This article was produced by Stateline, an initiative of The Pew Charitable Trusts.

CLARKSDALE, Mississippi. — Katy Binstead’s 13-year-old transgender daughter, Emily Wilson, enjoyed playing basketball recreationally this past summer. When school reopened, she decided to try out for the girls basketball team at her middle school on the Mississippi Gulf Coast.

The school denied Emily the chance, her mother recalled, telling her to try out for the boys team instead, because her birth certificate identified her as male. 

As dozens of states consider legislation that would restrict transgender girls’ participation in sports, Emily and her mom are advocating for other families who may face similar trials.

“This tells me that our school district doesn’t know the difference between sex and gender,” Binstead said recently, as Mississippi lawmakers were considering a bill that would institute a similar ban statewide. “She can’t play with the boys because she’s not a boy, so the legislation won’t change the school district’s policy.”

Earlier this month Mississippi Governor Tate Reeves, a Republican, signed legislation prohibiting transgender girls’ participation in girls high school and women’s college sports, the first such bill enacted this year. Idaho passed the first such law, in 2020, though that’s been blocked by a federal court after the ACLU filed suit.

Emily may become a plaintiff in a similar lawsuit in Mississippi, she recently told Sports Illustrated.

And more state bans could follow. Lawmakers in at least 29 other states are debating similar legislation, according to Stateline research. Many of the bills also would require proof of an athlete’s sex, meaning some girls could be forced to undergo physical exams, including of their genitals, before being allowed to play.

Supporters of the bills say transgender girls have an unfair athletic advantage over cisgender girls and women, and that allowing them to compete threatens the athletic opportunities that women and girls have enjoyed since the passage of Title IX in 1972, which requires that women and men be granted equitable opportunities to participate in sports.

But LGBTQ advocates and some researchers say barring transgender kids from school sports would jeopardize their mental and physical health and increase their isolation—a problem that is particularly acute in rural America.

12% of Trans Youth Live in Rural Areas

Surveys show that rural youth are as likely as their urban counterparts to identify as LGBTQ, and census numbers indicate that nearly a fifth of the nation’s LGBTQ residents live in rural areas. The Williams Institute at UCLA School of Law estimated there are about 150,000 trans youth between the ages of 13 and 17 nationwide, with nearly 12% living in rural areas. Outside urban regions, a lack of services and community support can leave transgender youth feeling especially alone.

More than 2% of high school students identify as transgender, according to the federal Centers for Disease Control and Prevention, and they experience more violence and suicide risks than heterosexual youth. More than a third attempt suicide and endure bullying at school. Playing sports could make a difference: A 2019 study published in JAMA Pediatrics showed that youth team sports can ward off depression and anxiety among all youth who face adverse childhood experiences and lead to better mental health in adulthood.

Jaime Gabrielli, a mother of two from rural Montana, grew concerned when her 16-year-old transgender son, Justin, quit track and basketball in the eighth grade to publicly transition, she said. The fear of not belonging factored into Justin’s decision to let go of his favorite sports.

Justin suffered from social anxiety and depression as a result of gender dysphoria—psychological distress caused by the disconnect between a person’s biological sex and gender identity. Gabrielli, disappointed with Justin’s decision, felt these issues would be amplified without sports, which served as an outlet for him, she said.

“He really misses it. It makes me sad because there’s so many benefits to teen sports,” Gabrielli told Stateline in a phone call. “[But playing sports] was already a challenge for him because he was very masculine-looking, and they always were mistaking him for a boy.”

Gabrielli said the lawmakers pushing the athletic bans are making a mistake.

“For anyone who is confused about this, take the time to talk to transgender people,” she said, “to talk to parents who are walking through this, and to try to understand what this means before moving forward with the aim of protecting against kids like my son.”

For Emily Wilson, being denied the chance to play sports was one of many troubling experiences. Emily, who is autistic, suffered bullying and violence from the boys at school because of her gender, Binstead said, including being hit by another student and having a teacher misuse her pronouns. To ensure the safety of her child, Binstead removed her daughter from public school to homeschool her.

“I’m not willing for my daughter to be one of the ones that die by suicide because people are ugly to her,” Binstead said.

Mixed Policies

Several years ago, state lawmakers in more than a dozen states debated so-called bathroom bills, which would have required transgender youth to use bathrooms corresponding to the sex on their birth certificates. Only one state, North Carolina, approved such a law—though it quickly retreated when corporations and athletic conferences threatened to boycott the state. This week, on the fifth anniversary of that bill’s passage, Republican lawmakers pushed for a bill to ban transgender girls from playing in high school girls sports.

In addition to the threat of political and economic blowback, the bathroom bills failed in part because supporters were hard-pressed to cite instances in which allowing transgender people to use the bathroom of their choice had caused anybody any harm.

The issue of athletic participation is more complicated, some say, though transgender athletes have been competing at high levels for years.

The International Olympic Committee has allowed transgender athletes to participate in competition since 2004. In 2016, the committee waived the requirement that transgender athletes undergo sex reassignment surgery. Now, transgender women must maintain testosterone levels below a certain point for at least a year before competing and during the eligibility period for competition. Trans men can compete without restrictions.

At the college level, the National Collegiate Athletic Association (NCAA) has allowed transgender students to participate in sports in accordance with their gender identity since 2011, though transgender women must complete one calendar year of testosterone suppression before competing.

Earlier this month, more than 500 college athletes from schools across the nation signed a letter asking the NCAA to stop holding championship games and other events in states that are considering barring transgender athletes from participating in the sports that match their gender identity.

In 2008, Washington state became the first state to allow transgender students to compete in high school sports in accordance with their gender identity. Today, 16 states and the District of Columbia have similar statewide policies, meaning they don’t require proof of medical transition or hormone therapy, according to Shoshana Goldberg, a research assistant professor at the Gillings School of Global Public Health at the University of North Carolina who specializes in transgender health.

Ten states have no guidance on transgender sports participation. However, schools can create their own regulations. Only three states—Indiana, Kentucky and Louisiana—require trans women undergo gender confirmation surgery in order to play sports.

Goldberg said this year’s wave of transgender sports bills is based on fears of what might happen, rather than addressing a problem that exists. States with trans-inclusive policies saw an increase in girls’ participation in athletics from 2011 to 2019. States without these policies saw a decrease in participation, according to data from the Youth Risk Behavior Surveillance System, a system of health-related surveys by the Centers for Disease Control and Prevention.

In a recent report Goldberg wrote for the Center for American Progress, a left-leaning think tank, she predicted that participation rates in states that implement trans-inclusive policies will continue to climb. As an example, she cited California, where participation in high school girls athletics has increased 14% since 2014, when the state implemented a trans-inclusive policy.

“[Transgender] athletes just want to play for the same reason as athletes. They have a sport that they love and they’re good at it,” Goldberg said. “They don’t want to choose between that and who they are.”

Advocates for transgender rights got a boost from the change in administration in Washington. On his first day in office, President Joe Biden issued an executive order that prohibits discrimination based on sex, gender identity or sexual orientation. “Children should be able to learn without worrying about whether they will be denied access to the restroom, the locker room, or school sports,” the order said.

State Lawmakers Push Back

But lawmakers who are pushing the athletic bans in their states say their goal is to safeguard girls’ participation in school sports, which has grown exponentially since the passage of Title IX. Reeves, whose three daughters play sports, tweeted before signing the Mississippi legislation that Biden “forced the issue.”

Tennessee Republican state Senator Joey Hensley, who is the primary sponsor of a bill that passed the state Legislature this week , told Stateline in a statement that the legislation “seeks to protect girls’ sports in Tennessee and maintain a level playing field for female athletes.”

It is “alarming,” Hensley added, that Biden’s executive order mandates “biological boys who identify as girls compete on the female sports team.”

Montana GOP state Representative John Fuller sponsored a related bill in his state. Fuller said the immediacy of this bill results from Montana’s short legislative session. Lawmakers only meet once every two years, he said in a phone call with Stateline, and this is the first session since 2019, when University of Montana runner June Eastwood became the first transgender athlete to compete for a NCAA Division I women’s cross country team.

Fuller, a former high school teacher, and Division I college wrestler who also has refereed and coached wrestling and track, said males have physical advantages over women. Since its inception, he said, Title IX has been “right and reasonable,” but forcing cisgender girls to play alongside transgender girls “is a grave concern.”

“This [guidance from the NCAA on testosterone suppression] is duplicity and hypocrisy at the greatest level,” Fuller said. “I’m not discriminating. … They’re free to compete in their sports.”

Most of the two dozen state lawmakers who sponsored related bills across the country have not cited an instance in their state in which transgender athletes caused a controversy, the Associated Press reported.

But a recent lawsuit in Connecticut does allege specific harm. Last year, the parents of three high school runners filed a federal lawsuit against Connecticut athletic and school officials claiming that their daughters missed out on victories and scholarship opportunities because they were forced to compete against transgender girls in races.

“This discriminatory policy is now regularly resulting in boys displacing girls in competitive track events in Connecticut—excluding specific and identifiable girls including Plaintiffs from honors, opportunities to compete at higher levels, and public recognition critical to college recruiting and scholarship opportunities that should go to those outstanding female athletes,” the plaintiffs’ lawyers said in the complaint.

Christiana Holcomb, legal counsel at the Alliance for Defending Freedom, a conservative, faith-based nonprofit organization that advocates for First Amendment rights and religious freedoms,said the “only fair solution” to prevent unfair competition is through state legislation. Holcomb is one of the attorneys representing the three runners in Connecticut.

“No amount of testosterone suppression can reverse males’ larger hearts, greater lung capacity, denser bones, stronger muscles, and greater explosive power,” she said in a statement. “When we ignore biological reality, women and girls get hurt—and groups across the ideological spectrum recognize that.”

Rural Difficulties

The athletic bans would only add to the burdens that trans people experience in rural areas, which include a lack of access to health care and support services, said Celeste Lehr, a trans woman who lives in the Mississippi Delta.

Lehr, 26, never had an interest in sports, but she shared Justin and Emily’s feelings of isolation as a young adult. In the past, Lehr endured transphobic slurs and threats, she said, and some of her friends have been violently attacked.

“This is a real thing. You gotta be really careful out here,” Lehr said. “[Mississippi lawmakers] already make things so difficult out here, and they just add insult to injury by [passing this law].”

Gabrielli said there are few resources available for her son, who is not physically transitioning.

“We really had to extend ourselves. It was hard, stressful and scary,” she said. “We have to drive two hours one way to go to a doctor just to be able to access the right kind of care.”

Christina King, a trans activist in rural Illinois, said transitioning physically takes a toll, especially in a rural area, where residents might have to drive hours to get medical care and pay thousands of dollars in out-of-pocket costs. King, who ran track in high school, waited until adulthood to transition.

King said she had strong support as a youth. But these bills, she said, have real effects on real human beings.

“It starts with small bills, doesn’t it? It’s legislating bathroom rights. … Now we’re talking about sports rights, then we’ll be talking about where people can live,” King said. “Slow laws institute gradual effects. If it’s not stopped, it just gets worse and worse.”

It’s difficult to track the number of transgender athletes by state, which makes it hard to know how many people may be affected by the new Mississippi law, said Jensen Luke Matar, coordinator of the ACLU of Mississippi’s Transgender Education and Advocacy Program. Matar said he’s found individuals such as Emily who were interested in sports but immediately were rejected prior to the implementation of this bill.

Regardless of sex or gender, participating in sports benefits students, though transgender youth are less likely to participate in sports. Research has found sports help to decrease hopelessness, suicide and symptoms of depression while boosting self-esteem and feelings of belonging.

A 2020 survey by The Trevor Project, a nonprofit that provides crisis intervention and suicide prevention services to LGBTQ youth, found that LGBTQ youth who participated in sports reported having better grades. Transgender athletes in states with inclusive policies were less likely to have considered suicide in the past year, according to an analysis of 2017-2019 Youth Risk Behavior Survey data.

Matar emphasized the broader benefits of participating in sports. “The value of playing in sports is beyond the game of sports. You learn self-confidence. You learn how to participate as a part of a team,” he said. “You learn so many life skills in sports. Sports can greatly benefit the way in which their lives are shaped and the relationships they have with others.”

Douglas Knutson, a licensed psychologist and an assistant professor at Oklahoma State University, said it’s important to affirm and accept transgender youth in rural areas to overcome the negative messages they receive about their identities.

“One of the lies that are told is everybody in a rural area that is trans … is self-hating and distressed,” said Knutson, who is director of the university’s Diversity and Rural Advocacy Group, which researches LGBTQ-related policies and attitudes. “That’s not the case. Lots of people are vibrant and happy.”

The long-term implications of the messaging and language around transgender youth can follow a child throughout their adult life, said Matar, and it’s incumbent on communities to be supportive.

“We all just want to be acknowledged, validated in who we are,” Matar said. “[Transgender people] are not this magical category of aliens that do life differently. They are kids. These trans students are just regular kids.”

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