Desistance studies in children with Gender Dysphoria
Ten studies have been conducted looking at whether gender dysphoria persists throughout childhood. On average 80% of children change their minds and do not continue into adulthood as transgender. Some of these studies are very old, the first being published in 1968 and others in the 1980s. This was during a time when being transgender was not accepted as widely in society as it is now so it can be argued that this may have influenced many to change their minds. An analysis of all published studies can be seen here.
However, the most recent study published in 2013 confirms once again that gender dysphoria does not persist in most children past puberty.
In this Dutch study they identified 127 children who were referred to the Gender Identity clinic in Amsterdam when they were under the age of 12. They then looked to see if these children were still gender dysphoric by the time they reached adolescence at age 15. 47 (37%) of these children had persisted. However 80 (64%) of children had either desisted (52) or were no longer traceable (28). See Figure 1. Since there is only one Gender Identity clinic for children in Holland it can be assumed that the latter no longer required support and so had also desisted.
It is well known that the on-set of puberty is an important time when personal identities begin to form and develop. Interestingly, at the gender clinic in this study the children were not given puberty blockers until age 15 and so most will have started their natural puberty by the time of follow-up. It is currently unknown what role puberty plays in the observed resolution of gender dysphoria in most of the children in the study. It is also unknown whether the increased use of puberty blockers in younger children, thereby postponing puberty altogether, will inadvertently increase persistence rates for gender dysphoria. No long term studies on the effect of puberty suppression have yet been conducted.
Evidence obtained from the children’s Gender Identity Clinic in the UK (Tavistock clinic) is that 40% of the children referred to them progress onto puberty blockers. This correlates well with the results from the Dutch study. Alarmingly however, almost all children who start puberty blockers then go onto cross-sex hormones suggesting that desistance after medication begins is very rare. This may of course reflect the increased certainty of the persisters at this stage. Or it may be that it is simply too difficult to consider or admit to a change of mind. Long term studies are needed to determine how long these children persist in their new gender identity and whether they de-transition later in life. This is currently unknown.
Childhood social transitions (name changes and presenting as the opposite sex using hairstyles and dress) were also shown to be important predictors for persistence of gender dysphoria into adolescence, especially for boys (see Figure 2). The reasons for this are currently unknown. The independent role and impact that social transitions play on persistence has never been studied. It may be that social transitions make it easier to persist in their new gender identity or conversely it may make it more difficult psychologically for the gender dysphoria to resolve and for children to desist. Long term studies are urgently needed in this area.
CONCLUSION: Most children grow out of their gender dysphoria as they reach adolescence. Social transitions and/or puberty blockers are frequently used to ameliorate symptoms in these children. However, the long-term psychological impact of these therapeutic strategies on children is unknown. Therapeutic approaches for children with gender dysphoria are not evidence based and long-term outcome studies are urgently needed in this area.
If you’d like to read more about the area of childhood desistance here is an excellent article by Jesse Singal written in 2016.