Gender Dysphoria & Sports

Gender dysphoria is a psychological condition characterized by significant distress or discomfort that arises when a person's gender identity (their deeply felt sense of being male, female, or something else) does not align with their sex assigned at birth or societal expectations associated with that sex.

Gender dysphoria is real. However, how many people suffer from it is still uncertain. DSM-5 estimates are that 0.005% to 0.14% of cisgender males and 0.002% to 0.003% cisgender females experience some form of gender dysphoria. These numbers are generally believed to be underestimated. Broader surveys on self-identified transgender populations suggest that 0.5% to 1.3% of the population identifies in ways that may involve some form of gender dysphoria.

Still, the numbers from a percentage point of view may seem small, but assuming the lower number (0.5%) of self-identified transgender and non-binary people means that well over a million and a half people suffer in some way from gender dysphoria in the United States.

From my perspective, human beings should be treated with respect and the acknowledgment that you can’t really know someone unless you walk a mile in their shoes. Experiencing gender dysphoria can lead to anxiety, depression, isolation, and the feeling of not having a place in society. Approximately 40% of transgender adults have attempted suicide at some point in their lives, a stark contrast to the 5% attempt rate among the general U.S. population. Gender dysphoria is not generally something someone would choose to experience.

Transgender advocacy in the United States has led to a backlash that has included hate-filled vitriol and the demonization of transgender and non-binary people. Still, not all the push back associated with transgender advocacy has been mean spirited or hate filled. Some of it has been motivated, in large measure, by parental concerns about their children’s safety, education, and mental health.

Some transgender advocates dismiss these concerns as bigoted or unfounded. They are strident in their insistence on integrating transgender folks into the mainstream of society without acknowledging the legitimate concerns of parents about the way such integration is being done. Obviously, cisgender males who identify as female competing in girls (and women’s) sports is one of the most conspicuous and widely touted examples.

Yet, this is one of the easier problems to solve in terms of integrating transgender and non-binary folks into the societal mainstream. But the solution does require the acknowledgment from both transgender advocates and parents that a perfect solution is just not possible.

Allowing cisgender males to compete in girls/women’s sports is not part of the solution, at least in sports that depend on physical prowess. The inequity and unfairness of this is obvious to all but the most partisan advocates of transgender rights. (Note: this is not what happened in the most recent Olympics, where Transphobic fever blinded some to the fact that the women involved in the controversy where born women at birth, and had never identified as transgender. That was a manufactured controversy spurred by misinformation.) Yet the desire of transgender athletes to compete in a sport in a way that feels inclusive and self-affirming is completely understandable.

The best yet still imperfect solution is to allow transgender athletes to compete as follows: according to their cisgender; where their cisgender does not give them an unfair physical advantage; or in an open competition where gender is not a consideration.

Dividing competition into three distinct categories (male, female, open) instead of two, allows everyone to compete under relatively equal conditions.

Still, the most difficult aspect of this solution for cisgender men who identify as female, is that if they are transitioning, they are actively trying to negate the things that give them a cisgender advantage through estrogen therapies and anti-androgens (to suppress testosterones).

However, these steps are not likely to completely remove the physical advantages a cisgender man would have over a cisgender female. Though anti-androgens do reduce muscle mass and strength, the reduction does not usually match typical cisgender female levels. Nor do anti-androgens entirely reverse skeletal and physical structural differences such as broader shoulders, a larger ribcage, narrower hips, hand and feet size, and larger lung and heart capacity.

Unfortunately, these facts make the solution of having three categories of competition, an imperfect one. Transitioning cisgender men could compete in the open category or in the (cisgender) male category but not in the (cisgender) female category.

An argument could be made that this solution is little more than a “separate but equal” approach like the one advocated to ensure racial segregation and to deny same sex couples the right to marry. Having written an Amicus Curiae (friend of the court) brief in favor of the Goodridge decision that legalized same sex marriage in Massachusetts, I know a little about the weaknesses of the “separate but equal” argument. However, the analogy can only be weakly applied in this case. In both Brown v Board of Education and the Goodridge decision, there was no competing or compelling interest that justified maintaining racial segregation or excluding same sex couples from marrying.

In the case of transgender athletes wishing to compete according to the gender to which they identify and not their cisgender, there is the conflicting interest of other athletes to be able to compete without being at an unfair physical disadvantage.

Where one side refuses to acknowledge these conflicting interests, they are essentially not making fact-based arguments. They are arguing based on emotion and preference, but not on the facts.

There is still a lot to do to meet the challenge of integrating transgender individuals into American society where they no longer feel excluded or vilified. But acknowledging that there are legitimate, though conflicting, interests on both sides is a necessary first step. It is perhaps equally important for both sides to start treating each other with mutual respect and understanding. By itself, it will not resolve the challenges, but it will make it easier for facts and reason to play their crucial role. And that would be a good start.