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Opinion Lydia Polgreen

Born This Way? Born Which Way?

Credit... Illustration by Najeebah Al-Ghadban. Photographs, via Getty Images/Room Rf

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By Lydia Polgreen

Opinion Columnist

• Dec. 1, 2023

When I was in sixth grade, I made a decision that changed the course of my life. I decided not to try out for the middle school swim team. I know that might not sound like a big deal, but it was. As a grade schooler I was a standout swimmer — strong shoulders and back, and well-muscled legs that powered me through the water with ease and speed. I was disciplined, obsessive. My form was excellent. My coach saw potential.

Had I stuck with it, my life might have turned out pretty different. I might have been a popular jock rather than a lonely weirdo. I might have become a varsity athlete who won admission to a top college rather than a barely graduated teenager who had to take remedial math at a community college to scrape my way into a not-very-competitive school.

I have been thinking about this decision a lot lately, because many of us have been forced, regardless of whether we want to, to think about children and the decisions we allow them to make, and what it might mean for them to regret those decisions. I am speaking, of course, about the ongoing war over transgender and gender-nonconforming children.

For people on the right who oppose gender transition at any age, the argument is simple: There are two genders, and people who think they are a different sex or gender than the one they were assigned at birth are delusional; indulging that delusion is wrong. Biological reality requires all people to simply live with the gender associated with their birth sex. (Unless they are intersex, in which case it is evidently OK for parents and doctors to decide and surgically alter a child’s body to conform with that decision without the child’s consent or even knowledge.)

For those liberals and progressives who fret about the rapidly changing gender landscape, the agonized argument over gender-affirming care for children is different. As this thinking goes, there is a small category of people who were born in the wrong bodies, and those individuals are entitled to express their identities. But when children say they are one of these people, we must be extremely careful and rigorous in being absolutely certain that their gender identities have been unearthed and verified through a lengthy medical and psychiatric inquiry before they are validated by social, legal and medical interventions. We must be sure that this is the pure expression of an immutable self, not simply the adoption of a fad or the byproduct of autism or bipolar disorder. The possibility that children might make irreversible decisions on this particular question that they later regret is, for many people, simply intolerable. Transition, to borrow a phrase, should be safe, legal and rare.

We allow children to make irreversible decisions about their lives all the time, ideally with the guidance and support of the communities that care for them. Sometimes they regret those decisions. The stakes vary, but they are real. So what are we saying, really, when we worry that a child will regret this particular decision, the decision to transition? And how is it different, really, from the decision I made to quit competitive swimming? To many people — I am guessing most — this question is absurd. How could you possibly compare something as fundamental and consequential to one’s life as gender to something that seems comparatively trivial, competitive sport?

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The Experiences, Challenges and Hopes of Transgender and Nonbinary U.S. Adults

Findings from pew research center focus groups, table of contents, identity and the gender journey, navigating gender day-to-day, seeking medical care for gender transitions , connections with the broader lgbtq+ community, policy and social change.

• Focus groups
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Introduction

Transgender and nonbinary people have gained visibility in the U.S. in recent years as celebrities from  Laverne Cox  to  Caitlyn Jenner  to  Elliot Page  have spoken openly about their gender transitions. On March 30, 2022, the White House issued a proclamation  recognizing Transgender Day of Visibility , the first time a U.S. president has done so.  

More recently, singer and actor Janelle Monáe  came out as nonbinary , while the U.S. State Department and Social Security Administration announced that Americans  will be allowed to select “X” rather than “male” or “female” for their sex  marker on their passport and Social Security applications. 

At the same time, several states have enacted or are considering legislation that would  limit the rights of transgender and nonbinary people . These include bills requiring people to use public bathrooms that correspond with the sex they were assigned at birth, prohibiting trans athletes from competing on teams that match their gender identity, and restricting the availability of health care to trans youth seeking to medically transition. 

A new Pew Research Center survey finds that 1.6% of U.S. adults are transgender or nonbinary – that is, their gender is different from the sex they were assigned at birth. This includes people who describe themselves as a man, a woman or nonbinary, or who use terms such as gender fluid or agender to describe their gender. While relatively few U.S. adults are transgender, a growing share say they know someone who is (44% today vs.  37% in 2017 ). One-in-five say they know someone who doesn’t identify as a man or woman. 

In order to better understand the experiences of transgender and nonbinary adults at a time when gender identity is at the center of many national debates, Pew Research Center conducted a series of focus groups with trans men, trans women and nonbinary adults on issues ranging from their gender journey, to how they navigate issues of gender in their day-to-day life, to what they see as the most pressing policy issues facing people who are trans or nonbinary. This is part of a larger study that includes a survey of the general public on their attitudes about gender identity and issues related to people who are transgender or nonbinary.

The terms  transgender  and  trans  are used interchangeably throughout this essay to refer to people whose gender is different from the sex they were assigned at birth. This includes, but is not limited to, transgender men (that is, men who were assigned female at birth) and transgender women (women who were assigned male at birth). 

Nonbinary adults  are defined here as those who are neither a man nor a woman or who aren’t strictly one or the other. While some nonbinary focus group participants sometimes use different terms to describe themselves, such as “gender queer,” “gender fluid” or “genderless,” all said the term “nonbinary” describes their gender in the screening questionnaire. Some, but not all, nonbinary participants also consider themselves to be transgender.

References to  gender transitions  relate to the process through which trans and nonbinary people express their gender as different from social expectations associated with the sex they were assigned at birth. This may include social, legal and medical transitions. The social aspect of a gender transition may include going by a new name or using different pronouns, or expressing their gender through their dress, mannerisms, gender roles or other ways. The legal aspect may include legally changing their name or changing their sex or gender designation on legal documents or identification.  Medical care  may include treatments such as hormone therapy, laser hair removal and/or surgery. 

References to  femme  indicate feminine gender expression. This is often in contrast to “masc,” meaning masculine gender expression.

Cisgender  is used to describe people whose gender matches the sex they were assigned at birth and who do not identify as transgender or nonbinary. 

Misgendering  is defined as referring to or addressing a person in ways that do not align with their gender identity, including using incorrect pronouns, titles (such as “sir” or “ma’am”), and other terms (such as “son” or “daughter”) that do not match their gender. 

References to  dysphoria  may include feelings of distress due to the mismatch of one’s gender and sex assigned at birth, as well as a  diagnosis of gender dysphoria , which is sometimes a prerequisite for access to health care and medical transitions.

The acronym  LGBTQ+  refers to lesbian, gay, bisexual, transgender, queer (or, in some cases, questioning), and other sexual orientations or gender identities that are not straight or cisgender, such as intersex, asexual or pansexual. 

Pew Research Center conducted this research to better understand the experiences and views of transgender and nonbinary U.S. adults. Because transgender and nonbinary people make up only about 1.6% of the adult U.S. population, this is a difficult population to reach with a probability-based, nationally representative survey. As an alternative, we conducted a series of focus groups with trans and nonbinary adults covering a variety of topics related to the trans and nonbinary experience. This allows us to go more in-depth on some of these topics than a survey would typically allow, and to share these experiences in the participants’ own words.

For this project, we conducted six online focus groups, with a total of 27 participants (four to five participants in each group), from March 8-10, 2022. Participants were recruited by targeted email outreach among a panel of adults who had previously said on a survey that they were transgender or nonbinary, as well as via connections through professional networks and LGBTQ+ organizations, followed by a screening call. Candidates were eligible if they met the technology requirements to participate in an online focus group and if they either said they consider themselves to be transgender or if they said their gender was nonbinary or another identity other than man or woman (regardless of whether or not they also said they were transgender). For more details, see the  Methodology . 

Participants who qualified were placed in groups as follows: one group of nonbinary adults only (with a nonbinary moderator); one group of trans women only (with a trans woman moderator); one group of trans men only (with a trans man moderator); and three groups with a mix of trans and nonbinary adults (with either a nonbinary moderator or a trans man moderator). All of the moderators had extensive experience facilitating groups, including with transgender and nonbinary participants. 

The participants were a mix of ages, races/ethnicities, and were from all corners of the country. For a detailed breakdown of the participants’ demographic characteristics, see the  Methodology .

The findings are not statistically representative and cannot be extrapolated to wider populations.

Some quotes have been lightly edited for clarity or to remove identifying details. In this essay, participants are identified as trans men, trans women, or nonbinary adults based on their answers to the screening questionnaire. These words don’t necessarily encompass all of the ways in which participants described their gender. Participants’ ages are grouped into the following categories:  late teens; early/mid/late 20s, 30s and 40s; and 50s and 60s (those ages 50 to 69 were grouped into bigger “buckets” to better preserve their anonymity).

These focus groups were not designed to be representative of the entire population of trans and nonbinary U.S. adults, but the participants’ stories provide a glimpse into some of the experiences of people who are transgender and/or nonbinary. The groups included a total of 27 transgender and nonbinary adults from around the U.S. and ranging in age from late teens to mid-60s. Most currently live in an urban area, but about half said they grew up in a suburb. The groups included a mix of White, Black, Hispanic, Asian and multiracial American participants. See  Methodology  for more details.

Most focus group participants said they knew from an early age – many as young as preschool or elementary school – that there was something different about them, even if they didn’t have the words to describe what it was. Some described feeling like they didn’t fit in with other children of their sex but didn’t know exactly why. Others said they felt like they were in the wrong body. 

“I remember preschool, [where] the boys were playing on one side and the girls were playing on the other, and I just had a moment where I realized what side I was supposed to be on and what side people thought I was supposed to be on. … Yeah, I always knew that I was male, since my earliest memories.” – Trans man, late 30s

“As a small child, like around kindergarten [or] first grade … I just was [fascinated] by how some people were small girls, and some people were small boys, and it was on my mind constantly. And I started to feel very uncomfortable, just existing as a young girl.” – Trans man, early 30s

“I was 9 and I was at day camp and I was changing with all the other 9-year-old girls … and I remember looking at everybody’s body around me and at my own body, and even though I was visually seeing the exact shapeless nine-year-old form, I literally thought to myself, ‘oh, maybe I was supposed to be a boy,’ even though I know I wasn’t seeing anything different. … And I remember being so unbothered by the thought, like not a panic, not like, ‘oh man, I’m so different, like everybody here I’m so different and this is terrible,’ I was like, ‘oh, maybe I was supposed to be a boy,’ and for some reason that exact quote really stuck in my memory.” – Nonbinary person, late 30s

“Since I was little, I felt as though I was a man who, when they were passing out bodies, someone made a goof and I got a female body instead of the male body that I should have had. But I was forced by society, especially at that time growing up, to just make my peace with having a female body.” – Nonbinary person, 50s

“I’ve known ever since I was little. I’m not really sure the age, but I just always knew when I put on boy clothes, I just felt so uncomfortable.” – Trans woman, late 30s

“It was probably as early as I can remember that I wasn’t like my brother or my father [and] not exactly like my girl cousins but I was something else, but I didn’t know what it was.” – Nonbinary person, 60s

Many participants were well into adulthood before they found the words to describe their gender. For those focus group participants, the path to self-discovery varied. Some described meeting someone who was transgender and relating to their experience; others described learning about people who are trans or nonbinary in college classes or by doing their own research.  

“I read a Time magazine article … called ‘Homosexuality in America’ … in 1969. … Of course, we didn’t have language like we do now or people were not willing to use it … [but] it was kind of the first word that I had ever heard that resonated with me at all. So, I went to school and I took the magazine, we were doing show-and-tell, and I stood up in front of the class and said, ‘I am a homosexual.’ So that began my journey to figure this stuff out.” – Nonbinary person, 60s

“It wasn’t until maybe I was 20 or so when my friend started his transition where I was like, ‘Wow, that sounds very similar to the emotions and challenges I am going through with my own identity.’ … My whole life from a very young age I was confused, but I didn’t really put a name on it until I was about 20.” – Nonbinary person, late 20s

“I knew about drag queens, but I didn’t know what trans was until I got to college and was exposed to new things, and that was when I had a word for myself for the first time.” – Trans man, early 40s

“I thought that by figuring out that I was interested in women, identifying as lesbian, I thought [my anxiety and sadness] would dissipate in time, and that was me cracking the code. But then, when I got older, I left home for the first time. I started to meet other trans people in the world. That’s when I started to become equipped with the vocabulary. The understanding that this is a concept, and this makes sense. And that’s when I started to understand that I wasn’t cisgender.” – Trans man, early 30s

“When I took a human sexuality class in undergrad and I started learning about gender and different sexualities and things like that, I was like, ‘oh my god. I feel seen.’ So, that’s where I learned about it for the first time and started understanding how I identify.” – Nonbinary person, mid-20s

Focus group participants used a wide range of words to describe how they see their gender. For many nonbinary participants, the term “nonbinary” is more of an umbrella term, but when it comes to how they describe themselves, they tend to use words like “gender queer” or “gender fluid.” The word “queer” came up many times across different groups, often to describe anyone who is not straight or cisgender. Some trans men and women preferred just the terms “man” or “woman,” while some identified strongly with the term “transgender.” The graphic below shows just some of the words the participants used to describe their gender.

The way nonbinary people conceptualize their gender varies. Some said they feel like they’re both a man and a woman – and how much they feel like they are one or the other may change depending on the day or the circumstance. Others said they don’t feel like they are either a man or a woman, or that they don’t have a gender at all. Some, but not all, also identified with the term transgender. 

“I had days where I would go out and just play with the boys and be one of the boys, and then there would be times that I would play with the girls and be one of the girls. And then I just never really knew what I was. I just knew that I would go back and forth.” – Nonbinary person, mid-20s

“Growing up with more of a masculine side or a feminine side, I just never was a fan of the labelling in terms of, ‘oh, this is a bit too masculine, you don’t wear jewelry, you don’t wear makeup, oh you’re not feminine enough.’ … I used to alternate just based on who I felt I was. So, on a certain day if I felt like wearing a dress, or a skirt versus on a different day, I felt like wearing what was considered men’s pants. … So, for me it’s always been both.” – Nonbinary person, mid-30s

“I feel like my gender is so amorphous and hard to hold and describe even. It’s been important to find words for it, to find the outlines of it, to see the shape of it, but it’s not something that I think about as who I am, because I’m more than just that.” – Nonbinary person, early 30s

“What words would I use to describe me? Genderless, if gender wasn’t a thing. … I guess if pronouns didn’t exist and you just called me [by my name]. That’s what my gender is. … And I do use nonbinary also, just because it feels easier, I guess.” – Nonbinary person, late 20s

Some participants said their gender is one of the most important parts of their identity, while others described it as one of many important parts or a small piece of how they see themselves. For some, the focus on gender can get tiring. Those who said gender isn’t a central – or at least not the most central – part of their identity mentioned race, ethnicity, religion and socioeconomic class as important aspects that shape their identity and experiences.

“It is tough because [gender] does affect every factor of your life. If you are doing medical transitioning then you have appointments, you have to pay for the appointments, you have to be working in a job that supports you to pay for those appointments. So, it is definitely integral, and it has a lot of branches. And it deals with how you act, how you relate to friends, you know, I am sure some of us can relate to having to come out multiple times in our lives. That is why sexuality and gender are very integral and I would definitely say I am proud of it. And I think being able to say that I am proud of it, and my gender, I guess is a very important part of my identity.” – Nonbinary person, late 20s

“Sometimes I get tired of thinking about my gender because I am actively [undergoing my medical transition]. So, it is a lot of things on my mind right now, constantly, and it sometimes gets very tiring. I just want to not have to think about it some days. So, I would say it’s, it’s probably in my top three [most important parts of my identity] – parent, Black, queer nonbinary.” – Nonbinary person, mid-40s

“I live in a town with a large queer and trans population and I don’t have to think about my gender most of the time other than having to come out as trans. But I’m poor and that colors everything. It’s not a chosen part of my identity but that part of my identity is a lot more influential than my gender.” – Trans man, early 40s

“My gender is very important to my identity because I feel that they go hand in hand. Now my identity is also broken down into other factors [like] character, personality and other stuff that make up the recipe for my identity. But my gender plays a big part of it. … It is important because it’s how I live my life every day. When I wake up in the morning, I do things as a woman.” – Trans woman, mid-40s

“I feel more strongly connected to my other identities outside of my gender, and I feel like parts of it’s just a more universal thing, like there’s a lot more people in my socioeconomic class and we have much more shared experiences.” – Trans man, late 30s

Some participants spoke about how their gender interacted with other aspects of their identity, such as their race, culture and religion. For some, being transgender or nonbinary can be at odds with other parts of their identity or background. 

“Culturally I’m Dominican and Puerto Rican, a little bit of the macho machismo culture, in my family, and even now, if I’m going to be a man, I’ve got to be a certain type of man. So, I cannot just be who I’m meant to be or who I want myself to be, the human being that I am.” – Trans man, mid-30s

“[Judaism] is a very binary religion. There is a lot of things like for men to do and a lot of things for women to do. … So, it is hard for me now as a gender queer person, right, to connect on some levels with [my] religion … I have just now been exposed to a bunch of trans Jewish spaces online which is amazing.” – Nonbinary person, mid-40s

“Just being Indian American, I identify and love aspects of my culture and ethnicity, and I find them amazing and I identify with that, but it’s kind of separated. So, I identify with the culture, then I identify here in terms of gender and being who I am, but I kind of feel the necessity to separate the two, unfortunately.” – Nonbinary person, mid-30s

“I think it’s really me being a Black woman or a Black man that can sometimes be difficult. And also, my ethnic background too. It’s really rough for me with my family back home and things of that nature.” – Nonbinary person, mid-20s

For some, deciding how open to be about their gender identity can be a constant calculation. Some participants reported that they choose whether or not to disclose that they are trans or nonbinary in a given situation based on how safe or comfortable they feel and whether it’s necessary for other people to know. This also varies depending on whether the participant can easily pass as a cisgender man or woman (that is, they can blend in so that others assume them to be cisgender and don’t recognize that they are trans or nonbinary).

“It just depends on whether I feel like I have the energy to bring it up, or if it feels worth it to me like with doctors and stuff like that. I always bring it up with my therapists, my primary [care doctor], I feel like she would get it. I guess it does vary on the situation and my capacity level.” – Nonbinary person, late 20s

“I decide based on the person and based on the context, like if I feel comfortable enough to share that piece of myself with them, because I do have the privilege of being able to move through the world and be identified as cis[gender] if I want to. But then it is important to me – if you’re important to me, then you will know who I am and how I identify. Otherwise, if I don’t feel comfortable or safe then I might not.” – Nonbinary person, early 30s

“The expression of my gender doesn’t vary. Who I let in to know that I was formerly female – or formerly perceived as female – is kind of on a need to know basis.” – Trans man, 60s

“It’s important to me that people not see me as cis[gender], so I have to come out a lot when I’m around new people, and sometimes that’s challenging. … It’s not information that comes out in a normal conversation. You have to force it and that’s difficult sometimes.” – Trans man, early 40s

Work is one realm where many participants said they choose not to share that they are trans or nonbinary. In some cases, this is because they want to be recognized for their work rather than the fact that they are trans or nonbinary; in others, especially for nonbinary participants, they fear it will be perceived as unprofessional.

“It’s gotten a lot better recently, but I feel like when you’re nonbinary and you use they/them pronouns, it’s just seen as really unprofessional and has been for a lot of my life.” – Nonbinary person, early 30s

“Whether it’s LinkedIn or profiles [that] have been updated, I’ve noticed people’s resumes have their pronouns now. I don’t go that far because I just feel like it’s a professional environment, it’s nobody’s business.” – Nonbinary person, mid-30s

“I don’t necessarily volunteer the information just to make it public; I want to be recognized for my character, my skill set, in my work in other ways.” – Trans man, early 30s

Some focus group participants said they don’t mind answering questions about what it’s like to be trans or nonbinary but were wary of being seen as the token trans or nonbinary person in their workplace or among acquaintances. Whether or not they are comfortable answering these types of questions sometimes depends on who’s asking, why they want to know, and how personal the questions get.

“I’ve talked to [my cousin about being trans] a lot because she has a daughter, and her daughter wants to transition. So, she always will come to me asking questions.” – Trans woman, early 40s

“It is tough being considered the only resource for these topics, right? In my job, I would hate to call myself the token nonbinary, but I was the first nonbinary person that they hired and they were like, ‘Oh, my gosh, let me ask you all the questions as you are obviously the authority on the subject.’ And it is like, ‘No, that is a part of me, but there are so many other great resources.’” – Nonbinary person, late 20s

“I don’t want to be the token. I’m not going to be no spokesperson. If you have questions, I’m the first person you can ask. Absolutely. I don’t mind discussing. Ask me some of the hardest questions, because if you ask somebody else you might get you know your clock cleaned. So, ask me now … so you can be educated properly. Otherwise, I don’t believe it’s anybody’s business.” – Trans woman, early 40s

Most nonbinary participants said they use “they/them” as their pronouns, but some prefer alternatives. These alternatives include a combination of gendered and gender-neutral pronouns (like she/they) or simply preferring that others use one’s names rather than pronouns. 

“If I could, I would just say my name is my pronoun, which I do in some spaces, but it just is not like a larger view. It feels like I’d rather have less labor on me in that regard, so I just say they/them.” – Nonbinary person, late 20s

“For me personally, I don’t get mad if someone calls me ‘he’ because I see what they’re looking at. They look and they see a guy. So, I don’t get upset. I know a few people who do … and they correct you. Me, I’m a little more fluid. So, that’s how it works for me.” – Nonbinary person, mid-30s

“I use they/she pronouns and I put ‘they’ first because that is what I think is most comfortable and it’s what I want to draw people’s attention to, because I’m 5 feet tall and 100 pounds so it’s not like I scream masculine at first sight, so I like putting ‘they’ first because otherwise people always default to ‘she.’ But I have ‘she’ in there, and I don’t know if I’d have ‘she’ in there if I had not had kids.” – Nonbinary person, late 30s

“Why is it so hard for people to think of me as nonbinary? I choose not to use only they/them pronouns because I do sometimes identify with ‘she.’ But I’m like, ‘Do I need to use they/them pronouns to be respected as nonbinary?’ Sometimes I feel like I should do that. But I don’t want to feel like I should do anything. I just want to be myself and have that be accepted and respected.” – Nonbinary person, early 30s

“I have a lot of patience for people, but [once someone in public used] they/them pronouns and I thanked them and they were like, ‘Yeah, I just figure I’d do it when I don’t know [someone’s] pronouns.’ And I’m like, ‘I love it, thank you.’” – Nonbinary person, early 30s

Transgender and nonbinary participants find affirmation of their gender identity and support in various places. Many cited their friends, chosen families (and, less commonly, their relatives), therapists or other health care providers, religion, or LGBTQ+ spaces as sources of support.

“I’m just not close with my family [of origin], but I have a huge chosen family that I love and that fully respects my identity.” – Nonbinary person, early 30s

“Before the pandemic I used to go out to bars a lot; there’s a queer bar in my town and it was a really nice place just being friends with everybody who went and everybody who worked there, it felt really nice you know, and just hearing everybody use the right pronouns for me it just felt really good.” – Nonbinary person, early 30s

“I don’t necessarily go to a lot of dedicated support groups, but I found that there’s kind of a good amount of support in areas or groups or fandoms for things that have a large LGBT population within them. Like certain shows or video games, where it’s just kind of a joke that all the gay people flock to this.”  – Trans woman, late teens

“Being able to practice my religion in a location with a congregation that is just completely chill about it, or so far has been completely chill about it, has been really amazing.” – Nonbinary person, late 30s

Many participants shared specific moments they said were small in the grand scheme of things but made them feel accepted and affirmed. Examples included going on dates, gestures of acceptance by a friend or social group, or simply participating in everyday activities.

“I went on a date with a really good-looking, handsome guy. And he didn’t know that I was trans. But I told him, and we kept talking and hanging out. … That’s not the first time that I felt affirmed or felt like somebody is treating me as I present myself. But … he made me feel wanted and beautiful.” – Trans woman, late 30s

“I play [on a men’s rec league] hockey [team]. … I joined the league like right when I first transitioned and I showed up and I was … nervous with locker rooms and stuff, and they just accepted me as male right away.” – Trans man, late 30s

“I ended up going into a barbershop. … The barber was very welcoming, and talked to me as if I was just a casual customer and there was something that clicked within that moment where, figuring out my gender identity, I just wanted to exist in the world to do these natural things like other boys and men would do. So, there was just something exciting about that. It wasn’t a super macho masculine moment, … he just made me feel like I blended in.” – Trans man, early 30s

Participants also talked about negative experiences, such as being misgendered, either intentionally or unintentionally. For example, some shared instances where they were treated or addressed as a gender other than the gender that they identify as, such as people referring to them as “he” when they go by “she,” or where they were deadnamed, meaning they were called by the name they had before they transitioned. 

“I get misgendered on the phone a lot and that’s really annoying. And then, even after I correct them, they keep doing it, sometimes on purpose and sometimes I think they’re just reading a script or something.” – Trans man, late 30s

“The times that I have been out, presenting femme, there is this very subconscious misgendering that people do and it can be very frustrating. [Once, at a restaurant,] I was dressed in makeup and nails and shoes and everything and still everyone was like, ‘Sir, what would you like?’ … Those little things – those microaggressions – they can really eat away at people.” – Nonbinary person, mid-40s

“People not calling me by the right name. My family is a big problem, they just won’t call me by my name, you know? Except for my nephew, who is of the Millennial generation, so at least he gets it.” – Nonbinary person, 60s

“I’m constantly misgendered when I go out places. I accept this – because of the way I look, people are going to perceive me as a woman and it doesn’t cause me huge dysphoria or anything, it’s just nice that the company that I keep does use the right pronouns.” – Nonbinary person, early 30s

Some participants also shared stories of discrimination, bias, humiliation, and even violence. These experiences ranged from employment discrimination to being outed (that is, someone else disclosing the fact that they are transgender or nonbinary without their permission) without their permission to physical attacks.

“I was on a date with this girl and I had to use the bathroom … and the janitor … wouldn’t let me use the men’s room, and he kept refusing to let me use the men’s room, so essentially, I ended up having to use the same bathroom as my date.” – Trans man, late 30s

“I’ve been denied employment due to my gender identity. I walked into a supermarket looking for jobs. … And they flat out didn’t let me apply. They didn’t even let me apply.” – Trans man, mid-30s

“[In high school,] this group of guys said, ‘[name] is gay.’ I ignored them but they literally threw me and tore my shirt from my back and pushed me to the ground and tried to strip me naked. And I had to fight for myself and use my bag to hit him in the face.” – Trans woman, late 20s

“I took a college course [after] I had my name changed legally and the instructor called me out in front of the class and called me a liar and outed me.” – Trans man, late 30s 

Many, but not all, participants said they have received  medical care , such as surgery or hormone therapy, as part of their gender transition. For those who haven’t undergone a medical transition, the reasons ranged from financial barriers to being nervous about medical procedures in general to simply not feeling that it was the right thing for them.

“For me to really to live my truth and live my identity, I had to have the surgery, which is why I went through it. It doesn’t mean [that others] have to, or that it will make you more or less of a woman because you have it. But for me to be comfortable, … that was a big part of it. And so, that’s why I felt I had to get it.” – Trans woman, early 40s

“I’m older and it’s an operation. … I’m just kind of scared, I guess. I’ve never had an operation. I mean, like any kind of operation. I’ve never been to the hospital or anything like that. So, it [is] just kind of scary. But I mean, I want to. I think about all the time. I guess have got to get the courage up to do it.” – Trans woman, early 40s

“I’ve decided that the dysphoria of a second puberty … would just be too much for me and I’m gender fluid enough where I’m happy, I guess.” – Nonbinary person, early 30s

“I’m too old to change anything, I mean I am what I am. [laughs]” – Nonbinary person, 60s

Many focus group participants who have sought medical treatment for their gender transition faced barriers, although some had positive experiences. For those who said there were barriers, the cost and the struggle to find sympathetic doctors were often cited as challenges. 

“I was flat out turned down by the primary care physician who had to give the go-ahead to give me a referral to an endocrinologist; I was just shut down. That was it, end of story.” – Nonbinary person, 50s

“I have not had surgery, because I can’t access surgery. So unless I get breast cancer and have a double mastectomy, surgery is just not going to happen … because my health insurance wouldn’t cover something like that. … It would be an out-of-pocket plastic surgery expense and I can’t afford that at this time.” – Nonbinary person, 50s

“Why do I need the permission of a therapist to say, ‘This person’s identity is valid,’ before I can get the health care that I need to be me, that is vital for myself and for my way of life?” – Nonbinary person, mid-40s

“[My doctor] is basically the first person that actually embraced me and made me accept [who I am].” – Trans woman, late 20s

Many people who transitioned in previous decades described how access has gotten much easier in recent years. Some described relying on underground networks to learn which doctors would help them obtain medical care or where to obtain hormones illegally. 

“It was hard financially because I started so long ago, just didn’t have access like that. Sometimes you have to try to go to Mexico or learn about someone in Mexico that was a pharmacist, I can remember that. That was a big thing, going through the border to Mexico, that was wild. So, it was just hard financially because they would charge so much for testosterone. And there was the whole bodybuilding community. If you were transitioning, you went to bodybuilders, and they would charge you five times what they got it [for], so it was kind of tough.” – Trans man, early 40s

“It was a lot harder to get a surgeon when I started transitioning; insurance was out of the question, there wasn’t really a national discussion around trans people and their particular medical needs. So, it was challenging having to pay everything out of pocket at a young age.” – Trans man, early 30s

“I guess it was hard for me to access hormones initially just because you had to jump through so many hoops, get letters, and then you had to find a provider that was willing to write it. And now it’s like people are getting it from their primary care doctor, which is great, but a very different experience than I had.” – Trans man, early 40s

The discussions also touched on whether the participants feel a connection with a broader lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community or with other people who are LGBTQ+. Views varied, with some saying they feel an immediate connection with other people who are LGBTQ+, even with those who aren’t trans or nonbinary, and others saying they don’t necessarily feel this way. 

“It’s kind of a recurring joke where you can meet another LGBT person and it is like there is an immediate understanding, and you are basically talking and giving each other emotional support, like you have been friends for 10-plus years.” – Trans woman, late teens 

“I don’t think it’s automatic friendship between queer people, there’s like a kinship, but I don’t think there’s automatic friendship or anything. I think it’s just normal, like, how normal people make friends, just based on common interests.” – Nonbinary person, early 30s 

“I do think of myself as part of the LGBT [community] … I use the resources that are put in place for these communities, whether that’s different health care programs, support groups, they have the community centers. … So, I do consider myself to be part of this community, and I’m able to hopefully take when needed, as well as give back.” – Trans man, mid-30s

“I feel like that’s such an important part of being a part of the [LGBTQ+] alphabet soup community, that process of constantly learning and listening to each other and … growing and developing language together … I love that aspect of creating who we are together, learning and unlearning together, and I feel like that’s a part of at least the queer community spaces that I want to be in. That’s something that’s core to me.” – Nonbinary person, early 30s

“I identify as queer. I feel like I’m a part of the LGBT community. That’s more of a part of my identity than being trans. … Before I came out as trans, I identified as a lesbian. That was also a big part of my identity. So, that may be too why I feel like I’m more part of the LGB community.” – Trans man, early 40s

While many trans and nonbinary participants said they felt accepted by others in the LGBTQ+ community, some participants described their gender identity as a barrier to full acceptance. There was a sense among some participants that cisgender people who are lesbian, gay or bisexual don’t always accept people who are transgender or nonbinary.  

“I would really like to be included in the [LGBTQ+] community. But I have seen some people try to separate the T from LGB … I’ve run into a few situations throughout my time navigating the [LGBTQ+] community where I’ve been perceived – and I just want to say that there’s nothing wrong with this – I’ve been perceived as like a more feminine or gay man in a social setting, even though I’m heterosexual. … But the minute that that person found out that I wasn’t a gay man … and that I was actually a transgender person, they became cold and just distancing themselves. And I’ve been in a lot of those types of circumstances where there’s that divide between the rest of the community.” – Trans man, early 30s

“There are some lesbians who see trans men as being traitors to womanhood. Those are not people that I really identify with or want to be close to.” – Trans man, early 40s 

“It’s only in the past maybe dozen or so years, that an identity like gender fluid or gender queer was acceptable even within the LGBTQ+ community. … I tried to go to certain LGBTQ+ events as a trans man and, you know, I was not allowed in because I looked too female. The gay men would not allow me to participate.” – Nonbinary person, 50s 

“Technically based on the letters [in the acronym LGBTQ+] I am part of that community, but I’ve felt discrimination, it’s very heavily exclusive to people who are either gay or lesbian and I think that’s true … for queer or bisexual or asexual, intersex … anybody who’s not like exclusively hardcore gay or lesbian. It’s very exclusive, like excluding to those people. … I feel like the BTQ is a separate group of people…. So, I identify with the second half of the letters as a separate subset.” – Trans man, late 30s

When asked to name the most important policy or political issues facing transgender and nonbinary people in the United States today, many participants named basic needs such as housing, employment, and health care. Others cited recent legislation or policies related to people who are transgender that have made national news.

“Housing is a huge issue. Health care might be good in New York, it might be good in California, but … it’s not a national equality for trans folks. Health care is not equal across the states. Housing is not equal across the states. So, I think that the issues right now that we’re all facing is health care and housing. That’s the top, the most important things.” – Trans woman, early 40s 

“Definitely education. I think that’s very important … Whether you identify as trans or not as a young child, it’s good to understand and know the different things under the umbrella, the queer umbrella. And it is also just a respect thing. And also, the violence that happens against trans and nonbinary people. I feel like educating them very young, that kind of helps – well, it is going to help because once you understand what’s going on and you see somebody that doesn’t identify the same as you, you’ll have that respect, or you’ll have that understanding and you’re less likely to be very violent towards them.” – Nonbinary person, mid-20s 

“Employment is a big one. And I know that some areas, more metropolitan progressive-leaning areas, are really on top of this, but they’re trans people everywhere that are still being discriminated against. I think it’s a personal thing for me that goes back to my military service, but still, it’s just unfortunate. It’s an unfortunate reality.” – Trans man, early 30s

“I think just the strong intersectionality of trans people with mental health issues, or even physical health issues. … So in that way, accessing good health care or having good mental health.” – Trans man, late 30s

“I honestly think that the situation in Texas is the most pressing political and policy situation because it is a direct attack on the trans community. … And it is so insidious because it doesn’t just target bathrooms. This is saying that if you provide medical care to trans youth it is tantamount to child abuse. And it is so enraging because it is a known proven fact that access to gender affirming medical care saves lives. It saves the lives of trans youth. And trans youth have the highest suicide rate in the country.” – Nonbinary person, mid-40s 

Participants had different takes on what gets in the way of progress on issues facing transgender and nonbinary people. Some pointed to the lack of knowledge surrounding the history of these issues or not knowing someone who is transgender or nonbinary. Others mentioned misconceptions people might have about transgender and nonbinary people that influence their political and policy perspectives. 

“People who don’t know trans people, honestly … that’s the only barrier I can understand because people fear what they don’t know and then react to it a lot of the time.” – Nonbinary person, early 30s

“Sometimes even if they know someone, they still don’t consider them to be a human being, they are an ‘other,’ they are an ‘it,’ they are a ‘not like me,’ ‘not like my family,’ person and so they are put into a place socially where they can be treated badly.” – Nonbinary person, 50s

“Just the ignorance and misinformation and this quick fake social media fodder, where it encourages people who should not be part of the conversation to spread things that are not true.” – Trans man, late 30s

“Also, the political issues that face nonbinary people, it’s that people think nonbinary is some made-up thing to feel cool. It’s not to feel cool. And if someone does do it to feel cool, maybe they’re just doing that because they don’t feel comfortable within themselves.” – Nonbinary person, mid-30s

“There’s so much fear around it, and misunderstanding, and people thinking that if you’re talking to kids about gender and sexuality, that it’s sexual. And it’s like, we really need to break down that our bodies are not inherently sexual. We need to be able to talk with students and children about their bodies so that they can then feel empowered to understand themselves, advocate for themselves.” – Nonbinary person, early 30s

When asked what makes them hopeful for the future for trans and nonbinary people, some participants pointed to the way things in society have already changed and progress that has been made. For example, some mentioned greater representation and visibility of transgender and nonbinary people in entertainment and other industries, while others focused on changing societal views as things that give them hope for the future. 

“I am hopeful about the future because I see so many of us coming out and being visible and representing and showing folks that we are not to stereotype.” – Trans woman, early 40s

“Also, even though celebrity is annoying, it’s still cool when people like Willow [Smith] or Billie Eilish or all these popstars that the kids really love are like, ‘I’m nonbinary, I’m queer,’ like a lot more progressive. … Even just more visibility in TV shows and movies, the more and more that happens the more it’s like, ‘Oh yeah, we are really here, you can’t not see us.’” – Nonbinary person, late 20s

“We shouldn’t have to look to the entertainment industry for role models, we shouldn’t have to, we should be able to look to our leaders, our political leaders, but I think, that’s what gives me hope. Soon, it’s going to become a nonissue, maybe in my lifetime.” – Trans man, 60s

“I have gotten a little bit into stand-up comedy in the last few weeks, and it is like the jokes that people made ten years ago are resurfacing online and people are enraged about it. They are saying like, ‘Oh, this is totally inappropriate.’ But that comes with the recognition that things have changed, and language has changed, and people are becoming more intolerant of allowing these things to occur. So that is why I am hopeful, is being able to see that progression and hopeful continued improvement on that front.” – Nonbinary person, late 20s

“I think because of the shift of what’s happening, how everything has become so normal, and people are being more open, and within the umbrella of queerness so many different things are happening, I think as we get more comfortable and we progress as a society, it’s just going to be better. So, people don’t have to hide who they are. So, that gives me hope.” – Nonbinary person, mid-20s

For many, young people are a source of hope. Several participants talked about younger generations being more accepting of those who are transgender or nonbinary and also being more accepted by their families if they themselves are trans or nonbinary. 

“And then the other portion that gives me hope are the kids, because I work now with so many kids who are coming out as trans earlier and their families are embracing them and everything. … So I really am trusting in the young generation.” – Nonbinary person, 60s

“I mean kids don’t judge you the same way as adults do about gender, and they’re so expansive and have so much creativity. … So it’s just the kids, Gen Z, and it just makes me feel really, really hopeful.” – Nonbinary person, early 30s

“The youth, the youth. They understand almost intrinsically so much more about these things than I feel like my generation did. They give me so much hope for the future.” – Nonbinary person, early 30s

“I think future generations, just seeing this growing amount of support that they have, that it’s just going to keep improving … there’s an increase in visibility but there’s also an increase in support … like resources for parents where they can see that they don’t have to punish their kids. Their kids can grow up feeling like, ‘This is okay to be this way.’ And I feel like that’s not something that can be stopped.” – Trans man, late 30s

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85 Transgender Essay Topic Ideas & Examples

🏆 best transgender topic ideas & essay examples, ⭐ simple & easy transgender essay titles, 📌 most interesting transgender topics to write about, 👍 good research topics about transgender.

• Xaniths as a Transgender in Omani Culture The Xaniths are the third gender within the Omani social system. The Xaniths represents the transsexuals and homosexuals within the Omani society.
• Transgender Women Should Be Allowed to Compete in Olympic Sports It is all due to the higher level of testosterone in their bodies and that some of them can pretend to be transgender to compete against women.
• Transgender Issues in “The Crying Game” and “M. Butterfly” The acceptance of the phenomenon of transgender status in contrast to widely spread stereotypes on it is one of the central themes and moral messages of the 1992 movie The Crying Game and the 1993 […]
• Equality of Transgender and LGBTQ+ Populations The principles of the struggle for the transgender and LGBTQ+ populations should include respect for the choice and self-identification of a person.
• Aspects of Equality for Transgender Athletes The authors of the article claim that transgender athletes deserve equal representation and the right to participate in competitions in the divisions of the gender they identify themselves by referring to social structures and justice.
• Transgender Student-Athlete Participation Policy The updated regulations place the decision to let transgender sportsmen take part in the competition in the hands of the national governing body or, in the absence of such, of a sport’s international federation.
• Health Disparities in the Transgender Community The purpose of the research study is to improve health disparities in the transgender community by eliminating financial barriers, discrimination, lack of cultural competence of providers, and socioeconomic and health system barriers that will increase […]
• Transgender Bathroom Policies in Schools The topic of why transgender pupils cannot simply utilize private rooms designated for such gender identification, given that individuals who identify as boys and girls have their washrooms, is at the heart of the discussion […]
• The Transgender Teens Policy Issues Problem recognition involves recognizing that policies serving to protect the interests of transgender teens need proper enforcement or even proper formulation to ensure effectiveness in protecting and ensuring the best interests of the children.
• The Issue of Transgender in Sporting Activities Transgender women’s increased body strength and mass make it unfair for them to compete with cisgender women in the same sporting categories. The IOC sets the recommended testosterone level for transgender women to participate in […]
• Transgender Women in Sports: Is the Threat Real? In this regard, it can be argued that the advantages of transgender women are a barrier to women’s sports. However, the topic of transgender people has received the most discussion in the last few years […]
• The Advantages of Transgender Women Are a Barrier to Women’s Sports The main counterargument of proponents of transpeople participation in women’s sports is that there is no proven link between biology and endurance.
• The Article “The Transgender Threat to Women’s Sports” by Abigail Shrier Abigail Shrier’s article The Transgender Threat to Women’s Sports provides a series of arguments and evidence that support the idea of excluding transgender people from women’s sports.
• Transgender Women Take Part in Sports Competitions The issues that support this statement are unequal muscular mass of men and women unchanged by transgender therapy; and unequal height and length of the body needed in game sports and jumping.
• Transgender Participation in Sports Among the successes in resolving the subject of transgenderism in society, medicine, psychology and sports, scientists include the exclusion of transgender issues from the sections of psychiatric diseases, and their inclusion in the section of […]
• Aspects of Identity: Transgender Status, Gender Identity In many countries in Europe and the rest of the world, the whites always obtain more benefits at the expense of the people of color and other races.
• Lesbian, Gay, Bisexual, Transgender, and Queer Families’ Issues In tendency for this, it is essential to analyze issues faced by such families in the community and thus provide recommendations on approaches to adopt during counseling sessions of LGBTQ families.
• Considering Social Acceptability of Transgender and Transracial Identities This essay will examine two articles providing different views on transgender and transracial identities and argue that considerations used to support the transgender community are not transferable to the issue of transracial.
• Anti-Transgender and Anti-LGBQ Violence Crisis in the US The vicious circle of minority stress that leads to marginalization and the marginalization that contributes to the stigma has to be broken.
• LGBT (Lesbian, Gay, Bisexual, and Transgender) in Canada, Japan and China With a perfect understanding of the LGBTQ issue in Canada, my team and I started to compare LGBTQ in Canada, China, and Japan.
• Why LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer) Is Becoming Popular In the context of the continuity of experience, morality, and moral values, it is appropriate to emphasize one of the most apparent global trends, namely the gradual recognition of the inalienable rights of the LGBTQ+ […]
• Harassment of Young Adults Who Are Gay, Lesbian, Bisexual, Transgender, Questioning According to the professional code of ethics, it is the duty of a social worker to help people in need and with problems.
• Lesbian, Gay, Bisexual, and Transgender Ideation, Correlations With ‘Suicidality’ In addition, experience of verbal ill-treatment and physical assault intensified feeling suicidal for both heterosexual and gay or bisexual men, not just for homosexual men alone as contained in many research findings, and that social […]
• Ethical Issues of the Transgender Rights One of the most significant burdens transgender people experience is the recognition of their identity. Therefore, to increase the chances for transgender adults’ health care, it is important to pay thorough attention to any signs […]
• Growing Up Transgender: Malisa’s Story on NBC News It is essential to develop a better understanding of the concept of gender in relation to children and their development to ensure the protection of the interests of all people and, thus, improve their lives.
• Equal Employment Opportunity Commission for Transgenders The representatives of the EEOC are able to investigate each case of discrimination in different organizations using the law and the intentions of people to leave in an equal society.
• Transgender Bathroom Rights and Legal Reforms One of the themes that deserve discussion is the possibility of creating transgender baths and the rights that can be given to this category of the population.
• Health Care for Transgender Individuals However, the medicalization of transsexualism made it more difficult to receive the treatment as individuals have to prove that they have such problems, and it is not just a temperate state of their mind that […]
• Racism in Lesbians, Gays, Bisexuals, Transgenders Instead of supporting one another as members of a minority group, these people arrange internal arguments within the society of LGBT that leads to the increased feeling of depression and psychological pressure on behalf of […]
• Cancer Screening in Lesbians, Gays, Transgenders Moreover, one of the diseases that are the burden of American society as a whole and the LGBT population, in particular, is cancer.
• Transgender Issues in Modern Society The legalization of gay marriage in many countries did not lead to the eradication of homophobia, protection of women’s rights did not eliminate sexism and gender inequality present in many aspects of life, and the […]
• Lesbian, Gay, Bisexual, Transgender at Life Stages In general, all people are claimed to be equal in the USA, however, there is a high possibility to lose a job or fail to be applied to it if one is a representative of […]
• Transgender Bathroom Rights and Needed Policy In both articles, the subject of the study is the right of transgenders to access bathrooms according to the preferences of these people.
• Women in Sports: Policy for Transgender Players Drawing from this elucidation, the proposed policy statement on transgender participation in mixed leagues will not require transgender athletes to prove their gender identity through the testimony of professional experts and psychologists; on the contrary, […]
• Transgender People in the USA The statistics are impressive and, no matter how unpleasant it is to some of us, we have to face the reality that quite a large number of people in our society can be classified as […]
• Transgender Inclusivity in Higher Education The individuals and organizations opposing trans inclusion in higher education stress that one of the main purposes of all-female colleges is to ensure the safety of the female students.
• Transgender Students on Colleges: Needs and Challenges In order to accommodate all the involved groups of people, there is no attributed definition of transgender due to the diversity of the subject.
• Lesbian, Gay, Bisexual and Transgender Sexuality in the Hispanic Culture Men are the breadwinners of the family, a duty that requires men to play the father figure role in the family.
• Leslie Feinberg: Transgenders in “Stone Butch Blues” On one hand, traditionally, the transgenders have never assumed the authority held by men in the society and on the other hand, there is the issue that arises in a situation comprising of families composed […]
• Transgender People and the Rights Act of 1964
• Bathroom Discrimination Against the Transgender Community
• Unjust and Inhumane Transgender Discrimination
• Understanding Transgender People and the Discrimination They Face Today
• Lesbian, Gay, Bisexual and Transgender Rights
• Treatment and Support for Transgender Children
• Transgender Individuals and Sex Reassignment Therapy
• Violence Against Lesbians, Gays, Bisexuals and Transgender
• Women, Gay, Bisexual and Transgender Rights
• Transgender Sexuality and The Transgender Rights Movement
• Philosophy: Transgender and Radical Freedom
• Transgender People Face Harassment and Discrimination
• Transgender Sexuality and the Transgender Rights Movement
• Oppression and Lesbian, Gay, Bisexual, and Transgender Persons
• Understanding the Transgender Phenomenon
• Stigma and Discrimination That Transgender Individuals Experience
• Hate Crimes Against Lesbian, Gay, Bisexual, and Transgender
• Discrimination Against Transgender Individuals Within Society
• Building Relationships With Transgender Individuals
• Domestic Violence and Lesbian, Gay, Bisexual and Transgender Relationships
• Beyond Depression and Suicide: The Mental Health of Transgender College Students
• Transgender Rights and Representation in Sports
• Gender Dysphoria and the Persecution of Transgender People
• Lesbian, Gay, Bisexual and Transgender Inclusion
• Critical Race Studies Program Panel Detention Conditions Facing Queer and Transgender Immigrants
• U.S. Politics and Society: Lesbian, Gay, Bisexual, and Transgender Political Identity
• The Health and Well Being of Transgender High School Students
• The Pros and Cons of Transgender and Gender Nonconforming
• Comparing Intersex and Transgender Females
• Capitalism and Its Impact on the Transgender Movement
• Transgender Surgery and the Separation Between Mind and Body
• Gender Differences Between Effeminate Boys and Transgender
• How Schools Can Support Transgender Students and Improve School Climate
• The Transgender Community For Hate Based Crimes of Violence
• Public Bathroom Controversies Due to Transgender Issue in America
• The First Transgender Woman to Speak at a Major Party Convention in America
• The Causes and Solutions to the Mental Health Issues of Transgender Youth
• Sexual Orientation, Sexual, And Transgender Orientation
• Researching and Working for Transgender Youth: Contexts, Problems and Solutions
• Transgender Orientation and The Transgender Community
• Why Transgender People Should Use the Public Restroom that Matches Their Gender Identity
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Transgender

Disgust, morality, and the transgender bathroom debate, new research explores attitudes about transgender bathroom bill restrictions..

Posted December 30, 2020 | Reviewed by Gary Drevitch

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The past few years have seen a great deal of political energy focused on the question of which bathrooms transgender individuals should be allowed to use when out in public. On the one hand, trans people and their allies argue that trans people should be free to use the bathroom that matches their gender identity , such that trans women should use women’s bathrooms and trans men should use men’s bathrooms. The counterpoint comes from those who argue that a person’s sex, as assigned at birth, should dictate which bathroom they use. In this case, trans men and women are relegated to the bathrooms that match their sex assigned at birth, but often not their current gender identity .

To be clear about what this means, bathroom bill restrictions state that trans women should use the men’s bathroom, which, in most cases amounts to someone visually understood as a woman entering the men’s bathroom. Transgender men, according to bathroom bill restrictions, should be required to use women’s bathrooms, which, in most cases, amounts to someone visually understood as a man entering the women’s bathroom. In fact, the #WeJustNeedtoPee hashtag was created by trans people to visually demonstrate the often striking incongruence between such bathroom bill restrictions and their outcomes.

In general, attitudes about trans people’s access to public bathrooms tend to follow traditional political lines, with liberals being more supportive of access based on gender identity (referred to as support for bathroom access) and conservatives more supportive of access based on sex assigned at birth (referred to as support for bathroom bans, or restricted access). While knowing the average political leanings of people who support bathroom bills that either allow or deny access to bathrooms based on gender identity may be somewhat useful in understanding this issue, given the increasingly polarized state of political opinions, it is important to understand the underlying sentiments generating support for such bills. A recent article by Matthew E. Vanaman and Hanah A. Chapman published in a special issue of Politics and the Life Sciences focused on political attitudes and disgust as potential predictors of bathroom bill attitudes.

In the study, 663 Americans completed an online survey in which they answered questions about their propensity for three different types of disgust, their tendency to be concerned about specific moral values, and their attitudes concerning hypothetical policies concerning transgender access to bathrooms. Participants were randomly assigned to answer questions about bathroom access for transgender men or transgender women.

The researchers hypothesized that there may be three specific types of disgust associated with bathroom bill attitudes: pathogen disgust, sexual disgust, and injury disgust. Theorizing about subtypes of disgust often relates to evolutionary theory, such that it is believed that we feel various forms of disgust as a means of protecting ourselves from potentially dangerous scenarios. Pathogen disgust is triggered by things that we associate with disease. For example, we may reel from someone coughing near us. Pathogen disgust is not necessarily rational: We can experience pathogen disgust in response to things that are not contagious or threatening, such as birthmarks. Sexual disgust refers to being turned off by behaviours that may jeopardize long-term reproductive success, and injury disgust has been theorized to function as a reverse form of empathy, such that instead of feeling sympathetic towards an injured individual, one feels disgusted and repulsed. While transgender people are not a source of disease, have many options for becoming biological parents, and are not any more likely to appear injured than anyone else, the close links between prejudice and disgust could mean that individuals may associate transgender people with one or more of these subtypes of disgust based on the negative stereotypes and connotations they hold about transgender individuals.

Disgust is also closely tied to our moral values. According to Moral Foundations Theory, we make a variety of moral judgments along 5 dimensions of moral values: care/harm, fairness/cheating, loyalty/betrayal, authority/subversion, and purity/degradation. Vanaman and Chapman focused on the dimensions of harm and purity, theorizing that they were most closely aligned with the public debates of bathroom bills. Indeed, those who argue for and against the bills often bring up the potential for harm on either side, either the harm that could be caused to “women and girls” by allowing “men” into women’s bathrooms, or the documented harm that often comes to transgender people in public washrooms.

Participants randomly assigned to evaluate trans women’s bathroom access were asked to rate their agreement with the following statement:

“When it comes to public bathrooms, someone who was born into a male body should be required to use the men’s bathroom, even if they are a woman.”

For the participants randomly assigned to evaluate trans men’s bathroom access, the statement read:

“When it comes to public bathrooms, someone who was born into a female body should be required to use the women’s bathroom, even if they are a man.”

The results of the study supported the notion that individuals who were more conservative were more in favor of bathroom restrictions. (In other words, they agreed more strongly with the above statements.) Turning to the measures of disgust, both pathogen and sexual disgust predicted greater support of bathroom restrictions, but pathogen disgust was by far the strongest disgust predictor. The researchers also found that the more a person was generally concerned with violations of purity, the more supportive they were of the bathroom restrictions. In fact, purity was a stronger predictor than conservatism and concerns about harm. Concern about harm functioned slightly differently, such that the more people were generally concerned about harm and the welfare of others, the less they supported bathroom restrictions.

The researchers concluded that feelings of pathogen disgust and concerns about violations of purity may contribute to people wanting to avoid transgender individuals, and they may see support for bathroom bills as a means of accomplishing this goal. Rationally speaking, however, restricting access to bathrooms based on sex assigned at birth is, if anything, more likely to increase awareness of contact with trans individuals, given that trans individuals would then be forced to use bathrooms that do not match their gender presentations. Ultimately, those interested in increasing support for the rights of transgender individuals to access public bathrooms of their choosing may want to focus on combatting harmful stereotypes of transgender individuals and promoting efforts that underscore the humanity of all trans people.

Vanaman, M. E., & Chapman, H. A. (2020). Disgust and disgust-driven moral concerns predict support for restrictions on transgender bathroom access. Politics and the life sciences, 39 (2), 200-214.

Haidt, J., & Joseph, C. (2004). Intuitive ethics: How innately prepared intuitions generate culturally variable virtues . Daedalus , 133 (4), 55-66.

Karen Blair, Ph.D. , is an assistant professor of psychology at Trent University. She researches the social determinants of health throughout the lifespan within the context of relationships.

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We Need to Change the Terms of the Debate on Trans Kids

Every night, when I walk my dog, several strangers, similarly tethered, will ask me the same two questions: “Boy or girl?” and “How old?” The pragmatic meaning of these questions escapes me. The answers do not inform the interactions between our dogs, nor do they tell a story. Wouldn’t it be more interesting to learn whether the dog was a longtime family member or a pandemic puppy, whether it lived with other pets, how much exercise it got or desired, how it tolerated last summer’s orgy of fireworks, or to learn at least the dog’s name? These are the questions I usually ask other dog owners as our pets sniff each other, but in response I am still asked—hundreds of times a year—about my dog’s age and gender. These categories, it seems, are so central to the way we organize the world around us that we apply them to everything, including random dogs in the night.

No wonder, then, that attempts to subvert these two categories make people uncomfortable and, often, scared and angry. This happens when children act with particular independence; when people challenge the norms of gender; and, especially, when both of these things happen at once, as in the case of trans children. In December, the British High Court of Justice ruled on the question of whether young people under the age of eighteen are capable of giving informed consent to treatments that forestall puberty. Such treatments can be prescribed to children given a diagnosis of gender dysphoria, both to alleviate discomfort that can stem from the physical changes brought on by puberty and to pave the way for later medical gender transition. The court ruled that children under sixteen cannot consent to such treatment because they are unable to grasp its long-term consequences, and cast doubt on the ability of young people between the ages of sixteen and eighteen to give informed consent. The decision effectively bars British children and adolescents from transitioning medically.

British media coverage of the High Court’s decision was generally positive. “Other countries should learn from a transgender verdict in England” the Economist wrote . “The court was correct to curb a disturbing trend,” the Observer wrote . Later in the month, the BBC’s media editor, Amol Rajan, published his list of the five best essays of the year, among them J. K. Rowling’s piece explaining her position “on sex and gender issues.” Rowling, who presents herself as a defender of bathrooms, dressing rooms, and other “single-sex spaces” against trans women, wrote that she was “concerned about the huge explosion in young women wishing to transition and also about the increasing numbers who seem to be detransitioning.” She cited the controversial hypothesis that some adolescent transitions may stem from a kind of social contagion. Had transition been an option during her own adolescence, Rowling wrote, she might have chosen it as a way to deal with her own mental-health challenges: “The allure of escaping womanhood would have been huge.”

In the United States, this line of argument has been advanced by Abigail Shrier, a writer for the Wall Street Journal who published a book last year titled “ Irreversible Damage: The Transgender Craze Seducing Our Daughters .” The cover art is a drawing of a prepubescent girl with a giant round cutout where her abdomen should be. The book is currently ranked “#1 Bestseller in Transgender Studies” on Amazon. Bills that would ban trans care for young people have already been prefiled for this year’s legislative sessions in Alabama, Texas, and Missouri; last year, a similar bill was defeated in South Dakota, thanks to opposition from the pharmaceutical industry. When such bills contain language explaining their rationale, they make similar arguments to those of Rowling, Shrier, and the British High Court: that the effects of trans care are irreversible and that many people who want to transition when they are adolescents will ultimately choose to identify with the gender they were assigned at birth.

The state bills tend to lump all kinds of trans care—puberty blockers, cross-sex hormones, and surgeries—together. As a narrative, this is not unreasonable: the vast majority of people who receive puberty blockers do go on to take cross-sex hormones, and many choose surgery. But the short- and long-term effects of the medical interventions are markedly different. Agonists of gonadotropin-releasing hormone, originally developed to treat prostate cancer and endometriosis in adults, can have the effect of preventing puberty-related changes: genital growth, breasts, body and facial hair, and voice changes. Estrogen promotes breast growth, and testosterone will likely lead to a lower voice and more body and facial hair; both kinds of hormones affect fat and muscle distribution. The effects of hormones are not as predictable—and the line between reversible and irreversible effects of hormone treatments isn’t as clear—as their opponents seem to think, but a person whose puberty is effectively prevented and who later receives cross-sex hormones is unlikely to preserve their fertility. Some European researchers are experimenting with reserving gonad tissue that may be used to create biological progeny later (similar efforts are made with children undergoing cancer treatment that is likely to render them infertile). Natal males and females who transition during adolescence forfeit their fertility equally, but Rowling, Shirer, and other opponents of pediatric trans care seem particularly concerned with people they see as girls clamoring to escape womanhood. (The lead plaintiff in the British case, Keira Bell, who was assigned female at birth, began taking puberty blockers at sixteen and testosterone at seventeen and had a double mastectomy at twenty. Bell later transitioned back to being female.)

“Women and children are always mentioned in the same breath,” the visionary feminist activist Shulamith Firestone observed in the book “ The Dialectic of Sex: The Case for Feminist Revolution ,” from 1970. “I submit . . . that the nature of this bond is no more than shared oppression. And that moreover this oppression is intertwined and mutually reinforcing in such complex ways that we will be unable to speak of the liberation of women without also discussing the liberation of children, and vice versa.” Firestone noted that women and children were inextricably linked not only by the women’s duty of childbearing and child rearing but by the obligation, for both groups, to maintain innocence, fragility, immaturity, and dependence on others. She saw the path to liberation in divorcing the reproductive function from women’s biology, and in abolishing childhood. One might argue that young people who seek trans care are pursuing both of these projects, and that is why they inspire such panicked opposition.

Yet the arguments in favor of trans care for young people are usually not so much liberationist as they are determinist. Advocates generally claim that trans children are innately, immutably different from cis children and that access to medical transition is essential for staving off depression and even suicide. “The fear that puberty per se can be a threat to life for transgender children permeates pediatric trans care,” Sahar Sadjadi wrote in an essay in Transgender Studies Quarterly last year. (Sadjadi is a medical anthropologist who has studied clinical practices for transitioning and other non-gender-conforming children for a decade.) This type of advocacy, she argues, builds on two long-standing tendencies: the habit of thinking of gender transition as primarily a medical process, and the habit of grounding L.G.B.T. civil-rights claims in “born this way” rhetoric. These habits make for a compelling, easily digestible argument: transness is an immutable characteristic, and denying young people access to medical transition can be tantamount to killing them. This argument is grounded in the lived experience of some advocates, whose own medical transition relieved extreme anguish. But an argument rooted in despair cannot and should not represent all young trans people.

When we are not talking about children and adolescents, trans people talk about a much broader range of options than medical transition—a spectrum of gender expression more varied than the linear path of puberty blockers followed by cross-sex hormones. Some adult trans people consider themselves binary, and some don’t; some use hormones and have surgeries, some choose one or the other, some try different approaches, and some eschew medical interventions altogether. Medical intervention requires a diagnosis of gender dysphoria, even if the person is paying for surgery and hormones out of pocket. In general, though, adults are not required to prove that they have always felt like they were in the wrong body (although some have).

If we hold to the premise that transness is an immutable, inborn trait, it follows that every young person who chooses to detransition will undermine the case any other young person may have for seeking trans care. “The main debate has become whether these young people will ‘persevere,’ ” Sadjadi told me by Zoom from Montreal, where she is on the faculty at McGill University’s Department of Social Studies of Medicine. “I think this is the wrong question. Gender changes with age. The gender of a fifty-year-old woman is not the same as of a five-year-old girl. Nothing terrible happens if a person transitions again, which is how I think we should think about it.”

The British High Court’s decision makes a point that appears compelling and compassionate. A child, the panel decided, cannot fully comprehend the meaning of infertility and possible loss of sexual function that come with transitioning at a young age. (One concern is that puberty blockers prevent genital growth, making gender-affirming bottom surgery more complicated.) But this argument rests not only on a narrow definition of sexual pleasure but on an impossible ideal of comprehension: we can never fully imagine loss, especially the loss of something we’ve never had. Keira Bell testified, “It is only until recently that I have started to think about having children and if that is ever a possibility, I have to live with the fact that I will not be able to breastfeed my children. I still do not believe that I have fully processed the surgical procedure that I had to remove my breasts and how major it really was.” As heartbreaking as that admission is, all available data indicate that such regrets are exceedingly rare. That one person’s testimony convinced the court to make a decision that will affect untold thousands tells us more about the pull that human reproduction has on the imagination than it does about gender transition.

“People change their minds about all kinds of decisions,” Sadjadi added. Hers is not an argument against thinking of transition as a serious, consequential decision, but rather an argument for viewing gender transition as one of the many important choices some people face. People—including young people, acting legally, with their parents’ support—choose to have babies, move continents, subject themselves to extreme physical risk by engaging in certain sports, make what often amounts to commitments to lifelong medical intervention with S.S.R.I.s for depression or stimulants for attention deficit hyperactivity disorder, join the R.O.T.C. or the National Guard. None of these decisions is just like the decision to transition. But are they really so much lighter, so much less consequential, that the possibility of one person reversing course shouldn’t prevent others from making the same choices?

In her 1970 book, Firestone discussed the arbitrary historical boundaries of childhood. In other eras, boys would be expected to abandon toys and take up adult vocations at the age of seven; girls were historically married off as soon as they went through puberty. Firestone’s point was that childhood was a relatively new category, and an unstable one. Our own ideas of maturity are no less arbitrary than our ancestors’. We know that a fifteen-year-old is probably better equipped to make life decisions than is a nine-year-old, who is still vastly more experienced and informed than a four-year-old. But for the purposes of the law, we lump them in the same category. An eighteen-year-old, on the other hand, is deemed capable of making the full range of life choices—except for whether to ingest alcohol. There is little doubt, however, that the experience, wisdom, and skill for assessing risk and making decisions continue to accumulate well past middle age. If you think about it, a fifty-year-old who has experienced life in a particular gender is in a much better position to make a decision about transition than is a twenty-year-old. But at that point, it’s too late to decide to be a young person in the other gender, and this, too, is irreversible. I began my own transition at fifty, long after experiencing the misery of pregnancy and the incomparable joy of breastfeeding. I have no regrets. Had I had the option of transitioning as a teen-ager, I would have chosen to do so—and I am almost certain that I would have had no regrets then, either, because I would have had a different life.

Sadjadi, who was a physician before she became an anthropologist, has written that puberty blockers are not as medically inconsequential as they are often portrayed. Although they appear to have no long-term physical effects if they are used for a short time (a year or less), some studies suggest that they can have long-term detrimental effects for the musculoskeletal system if they are used for three or four years. (Long-term data comes from the use of puberty blockers to forestall what is deemed “precocious” puberty, occurring in children under the age of nine.) The manufacturer of Lupron, the drug most commonly used as a puberty blocker, warns of depression as a possible side effect. Sadjadi suggested freeing gender transition in young people from the assumption that they will necessarily take puberty blockers. For some kids, she said, it may be worth considering social transition as the first or even only step. Social transition is often conspicuously absent from the menu offered to adolescents. For others, cross-sex hormones may be preferable to puberty blockers, which are supposed to “buy time” before a child is deemed old enough to make the commitment to transitioning. There is not enough data to say whether and when these may be the better care options.

To be able to talk about a range of transition options, at different times in life, we would need to change the terms of the debate. We would need to view both age and gender on a continuum, not as binary states. None of us has ever been as innocent and ignorant as the children of our imagination, and none of us will ever be as wise and competent as the adults we make ourselves out to be. What if we saw ourselves as always changing, always uncertain, but always capable of making choices? What if we accepted that some losses are desirable and some are regrettable, and that we can’t always know the difference? What if we knew that we are always changing not only as individuals but as societies, and the categories we use to sort ourselves mutate faster than we realize? Then maybe we could have a real conversation about trans care for young people.

Transgender - Free Essay Samples And Topic Ideas

Transgender individuals have a gender identity that differs from the sex they were assigned at birth. Essays on transgender topics could explore the experiences of transgender individuals, the challenges they face, and the societal attitudes towards transgender people. Discussions might also delve into the legal protections, healthcare access, and representation of transgender individuals in media and popular culture. Moreover, examining the ongoing efforts of advocacy groups, the impact of gender-affirming care, and the importance of fostering inclusivity and understanding can provide a comprehensive exploration of the transgender experience and the journey towards achieving equality and acceptance. A vast selection of complimentary essay illustrations pertaining to Transgender you can find in Papersowl database. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

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Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies

Bethany alice jones.

1 Nottingham Centre for Gender Dysphoria, 3 Oxford Street, Nottingham, NG1 5BH UK

2 School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK

Jon Arcelus

3 Division of Psychiatry and Applied Psychology, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK

Walter Pierre Bouman

Emma haycraft.

Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation.

To the authors’ knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature.

Eight research articles and 31 sport policies were reviewed.

In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport’s policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based.

Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.

Introduction

Transgender people are those who experience incongruence between the gender that they were assigned at birth (based on the appearance of their genitals) and their gender identity/experienced gender. Gender identity, or experienced gender, can be defined as a person’s internal sense of gender, whether this be male, female, neither or somewhere along the gender continuum. Some transgender people, but not all, will choose to affirm their gender identity by socially transitioning (i.e. living as their experienced gender socially, at work or at an educational institution, with friends and family, outside the home) and some, in addition, will choose to medically transition with cross-sex hormones and gender-confirming surgeries [ 1 , 2 ]. Although over time various different terms have been used, the term ‘transgender female individual’ will be used to describe individuals assigned male at birth, based on their genital appearance, but who later identify as female. ‘Transgender male individual’ will be used to describe people who are assigned female at birth, based on their genital appearance, but later identify as male. ‘Cisgender’ will be used to describe people who do not experience incongruence between their gender assigned at birth and their gender identity.

Recent reports indicate that the number of transgender individuals who attend transgender health services has increased substantially over the years in many European countries [ 3 – 5 ]. There has also been a significant increase in the number of people who self-identify as transgender and do not necessarily attend transgender health services [ 6 ]. For example, Kuyper and Wijsen [ 6 ] found that 4.6 % of people who were assigned male at birth and 3.2 % of people who were assigned female at birth in their Dutch population sample reported an ambivalent gender identity (equal identification with the other gender as with the gender they were assigned at birth). The authors also reported that 1.1 % of the people who were assigned male at birth and 0.8 % of the people who were assigned female at birth identified as transgender. It remains unknown how many of these people will seek treatment through a transgender health service. The increase in people who identify as transgender may be at least partly explained by the increase in visibility of transgender people within Western society [ 4 , 5 ]. For example, Caitlin Jenner, a former athlete and current television personality, recently came out as transgender during a television interview that was viewed all over the world [ 7 ]. Increases in visibility may have prompted some people to reflect and question their gender identity [ 8 ].

Some transgender people experience stigma, transphobia, prejudice, discrimination and violence as a consequence of their gender identity [ 9 – 11 ]. Ellis et al. [ 12 ] found that transgender people were more likely to avoid situations when they were afraid of being harassed, identified as transgender or ‘outed’, such as in clothes shops, public toilets and gyms. Gyms are a popular outlet to engage in sport-related physical activities (i.e. gym fitness exercises) and therefore it is important to create an inclusive environment given the established mental and physical health benefits of physical activity and sport [ 13 , 14 ]. This is particularly important for transgender people as they have been found to report a high prevalence of depression and anxiety [ 15 , 16 ], which could be managed with physical activity. Furthermore, physical activity and sport can also contribute towards maintaining the appropriate weight necessary to undergo gender-confirming surgery, acknowledging that not every transgender person will wish to do so [ 1 , 2 , 17 ].

The premise of competitive sport is fairness (i.e. inclusion in the absence of advantage) and, owing to fears surrounding the perceived athletic advantage of transgender people, the question of whether transgender people should be permitted to compete in accordance with their gender identity has been raised and greatly contested within the literature, among sport organisations, fellow competitors and spectators. It is a commonly held belief that androgenic hormones (especially testosterone) confer an athletic advantage in competitive sport. Therefore transgender female individuals, because of high endogenous testosterone levels, are perceived to hold an advantage in sport (when testosterone has not been blocked to a cisgender female level). Transgender men are not thought to possess an athletic advantage, despite being injected with testosterone if they chose to medically transition with cross-sex hormones. However, there has been a paucity of research that has directly explored how androgenic hormone levels are associated with athletic competence in both cisgender and transgender populations (e.g. running time).

To facilitate the inclusion of transgender competitors, in 2004, the International Olympic Committee (IOC) [ 18 ] announced that transgender people could participate in all future Olympic games providing they had fully medically transitioned (i.e. had been prescribed cross-sex hormone treatment for 2 years and undergone gender-confirming surgery). Although the requirements of this policy appear to concur with the commonly held belief that transgender people hold an athletic advantage, they have been criticised for not being underpinned by an evidence-based rationale [ 19 ]. The IOC [ 20 ] has recently updated its policy to be more inclusive of transgender athletes (i.e. fewer restrictions); however, the 2004 policy has been extremely influential on other sport organisations’ policy development. The new (2016) IOC policy will be considered in Sect. 3 .

In an attempt to draw a consensus as to whether transgender people should be able to compete in accordance with their gender identity, in 2005 Reeser [ 21 ] conducted a review of the literature pertaining to gender identity issues in competitive (elite) sport. Reeser paid particular attention to the evolution of gender verification in competitive sport and whether current competitive sport policies for transgender people are fair. He concluded that, while gender verification has made significant advances, there is a lack of physiological performance-related data in transgender people. This is preventing an overall consensus from being made as to whether transgender sport policies are fair or not (i.e. fairness in the absence of advantage). Reeser’s review, although important, has some limitations. He did not adopt a systematic methodology and therefore did not include the majority of transgender sport policies. Additionally, Reeser only considered the implications of such policies in relation to elite competitive sport and did not consider the experiences of transgender people who engage in sport or sport-related physical activity for leisure or fitness (e.g. gym fitness activities, jogging).

With the intention of addressing the limitations of the previous literature review, this systematic review has two aims. First, to systematically analyse and critically review the available literature regarding transgender people’s experiences in relation to competitive sport (elite and recreational) and sport-related physical activity participation (e.g. jogging, gym fitness activities). Second, to systematically review the available transgender competitive sport policies with regard to their fairness (i.e. competition in the absence of advantage). It is hoped that this systematic review will further enhance the understanding of sport participation and competition amongst transgender people. It may be expected that as more people define themselves as transgender, the issues that transgender people experience in competitive sport and sport-related physical activity will become more pronounced. It is therefore important that those who work to facilitate and promote sport and develop policies for their own sport organisations (e.g. sport medicine specialists, sport policymakers) are informed about the issues that this vulnerable population face. This will allow for a non-discriminatory atmosphere in sport, whilst ensuring a fair system for all participants and competitors (regardless of their gender identity).

Search Strategy

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to undertake this systematic review [ 22 ]. To obtain relevant peer-reviewed articles, an electronic search of literature published between January 1966 and August 2015 was conducted using the following search engines: ScienceDirect, Web of Science, Scopus and PubMed. Within each search engine, the following search terms were entered: gender dysphoria, gender identity disorder, trans people, trans individual, transgender and transsexual. These terms were combined with three terms relating to sport (physical activity, exercise and sport) using the “AND” operator. The reference lists of eligible papers were searched for potentially relevant publications. Sport policies were obtained through a Google search using the above search terms with the addition of “policy” at the end of all sport-related terms.

Inclusion and Exclusion Criteria

To address the first aim, articles that were selected were concerned with the experiences and issues surrounding physical activity and sport participation for transgender people. This systematic review only considered articles eligible if they were research articles, as opposed to discussion papers. Case studies were also considered eligible, as research articles were limited. Peer-reviewed articles that were written in English only were included. For the second aim, all available national and international policies on competitive sport in transgender people were selected and reviewed.

Study Selection

Thirty-one research articles were considered potentially relevant to the remit of this review. The search also identified 31 competitive sport policies for transgender people. After screening the abstracts, ten research articles were excluded as six were concerned with lesbian, gay, bisexual and transgender sport, one was a Scottish non-academic survey, one was a book chapter, one was concerned with an irrelevant topic and another focused on cisgender participants. The remaining 21 articles were downloaded for full-text review and 13 papers were excluded as they were discussion papers, as opposed to research articles. Therefore, eight research articles fulfilled the inclusion criteria and were consequently included within this systematic review (Fig.  1 ). All 31 competitive sport policies for transgender people were reviewed and included within this systematic review.

Process of identifying eligible research articles. LGBT : lesbian, gay, bisexual, transgender

This section presents the findings from the research articles and sport policies included within this systematic review. First, the findings from the research articles that explored participation in sports (both elite and recreational standards) and sport-related physical activities (i.e. gym fitness activities, jogging) are provided. Second, findings from the reviewed competitive sport policies relating to transgender inclusion are given.

Transgender People and Sport Participation

Characteristics of the eligible research studies.

The oldest research article included was published in 2004 [ 23 ] and the most recent publication was from 2015 [ 24 ]. The majority of the studies were qualitative in nature, all of which employed interviews [ 24 – 29 ]. The remaining two research articles included an experimental study [ 23 ] and a cross-sectional survey [ 30 ]. Most of the studies were concerned with transgender people who participated in sport competitively, at an elite or recreational level [ 21 , 23 , 25 – 29 ]. Some authors focused on a specific sport; ice hockey, netball and softball [ 26 , 28 , 29 ] while others were concerned with transgender people engaging in any sport [ 25 , 27 , 29 ]. Broadly, across all sports, Gooren and Bunck [ 23 ] explored whether transgender athletes have a physiological advantage in competitive sport. One study explored participation in competitive sports and sport-related physical activity [ 24 ] and another study discussed participation in sport-related physical activity only [ 30 ]. Details of all of the research articles included within this systematic review can be found in Table  1 .

Table 1

Study characteristics of research articles included within the review

Review of Transgender People and Competitive Sport Participation (Elite and Recreational): Research Articles

The same data were extracted from all research articles reviewed (Table  1 ). Below, we provide the most prominent findings in relation to competitive sport participation from each of these articles. Six research articles were concerned with competitive sport participation within this systematic review [ 23 , 25 – 29 ]. The only experimental study was by Gooren and Bunck [ 23 ] who aimed to explore whether transgender people taking cross-sex hormone treatment can fairly compete in sport. The authors measured transgender people’s muscle mass (via magnetic resonance imaging) and hormone levels (via urine and blood analyses) before and 1 year after cross-sex hormone treatment. They found that 1 year after transgender male individuals had been administered cross-sex hormone treatment, testosterone levels significantly increased and these levels were within a cisgender male range. They also found that 1 year after cross-sex hormone treatment, transgender male individuals’ muscle mass had increased and was within the same range as transgender female individuals (assigned male at birth) who had not been prescribed cross-sex hormone treatment. In relation to transgender female individuals, Gooren and Bunck found testosterone levels had significantly reduced to castration levels after 1 year of cross-sex hormone treatment. Muscle mass had also reduced after 1 year of cross-sex hormone treatment. However, muscle mass remained significantly greater than in transgender male individuals (assigned female at birth) who had not been prescribed cross-sex hormone treatment.

Therefore, Gooren and Bunck concluded that transgender male individuals are likely to be able to compete without an athletic advantage 1-year post-cross-sex hormone treatment. To a certain extent this also applies to transgender female individuals; however, there still remains a level of uncertainty owing to a large muscle mass 1-year post-cross-sex hormones. While this study was the first to explore, experimentally, whether transgender people can compete fairly, the sample size was relatively small ( n  = 36). Additionally, they did not explore the role of testosterone blockers and did not directly measure the effect cross-sex hormones had on athletic performance (e.g. running time). Many, but not all, transgender female individuals are prescribed testosterone blockers to help them to reach cisgender female testosterone levels, when administration of oestrogen alone is not enough to reduce testosterone levels. This is particularly important if the person aims to undergo gender-confirming surgery, as 6 months of testosterone suppression is a requirement for such procedures. However, if a transgender woman does not wish to undergo surgery or does not wish to have their testosterone blocked to cisgender female levels (e.g. as they wish to use their penis), their testosterone levels will be above cisgender female levels. Differentiating not only between those taking cross-sex hormones and not taking cross-sex hormones, but also transgender female individuals taking testosterone blockers, may be necessary when discussing an athletic advantage.

The remaining studies considered within this section are qualitative, and although they have provided insight into the experiences of transgender people participating in competitive sport, the findings cannot be generalised. Semerjian and Cohen’s [ 27 ] narrative account provides a good overview of how diverse and individual the issues and experiences of transgender people participating in competitive sport can be. Some participants felt anxious when engaging in sport because they felt their genitals may be revealed (e.g. when changing). In contrast, one participant used sport as a safe space to escape from the harassment he received at school. It must be considered though, that participants within the study engaged in different sports and their experiences could therefore be associated with the specific sport (i.e. some sports could be more inclusive then others).

Three qualitative studies described the implications that sport policies had on the experiences of transgender people who engaged in sport [ 26 , 28 , 29 ]. Cohen and Semerjian [ 26 ] published a case study about a transgender woman (pre-gender-confirming surgery) who was playing in the women’s national ice hockey tournament, but who was eventually banned from playing in the tournament because it was felt she had an athletic advantage. She described how she felt under constant surveillance when she was playing and at times felt ambivalent about what gendered team she should play on. It was apparent that although teammates were supportive, the issues she experienced in relation to inclusion in the tournament were primarily related to constraints put in place by competitive sport policies. Similarly, the discussions held by two former New Zealand transgender female netball players in Tagg’s [ 28 ] study gave the impression that although transgender sport policies were supposedly implemented to increase the inclusivity of transgender people, this was not always the case. They discussed how policy would allow a pre-gender-confirming surgery transgender woman to compete in a male or mixed-gender netball team only and they must obey male dress codes. However, the participants in this study were former netball players and therefore their discussions may not have been based on the current state of netball in relation to transgender participation. In contrast to the previously mentioned studies, the majority of participants ( n  = 12) in Travers and Deri’s [ 29 ] study discussed the positive experiences they had in relation to transgender participation in competitive sport. However, some of the transgender men did discuss how they had hostile experiences (e.g. incorrect pronoun use). Several of the participants in this study also felt that testosterone gave transgender women (endogenous) and men (when injected) an athletic advantage.

For the two young transgender male individuals in Caudwell’s [ 25 ] study, the stage of transition appeared to be instrumental in disengagement from participation in competitive sport. The discussion held by the participants highlighted how accessing sport during their transitional period was difficult as they would not be accepted or feel comfortable on either a male or female team during this period. However, this study again discussed sport very broadly and therefore it is unknown whether the participants’ experiences were associated with specific sports or whether they are generalisable across other sports.

In summary, there is limited research from which to draw any conclusion about whether transgender people have an athletic advantage in competitive sport or not. The limited physiological research conducted to date has informed the development of transgender sport policies that are implemented by sporting organisations all over the world. It is these sport policies that appear to be instrumental in transgender people’s experiences with competitive sport, most of which are negative.

Review of Transgender People and Sport-Related Physical Activities: Research Articles

Within this systematic review, only two studies explored sport-related physical activities [ 24 , 30 ]. Muchicko et al. [ 30 ] set out to quantitatively explore the relationship between gender identity and physical activity. They compared levels of physical activity between cisgender and transgender people. The study found that self-identified transgender participants ( n  = 33) reported engaging in less physical activity than cisgender participants ( n  = 47). Social support and self-perception were found to mediate the relationship between gender identity and physical activity. The authors suggested that their study highlights how leisure centres need to be more inclusive, and transgender people need to be given more social support to encourage physical activity. However, this study was limited by the sampling methods employed. The cisgender participants were recruited from a university campus where they potentially had more opportunity to walk around campus, and opportunity for discounted gym memberships, whereas the transgender participants were recruited from a support group for transgender people and were not associated with the university.

As with transgender people who engage in sport at a competitive level, transgender people who engage in sport-related physical activity also appear to experience a range of different barriers. Hargie et al. [ 24 ] found in their qualitative study that transgender people prefer to engage in individual, as opposed to group, sport-related physical activities. This was reportedly owing to their fear of being ‘outed’. Regardless of whether sport-related physical activities are engaged in individually or in a group, changing rooms appeared to be a significant barrier. Being excluded from sport-related physical activities was distressing for participants, as they could not maintain physical fitness, which they felt was important in preparation for gender-confirming surgery. Despite these interesting findings, the study is limited by the lack of sociodemographic information provided about participants. Within qualitative research, because of the small sample size, it is often desirable to provide a large amount of sociodemographic detail about participants so that the findings can be interpreted in relation to this information. For instance, in the context of sport-related physical activities, the stage of transition may be an important factor when interpreting the individuals’ current experiences of sport-related physical activities.

The limited research studies concerned with sport-related physical activities suggest that inclusive environments are not created for transgender people engaging in such activities, which may deter engagement.

Transgender-Inclusive Sport Policies

Characteristics of the eligible sport policies.

Of the 31 transgender inclusive policies reviewed, 13 were from the USA [ 31 – 43 ]. Ten of the policies reviewed were from the UK [ 44 – 53 ]. One policy was from Australia [ 54 ]. The rest of the policies ( n  = 7) were international [ 18 , 20 , 55 – 59 ]. Details of all of the sport policies included within this review can be found in Table  2 .

Table 2

Transgender-inclusive sport policies included within this systematic review

GCS gender-confirming surgery, CHT cross-sex hormone therapy, IOC International Olympic Committee, TUE therapeutic use exemption, n.d. no date

a Gender dysphoria is the diagnostic name included within the Diagnostic and Statistical Manual for Mental Disorders , Fifth Edition, for people who experience an incongruence between their gender assigned at birth and gender identity [ 60 ]

Review of the Sport Policies

Policies within this section were systematically reviewed in relation to their inclusiveness of transgender competitors (i.e. maintaining fairness in the absence of advantage for all competitors). The fairness of the policy requirements was judged against the available physiological research that has explored athletic advantage. The time restrictions associated with each requirement were also reviewed (e.g. cross-sex hormones must have been administered for at least 2 years prior to competition). The requirements from each policy are summarised within Table  2 and the most salient points of these policies are then presented in the section that follows.

In 2004, the IOC [ 18 ] announced that transgender people who transition after puberty are permitted to compete in sport in line with their experienced gender identity providing they have had gender-confirming surgery, can provide legal recognition of their gender, have been prescribed cross-sex hormone treatment for at least 2 years and have lived in their experienced gender for the same amount of time [ 18 ]. Additionally, transgender people who had undergone gender-confirming surgery pre-puberty are eligible to compete in sport in line with their experienced gender identity [ 18 ]. This is an international policy and has been adopted by sport organisations all over the world.

While the 2004 IOC [ 18 ] policy has been praised for its efforts to address the inclusion of transgender athletes [ 61 ], several flaws have been identified [ 61 ]. First, the policy excludes transgender people who choose not to have gender-confirming surgery owing to a lack of genital dysphoria (distress), medical reasons, fears about risk during operations, and/or because of other personal reasons [ 28 , 62 , 63 ]. The 2004 IOC [ 18 ] policy also excludes transgender people who are in the process of transitioning. For instance, a transgender athlete may be prescribed cross-sex hormone treatment, but be yet to undergo gender-confirming surgery. The 2004 IOC policy [ 18 ] therefore adopts a very narrow definition and excludes a large proportion of transgender people [ 19 ]. In addition to this, the policy appears to have been developed with only transgender female individuals in mind, possibly as transgender male individuals are not thought to possess athletic advantages in the majority of sports, and therefore the policy discriminates against transgender male individuals [ 21 ]. Moreover, the 2004 IOC [ 18 ] policy fails to take into consideration the regional, national and international differences in accessing cross-sex hormone treatment and gender-confirming surgery [ 18 , 63 – 65 ]. Within this policy, there also appears a lack of an evidence-based rationale as to why a period of 2 years was chosen as the length of time cross-sex hormone treatment must be administered prior to sport competition and why individual differences in blood hormone levels are not considered [ 66 ]. As mentioned previously, the role of testosterone blockers in transgender women is also not considered. Although the rationale for the 2-year time period is not made explicit, it may be related to the fact that this time period was imposed by the IOC in 2004, when banning athletes from competitive sport to discipline them for doping violations. The evidence-based rationale for gender-confirming surgery is also not clear [ 61 ]; whether an athlete has a penis or vagina appears irrelevant, as this will not change the physiology of the body or the physiological advantage of the person [ 63 ].

Approximately 200 days before the 2016 Rio Olympic Games, the IOC announced changes to their competitive sport policy for transgender people. The new 2016 IOC [ 20 ] policy suggests that transgender male athletes are able to compete in a male category without any restrictions. Transgender female athletes may compete in a female category if they have declared their gender as female for at least 4 years and their blood testosterone levels are below 10 nmol/L for at least 12 months prior to competition. However, the latter requirement is a general guideline, and each case will be reviewed individually to determine whether 12 months is a sufficient amount of time to suppress testosterone levels to an appropriate level. If transgender female athletes do not meet these requirements, they will be able to compete in a male category. This is a great improvement in sport policy, which considers gender assigned at birth and individual difference in relation to bloody hormone levels and moves away from the requirement of surgery to compete in their experienced gender category. However, we could not find any evidence to support the requirement for testosterone levels to be below 10 nmol/L for at least 12 months.

Despite its flaws, the 2004 IOC policy [ 18 ] has been adopted by several other sport organisations. Within this systematic review, 11 sport organisations adopted the policy outlined by the IOC in 2004 [ 33 , 36 , 38 – 40 , 45 , 46 , 48 , 49 , 51 , 57 ]. All but one (the International Tennis Federation) of these sport organisation policies are employed at a national level. Not only is it problematic that other sport organisations adopted the 2004 IOC policy, but elements of the 2004 IOC policy concerning children pre-puberty are not applicable to sport organisations in the UK and many other countries. Within the UK (and many other countries), children presenting with gender incongruence cannot undergo gender-confirming surgery before the age of 18 years, by which time puberty has usually started.

Three policies stated that it is only necessary to provide legal recognition of gender and to be prescribed cross-sex hormone treatment for a ‘sufficient amount of time’ (international policy) [ 56 ] or so that hormone blood levels are within cisgender female or male ranges (national policy) [ 44 , 52 ]. Policies from the National Collegiate Athletic Association [ 32 ] and British Rowing [ 50 ] also state that only cross-sex hormone treatment is required; however, the specifics of this requirement differ for both transgender male and female individuals. With both of these policies, transgender female individuals have to provide more evidence of cross-sex hormone treatment and their blood hormone levels in comparison to transgender male individuals. Similarly, the Association of Boxing Commissions [ 31 ] in its national policy has different cross-sex hormone treatment requirements depending on gender assigned at birth and how the athlete identifies themselves (transgender or transsexual). The language used within the Association of Boxing Commissions’ policy [ 31 ] may be seen as offensive by some transgender people and the difference between “transsexuals” and “transgender” people remains unclear. Policies held by the Ladies Professional Golf Association (international policy) [ 43 ] and the International Association of Athletics Federations [ 55 ] differ dramatically in relation to gender and gender-confirming surgery as a requirement. In both cases, it is necessary for transgender female individuals to have undergone this procedure, but not for transgender male individuals. Although some of the requirements of these policies are unreasonable and not evidence based (e.g. gender-confirming surgery), the gender difference in relation to the amount of evidence that is required about their gender change seems acceptable considering that only transgender female individuals (and not transgender male individuals) are currently seen to potentially have an athletic advantage [ 23 ].

The more inclusive sport policies reviewed here only required legal or medical recognition or do not ask for any evidence of gender; thus they encourage competition in line with the experienced gender (five were national policies and two were international) [ 34 , 35 , 41 , 42 , 53 , 54 , 59 ]. The Fédération Internationale de Volleyball [ 58 ] had the most invasive policy considered within this systematic review; they ask players to provide a birth certificate to verify gender. Additionally, female players may be asked to provide a gender certificate or submit themselves to a medical examination if the medical evidence is not sufficient. Both British Universities & Colleges Sport [ 47 ] and USA Triathlon [ 37 ] do not have their own policies, but suggest the adoption of other policies (i.e. those relevant to the sport in question or guidelines of the US Anti-Doping Agency, respectively).

Currently, the majority of sport policies unfairly exclude transgender people from competitive sport, as the requirements they place on them are not underpinned by evidence-based medicine. Until (and if) there is consistent and direct evidence to demonstrate transgender people have an athletic advantage, it seems unreasonable to exclude them on any basis.

The first aim of this systematic review was to explore the experiences of transgender people in relation to competitive sport participation (elite and recreational) and sport-related physical activity. The majority of the studies within this body of literature are qualitative in nature, which may be at least partly a reflection of the low numbers of transgender people in the general population. It is therefore difficult to draw any definite conclusions because of the lack of quantitative research. By its very nature, the findings from qualitative research cannot be generalised but the findings can be used to form a platform from which generalisations can be made. The research articles reviewed here described a generally negative experience of sport participation and sport-related physical activity for transgender individuals. It was evident from these studies that transgender people are facing barriers when engaging in competitive sport and sport-related physical activity. In relation to sport-related physical activity, lack of accessibility to an inclusive and comfortable environment appeared to be the primary barrier to participation. Charities and support organisations working with transgender people should consider developing campaigns to raise awareness about different gender identities. Leisure centres should also be made more aware of potential gender differences (i.e. via training and greater information provision) and be given advice on how to make such environments more inclusive of transgender people (e.g. gender neutral changing facilities with cubicles). In relation to competitive sport participation, the findings from this systematic review suggest that the requirements that transgender competitive sport policies place on competitors were instrumental in transgender athletes’ negative experiences.

While a distinction needs to be made between the issues and experiences transgender people have with regard to participation in sport and competitive sport, it also needs to be acknowledged that there is an overlap. Transgender male and female individuals have anecdotally discussed that access to sport participation (such as becoming part of the local football team) is restricted as even community and local sport organisations who play at a recreational level implement transgender competitive sport policies.

The second aim was to review the available sport policies regarding the fairness for transgender people in competitive sport (i.e. fairness in the absence of advantage). Owing to overinterpretation and fear of the athletic advantage in transgender athletes, the majority of the policies reviewed were discriminatory against transgender people, especially transgender male individuals (i.e. exclusion in the absence of advantage). Although the updated IOC policy may be perceived as more inclusive then the 2004 version, there are still flaws. The requirement for a transgender female individual to have declared their gender as female for at least 4 years is excessive. In the UK and many other countries, once a transgender person has accessed a transgender health service, it is likely to be less than 4 years before a person legally changes their name, undergoes irreversible treatments and, hence, fully commits to their experienced gender. There appears to be a lack of rationale regarding the 4-year time period for transgender athletes, although this time restriction is consistent with the current disciplinary action for cisgender athletes when a doping incident occurs [ 67 ]. The 2016 IOC policy [ 20 ] also states that to avoid discrimination against transgender female individuals, they are allowed to complete in a male category if they do not meet the requirements for transgender female athletes. For most transgender female individuals, competing in a male category, when their experienced gender is female, would be distressing and may deter engagement in competitive sport altogether. This particular requirement may be promoting exclusion of transgender female individuals in competitive sport, rather than avoiding discrimination.

Several sport policies, including the recently updated IOC 2016 [ 20 ] policy, have based their requirements for transgender competitors on indirect, inconsistent and unambiguous evidence. Physiological research involving cisgender people has shown that testosterone deficiency in young men is associated with a decrease in muscle strength [ 68 ] and testosterone injections in cisgender men are associated with an increase in some aspects of muscle strength [ 69 ]. However, this research did not determine whether these decreases and increases in muscle mass are within ranges for cisgender female and male individuals and the time required to reach cisgender male or female levels. Elbers et al. [ 70 ] expanded on this research by exploring the effects of oestrogen supplements and androgen deprivation on fat distribution and thigh muscle mass (by using magnetic resonance imaging) in 20 transgender female individuals. They found that 12 months after cross-sex hormone treatment, transgender female individuals had a more feminine pattern of adiposity and their thigh muscles had decreased. Other research has found that transgender female athletes who have hormonally and surgically transitioned have reported feeling weaker and their testosterone levels tend to be lower than average compared with cisgender women [ 19 , 71 ]. However, this research does not tell us anything about the relationship between androgenic hormones and athletic ability.

To date, Harper’s study [ 72 ] is the only one to directly explore androgenic hormones and athletic ability. The aim of the study was to explore the long-distance (5–42 km) running times of eight transgender female individuals pre- and post-testosterone suppression. It was found that post-testosterone suppression running times were significantly slower in comparison to pre-testosterone suppression. Harper stated that owing to reductions in testosterone and haemoglobin, transgender female individuals post-transition would have the same endurance capabilities as a cisgender female individual. However, the sample size was very small ( n  = 8) and participants were asked to self-report their race times, which might have been subject to recall or social desirability bias.

On average, men perform better than women in sport; however, no empirical research has identified the specific reason(s) why. Based mainly on indirect research with cisgender people, it is commonly believed that androgenic hormones (specifically high testosterone levels) confer an advantage in competitive sports (i.e. enhance endurance, increase muscle mass) and, while this belief has informed several sporting policies, testosterone may not be the primary, or even a helpful, marker in determining athletic advantage [ 73 ]. Karkazis et al. [ 73 ] have argued that there is no evidence to suggest that endogenous testosterone levels are predictive of athletic performance (apart from doping), as there is variation in how bodies make and respond to the hormone. Testosterone is only one part of a person’s physiology and there are other important factors (both biological and environmental) that should be considered if fairness (the absence of advantage) is the aim in competitive sport. For instance, having large hands is key for manipulation in some sports (e.g. basketball), but this is not seen as an unfair advantage. Establishing what an athletic advantage is in competitive sport would facilitate inclusion of all athletes (regardless of their gender identity) on the premise of fairness.

The Canadian Centre for Ethics in Sport [ 74 ] recently released a document offering guidance to sport organisations on how to develop inclusive competitive sport policies for transgender people. An expert panel maintained the viewpoint that everyone has the right to compete in accordance with their gender identity at a recreational and elite level. Cross-sex hormones and gender-confirming surgeries should not be a requirement at any level of sport. If any sport organisation requires transgender competitors to take cross-sex hormones for a specified time, they will have to provide evidence to support that this is reasonable. The panel suggests that when sporting organisations are concerned about safety, based on the size or strength of competitors, such organisations should develop skill and size categories, such as in wrestling.

The issues and challenges that transgender people experience when engaging in competitive sport and sport-related physical activity will undoubtedly become more prominent as the visibility and prevalence of transgender people become more pronounced. Consequently, health professionals working in sport will need to become more familiar with the specific issues and challenges that a transgender person may experience when engaging in sport. By doing this, these professionals will be able to ensure transgender people can start or continue to engage in sport in a safe and inclusive manner. The most common question of people working within the sport domain will likely be: When it is safe and fair to permit a transgender person to compete in sport in line with their experienced gender? At the current time, this is a difficult issue to address considering that there is a lack of direct and consistent physiological performance-related data with transgender people, which is preventing a consensus from being made as to whether transgender people (especially transgender female individuals) do or do not have an athletic advantage. It may be sensible to suggest that until there are direct and consistent scientific data to suggest that transgender competitors have an advantage, transgender people should be allowed to compete in accordance with their gender identity with no restrictions (e.g. no requirement to have cross-sex hormones, gender-confirming surgery). The athletic advantage transgender female individuals are perceived to have (based on indirect and ambiguous evidence) may be no greater than widely accepted physiological (e.g. large hands) and financial (e.g. training opportunities) advantages that some cisgender people possess in competitive sport. Sport organisations wanting to exclude a transgender person from competing in their experienced gender category would need to demonstrate that the sport is gender affected and that exclusion is necessary for fair and safe competition [ 74 , 75 ]. At the current time, this would be difficult considering there is no evidence to suggest that androgenic hormone levels consistently confer a competitive advantage [ 74 , 75 ].

Limitations of the Area and Directions for Future Research

Within the area of sport, physical activity and transgender individuals, research is limited and mainly qualitative. More quantitative research needs to be conducted to increase the applicability and generalisability of the research findings and so that conclusions about transgender people and sport can be drawn. At a medical level, more physiological research is needed with the transgender population to accurately determine whether transgender people have an advantage in competitive sport or not. Future studies should investigate when a person can be considered physiologically as their experienced gender. This in turn should aid more inclusive (i.e. inclusion in the absence of advantage) sport policies for transgender individuals and a fair system for all. To date, the few studies exploring the experiences of transgender people have mainly been concerned with exploring experiences in relation to competitive sport. This research now needs to be extended to those who participate in sport-related physical activity for leisure and fitness. It is also important to understand transgender people’s experiences in the context of different sports. The barriers to, and facilitators of, football participation, for example, may greatly differ to those experienced when engaging in gymnastics, athletics, swimming or aquatic activities. For the latter four sports, clothing may be revealing and an indication of one’s gender. For example, feeling comfortable in swimwear may be an issue for transgender people, especially when they are in the process of transitioning, as the body is often more exposed than in other sportswear (e.g. a football kit) and swimwear is heavily gendered (i.e. swimming trunks are worn by male individuals and swimming costumes by female individuals). In light of this, it would be interesting to explore the experiences of transgender people who have previously participated, or are currently participating, in aquatic activates, gymnastics and/or athletics.

Overall, it appears that the majority of transgender people have a negative experience of competitive sport and sport-related physical activities. Accessibility to sport-related physical activity needs to be improved. Within competitive sport, the athletic advantage transgender athletes are perceived to have appears to have been overinterpreted by many sport organisations around the world, which has had a negative effect on the experiences of this population. When the indirect and ambiguous physiological evidence is dissected, it is only transgender female individuals who are perceived to potentially have an advantage as a result of androgenic hormones. Within the literature, it has been questioned as to whether androgenic hormones should be the only marker of athletic advantage or, indeed, if they are even a useful marker of athletic advantage. Given the established mental and physical health benefits of engaging in physical activity and sport [ 13 , 14 ], the barriers transgender people experience are a significant limitation to the promotion of healthy behaviours in transgender individuals. There are several areas of future research required to significantly improve our knowledge of transgender people’s experiences in sport, inform the development of more inclusive sport policies, and most importantly, enhance the lives of transgender people, both physically and psychosocially.

Acknowledgments

We sincerely thank Prof. Barrie Houlihan for his helpful advice and feedback on an early draft of this systematic review.

Compliance with Ethical Standards

Bethany Jones was supported by a PhD studentship co-funded by Leicestershire Partnership NHS Trust and Loughborough University. No other sources of funding were used to assist in the preparation of this article.

Bethany Jones, Jon Arcelus, Walter Bouman and Emma Haycraft declare that they have no conflicts of interest relevant to the content of this review.

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Transgender Athletes Essay

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