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An Expert's View: Exclusion Of Transgender Women From Scholastic Sports Will Have Many Negative Consequences

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A bill heading to the House floor would effectively ban transgender women and girls from competing in women and girls school sports teams. The measure’s sponsor says this ban is needed because biological males have a physical advantage over biological females when it comes to sports. Robbie Gaffney speaks with Janet Silverstein, a pediatric endocrinologist who works at UF Health’s Youth Gender Program, which provides services to transgender and gender-nonconforming youth and their families. They begin their conversation with the changes transgender girls go through when undergoing hormone therapy. To listen to the discussion, press the play button at the top of this article or read the transcription below.

JANET SILVERSTEIN: Trans females are born male. So, they can make testosterone. However, we block the testosterone with hormone blockers. And when we block the testosterone in the informed consent, one of the biggest things that we talk about is the fact that they will early on lose muscle mass and they will lose strength, and that is probably the first thing that we see as far as changes go. So, they lose that early and when they’re ready we will start estrogen. But again, that doesn’t happen right away. It will take a while before we start estrogen. The whole process is a long process because it’s a slow very gradual process. But even after the first hormone blocker shot, they lose muscle mass. And they lose strength and really when it is all said and done and they’ve started estrogen after a year or so their muscle strength, their muscle mass is no different than that of a natal female.

ROBBIE GAFFNEY: Yeah, I was going to ask about that because, you know, Tuck was saying that, oh there’s differences between biological men and biological women and because of this biological males have an advantage over biological females so we need to keep them separate but it sounds like you’re saying if you’re a transgender woman and you’re going through hormone therapy, you’re no different from a cisgender woman, do I have that correct?”

Note: Rep. Kaylee Tuck (R-Sebring) is sponsoring the bill that would effectively block transgender women and girls from playing on women and girls’ school sports teams.

Note: Cisgender refers to someone who is not transgender.

JANET SILVERSTEIN: Yeah, that’s pretty true. Yes.

ROBBIE GAFFNEY: And so, part of this bill—if there is a dispute over a student’s sex—so someone says, ‘you’re not a girl, you’re really a boy or a biological male,’ the student would then have to go to a physician to verify their sex and it would have to be based on their reproductive anatomy, genetic makeup, and normal produced testosterone levels. In your opinion, is that a good way to determine someone’s sex?

JANET SILVERSTEIN: No. We actually legally change their gender and we legally change their name when they’re ready for those things and in reality, I don’t think the word ‘sex’ is a good way to describe them. I think that who they are is really who they are physiologically. And once they’ve undergone you know, the treatment to become a female they basically are females.

ROBBIE GAFFNEY: So, do you think in your opinion that looking at someone’s reproductive anatomy as a way to say whether you’re a girl or a guy is a good way to go about verifying a student’s sex?

JANET SILVERSTEIN: To label somebody as male or female based solely on that I don’t think is fair for these transgender youth.

ROBBIE GAFFNEY: And what about their genetic makeup or normal produced testosterone levels?

JANET SILVERSTEIN: We have blocked them. Once the estrogen level is high enough it causes suppression of the hormone from the brain called LH which is what stimulates the testes to produce testosterone. And so, once you block that it doesn’t make testosterone anymore. So, we always get testosterone levels and they’re low.

ROBBIE GAFFNEY: Yeah, so a companion bill in the Senate by Senator Kelli Stargel—it allows transgender women and girls to compete but their testosterone has to be below 10 nanomoles per [liter]. Can you explain what that is?

JANET SILVERSTEIN: That’s a very low testosterone level and there are girls who are natal females who have a condition called polycystic ovary syndrome and they are XX they are uteruses or uteri and they have higher testosterone levels than many of these transgender females. Many of them.

ROBBIE GAFFNEY: What do you think of saying, ‘alright, transgender woman, you can compete, but you can only compete if your levels are at 10 nanomoles—I might be pronouncing that word incorrectly—what do you think of that, you know, keeping to that number?

JANET SILVERSTEIN: I think a number is not a particularly good way to do it. Yes, I think you need to measure testosterone levels and if they’re high enough, they’re in the male range, sure, then that would be an uneven playing field. But if it’s not in a male range, anything below the male range, I think should be acceptable.

ROBBIE GAFFNEY: So, what do you think the effect would be on a transgender woman or transgender girl’s psyche if they were told, ‘hey you can’t compete in women and girls school sports—’ you know, you deal with this population in your transgender clinic, what do you think that psychological effect would be on them?

JANET SILVERSTEIN: Devastating. It would be devastating for them because you know, they want to be accepted. They want to be accepted for who they are and there’s no reason to really ban them physiologically.

ROBBIE GAFFNEY: And what do you think the effect would be if lawmakers were like, ‘okay you can compete, but you have to keep your testosterone levels at that 10 number?

JANET SILVERSTEIN: I think that they want to have low testosterone levels because they feel that they’re girls. And they are girls. If you look at them, they look like girls. There are many actresses for instance who are transgender, some models are transgender, and you’d never know. I think that as long as they’re able to compete they would feel fine.

ROBBIE GAFFNEY: Thank you so much for speaking with me I do appreciate it.

JANET SILVERSTEIN: You’re welcome. You take care.