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For the first time in the state of Vermont, one school team refused to compete against another because of a transgender athlete. As reported in this newspaper and others, the Mid Vermont Christian School girls’ basketball team forfeited their first-round game in the Division IV state tournament against the Long Trail School, citing concerns about playing against a transgender member of the opposing team.

Vicky Fogg, the Mid Vermont head of school, identified fairness, safety and bad precedent as the reasons for her team’s withdrawal. The withdrawal diverges from recommendations put forth by the Vermont Principals’ Association and the Vermont Agency of Education, both of which support equity for transgender student-athletes. According to their policies, discrimination based on a student’s actual or perceived sex and gender is prohibited, and transgender and gender-nonconforming students should be afforded the same opportunities to participate in physical education and sports as everyone else. Though the Vermont Agency of Education’s best practices for schools stipulate that gender identity, not biological sex, should dictate whether a student participates on a boys’ or a girls’ team, they also concede that case-by-case decisions might be needed for competitions.

Are things ever completely fair or safe in competitive sports? A team might receive a disadvantageous call that seems unwarranted. A player might take a bad step, resulting in an injury. Sport governing bodies, athletic directors, coaches, and other stakeholders do what they can to level the playing field and keep athletes safe, but some risks and advantages cannot be quantified or controlled. Is allowing a teenaged transgender athlete who is biologically male to play on a girls’ team that much more of a risk or advantage than anything else a high school athlete might encounter during a given game?

The answer is, we have no idea. What we do know, and must acknowledge, is there are physiologic characteristics bestowed by male levels of testosterone, beginning before birth, that are irrevocable, even in those on long-term hormonal suppression. Dr. Alison K. Heather, an expert in the field from the University of Otago in New Zealand, summarizes these comprehensively in a recent review article in the International Journal of Environmental Research and Public Health. Male-specific brain physiology, bone mass and structure, and heart and lung size and capacity are all permanent sex differences that cannot be modified, even with hormonal changes later in life that skew a male individual toward female biology. Other physical characteristics, like strength, muscle mass and blood oxygen-carrying capacity, can be influenced by testosterone suppression.

Even so, successful testosterone suppression is variable, and on the elite level, at least, transwomen might still be at significant advantage for some parameters compared to their cisgender peers. For example, investigators at the Children’s Mercy Division of Adolescent Medicine, in a 2021 study of transgender members of the U.S. Air Force published in the British Journal of Sports Medicine, showed that even after two years of feminizing hormone treatment, transwomen were still able to run 12 percent faster than their biologically female counterparts.

While this might be significant in the realm of elite sports, where a less than 1 percent difference in performance is often the gap between victory and defeat, it might not matter in many other circumstances. Joanna Harper, a sports scientist at Loughborough University who is herself a transwoman athlete and an expert on transgender athletic performance, argues in a debate aired on BBC Sport that the focus should not be on whether transwomen have an advantage, but rather, on whether transwomen and ciswomen can compete against one another meaningfully. This would mean that if the participation of a transgender athlete does not profoundly alter the spirit and nature of competition, that athlete’s gender identity should be all that matters.

Currently, sport governance organizations provide few specific regulations. In November 2021, the International Olympic Committee revised its policy on transgender athlete participation, which had previously required transwomen athletes to maintain a testosterone level of less than 10 nmol/liter for 12 months prior to competition. The new policy, known as the Framework on Fairness, Inclusion and Non-Discrimination on the Basis of Gender Identify and Sex Variations, is nonbinding and encourages each sport to develop its own eligibility criteria based on the unique characteristics of the sport. In January 2022, the NCAA followed suit and endorsed a sport-by-sport approach. This noncommittal guidance highlights the uncertainty around this issue and the need for further investigation and continued debate.

But, as Dr. Jack Turban, a child and adolescent psychiatrist at the University of California San Francisco, points out in his 2021 article in Scientific American, there is hardly an epidemic of transgender girls dominating female high school sports. The presence of transgender girls on high school sports teams is exceedingly rare, and there are documented cases where cisgender girls have successfully competed against them. As Turban explains, transgender and gender-nonconforming kids might arguably have a biological advantage in sports, but they are otherwise culturally disadvantaged in our cisgender world. As a result, they suffer from higher rates of mental illness, bullying, family rejection, homelessness and poverty.

If inclusion on a sports team aligned with their gender identity mitigates even a fraction of hardship for a struggling young person, shouldn’t we support it?

Dr. Rebecca Breslow is a sports medicine doctor, freelance health care writer, and Burr and Burton Academy assistant cross country coach. Reach out to her at


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