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According to the U.S. Trans Survey, conducted by the National Center for Transgender Equality, a third of trans people have faced discrimination from a health care provider.

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This is part of a series the Detroit Free Press is doing on public issues in conjunction with PolitiFact, a nonprofit national news organization. Suggest a fact-check here.

A new ad from the American Principles Project, a conservative political action committee, claims that incumbent Democratic Sen. Gary Peters is “too extreme for Michigan.”

“All female athletes want is fair shot at competition, at a scholarship, at a title, at victory. But what if that shot was taken away by a competitor who claims to be a girl but was born a boy? Senator Gary Peters and Joe Biden support legislation that would destroy girls’ sports,” the ad claims.

The basis of the attack? Peters has co-sponsored the Equality Act, a bill that would prohibit discrimination on the basis of sexual orientation and gender identity in employment, education and public accommodations. Democratic presidential nominee Joe Biden also supports the bill.

While the legislation addresses discrimination in a range of areas, many Republican opponents have focused on the fact that it would allow transgender students to compete on school sports teams based on their gender identity rather than their sex assigned at birth. So transgender boys and men — born female — could compete on boys’ and men’s school teams, and transgender girls and women — born male — could compete on girls’ and women’s school teams.

Their specific criticism is that allowing transgender girls and women to compete on the basis of their gender identity would create an uneven playing field for student athletes and ultimately end girls’ and women’s sports. That’s a prediction that we can’t fact-check.

C.J. Warnke, the press secretary for Peters’ reelection campaign, called the ad “a blatant attempt to mislead voters and distort the truth about the Equality Act.”

Explaining his support for the same legislation back in 2015, Peters wrote it “would ensure that the same protections our nation has already extended based on characteristics like race and religion are equally available to the lesbian, gay, bisexual and transgender (LGBT) community.”

Peters’ opponent in his Senate race is metro Detroit businessman John James, who ran unsuccessfully for the Senate in 2018. James’ campaign said it was not involved with the ad and declined to comment.

Here, we’ll lay out how the Equality Act would impact transgender student athletes and the arguments made by those who support allowing transgender athletes to compete according to their gender identity and those who oppose the idea.

Current policies in place regarding transgender girls and women competing as student athletes

The provisions of the Equality Act would affect rules governing student athletes at both the collegiate and scholastic levels.

The NCAA, which regulates student athletics for over 1,000 colleges and universities in the U.S., allows transgender women to compete on women’s sports teams if they’ve completed at least one year of testosterone suppression treatment.

Policies for high school athletes vary by state. Some states allow transgender students to play on girls’ or boys’ teams based on their gender identity, while other states have restrictions in place.

Both policy approaches are being litigated in the courts. Three Connecticut high schoolers have filed a federal lawsuit against the state’s policy allowing transgender students to participate in sports teams according to their gender identity. In August, a federal judge granted a motion for preliminary injunction against Idaho’s law banning transgender women and girls from competing on sports teams corresponding to their gender.

In Michigan, the state Board of Education issued guidance in 2016 stating students should generally be allowed to participate in school sports teams based on their gender identity. But the guidance leaves it to the Michigan High School Athletic Association, which oversees interscholastic sports, to determine the eligibility of transgender student athletes to compete in post-season tournaments sponsored by the association.

The MHSAA makes its decisions case by case. Kathy Vruggink Westdorp, the MHSAA’s assistant director, told PolitiFact Michigan that the association considers school and medical records, but said the association does not have a publicly available policy in place laying out criteria.

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What the Equality Act would change 

Title IX of the federal Education Amendments, signed into law in 1972, prohibits sex discrimination in programs that receive federal funding. Title IX has led schools and colleges to devote more resources to girls and women’s sports, creating more opportunities for them.

The debate over the Equality Act centers on whether the sex discrimination prohibited under Title IX includes discrimination on the basis of gender identity. The Obama administration issued guidance in 2016 that said the Justice Department and Education Department would treat “a student’s gender identity as the student’s sex for purposes of Title IX,” but the Trump administration rescinded the policy. In May, the Education Department ruled that Connecticut’s policy allowing transgender girls to compete on girls’ sports teams violates Title IX.

The Equality Act would amend the Civil Rights Act of 1964, among other laws, to bar discrimination on the basis of gender identity and sexual orientation. It does not technically amend Title IX.

In the Supreme Court’s June ruling barring employment discrimination against LGBTQ individuals, the court interpreted Title VII of the Civil Rights Act — which prohibits workplace discrimination on the basis of sex — to include sexual orientation and gender identity. In August, another federal court reached a similar determination that Title IX’s protections also apply to transgender students.

In addition to Republican opponents to the Equality Act, three former elite female athletes wrote a Washington Post op-ed against allowing transgender students to compete based on their gender identity. They argued that it is unfair to allow transgender girls and women to compete on girls’ and women’s sports teams, on the premise that they have physical competitive advantages over girls and women born female.

Supporters of the bill dismiss this argument. “There may be individual success by particular trans athletes just as there are with any athletes,”  said Neena Chaudhry, general counsel and senior adviser for education at the National Women’s Law Center, which supports the Equality Act. Some transgender girls and women have won competitions participating on girls and women’s teams while some performed worse competing against girls and women, she said.

In any case, she said, “women’s sports hasn’t ended.”

Joanna Harper, a researcher at the Providence Portland Medical Center in Oregon published the first study examining the effect of hormone therapy on transgender athletes. The study, published in the peer-reviewed Journal of Sporting Cultures and Identities, looked only at distance runners and found that the transgender women studied did not have a competitive edge over competitors born female.  

Tommy Lundberg, a researcher at the Karolinska Institute — a leading medical institute in Sweden — has also studied the impact of testosterone suppression on transgender women’s muscle strength and mass and found a negligible decrease in strength and muscle mass among 11 transgender women who underwent testosterone suppression for a year. But, he noted that the research in this area falls short. “There are no longitudinal studies,” he told the New York Times. “I’m not sure there will be any reliable data at any point,” he said.

“Whether or not there is adequate research on the effects of testosterone suppression is irrelevant,” wrote Terry Schilling, executive director of the American Principles Project, in an email to PolitiFact Michigan. He said that differences in the athletic performance of females and males is the central concern.

While research finds there is not a significant difference in the athletic performance of male and female children, hormonal changes that occur in puberty generally lead males to outperform females. “The Equality Act would not mandate that schools implement testosterone suppression requirements,” Schilling wrote.

The American Principles Project ad against Peters argues that the inclusion of transgender student athletes is not fair and would destroy girls’ sports teams. Meanwhile, 23 women’s rights and gender justice organizations have come out against excluding transgender people from participating on teams that align with their gender identity.

The Equality Act is unlikely to pass in the Republican-controlled Senate, but courts across the country will continue to weigh in. And while the ad attacks Peters’ support for the Equality Act as out of step with Michigan, the state’s own Board of Education has generally supported allowing transgender students to compete on the basis of their gender identity for years.

Clara Hendrickson fact-checks Michigan issues and politics as a corps member with Report for America, an initiative of The GroundTruth Project. Contact Clara at chendrickson@freepress.com or 313-296-5743 for comments or to suggest a fact-check. 

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