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LGBTQ+ Mental Health and Participation in Sports

  • November 02, 2023
  • LGBTQ+

Approximately 7-9% of youth identify as LGBTQ+, including 2% identifying as transgender. Well-established research shows LGBTQ+ persons are at a higher risk for anxiety, depression, substance misuse, disordered eating, homelessness, and suicide. Since youth participation in sports has been linked to better outcomes in academics, self-esteem, confidence, stress, anxiety, depression, and risky behavior engagement, it would seem to make sense to encourage LGBTQ+ people to participate in sports as one way to mitigate the mentioned disparities.

Why then do only 20-29% of LGBTQ+ youth, and 12-14% of transgender youth, participate in sports, compared to 68% of their counterparts?

swim competition

The data is sound on some of the reasons we see differences in LGBTQ+ sports participation. A surprising 78% of American spectators believe that youth sports aren’t safe for LGBTQ+ people. These athletes often fear rejection by their teammates and/or coaches for their identity. In fact, nearly 80% of LGBTQ+ youth and 82% of transgender youth are not out to their coaches. If not explicitly, the culture of the sports environment can consist of crude, homophobic, and transphobic language that damages LGBTQ+ athletes’ self-esteem and image, while indirectly suggesting they hide that part of their identity. Some articles have reported that athletic coaches have threatened student-athlete scholarships if they go to a queer bar or partake in queer social activities.

There is also a lot of fear for LGBTQ+ individuals in sports locker rooms, especially for transgender athletes. Eleven percent of LGBTQ+ athletes feel unsafe in the locker room, and 51% never use the locker room aligned with their gender identity. The locker room is a high-risk area for bullying and harassment due to the vulnerability of having to change clothes and expose body parts at times. Also, events in the locker room often cannot be verified since it is a place without cameras for obvious privacy reasons.

LGBTQ+ athletes are at higher risk of abuse (psychological, physical, sexual, neglect), and efforts to mitigate these hard truths have made minimal impact over the recent years. This could easily be one of the many reasons LGBTQ+ individuals drop out of sports two times the rate of other athletes. Even if an athlete hasn’t experienced abuse themself, hearing one tragic story across the country can invoke enough fear to cause debilitating anxiety and stress.

Transgender Athlete Policies

A particular controversial topic in sports participation is transgender and gender non-conforming (GNC) participation. This seems to be less of a debated issue at the pre-teen level and below, likely because hormone levels do not differ significantly pre-puberty. The competitiveness of sports typically increases as athletes progress throughout adolescence and young adulthood. Recent news has highlighted NCAA transgender swimmers Lia Thomas and Iszac Henig who competed against each other. Lia is a transgender woman and has been able to participate in NCAA women’s sports while being on testosterone blockers and estrogen, but some say she still carries an advantage given the phenomena of aerobic and cardiovascular capacity in people assigned male at birth. Iszac is a transgender man and has been able to participate in NCAA women’s sports due to forgoing testosterone therapy, though he has received “top surgery,” which is also known as a double mastectomy to align anatomy with gender identity.

Currently, there are 23 states with transgender athlete bans, 18 of them targeting transgender girls only, and 5 targeting transgender boys and girls. A third of transgender athletes live in those states. This means that one-third of transgender athletes will have to modify their gender-affirming care to participate in the sport aligned with their gender identity or participate in the sport that does not align with their gender identity. Even if a transgender athlete wants to participate one way or the other, the potential for a harmful environment and harassment and associated negative impact on their mental health is often enough to deter them from engaging in sports at all.

What Can We Do To Help?

Community support and intrapersonal resilience appear to be some of the most protective factors for LGBTQ+ athletes’ mental health and participation. Policy support can be targeted by active civic participation in voting. Team support can be fostered by educating coaches and athletes about LGBTQ+ topics, reducing stigma, and encouraging teams to demonstrate their support for these athletes explicitly. Many collegiate and professional sports teams today are utilizing uniforms and athletic wear to show support for different minority groups, including queer people.

Simply using inclusive language can indirectly communicate to others that it is safe to come out to them. Others should let LGBTQ+ athletes come out on their own terms, and if they do, ask what you can do to support them. To engender resilience in LGBTQ+ athletes, set them up with supportive mentors, have open discussions about mental health, and consider mental health care when needed. If you are transgender/GNC or have a transgender/GNC child, have a discussion with their doctor about what options they have for their gender-affirming care. Learning about the options potentially available to them can improve a child’s mental health drastically.

Drew D. Richards, Medical Student
University of Wisconsin

Reviewed by
Claudia Reardon, M.D.
Associate Professor, University of Wisconsin
School of Medicine and Public Health, Department of Psychiatry


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