Trans health, exercise specialists weigh in on Nebraska trans sports proposal

June 23, 2023, 1 p.m. ·

Young athletes’ sex at birth would determine which school-sponsored sports they could participate in and which bathrooms or locker rooms they could use under a proposal in the Nebraska Legislature. (Photo courtesy of Unsplash)

This story is the second in a two-part series on trans youth legislation in Nebraska.

LINCOLN — While Nebraska lawmakers consider whether to take up a bill next year that would govern which bathrooms and sporting teams transgender youth can use, professionals in transgender health care and exercise science are weighing in on the proposal and its prospects.

Legislative Bill 575, proposed by State Sen. Kathleen Kauth of Omaha, would define group school bathrooms, locker rooms and sporting teams as either male or female and require students to use the facilities or play on teams according to their sex at birth.

Senator Kathleen Kauth during debate on her bill Tuesday (Photo by Fred Knapp, Nebraska Public Media News)
Sen. Kathleen Kauth during debate (Photo by Fred Knapp, Nebraska Public Media News)

Some argue lawmakers don’t need to pass a law because of a Nebraska School Activities Association policy already in place governing trans participation for member schools. A committee must approve a trans student’s application before participating according to their gender identity.

The policy’s goals include balancing equal opportunity, the physical safety of students, competitive equity and personal privacy.

Trans female students must also prove through medical examination and physiological testing they do “not possess physical … or physiological advantages over genetic females of the same age group.” This includes bone structure, muscle mass and testosterone hormonal levels.

LB 575 would effectively override that policy and require participation based on sex at birth.

‘Well-intentioned’ but with flaws

Dr. Greg Brown, who has a Ph.D. in the biological basis of health and human performance and is a professor of exercise science at the University of Nebraska at Kearney, said the NSAA’s Gender Participation Policy is “well-intentioned” in protecting the “safety, fairness and integrity” of girls’ sports for female athletes.

“And it really endeavors to ensure that a trans girl will not have any sex-based advantages,” Brown said.

According to the NSAA, five Nebraska students between 2017 and January 2023 used the policy to play according to their gender identity.

Dr. Greg Brown testifies in favor of LB 575 defining group school bathrooms, locker rooms and sporting teams as either male or female. (Photo courtesy of the Nebraska Examiner)

However, Brown said, there is no biological test to detect whether someone is transgender, and the line gets blurred for female sports.

“Smaller, less muscular or less talented males are not typically allowed into girls’ sports. Should they then be allowed into girls’ sports based on a transgender identity and testosterone suppression?” Brown asked in an email.

Brown, while testifying in support of LB 575, told Nebraska’s Education Committee that he wrote a brief for the Alliance Defending Freedom and has been an expert, volunteer witness for the organization.

Alliance Defending Freedom, a faith-rooted legal organization, has been behind major cases involving abortion and LGBTQ rights but denies “anti-LGBT” or “hate” labels placed on it by the Southern Poverty Law Center.

‘Competitive disadvantage’

Dr. Alex Dworak of OneWorld Community Health Centers, who provides trans health care, said trans girls targeted in bills such as LB 575 start low and go slow when prescribed testosterone. 

“At any given point, they’re going to have both less testosterone and less estrogen in their body than an equivalent person of the same age,” Dworak said. “And thus, they will, if anything, be at a competitive disadvantage.”

Dworak said trans people face heightened discrimination that causes stress and hurts their health, further compounding what he said is a disadvantage.

“To level the playing field, we would have to subject all the cis girls to that,” Dworak said, noting there is sexism against cisgender women, too.

He said youths who are transitioning will regularly meet with their physicians, and their hormones or physiological characteristics would be more regularly tracked than cisgender youths.

Dworak said sports bring social and physical health benefits, and he emphasizes exercise as a doctor.

Sex-based differences

Dr. Alex Dworak testifies before a legislative committee in February. He also testified against LB 575. (Photo courtesy of the Nebraska Examiner)

Brown, however, said there are sex-based differences, including among children, pointing to body height and lean body mass. These are not reversed with blockers or hormones.

“Even if the puberty blockers and/or cross sex hormones are started before puberty, we simply cannot say (based on published research) how much male pattern growth in height or muscle mass will be impaired,” he said.

Brown said some physiological tests may be effort-based, allowing some control in the tests’ outcome, or they could be impaired by dehydration or fatigue.

Dworak said these tests are regularly part of examinations.

Brown said that while at an annual American College of Sports Medicine meeting, he presented research that shows 7- to 8-year-old boys run 3-5% faster and jump higher and farther than girls in the same age group. The same, he said, is true for 9- to 10-year-old boys and girls. Another set of researchers, from another university, presented similar data and conclusions.

Brown said data from Australia shows a 10-year-old boy in the 95th percentile for aerobic fitness will run 1.6 kilometers per hour faster than girls ages 10 to 17 in the same percentile for their age.

“There is considerable evidence that there are male sex-based athletic advantages even before puberty, so there really is no good reason to entertain the notion that puberty blockers and/or cross sex hormones will eliminate the athletic advantages males possess over similarly aged, gifted, and trained females,” Brown said.

‘Total fairness’

Dworak said LB 575 and other proposals like it nationwide single out only trans youth, stigmatizing them and limiting participation without regard to individual or medical nuances.

The idea that people would transition just for a supposed advantage in sports, he said, is “absolutely absurd” because it could include the stresses of coming out, seeking medical care, modifying hormones and being the subject of harassment or discrimination.

“Somebody’s going to do all that for a freaking trophy from, like, sixth grade softball?” Dworak said. “I mean, it’s absurd.”

“It’s just unbelievably stupid and it is disrespectful to the gravity of the debate that people keep bringing that up, and yet they do,” Dworak added.

Dworak said if lawmakers want to pursue “total fairness,” it would be next to impossible because every child has varying strengths and weaknesses.

“This is a solution to something that is not a problem that is causing harm without causing any benefit,” Dworak said. “It’s all to score political points.”