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In 2015, Erin Hamilton was just like every other cyclist. It was spring—in fact, it was Bike to Work Day. Hamilton was fit and looking forward to a summer of racing. But today was just a commute ride after work, to the wife and daughter waiting at home in Seattle.
And then came the Cadillac Escalade. It barged through a corner with its oversized grill, forever altering the trajectory of this cyclist’s life.
When Hamilton was hit she wasn’t yet known as Erin Hamilton. At the time, she was living and racing bikes as a cisgender man. But that was about to change.
A Life Re-Imagined
For 20 feet, “I basically pogo-sticked on my head. My helmet was pancaked.” EMTs loaded Hamilton into an ambulance and drove to the nearest emergency room. After being released, the symptoms got worse: confusion, imbalance, strange mood swings. A second trip to the ER revealed a diffuse axonal traumatic brain injury, a severe injury that often results in a permanent loss of function.
Traumatic brain injuries (TBI) are unfortunately way too common among cyclists. According to research collected by the American Association of Neurological Surgeons, cycling results in the most head injuries of any sport—even football. But what happened next to Hamilton is not at all the norm. The traumatic brain injury didn’t just make Hamilton lucky for a second shot at life. It made her restart life all over again. This time, as a woman.
For most folks, a brain injury can cause amnesia, or short or long-term memory loss. For Hamilton, the opposite happened. It caused her to remember. And then she had no choice but to rethink her whole life.
Human brains have a convenient coping mechanism for dealing with traumatic memories: They hide them. It’s not uncommon for people with abusive childhoods to have “lost” pieces from the worst moments they experienced. For Hamilton, her injury “unlocked a lot of very suppressed and locked down memories,” she said. “We’re talking stronger- than-the-Disney-Vault status,” she joked about how tucked away those thoughts were.
In the shadows of her brain, Hamilton remembered experimenting with cross-dressing. “The major one I remembered was having my secret bag, this secret backpack I hid from everybody that had women’s clothing in it. When my parents weren’t home, usually after school, I would dress in women’s clothing,” she said. There were memories of shopping for clothes and wondering why her parents relegated her to the boy’s section. There were memories from experimenting with having sex with men prior to her marriage.
What these memories meant, though, was harder to figure out. “Am I trans? Is this just a cross-dressy thing? Am I gender fluid?” Hamilton made an appointment with a therapist to try to sort through what, exactly, to do with this info.
At the same time, Hamilton started to ask the doctors about returning to bike racing. A little piece of normalcy was needed and fitness had always been an outlet. Absolutely not, they replied. “If I got another concussion, they told me there was a chance I might not wake up again,” she said. Then Hamilton got an idea: What if she removed the peloton from the equation? Could she ride her bike in something like a triathlon? After a bit of begging and maybe a little pleading, her doctors agreed that this solution might work.
Hamilton began dreaming of an Ironman finish line. The question remained, though, how would she identify when she crossed the finish line? And would the sport welcome her when she got there?
Being a Trans Athlete in an Anti-Trans World
The world is not a friendly place for trans folks in general. It’s even more hostile to trans athletes. According to a 2015 survey conducted by the National Resource Center on Domestic Violence, nearly half of trans people reported being verbally harassed, while one in 10 had experienced violence in the past year. Even more disturbing is that nearly half of all respondents said they’d been sexually assaulted in their lifetimes. In many places, legislators are not helping things.
For the past few years, some states have tried—sometimes successfully, often not—to pass bathroom bills, or bills forcing people to use the bathroom that matches the gender assigned at birth. Repercussions from those bills—like businesses boycotting states that pass them—then sent anti-trans groups to an easier target: sports. Anne Lieberman is the director of policy for Athlete Ally, a group committed to making sport more inclusive, and she said in 2020, 18 bills have been filed across the country which specifically aim to exclude trans people from sports. A huge percentage of these bills focus on K-12 sports. “We’re talking about kids who just want to play on their middle school soccer team with their friends,” she said.
And here’s the thing: The vast majority of kids are really and truly just OK at sports, especially at the elementary and middle school levels. In fact, many soccer leagues are co-ed for young kids, and some child psychologists argue that it makes more sense to separate kids by skill and cognitive ability than by gender. Lieberman also said some of these proposed laws open up children to extremely intrusive protocols—like having their genitals checked just so they can play on the local team.
While there’s been controversy in recent years over whether trans women have a physical advantage in sports—either pre- or post-transition—the reality is that for the vast majority of women (trans- and cisgender) competing isn’t about winning. It’s about the chance to participate as the person they really are. And in that way, trans athletes are just like every other athlete, said Chris Mosier, the first trans athlete to sign a sponsorship deal with Nike. “We’re all out there just trying to get through it. It’s very similar to life.”
Even at the top levels of competition, the science remains mixed on who has what kind of physical advantage—if any. Regulations mostly focus on testosterone, and multiple studies show that’s not a direct measure of athletic prowess or sex. In fact, sex is determined by a range of factors including chromosomes, hormones, internal and external gonads, and secondary sex characteristics—think Adam’s apples on men and wider hips on women. But men and women can range not just on how much testosterone their bodies produce, but also on hormone levels and secondary sex characteristics. Bodies vary in so many ways—which is what makes sports interesting in the first place.
For those looking to limit trans people’s access and options, though, focusing on sports is a smart strategy. Women see gender inequality everywhere in athletics—look at pay gaps and resources for high school and collegiate athletes. “A lot of women are operating in the psyche of the oppressed—that there is not enough space for everybody,” Lieberman explained. Think of it like this: If you’re a female athlete and someone asks if they can sit and eat pie with you, your immediate reaction may be there’s not enough pie!
Furthermore, many women (and men) have deeply internalized the idea that trans women will immediately eclipse cis women if they’re allowed to compete. But that is just not panning out. In 2003, the International Olympic Committee first introduced policies allowing trans athletes to compete. Since then, 54,000 Olympians have competed at the games, said Lieberman. Not a single one of them has been an openly trans athlete.
Of course, trans athletes can be incredible athletes. Just look at Chris Mosier, who was the first (known) trans athlete to represent the U.S. in international competition. Mosier, a trans man, was the first trans athlete to qualify for the US Olympic Trials, where he raced in the men’s competition (to be clear). But Mosier said he’s constantly underestimated—because of archaic views on female bodies being lesser than. “That sexism is just so deeply ingrained,” he said. And, he acknowledges outright that Hamilton’s experience in triathlon will be different from his, simply because people hold so much more hostility for trans women than they do for trans men.
Hamilton knows all of this. But she doesn’t really care that it’s going to be hard, and that other athletes may be hostile to her. She just wants to race.
Not long after her accident, Hamilton came out to her wife. She felt like it was the honest thing to do, to tell her wife about this question she was grappling with. It did not go quite as she’d expected. “My ex-wife is not gay; she’s not a lesbian; she’s not bi. She is not attracted to women.” She was not interested in being married to a woman.
Hamilton loved her wife. She loved being a family with their young daughter. But the words “I think I may be trans” are not words you can take back. When Hamilton said she would be willing to live the rest of her life as a cis-man to keep their family together, she said her wife didn’t believe her. “I told her this is not worth losing my family over. Going down this path is not worth losing my family. If I’m risking losing all of this, I don’t want to transition. But she didn’t believe me, and you can’t make someone believe you.” They parted ways. (We reached out to Hamilton’s ex-wife, but she declined our interview request).
And so, Hamilton started her new life. First things first: In early 2017, Hamilton pressed “pay now” on the entry page for Ironman Coeur d’Alene.
As she began her training, she also began her transition process, starting with hormone replacement therapy (HRT). Hamilton had done hours and hours of research on what to expect as she moved forward. But every body is different. All the research in the world cannot predict how you specifically will react. She took her first doses of HRT and waited. The effects were slow. Eventually, breasts showed up, but the rest of her body stayed super-lean. Hamilton kept waiting for softer hips and more curves, but they never arrived.
HRT is also not without its side effects. For Hamilton, taking testosterone blockers and estrogen translated to a startling loss of strength. Her cycling was suddenly anemic. Her 5K time tanked. Worse was that the testosterone blocker she takes—spironolactone—acts as a strong diuretic. “I have to take on nearly twice as much hydration as I used to,” she said. Dry mouth became her constant companion on most training rides. The drugs also changed the way her body metabolizes energy. Her old nutrition plans didn’t work. “I bonk so easily now,” she said. Two coaches tried to help her, but neither could figure out why her body suddenly seemed unable to process and utilize calories on the go.
Still, training for Ironman gave her a goal. It got her out of bed in the morning when all she could think about was the loss of her family, the loss of her ability to work after the brain injury, the loss of her friends in the wake of the divorce. Having Ironman on the horizon did its job: keeping her sane through what she was sure would be the worst years of her life. And on the day of the race, she lined up, jumped in, and began what she was sure would be her big comeback.
Let Her Be
In the prep leading up to her 2017 Ironman, Hamilton ran into her fair share of unkind remarks and ugly looks—especially early in her transition days, when she was still so lean. She expected it to be worse once she was at Coeur d’Alene. For 140.6 miles, Hamilton waited for the whispers and the side-eye, but they never came. She thought a sunscreen smear volunteer would question her gender as they rubbed her down. No one did. She thought an official might point her toward the wrong transition tent. It never happened.
The magic of an Ironman is that it’s such an insane day that no one has time for anyone else’s business. Racers have no mental energy to question whether you belong. Officials are preoccupied with logistics, and the volunteers know their job is to support. And so they do.
“For so many athletes, triathlons are about athletes showing up to challenge themselves—for their own health and well-being,” said Mosier. “We’re all out there to be the best version of ourselves.” That was Hamilton on race day. She was living her most authentic life. She felt like she belonged. Sure, her time wasn’t what she’d hoped for, finishing in 16:39:31, but this was a sport that seemed happy to let her be.
Unfortunately, the rules aren’t quite so happy to let her just be. Hamilton did not declare that she was a trans woman on her entry form. Ironman requests athletes disclose their entire clinical treatment plan to Ironman’s Global Medical Advisory Board at least 60 days in advance of their race. Hamilton’s coach wanted her to go through the formal process. She, however, didn’t feel that sending a file of confidential medical records to a team of strangers was appropriate. Especially when she was just hoping to finish, not compete for a podium or Kona spot. Mosier agrees. In fact, he did not disclose that he was a transgender man when he raced his first Ironman after transitioning. “Treatment looks different for different people. There’s not one way to be a trans person,” he said. Some people choose not to transition medically or surgically. Having to justify your medical choices—and release your personal info to a panel of people you don’t know feels like “that is a lot of steps for me just to participate,” he explained.
USAT has more inclusive policies for trans athletes, especially at non-elite levels. For age groupers competing domestically, USAT athletes may self-select their gender when they register, though they have to show ID that matches that gender when checking in. For trans women competing in international competitions, they have to follow ITU or Olympic-level rules—meaning currently athletes must provide blood tests to show their total testosterone levels are below 10 nmol/L and have been for the past year. Trans men must make sure they have filed a therapeutic use exemption for any hormones they take. These are the same rules that govern triathletes at the Olympics and on the ITU circuit. But a lot of these rules are in flux and changing. The testosterone limits in Olympic track competition were a point of contention at the Court of Arbitration for Sport last year. It can be difficult, then, for a middle-of-the-pack age-group athlete to know what they need to do and what they should do.
In the future, this is territory that Hamilton will have to navigate to continue racing. She knows because the serious abuse did eventually come. She became one of those statistics on assault and violence against trans people. She faced harassment regularly at races; confrontations in gyms and pools. Things got so bad that she wanted, and tried, to take her own life. She knows all of this is her reality, and the reality of so many trans people. And she knows she’ll ultimately have to navigate all of this again, so she can rightfully race as the woman she is. But, right now, she just wants to get back to a start line.
One More Finish Line
It took Hamilton nearly two years to decide to have gender reaffirming surgery. Unlike HRT, which, at least to some degree, can be reversed, this procedure is final. While many trans women know adamantly that this is the right choice for them, Hamilton waffled. Surgery is both costly and permanent. She wanted to be 100% sure.
Eventually she arrived at her 100%. “I knew that in order for me to feel more confident about myself, surgery was the answer. I’m not doing it for the people in the locker rooms, or the swimming pool or at the gym. I’m doing it for myself: to have more confidence and to feel complete.”
Hamilton’s surgery was split into two surgeries. In the first procedure, they create a clitoris using the nerve endings from the penis, and then form a vaginal canal. The second surgery is mostly cosmetic. Hamilton made it through the first procedure and was sent home with these instructions: Absolutely no training allowed. Cycling? Definitely out. The repetitive movement of running was a no-go. And getting in a pool with fresh incisions was a horrible idea.
But Hamilton reminded herself this was a small sacrifice to complete the five-year-long process of transitioning. Doctors estimated she could return to training after three months—right after the start of the new year. Which is why all her hopes rested on 2020. It would be the one and only time that dumb magazine adage—New Year, New You!—was actually at least a little bit true.
Four weeks after her surgery, she found herself in the ER again, hemorrhaging from below, the doctor trying desperately to find a physician familiar enough with gender reaffirming surgery to guide him through what to do next. Another emergency surgery followed. That three-month date for getting back to training slipped away.
So far, Hamilton isn’t quite healing. For some reason, the skin just isn’t regenerating the way it should be. Doctors have no idea why and cannot say when things may turn around. They’ve banned her from doing any kind of physical exercise, except light walking, for the foreseeable future.
After losing so much—her family, her job, the support of many of her old family and friends— losing her ability to train feels like the last blow. “Training was one of the biggest parts of my life. I use it to release anxiety and stress, and I don’t have that outlet now,” she said. Her bike lives next to her bed, and all she can do is look at it and think about how much she misses riding.
“This was supposed to be this magical, happy moment, the last thing to end my journey of transition was this surgery. Now, it’s just like, was this the right decision?”
Having a body you love matters. Being able to do what you love in that body matters. That’s why so many of us do this sport—to fully celebrate the mess of skeleton and muscle we inhabit. What are triathlons if not slightly masochistic celebrations of our bodies and our ability to persevere?
At the first Ironman where Chris Mosier raced as a man, there was one terrible moment at the finish line. “They said, ‘Congratulations, you are an Ironwoman.’ I was just devastated. I can’t put into words how invalidating that was,” he said. But after that moment, as he had time to process, Mosier had an epiphany. “I realized I can’t control how other people see me. I can’t control what other people say about me. The only thing I can control is how I react.” Mosier knew he was going to keep racing, and that he wasn’t going to hide that he was a trans athlete. He knew there were kids out there in need of a role model. He knew he had a chance to be the person he never saw growing up. He hopes Hamilton will find the same confidence he’s found, no matter what the announcer said at the finish line.
In some ways, she already has. As soon as her body heals, she’s signing up for another race. Right now she’s thinking of a half-Ironman, though she’s concerned enough about Ironman’s intrusive trans athlete policy that she isn’t sure she’s ready to give the brand her money. Still, Coeur D’Alene is calling her. “I just want to demolish that course,” she said. But that’s just half of her plan. “I’m going to get a custom kit in trans pride colors. I want to be on that course and be the most annoying and in-your-face person, like: I’m trans, f***ing deal with it.”
If you’re not connected to the LGBTQI+ community, some of these terms may be unfamiliar. Here’s what we mean.
Sex: Assigned at birth, typically by a doctor and based off of anatomy
Gender Identity: Your internal sense of being male, female, neither, or some combination
Cisgender: When the sex you were assigned at birth aligns with your gender identity
Transgender: This is when your gender identity differs from the sex you were assigned at birth: Someone who was assigned male at birth, but who has a feeling of being and living as a woman is considered a trans woman. Someone assigned female at birth but who has an internal sense of being and living as a man is considered a trans man.
Non-binary: This is an umbrella term for people who do not strictly identify with the binary genders of man and woman. People may also identify as gender-fluid, or gender non-conforming.
LGBTQI+: This acronym stands for lesbian, gay, bisexual, trans, queer, and intersex. The plus sign references
other people who do not identify within typical gender constraints.
What’s Involved In Transitioning?
There’s no one way to be a trans person. Trans people will sometimes choose to engage in one or multiple of the following interventions, based on their sense of gender, access to trans-appropriate health care services, and laws in the states where they live.
Non-medical transitions: This can involve changing your name, pronouns, hair, and dress, as well as gender markers on legal documents.
Hormone therapy: Trans women may begin a course of estrogen and may also use antiandrogens to suppress testosterone. Trans men may begin a course of testosterone.
Gender reaffirming surgery: Trans men and women may choose to have top and bottom surgeries to bring parts of their body, such as their chest and genitals, into alignment with their gender identity. Trans women may also choose other procedures like facial feminization surgeries.