Table 1 The characteristics of included studies

Nye et al. (2019) [35]

Cross-sectional survey

A total of 1077 university and collegiate athlete trainers (ATs), comprising 420 males and 653 females, participated in this study. The highest degree earned by a total of 1074 athletes were as follows: 11.5% had an academic doctorate, 1.4% had a clinic doctorate, 73.6% had a master’s, and 13.6% had a bachelor’s degree.

The main aim of this survey was to explore ATs’ perception of treating LGBT (lesbian, gay, bisexual, and transgender) athlete patients. Using the Qualtrics software, a 19-item questionnaire assessed and with analyzed the approach, the care quality, and perceived behavior of athlete trainers with transgender student-athletes.

A cohort of 78.9% (844) participants revealed that they had a close friend or family member disclosing as transgender or LGBT, and 15.5% (167) identified themselves as LGBT. A majority reported they had not received formal training on the needs of transgender people (44.8%, 482); only a few said they had formal training on the needs of transgender people (9.6%, 103).

The mean + S.D.D. (range) of participants reporting an approach change when serving transgender people was 1.15 ± 0.56 for 597 female participants and 1.18 ± 0.58 for male participants; for quality of health care and comfort in providing service, 4.68 ± 0.71 (for females) and 4.60 ± 0.85 (for males).

Calzo et al.(2014) [36]

Survey (Growing Up Today Study)

A total of 16,882 participants were recruited for this study; 939 were females and 7843 were males, and their ages ranged from 12 to 22 years. All participants were from the United States.

The survey explored low self-esteem among transgender athletes, their sports involvement, and team participation.

Sexual minorities reported MVPA (moderate-vigorous physical activities) of p < 0.01 (1.21–2.62) and 46–76% were less likely to participate in sports than heterosexuals of the same gender. Athletes’ self-esteem contributed to approximately 46–100% of sexual identity MVPA differences.

Elling-Machartzki (2017) [37]

Interview

Twelve transgender individuals from the Netherlands participated in this study. Six were transgender men and six transgender women. Their age varied from 27 to 51 years

Challenging physical activities and sports in the lives of transgender individuals concerning the centrality of their bodies.

The 12 transgender women and men reported being forced to fit in or be excluded from some competitive sports, especially during the transition process. They expressed sports as disciplining, shaming, and dangerous for transgender individuals. However, a few participants were happy and felt empowered in supportive social environments.

McGannon et al. (2019) [38]

Conversational interview

Ten boxers from the women’s Canadian national team were recruited, aged 26 to 31 years, with a mean of 28.3 years. Five identified themselves as transgender, bisexual, or lesbian, and five as heterosexual. All participants had competed a world championship, four being world champions with medals, six having major games medals, and three having competed the Olympics on the Canadian team.

The study examined the psychological impact among transgender boxers in sports by employing a face-to-face video interview over Skype. Participants shared their performance, well-being, competition experiences, training connections, and the impacts of their identities.

50% of participants who responded were transgender boxers on the Canadian women’s team. The majority showed significant social-psychological effects.

Travers (2006) [39]

Open-ended interview

Twenty women from the NAGAAA (North American Gay Amateur Athletic Alliance) participated in this study.

Exploring softball leagues’ responses to challenges encountered by transgender people, and transgender-inclusive policies.

Most leagues have not solved the transgender issues in their legal policies in explaining the eligibility for participation. One transgender participant revealed that many women are not subjected to these policies and referred to it as not safe for transgender people. Another respondent indicated that men who transitioned into women still had more strength and could harm the rest of the players, referring to them as physically superior.

Travers and Deri (2011) [40]

Interview

A total of 12 individuals who identified as transgender, including eight transgender men, three transgender women, and one lesbian, participated in this study.

An interview was conducted to measure the inclusivity of transgender people in sports by employing a climate metaphor system developed by Sandler and Hall.

The eight transgender men reported that they were warmly accepted and faced no discrimination.

Hargie et al. (2017) [11]

Interview

Ten transgender individuals were recruited for an interview in this article. Six were females, and four were males. Their ages ranged from 25 to 62 years. All participants were from Northern Ireland.

Through a focus group, the identity Trust, a support group in Belfast conducted interviews with transgender people to explore their interests in sports, inclusionary and exclusionary experiences, their emotions in sports, and the impact of being transgender in sports. Interviews lasted between 30 minutes and one hour and were conducted at Ulster University.

Transgender people felt discomfort in changing rooms. They were told they were neither one gender nor the other and felt excluded. They reported negative experiences at school. They were humiliated in sports by being told to prove their gender identity for two or more years before joining sports teams.

Mereish and Poteat (2015) [15]

Survey

A total of 13,933 student participants from twenty-two high schools in Dane County were enrolled in this survey.

To examine sexual identity disparities in physical activities in sports among transgender individuals.

Among the LGBT participants, 8% were physically active; 57% of heterosexual and 35% of LGBT participants were involved in sports. (AOR = 1.28; 95% Cl = 0.46, 0.83) Heterosexual males were more likely than LGBT males to be physically active or involved in sports (AOR = 0.26; 95% CI = 0.20, 0.32).

Walen et al. (2020) [41]

Cross-sectional survey

A total of 5303 participants were eligible for the survey. Eight hundred ninety-four participants started the survey (response rate was 16.2%), and 667 identified as transgender in their own words (completion rate was 74.6%). Participants were 33 ± 10 years of age, and their average experience was 11 ± 10 years.

The measure of athlete’s trainers perceived defining of transgender people, comfortability working with transgender people, and competitive advantages perceptions. A multi-process 43-item questionnaire was employed to explore the objectives.

321 (48.1%) of the recruited individuals reported receiving transgender treatment, although 240 (36%) said they were in the process of screening drugs in consultation with an endocrinologist. 45.6% (304) of participants reported they were competent in using suitable technology related to transgender people. 321 (48.1%) disagreed that they were competent to counsel transgender people regarding replacement effects associated with hormones or mental health issues (n = 269, 40.3%). 35.1% (243) reported never having received education on caring for transgender patients, 278 (41.2%) believed that transgender females had more competitive advantages, while 44 (6.6%) thought male transgender athletes had more competitive advantages.

Munson and Ensign (2021) [42]

Qualitative phenomenological study (survey)

A total of nine individuals were recruited for this study. Six were recruited via a quantitative survey and three through word of mouth. Their age ranged from 18 to 35 years, with a mean age of 23.56 ± 5.32 years, and they were currently athletes or had been so in the last five years. Three were transgender women, four identified as gender-queer or nonbinary, and one identified as nonbinary and transgender male. Two were athletes in high school, four in collegiate, one semiprofessional, and two in league sports. Three were transgender male.

To examine challenges or experiences that ATs face and barriers transgender athletes face in sports. Interviews were conducted to find the primary objectives.

Most transgender people believe that ATs must be trained on different subjects concerning transgender individuals. Five reported that their ATs had insufficient knowledge of transgender people’s needs. One transgender individual said the ATs seemed ignorant when they did not know how to interact with him as a transgender athlete.

Herrick and Duncan (2018) [43]

Survey

A cumulative 42 individuals participated. All participants were 18 years and above and could speak and read English. The mean age was 28 years, and they were from Canadian cities. Participants identified as: twelve queer, eleven gay, nine lesbian, six bisexual, two polysexual, one asexual, and one not specified. The gender identities were: cis-men 16; cis-women 15; five non-binary; two gender-fluid; two transgender men; one transgender woman; and one agender individual. The majority were white (31); the rest were four Asians, four Arab, two Hispanics, and one Black.

The survey employed eight focus groups and semi-structured interview guidelines to examine challenges such as exclusion and discrimination among transgender people in sports and to explore their experiences and participation in physical activities as transgender athletes. All the focus groups had between three to eight individuals and were held between 55 minutes to 95 minutes.

Cis-women individuals felt they did not belong there and were not warmly welcomed in physical activities. Most participants reported negative experiences in changing rooms in the context of physical activities, and few had positive experiences. LGBT individuals said they felt shameful when entering locker rooms, were transgressing heteronormative interests and believed it was wrong. One transgender person, a 32-year-old, reported feeling fear and being discriminated against at the gym because they were misgendered.

Lucas-Carr and Krane (2012) [44]

Interview

Three transgender individuals participated in this study; all participated in high school sports, and two continued to participate in the collegiate club. In contrast, the others participated in non-university club sports. One participant, identified as Ryan, was 28 years of age; another, Harvey, was 29 years; and Jake was 23 years of age. All were white and lived in the United States.

The three transgender people were interviewed to explore athlete transgender experiences in sports using a life history methodology system. The themes examined were sex segregation and sport, the safety space in sports participation, and the inclusion of transgender people in sports.

One transgender individual, Harvey, revealed sex segregation as a frustration in sports participation. Ryan reported that few options were available in sports because of his identity. Jake expressed how being different is often seen as threatening. The three individuals were positioned to secure space in sport as they pushed the transgender boundaries. Harvey was frustrated when he joined the women’s rugby team because his friends frequently pointed out that he was on a girls’ team. All participants felt they were not well-accepted in sports, as Harvey constantly said sex segregation should be abolished in sports.