Gender-Diverse Teens May Be Less Physically Active

Transgender and gender-diverse adolescents aged between 11 and 12 years appear to be less physically active, with lower daily step counts than their cisgender peers, according to a new analysis of data from the Adolescent Brain Cognitive Development (ABCD) Study.

Transgender identity was associated with about 1400 fewer steps per day compared with cisgender identity, as measured using Fitbit devices.

“We need to understand whether there are unique differences in physical activity levels across genders in adolescents. This can help us tailor programming to ensure that adolescents are physically active and that we reduce barriers that may impede gender-diverse adolescents from participating in meaningful activities,” study author Kyle Ganson, PhD, assistant professor of social work at the University of Toronto, Toronto, Ontario, Canada, told Medscape Medical News.

“Providers should ask about gender identity and physical activity among adolescents,” he added. “We know that physical activity can have important lifelong benefits, so it should be encouraged for all adolescents, particularly for those who identify as gender diverse.”

Results from the study were published online on December 3 in Annals of Epidemiology.

Analyzing Steps

The ABCD Study has followed nearly 12,000 adolescents across 21 US research sites since they were aged 9 or 10 years in 2016-2018. Year 2 data from the study, which mostly included participants aged 11-12 years in 2018-2020, began to incorporate Fitbit and gender data.

In a previous analysis of year 2 data, Ganson and colleagues found that female adolescents had about 1500 fewer steps per day than male adolescents, and sexual minority adolescents had about 700 fewer steps per day than heterosexual adolescents.

In the current study, Ganson and colleagues analyzed steps for 6038 adolescents across multiple measures of gender diversity, including transgender identity, felt gender identity, gender expression, and gender “non-contentedness.” The research team also accounted for factors such as age, sex assigned at birth, race and ethnicity, parental education levels, household income level, seasonal variations in activity, and the data collection period (before and during the COVID-19 pandemic).

Overall, 49.7% of adolescents in the study were assigned female at birth, 39.4% were from racial and ethnic minority groups, 1% identified as transgender or maybe transgender, and 16.9% were considered non-cisgender or sex-congruent based on the felt gender categorization. The average daily step count across all adolescents was 9188.

Transgender identity was associated with 1394 fewer steps per day compared with cisgender identity, after adjustment for all covariates.

Greater gender diversity, as measured by felt gender and gender non-contentedness, was associated with lower daily step counts, ranging from about 400 to 700 fewer steps per day. Each one-increment increase in gender non-contentedness was associated with a lower daily step count.

“In some ways, it’s not surprising that adolescents who identify as transgender engage in fewer steps per day than their cisgender peers,” said Ganson. “It may be that transgender adolescents experience stigma and discrimination, deterring their engagement in physical activity. They may also find more supportive environments online.”

Physical Activity Policies

The findings have important implications for public health and for policies focused on supporting physical activity among transgender and gender-diverse adolescents, Ganson and colleagues wrote.

Previous studies have indicated that a step count of 12,000 meets the lower threshold of recommended daily activity for adolescents or about 60 minutes of moderate to vigorous physical activity. Therefore, a decrement of 1400 steps can make a big difference, according to the authors.

Bullying, political tension, or policies at the school, district, or state level may discourage transgender and gender-diverse adolescents from participating in team sports or physical activity, the authors noted.

Certain changes could make physical activity more inclusive, they added, such as allowing transgender students to use the locker rooms, showers, and restrooms, where they feel the safest, as well as offering private changing areas, updating students’ names on team rosters, and ensuring that those involved in the sport (such as coaches, referees, and announcers) know about students’ names and pronouns.

Physical and Health Education Canada (PHE Canada) offers resources to support gender and sexually diverse students in physical activity. The resources suggest ways to encourage students, lower the barriers to physical activity, and offer movement options for students of all types to enjoy.

“Gender plays an outsized role in physical and health education. Gender is part of the very structure of PHE,” Travers, PhD, a professor of sociology at Simon Fraser University in Burnaby, British Columbia, Canada, who uses a single name, told Medscape Medical News. “For instance, in many schools, there are only two options for change rooms and classes — male or female. This means that youth must select an option they may not be comfortable or feel safe with, resulting in feelings of exclusion before class even begins.”

Travers, who wasn’t involved in the study, worked with PHE Canada on its 2SLGBTQ+ resources. Travers researches sports and social justice and particularly focuses on the inclusion and exclusion of women, queer, and transgender athletes.

“Gender also informs our ideas about who is likely to succeed in PHE and influences our assumptions about the movements, skills, and activities that bodies can perform,” they said. “Sometimes we are not even aware of the role that gender plays in PHE, but its presence can hinder participation for many young people.”

The study’s lead author has received grants from the National Institutes of Health and the Doris Duke Charitable Foundation. Ganson and Travers reported no relevant financial relationships. 

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.