’t change a person’s biological sex,” said Christiana Holcomb, an Alliance lawyer working on the Connecticut case. “Nothing can undo the physiological advantages that come from being born biologically male.”

Strangio and the ACLU dispute whether transgender girls and women have advantages in sports, even if they’re not suppressing testosterone. Other prominent transgender activists, making this same argument, have called for the NCAA to remove its testosterone suppression requirement.

“The truth is, transgender women and girls have been competing in sports at all levels for years, and there is no research supporting the claim that they maintain a competitive advantage,” a 2019 ACLU article noted.

“Athleticism is complex,” Strangio said. Referring to Lopiano and her colleagues, he added, “I’m not a scientist, and neither are any of them.”

A growing research field

Benjamin Levine, a professor of cardiology at the University of Texas Southwestern Medical Center, is one of the world’s leading experts on the science of athletic performance. The founder and director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, one of the largest institutes of its kind in the world, Levine has published hundreds of peer-reviewed papers and consulted for the NCAA, the NFL, World Athletics and NASA.

In an interview, Levine said he understands why this topic stirs intense emotions. But, he said, there is no debate over whether post-pubescent transgender teenage girls and women have advantages in sports until they suppress testosterone.

Regardless of gender identity, Levine said, people who go through puberty with male levels of testosterone, on average, will grow taller and stronger than cisgender girls and women, with more muscle mass, larger hearts and advantages in several other physiological factors that affect athleticism. Puberty in boys typically begins by 12 and ends by 18.

“This is why, for every single record that you see in athletic competitions, boys and girls before puberty are about the same, and then everything diverges afterward,” said Levine, whose scientific research is cited by the women’s policy group.

Transgender advocates dismiss Levine’s research as irrelevant because he studies cisgender athletes. But several small-scale studies have found transgender women do have physiological advantages until they suppress their testosterone for at least one year.

The first was published in 2004 by Louis Gooren, a Dutch endocrinologist and founder of the Center of Expertise on Gender Dysphoria in Amsterdam, one of the largest transgender health clinics in the world. “Testosterone exposure has profound effects on muscle mass and strength,” wrote Gooren, who reported that as he gave more testosterone to 19 transgender men, they saw marked increases in muscle growth, as well as hemoglobin and insulinlike growth factor levels, both relevant in athletic performance. As he suppressed testosterone in 17 transgender women, the opposite occurred: Their muscles shrank, and their hemoglobin and IGF levels dropped.

Gooren’s findings were essentially replicated in November by a study published in the British Journal of Sports Medicine examining how 29 transgender men and 46 transgender women in the Air Force performed on routine fitness tests — push-ups, sit-ups and a 1½-mile run — as they transitioned hormonally.

After a year of treatment, transgender men were performing better and the transgender women worse. The transgender women were still running slightly faster than cisgender women, however, so the authors concluded elite sports organizations might need to lengthen testosterone suppression requirements beyond one year. In interviews, two of the study’s authors cautioned against drawing conclusions about high school athletes because their research subjects were all 18 or older.

Other recent research has been conducted by a transgender athlete herself: Joanna Harper, a medical physicist and runner. In 2015, Harper published an analysis of what happened to her and seven other transgender women runners as they transitioned hormonally. Seven of the eight women, including Harper, saw their times slow considerably.

After that, Harper left her job in Portland, Ore., and moved to England to research the effects of hormone treatment on transgender athletes at Loughborough University.

In February, she published a systematic review of 24 studies of the effects of hormone treatment on transgender women. Harper found some athletic benefits — such as higher hemoglobin levels, vital in endurance sports — dissipated after only four months of suppressing testosterone. But other advantages, such as increased muscle area and strength, remained even after 36 months.

Harper has consulted for the International Olympic Committee, World Athletics and other elite sports organizations, where she advocates for allowing transgender girls and women to compete after one year of hormone therapy. She also has signed on as a public supporter of the women’s policy group.

In a recent interview, Harper said she has been called both “the destroyer of women’s sport” and “a traitor to transgender people.”

“My agenda is to pull people toward the middle,” Harper said. “The science leads me there.”

My agenda is to pull people toward the middle. The science leads me there.
— Joanna Harper, transgender athlete and researcher

When asked for experts to support his belief that it’s unclear whether transgender girls and women have competitive advantages in sports, the ACLU’s Strangio mentioned two people: Katrina Karkazis and Joshua Safer.

Karkazis is a cultural anthropologist and bioethicist. She has not conducted original research on testosterone and athleticism, but she has written extensively on the subject, including the book, “Testosterone: An Unauthorized Biography.”

In an interview, Karkazis emphasized many complexities in scientific research of testosterone and athleticism — testosterone alone doesn’t build a better athlete, researchers have found — but did not dispute that transgender girls and women who do not suppress testosterone have advantages in sports.

“Yes, on average … there will be performance differences that will be better,” she said when pressed on this point. “Whether that’s an advantage or not … I actually think that’s a normative statement that involves a value judgment about what is advantaged.”

Safer is an endocrinologist and the director of a transgender health clinic who has served as an expert witness for the ACLU. In court filings, Safer has acknowledged transgender girls and women with higher levels of testosterone will have advantages in sports. But, he has noted, these advantages are less pronounced in high school.

“Testosterone begins to affect athletic performance at the start of puberty, and those effects increase each year until about age 18,” Safer wrote in a statement challenging a law barring transgender athletes in Idaho. “As a result, testosterone provides less of an impact for a 14-, 15- or 16-year-old than it does for a 17- or 18-year-old.”

In an interview, Safer emphasized that, despite the advantages conferred by testosterone, the list of known examples of transgender girls and women succeeding in sports, at any level, is vanishingly short.

There has never been an openly transgender athlete in the Olympics; the first three, all women, could compete this summer in Tokyo. There has been one openly transgender woman champion in the history of NCAA: CeCe Telfer, a Franklin Pierce University runner who won the Division II 400-meter hurdles in 2019. On the high school level, there are just Miller and Yearwood in Connecticut.

Said Safer, “The important thing to consider here, as it relates to high school sports and teenagers, is are we addressing a problem that actually exists, or are we simply addressing a fear?”

‘Sports does discriminate’

At their opening news conference, Lopiano spoke first and stressed that the group’s proposals represented “respectful inclusion” of transgender athletes.

“These are our kids. And we have to take care of all of them,” she said.

A few minutes later, the women turned the news conference over to one of their lesser-known colleagues: Doriane Lambelet Coleman, a Duke law professor and former elite runner who, in the late 1970s, was one of the first women to receive a track scholarship to Villanova University.

Over the past few years, Coleman has published law review articles and essays defending the preservation of girls’ and women’s sports for athletes with female levels of testosterone.

“I’ve tried to make clear that I support a science-based approach to inclusion, not categorical exclusion,” she said.

But as the debate moves beyond sports and into mainstream politics, more people have begun to see “science-based inclusion” as a form of exclusion. Which is why, to her dismay, her writings are routinely cited by right-wing politicians promoting wholesale bans of transgender athletes. It’s also why some transgender advocates say her and her colleague’s proposals are not only unfair but dangerous.

Research shows that transgender youth struggle with alarmingly high rates of anxiety, depression and suicidality. Emerging research has suggested affirmative transgender care — letting children transition socially for a period of time and then, if prescribed, start hormone therapy — can significantly reduce those mental health problems. A key to affirmative care, experts said, is to avoid situations where a transgender child is treated in any way that invalidates their gender identity.

When briefed on the women’s policy group’s proposals, several experts sharply criticized the idea of transgender-specific sports teams or events as stigmatizing.

“They have to go through so many obstacles just to recognize they are transgender, and for a lot of them, sports is the turning point. … You’d just end up exiling transgender girls from sports,” said Helen Carroll, former director of the Sports Project of the National Center for Lesbian Rights, who co-wrote the NCAA’s policy on transgender athletes.

And even if they do have physiological advantages, some experts argued, transgender teens face a minefield of challenges, including higher rates of bullying, rejection by their families and homelessness.

“The deck is stacked against them in every single way, so, to me, it seems silly to … look at this physiological advantage but not consider all the other substantial disadvantages these kids face,” said Jack Turban, fellow in child and adolescent psychiatry at Stanford University School of Medicine.

De Varona and her peers conceded that their concerns about high school sports are mostly hypothetical. As the legal and social climate for transgender people improves, they believe, more situations similar to what happened in Connecticut may arise.

But when asked to describe the harms that occurred to the girls who lost to the transgender athletes in Connecticut, they struggled to come up with anything concrete. Neither Miller nor Yearwood, the transgender girls, received track scholarships to college, and the women concede they are unaware of any cisgender girls who missed out on a scholarship opportunity as a result of Miller’s and Yearwood’s success.

There was other harm, the women argued, pointing to dozens of girls who lost races or opportunities to advance to postseason meets because they finished behind the transgender girls. Research has shown, they emphasized, that when girls succeed in sports, they’re more likely to go to college and have successful careers.

“Everybody here … has worked their entire lives to make sure that girls and women have equal opportunities in competitive sports,” Hogshead-Makar said.

And in those moments, these women tacitly conceded that, despite their talk of inclusion, they view transgender girls and women as different from the girls and women to whom they have devoted their careers — at least when they’re on the playing field.

“Yes, it’s important for everyone to have that opportunity in athletics,” de Varona said. “But sports does discriminate.”

From the field to the courts

The IOC is revising its guidelines on transgender athletes and is expected to announce them after this summer’s Tokyo Games. The NCAA also is examining its guidelines after hearing concerns from transgender advocates last fall.

The battle over transgender athletes in America’s high schools is likely to be settled, at least in part, in the courts. The ACLU is challenging an Idaho law that banned transgender athletes from competing in any public school, including colleges. The Connecticut lawsuit challenging that state’s policy also must be resolved.

Since its February news conference, the women’s policy group has had conversations with several members of the House and Senate, on both Judiciary Committees, according to Coleman, but they declined to specify whom or how many.

They also acquired a prominent supporter: Juniper Eastwood, one of the first openly transgender women to compete in NCAA Division I sports and the first cross-country runner.

There’s no way it would have been fair. My testosterone levels were so much higher than any of the girls I would’ve been running against.
— Juniper Eastwood, the first openly transgender cross-country athlete in NCAA Division I history

In an interview, Eastwood said she never would have competed against girls or women without suppressing her testosterone. In high school, she set a Montana state record in the 800 meters that, had she been running on the girls’ team, would have broken the women’s world record.

“There’s no way it would have been fair,” she said. “My testosterone levels were so much higher than any of the girls I would’ve been running against.”

A closer examination of Eastwood’s personal story, however, spotlights the ramifications of policies that would separate transgender youth from sports.

Eastwood always planned to transition after she finished her track career because she knew she would attract unwanted attention as a transgender runner. But in her sophomore year at the University of Montana, Eastwood got hurt and had to sit out the season. Running had always been her way of coping with gender dysphoria. Without it, Eastwood began drinking excessively and struggled with depression.

Eastwood decided to transition and then continue running track on the women’s team. As she had expected, she got considerably slower as she suppressed her testosterone. And, as she had dreaded, her performances were closely analyzed by right-wing news sites, track and field obsessives and transgender activists.

Eastwood’s senior track season ended abruptly because of the coronavirus. She’s in graduate school at Montana, studying environmental philosophy, and would like to work somewhere outdoors. Even though she feels a little out of shape lately, Eastwood said, she enjoys running now more than she ever did in high school or college.

She lives not far from several secluded trails where she can run for miles without seeing another person. When she runs now, she said, she feels free from the worry about what someone will write online the next day about her performance.

“It’s just me, the trails and no one else,” Eastwood said. “And I can just run.”

Correction: An earlier version of this article described Juniper Eastwood as the first openly transgender athlete in NCAA Division I sports history. Eastwood is one of the first openly transgender women to compete in Division I sports and the first to run cross-country. The story has been corrected.

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