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Experts weigh in on transgender student regulations
SARAH J. MOORE
KARIN SELVA, M.D.
Published: September 21, 2016
In our final article, we will examine the transgender athlete-student policies that educators should consider when it comes to participation in athletic programs. Although a federal injunction remains in place to prevent the U.S. Department of Education and other agencies from enforcing the May 2016 joint guidance, many schools nationwide have chosen to still implement those protections. With this in mind, it’s important to understand the issues involved in decisions regarding athletic participation in order to dispel unwarranted concerns and support inclusive practices.
Interscholastic Athletic Associations Are Responsible for Compliance
Most schools receiving federal funding participate in interscholastic athletic associations (IAA) and cede eligibility determinations to that entity. The May 2016 guidance recognizes that each IAA is subject to Title IX requirements if it or its members receive federal funding. Consequently, most IAA entities have already established policies on addressing transgender student-athlete participation and eligibility, while utilizing experts on transgender issues as resources.
What About Competitive Equity?
In August 2011, the NCAA Office of Inclusion published NCAA Inclusion of Transgender Student-Athletes, a guidance on best practices in supporting the participation of transgender student-athletes in intercollegiate athletic programs. In summarizing the competitive equity issue, this publication explains why several assumptions regarding perceived unfair competitive advantage are incorrect. For instance, the perception that transgender women have an advantage over “real women” is baseless, as they’re not automatically advantaged by being born with a male body.
The NCAA guidance ultimately provides transgender student-athlete policies recognizing that trans female (MTF) athletes may compete on a women’s team (without changing it to a mixed team status) after completing one calendar year of testosterone suppression treatment. It also explains that the athlete need to secure a medical exception review and monitoring, as testosterone is a banned substance. Trans male (FTM) athletes may compete on men’s teams after treatment with testosterone, but will no longer be eligible to compete on women’s teams without altering their status to a mixed team. However, the NCAA guidance acknowledges that policies at its level may be “unfair” and “too complicated” for high school competition.
Physiological Differences in Youth: High School vs. College
Leading resources note that transgender student-athlete policies must be different at the high school and college levels based on distinctly different developmental needs. The publication heavily relied upon by the NCAA Office of Inclusion, On the Team: Equal Opportunity for Transgender Student Athletes, recommends “high schools permit transgender athletes to play on teams consistent with the student’s gender identity, without regard to whether the student has undertaken any medical treatment.” Although the May 2016 guidance appears to support this approach, it recognizes that the school may adopt age-appropriate and other narrow requirements based on “sound, current and research-based medical knowledge about the impact of the students’ participation on the competitive fairness or physical safety of the sport.”
Many IAA entities are utilizing a quasi-NCAA approach to participation at the high school level. For example, in Ohio, the OHSAA requires member schools to report transgender student-athletes for eligibility determinations. For MTF, eligibility on a women’s team depends on completion of at least one year of hormone treatment related to transition, or sound medical evidence the student doesn’t have a physical or physiological advantage compared to genetic females of the same age. For FTM, the student must demonstrate either no testosterone treatment as yet or medical evidence that muscle mass from testosterone treatment doesn’t exceed muscle mass of comparably aged students, and that hormone levels don’t exceed normal levels and are being monitored. Regular reports are required to continue eligibility.
As such, it’s critical to examine the physiological changes in transgender youth. In a child who undergoes transition and pubertal suppression early, there’s no exposure to sex steroids. This phase applies to middle-school-aged children who are usually 11 to 14 years of age. In this cohort, the children have likely socially transitioned and look like their affirmed gender, but no sex hormones are cruising through their body. Their peers, however, may very well have started puberty and may actually be at a physical advantage over their transgender teammate. For example, a 13-year-old affirmed male on puberty blockers has no exposure to testosterone, while his biological male cis-gendered teammates are likely going through puberty and have developed more muscle mass. However, it would be very inappropriate for the transgender child to play on a female team, as he looks and identifies as male. Not surprisingly, the entire experience can be emotionally traumatic.
If the same child began cross hormones (testosterone) at 14 years of age, the body will mimic physiologic puberty at a typical rate. Levels of testosterone are measured throughout the process and never in super physiologic range. It can take 3-4 years to complete puberty. Thus, this FTM will be hormonally the same as his cis-gendered male peers. By the end of puberty, he will only have the muscle mass he is genetically capable of building. On the opposite side of the gender continuum, a MTF will never have experienced testosterone, and will be at the same hormonal level as her peers when she’s finished with puberty. Her muscle mass will be typical to estrogen exposure, not higher simply because of male genetics.
The waters get a little murkier when you have an adolescent teen who has already experienced endogenous puberty and is undergoing transition. In an affirmed female who’s been exposed to testosterone, levels decrease quite significantly while on estrogen. If an affirmed female has been on cross hormone therapy for a period of time, her endogenous testosterone is likely suppressed and would be equal to her teammates in terms of physical ability due to sex hormone exposure. The same holds true with an affirmed male on testosterone who has undergone endogenous puberty. His exposure to testosterone won’t place him at any advantage or disadvantage on a male team.
Privacy Requests for Locker Rooms
Although the May 2016 guidance allows transgender students to use locker rooms consistent with their gender identity, it recognizes that schools may provide any student who requests additional privacy a reasonable alternative. For example, a student requesting additional privacy can use restroom stalls or other private areas identified by the school. As a practical matter, schools should consider implementing restroom or locker room etiquette policies that re-enforce rules supporting privacy and appropriate behaviors under the student and athletic code of conduct.