P4A229: Transgender Youth Sports Participation: Recent Trends in State Policies

Background: Transgender youth have higher rates of mental health conditions and elevated risk of suicidal attempts when compared to their cisgender counterparts. Although sports participation improves the physical, mental, and emotional health of youth and adolescents, a significant number of states have passed laws limiting transgender youth sports participation in recent years.
The objectives of this study were to review state laws and statewide interscholastic association policies regarding transgender youth sports participation and to create an easy-to-follow diagram illustrating the current policies and how transgender youth are affected.

Methods: Legiscan (legiscan.com) and the search phrase “(gender OR "biological sex") AND (athlete OR athletic OR sport)” was used to search for bills enacted in all 50 states. Relevant bills were reviewed, and the following data was extracted: state, year of bill passage, effect on K-12 and/or college, and effect on public and/or private schools. Then, statewide interscholastic association websites were assessed for their current athlete participation guidelines, and the following data were extracted: if athletes were limited to participate as the sex stated on their original birth certificate, if athletes must complete sex reassignment surgery to compete, if athletes must complete 1 year of hormonal therapy to compete, and if there were specific policies to facilitate transgender sports participation without surgical or hormone therapy requirements.

Results: Idaho was the first state to limit transgender sports participation in 2020. Afterwards, eight states in 2021, nine states in 2022, and three states in 2023 passed laws restricting transgender youth sports participation. Out of the twenty-one states, three laws affect K-12 and fifteen laws affect K-12 and collegiate sports. Other states’ permutations include: Kentucky (6th grade through college); Tennessee (5th grade through college); and Wyoming (7th to 12th grade). All state laws impact public schools, but nineteen states also extend restrictions to private schools that compete with public schools.
Reviewing statewide interscholastic association policies, five states limit athletes’ eligibility based on their sex assigned at birth, one accepts an amended birth certificate, three require gender reassignment surgeries and hormonal therapy, and eight require one year of hormonal therapy. Twenty-six state associations (including DC) have established detailed policies to facilitate transgender sports participation. The remaining eight states either had no clear policies in place or deferred to local school districts.
Notably, there were five states where the state interscholastic associations support transgender participation without requiring hormones or surgery, while the state law bans transgender participation.

Conclusion: Twenty-two states currently restrict transgender sports participation, and this may negatively impact the wellbeing of transgender youth. Pediatricians should actively promote sports participation for all children, be aware of the rapidly changing legal landscape, and help break barriers and improve transgender youth’s access to sports activities.