Jordan K.’s personal story: being different meant violence

If you asked me where I was from, I would most likely give you a series of locations and distances from Chattanooga, Tennessee. If you were local, I might tell you I hailed from The Mountain or The Big Woods. At first glance, my hometown tells you I’m Appalachian, most likely protestant and white, and likely know about everyone in town. What it doesn’t tell you is that where I call home is nicknamed “Meth Mountain,” I can name almost every kid who went on to college before me in my town, or that if you played one sport it meant you played three.

I was no exception to this rule. Starting at 4 years old, I joined the recreational basketball league where I was invited to play softball by my coach toward the end of season. Too young to play softball just yet, I joined T-ball and fell in love with the game. By eight, I had joined a travel softball team and competed every weekend. By 11, I was on a sponsored team out of Nashville and by 14, I was training in Atlanta where I would finish my precollegiate career.

There are many unspoken rules in softball. Some are harmless: You always keep your throwing buddy, right arm over left when praying, and don’t scratch the chalk line. Others have deeper implications guiding expectations of girl/womanhood. In softball, it is acceptable and almost expected to wear mascara to keep your sporty look feminine, braiding hair is a treasured skill, and a bow in your hair signals your heterosexuality. “No bow, lesbo” and “dykes on spikes” accompany relayed statistics about opposing teams. Very early on, I learned to hold my glitter headband, comically large bows, and braiding techniques as sacred so that I would be seen as likable, safe, and nonthreatening.

Being different meant high school violence . After being forcibly outed as a lesbian in my high school basketball locker room my senior year, my teammates’ homophobic comments concerning lesbians who peek at girls in locker rooms affected the team such that they began hiding in stalls to change jerseys and stated pointed commentary during pregame devotionals. As my peers outside of the locker room as well as those in my hometown community learned of my queerness, I faced public outcry that a queer could win valedictorian over a good Southern Christian boy who was the starting quarterback. Over the last 5 months of my high school career I received death threats, bibles were tossed into my bookbag, and I was invited to sermons concerning “deviance.” While the homophobic reaction of my community was expected, losing a close friend was not. My friend, who I will call Ryan, created a public petition calling to stop me from presenting my valedictorian speech on the basis that I did not morally represent our community. Ryan created fake emails addresses pretending to be “concerned citizens” of our town, emailing the principals and superintendent with his “concerns”. Of the approximate 120 students that graduated with me, those who flanked me during ceremony did not speak with me for its entirety.

Being different meant college violence . Neither of my parents graduated high school—my father was a union boilermaker and my mother a direct support professional at a long-term care facility. But, they did their best to make sure I broke the poverty cycle. (The jury is still out on that one) Regardless, nothing could have prepared me for the culture shock of the concentrated wealth of attending a private college.

Leaving my hometown, I was eager to start college at a women’s college that had many queer students. Recruited during my junior year of high school for softball, I was able to attend campus events that introduced me to alum, current student-athletes, and administrative staff that convinced me to sign on. It was not until my final campus visit the spring before my fall enrollment that I was encouraged to also join the cross-country team. My recruiting softball coach was a runner in the off-season during college and she pushed me to join since I competed in track and field in high school. Since I had always played multiple sports and I wanted to make a good incoming impression, I signed onto the cross-country team that spring.

During my first week, I made my way through the dining hall confused by the foods being served. I had never heard of “quiche,” “quinoa,” or “bulgar.” Folks told me they loved my “earthy” and folky style of dressing as if my thrifted clothing was an intentional stylistic choice. I learned the meaning of the words “seersucker,” “capsule wardrobe,” and “minimalism.” I learned a new meaning of “cheap” as in 15–20-dollar entrees, 40-dollar ticketed events, and 12-dollar Ubers. I learned more outside of my classrooms than inside them in my first few weeks.

I did my best to quickly acclimate myself to my new environment in order to not stick out. Being different was violent back home and I was eager to not repeat that reality. For the most part, I managed. I occasionally would be shocked that folks didn’t know acronyms for TANF, WIC, EBT but knew specific airport acronyms. During my first semester, I took Intro to Queer Studies at the advice of my advisor. This class shook me to my core. The class was taught by a relatively young butch who matched their socks to their bowtie and taught us history that showed me for the first time that queer people could live past 18, be white-collar professionals, and have loving family structures. Around midterms, I started to play with gender expression. An open button-up over a t-shirt, borrowing men’s jeans from a friend, eventually buying a bowtie.

At this time, I knew I wasn’t mentally doing too well and took our college’s mental health facilities’ self-assessment for services. Sure enough, my “gender crisis” warranted psychiatry intervention according to the quiz, but I chose to ignore it. I grew up with almost everyone in my immediate family having a diagnosis of bipolar disorder and/or addiction. If my family went untreated for what I thought of as “real” mental illness, then I could push through whatever crisis I was having at the time.

Ignoring thoughts about gender does not work out, it turns out, especially at a college that centers gender and when you take classes on studying gender. By the spring semester, my anxiety had reached new heights. I was sending any money I made by babysitting back home, trying to balance practice, school, and a 40-game schedule, and figure out this whole gender thing. On a whim, I reached out to a therapist to work on “gender issues” but our sessions were spent trying to triage my unmanageable symptoms. Shortly after we started working together, my sister was diagnosed with schizophrenia, spending time bouncing between jail and in-patient psych wards. I began isolating myself from my teammates and peers knowing most of them have never had immediate family members incarcerated for any period of time, experienced caring for someone during active psychosis, or questioned their gender identity.

Being different meant sport violence . In practice, we talked about how to leave a legacy (though I’m not sure what legacy can be left after only winning 11 games out of 141 over 3 years). Every week, to work toward our “legacy,” we read a chapter of a sport psychology book and completed worksheets. Sometimes, it meant we were given rubber bands to pop on our wrists so we would not lash out at each other when we were angry. Other times, we developed pregame rituals to focus our energy. But, most of our conversations focused on “controlling the controllables” meaning focusing on what we had the power to change; we could not change calls the umpires made or the weather, but we could control our attitudes, how we practiced, and how we responded to errors. Controlling what was controllable was not a new concept to me, but my wealthier and more stable homelife peers could not fathom that perhaps softball was not my whole being and what is uncontrollable still matters. Perhaps, if I had been able to share the realities of my struggles with them, I might have felt heard, safe, included; instead, I knew I would be met with pity or disdain.

Unlike my teammates, I spent most of my free time in the Diversity and Inclusion Office. The walls were full of color and stories of resilience. I felt safest in that office and it’s eventually where I first muttered, “ I don’t know if I’m a woman” . I was met with a flurry of questions I didn’t have answers for: What pronouns do you want to use? Do you want to use a different name? What label is best for you? Do you need anything?

Sometimes, well-meaning support is overwhelming. Far removed from athletics, I eagerly informed my confidants—folks in the DEI office—I didn’t think I was a man, but couldn’t find words to place how I felt. They suggested I try they/them pronouns for a while to see how I felt. To be honest, I was not particularly open to the idea, but they both seemed sure it would help. I on the other hand was more interested in finding a new name. Again, they pushed me to just use my middle name, Jordan, for the time and see how I felt. Five years later, I still haven’t tried any other pronouns or names so I guess it stuck. I wonder often though what conclusion might I have come to had I been able to sit in my own uncertainty?

Being different meant more sport violence . The joy I felt about returning to campus the following fall was snuffed out early in the semester. Walking through the science center, hanging flyers for my work-study position, I waved hello to the assistant athletic director. She hurried over to my corner and whispered to me, “We need to talk, in my office”. No athlete wants to find themselves summoned to the AD’s office, let alone for an unknown reason. Later, I sat uneasily in her office, scanning old soccer team photographs and notes from former players. She opened the meeting by telling me a story about an athlete she coached several years before I arrived at the college. My heart sank—I knew this person’s story, or least the relevant details. She continued to tell me about the only previously out trans athlete and started listing the special treatment they gave him. She pointed out his face—sharing in a picture—and listed how I could use the single-stall restroom or ask my coach for men’s cut shirts. Teary-eyed, shaking, and terrified, I muttered, “ I do not need those things ” and “ I am not a trans man. ” She continued, naming the NCAA policy for transition and stern-faced told me I need to be honest if I was taking testosterone illegally.

Getting my first full sentences out since the beginning of the meeting, I backtracked to confirm I was not medically transitioning nor was I planning to, I did not need accommodations, and I would like to just play . I grabbed my gear and hurried to the closest bathroom stall to sob. I was humiliated, distraught, and hurt.

My experiences as a trans athlete—let alone a trans person—are not transferable to every trans person. Athletics makes so many decisions about how we as athletes move through the world from our clothing, accepted attitudes, food intake, our free time. I could not accept that athletics would be able to determine my gender future.

A few weeks later, by accident, I discovered both my cross-country and softball teams had meetings about my transness without my consent and without me there. I felt like a display object, a taboo, a nuisance. I remember thinking: Racing and ball are the only places I did not feel out of place at college and now even those places are no longer safe .

I began taking medication to manage my anxiety and depression and while my grades did not suffer, my athletic performance did. I was sleeping through individual lessons, making fundamental mistakes, and numb to the idea of getting better. I was defiant and not willing to buy in. How could I when my coaches continually misgendered me, my team distanced themselves from me, and the “accommodations” offered to me included a bathroom being used as a closet? My coaches told me my communication skills were lacking and that if I told them what was going on we could fix it. I told them, but they were not listening.

Transness was “difficult” and was my problem, not the team’s . My coaches told me to be “mentally tough,” recommending books on mindset training and sport psychology. If I was a “good athlete” I would just “let go of my problems and school” when I was playing and “just be happy.” When I tried communicating how my new medications were making me feel, I was told if I listened to the lessons on mental toughness, I did not need medication, I just needed softball.

Little did she know softball was actively contributing to my suicidal thoughts and my medications were keeping me alive. By spring semester, I had filed a Title IX report on intentional misgendering by my coaches which resulted in pushback. My communication skills were criticized again by my coaching staff and I was told my problems should have been “handled in-house.” Every punishment I received then made me question if my sticking up for myself or my transness was the cause .

My inability to keep issues “in-house” got me into more problems in the middle of the season. I worked as Resident Assistant to cover part of the cost of attending a private school. One evening visiting friends, I ran into one of my teammates who was noticeably upset. Upon asking if everything was okay, I was shrugged off only to have violent transphobic sentiments uttered to my friends about me. Since a graduate assistant heard the comments, too, I had to report the incident. Within an hour, a dean called me personally expressing how concerned she was. The dean turned the report over to student conduct which caused my teammate to confront me after practice following the case opening. My teammates watched on, never interfering, as my teammate approached me asking me to fight her and threatening my life. I locked myself in my car until my coach came over, telling me to quit “overreacting”. That night, I packed up my jersey intending to turn it in. The next morning, Student Conduct made me sign a “do not contact” order as if I was trying to interact with my assailant. I missed a week of practices and games, a choice frowned upon by athletic staff. They asked why we just couldn’t get along for the sake of the team’s success. I no longer loved the game I had played since I was four. I now feared it .

In my final year of college, I stopped caring about my ability to play. After starting for 2 years, I sat on the bench almost the entirety of the senior season and I never willingly stepped into my softball coach’s office. When the first years’ cohort started asking why I was not invited to unofficial team functions, I had to explain the violence of the previous year which for the first time gained me some respect. I finished my senior season only because I wanted a framed jersey to hang up to account for all of the efforts I sustained for softball over the years, not because it was good for me. Fortunately, I found solace in the new cross-country coach my senior year who told me stories of caring for her trans friends post top surgery, asked me what I needed, and listened to my story. Her kindness and ability to recognize my basic humanity kept me from abandoning sports altogether.

Present-day . Several years have passed since I graduated college and I have reconnected with sports in new ways. Prior to the pandemic, I coached a 9/10-year-old softball team and lamented the joyous times I had in this sport. With COVID-19, sports have once again been a distant reality but have forced me to connect with other trans athletes. In these times, I reflect on the care and remarkable tenderness of shared experiences. Malatino [ ] theorizes on surviving trans antagonism in their book, Trans Care , arguing that:

queer and trans care web has no center, but in some significant ways it has emerged because of the way the normative and presumed centers of a life have fallen out, or never were accessible to or desired by us in the first place (p. 2).

My best friends were not made on the field and have not carried into my post-graduate life. I do not grieve retiring my cleats on home plate. Instead, I savor the quietness of sitting side by side with my trans family, the unspoken trauma around access to sports, safety, and acceptance background static to the lives we have and will continue to cultivate that centers our autonomy, mental health, and outstanding joy.

Becoming whole: helping trans athletes with mental health challenges

Beauty isn’t all about just nice loveliness … beauty is more rounded, substantial becoming … [it is] about an emerging fullness, a greater sense of grace … a deeper sense of depth, and also a kind of homecoming for the enriched memory of your unfolding life (O’Donahue, 2008).

A theoretical starting point for helping trans athletes move through their sport experience is Relational-Cultural Theory (RCT) [ ]. An alternative to “traditional” models in psychology and sport psychology which center autonomy, agency, and individuality and prioritize Eurocentric and androcentric experience, RCT focuses on exploring how chronic and systematic experiences of interpersonal disconnection can lead to suffering and harm with resultant potential pathology. However, instead of positioning pathology as the core of intervention, RCT practitioners work on helping athletes maintain and build growth-fostering relationships in their lives [ ]. Further, RCT practitioners spotlight how historical, societal, and cultural forms of oppression experienced by those who are “different” are intimately tied to chronic disconnection; this includes oppressive experiences related to sexist, homophobic, or racist violence, abuse, mistreatment, or invalidation which can create maladaptive relational patterns. In other words, Jordan K.’s story clearly illustrates how they learned to keep certain parts of themselves hidden, and, therefore, related to people in ways that did not allow them to be fully authentic. Those working from an RCT framework begin by helping clients describe the parts of themselves they have kept hidden in their relational lives; question such as “ In what ways have you learned, over time, to silence your emotions? Your insecurities? Your fears? Your social identities or experiences of oppression and discrimination related to those identities? ” can be helpful starting points (see Ref. [ ]; p. 174).

Further, to truly care about trans athletes as people, we need to promote a critical consciousness about trans issues, create an active stance toward trans medical and psychological health, and create interventions where we regularly reflect on our own professional practices (see Ref. [ ]; for example). In sport medicine, this could mean asking ourselves: How do we explore the effects of transphobia in our own belief systems and acknowledge our complicity? How do we practice aligning values and moral commitments across our personal and professional lives? To what extent are we privileging athlete performance and performance enhancement ahead of athlete well-being? How might we disrupt hierarchies in sport and sport medicine to align our work with our moral commitments? How do we cultivate a commitment to all athletes that begins with an awareness of the intersections of interpersonal and institutional power in their lives and demands incisive examinations of its deployment? [ ].

Historical, societal, and cultural forms of trans oppression

Situating our discussion using Jordan’s experience of trans oppression—and to best contextualize the need for trans cultural competence training for sports medicine physicians and sport psychology providers, coaches, and teams—we begin by noting that this personal account of trans violence within collegiate sport reveals the mechanisms by which the medicalization of trans identity and the environment of “mental toughness” within sport creates a hostile environment for trans and intersex athletes. In fact, the medicalization of trans identity negatively impacts trans well-being and fails to account for the lived experiences of trans and intersex athletes.

For example, legislators in several United States have voiced strong support for state bills related to trans exclusion from sport, such as the Georgia SB 435 bill that was introduced to the Senate in February 2022. Many reproductive justice organizations including Spark Reproductive Justice NOW! in Atlanta, Georgia, have lobbied to prevent such discriminatory bills from becoming law (see Ref. [ ]. Similar bills in other states have been attempted but so far have stayed in committee. Supporters of such legislation argue that allowing trans athletes to play in accordance with their gender identity creates an unfair advantage, particularly for cisgender girls and women in sport [ ].

Though fairness is a factor when determining the ethics of trans inclusion in sport and there are physical considerations at play for trans athletes who have had medical gender-affirming interventions (GAIs), the medicalization of trans identity has greatly impacted the lived experiences of trans and intersex athletes. Trans athletes exist in harmful sport as well as daily life environments that rely on biological essentialist claims to justify trans and intersex exclusion.

Medicalization of Trans Identity. The social construction of what is determined to be an illness in need of medical intervention has been studied by scholars of intersex studies [ , ], disability studies [ ], and trans studies [ ]. Trans people, if they desire to change their secondary sex characteristics and/or identification records to match their gender identity and presentation, must navigate a highly restrictive medical and legal system to achieve their aims [ ]. In the US, the decision to transition hormonally or surgically is controlled through the gatekeeping of therapists, psychiatrists, doctors, and surgeons [ ]. The gatekeeping of county lawyers, local government offices, and the state similarly constrains name and gender marker changes on driver’s licenses, passports, birth certificates, and other forms of personal identification.

For example, some states—as well as insurance companies—deem surgeries for trans people “cosmetic” or “elective,” even if one sufficiently demonstrates the Diagnostic and Statistical Manual of Mental Disorders’ (DSM-V) criteria for gender dysphoria [ ]. In fact, Governor Greg Abbott of Texas just signed into law on February 22, 2022 that a number of gender-affirming medical interventions (referred to by Abbott as “sex change procedures”) constitute child abuse under Texas law; those doctors, nurses, etc., engaging in gender transitioning procedures such as reassignment surgeries, mastectomies, removals of otherwise healthy body parts, and administration of puberty-blocking drugs are to be reported so that criminal penalties may be applied. In Texas, therefore, medical professionals will be forced to decide if they want to care for trans people or face criminal procedures; in addition, as one (anonymous) pediatrician wrote:

I have two questions about the definitions contained in Abbott’s letter: (a) we use puberty blockers for reasons other than gender transition … for instance, in cases of central precocious puberty … and (b) would they also define circumcision as abuse because we are removing a “perfectly healthy body part”? Yet another reason these decisions should not be made by lawmakers who don’t practice medicine.

It is not only the political and legal establishments that present challenges for trans people. The medical and psychological establishments present a double bind for trans people desiring access to hormones and surgeries. Many trans people, often for fear of being denied access, choose to adopt the prescripted “transsexual narrative” in order to be granted approval for “treatment” [ , ]. Konnelly [ ] encouraged scholars of trans linguistics to acknowledge the nuance of trans people describing their experiences to medical professionals according to diagnostics to access care. While some trans people do experience gender dysphoria as described in the criteria for diagnosis (DSM-V; [ ], the act of reciting knowledge of medical criteria serves as a performance used to access care and mitigate safety and risk [ , ]. In addition to needing to appeal to medical diagnosis to access desired medical GAI, many trans people are coerced into undesired medical treatments [ ].

Further, stereotypical media depictions of transgender people perpetuate the pathologization and medicalization of trans bodies, the notion that to be transgender is to be “sick” and thus in need of treatment. As Vipond [ ] explained, “this model relies on medical practitioners being deemed ‘experts’ in the field of transsexuality, while trans persons zirselves are seen as uninformed patients” (p. 33). As trans people are already in a vulnerable position within institutions which strictly enforce binary ways of thinking about gender, negative stereotypes especially affect the most marginalized trans people who are always already othered and seen as deviant: People of color, androgynous people, those with illnesses or disabilities, indigenous people, sex workers, poor and impoverished people, immigrants, those incarcerated or in mental institutions, homeless people, and youth [ , , , ].

The growing fields of trans public health and medical sociology are documenting the effects of the medicalization of trans identities and experiences. Compared to cisgender adults, trans adults in the US experience high levels of stigma and discrimination, which is correlated with increased rates of psychological distress and other mental health conditions [ ]. Just as relational-cultural theorists argue that historical, societal, and cultural forms of oppression (i.e., sexist, homophobic, or racist violence, abuse, mistreatment, or invalidation) can create maladaptive relational patterns experienced by those who are “different” that are intimately tied to chronic disconnection, sociologists of health argue that stigma is a “fundamental cause of disease” [ ], limiting people from accessing health resources, including social support, autonomy, and validation [ , ]. Among the many negative health outcomes of stigma and discrimination based on gender identity or expression are high rates of depression, anxiety, eating disorders, suicidality, and tobacco and substance use [ , , , ].

Implications for service providers

Finally, we discuss the harmful implications of the lack of trans cultural competence in sport for sports medicine physicians and providers, coaches, and athletes and suggest avenues for improving sport culture through trans inclusive practices. In part due to stigma and previous negative experiences with medical providers, trans people report a general lack of trust in the healthcare system [ , , ]. In the Argentinian universal healthcare system, for example, avoidance of healthcare was positively associated with exposure to police violence, internalized stigma, experiences of discrimination by healthcare workers or patients, and living in the Buenos Aires metropolitan area [ ]. Recognizing the negative mental health impacts of stigma and discrimination on trans athletes allows sports medicine physicians and sport psychology providers to provide trans competent support for trans athletes when instances of stigma and discrimination occur.

However, transspecific content is lacking in medical school curricula and clinical training [ , , , ]. In addition, there is a lack of accepted methodology for teaching trans topics to medical school students [ ].

Though few empirical studies have been published, community-based and patient-driven solutions to trans healthcare inequity have been shown to decrease trans health disparities and improve patient satisfaction [ , , ]. Strategies aimed at fostering resilience such as connecting trans youth with trans adult mentors have been recommended to combat structural barriers [ ]. As such, positive outcomes for trans patients have been shown when physicians—and by extension, perhaps, sport medicine and sport psychology professionals—continue their education by attending transspecific trainings and workshops [ , ]. Such training will enable these professionals to assess risks and benefits with a more informed understanding of trans lived experiences.

Conclusions

We have reviewed existing sport medicine literature on trans athletes and have primarily focused on the impact of medical gender-affirming interventions (GAIs) on the physical health of trans athletes and the ethical implications of trans inclusion in sport. We provided a holistic perspective of health considerations of trans athletes for sport medicine providers and sport psychology professionals which contextualizes the need to consider mental and physical health factors when providing care (i.e., relational-cultural theory or RCT) [ ] and moves away from the medicalization of trans identity toward an analysis of the structural barriers inherent in sport and state spaces. To do this, we highlighted Jordan K.’s personal account of trans violence within collegiate sport to illustrate the mechanisms by which the medicalization of trans identity and the environment of “mental toughness” creates a hostile environment for trans and intersex athletes. We then discussed the harmful implications of the lack of trans cultural competence in sport for sport medicine and sport psychology professionals.

When we take seriously our commitment to developing athletes as whole people, then we underscore the need for improving sport medicine and sport culture through trans inclusive practices. As Malatino [ ] writes, trans care allows us to rethink our heretofore care ethics and care labor which is centered in normative and cis-centric gendered arrangements and familial structures.