11 January 2016

Do trans- kids stay trans- when they grow up?

Following the closure of the CAMH Gender Identity Clinic for children, I have been receiving requests for what the science says.  Do kids grow out of wanting to change sex, or does it continue when they are adults?

In total, there have been three large scale follow-up studies and a handful of smaller ones. I have listed all of them below, together with their results. (In the table, “cis-” means non-transsexual.) Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 6090% of trans- kids turn out no longer to be trans by adulthood.

Outcome
 Group
Study
2/16
4/16
10/16
gay
trans-/crossdress
straight/uncertain
Lebovitz, P. S. (1972). Feminine behavior in boys: Aspects of its outcome. American Journal of Psychiatry, 128, 1283–1289.
2/16
2/16
12/16
trans-
uncertain
gay
Zuger, B. (1978). Effeminate behavior present in boys from childhood: Ten additional years of follow-up. Comprehensive Psychiatry, 19, 363–369.
0/9
9/9
trans-
gay
Money, J., & Russo, A. J. (1979). Homosexual outcome of discordant gender identity/role: Longitudinal follow-up. Journal of Pediatric Psychology, 4, 29–41.
2/45
10/45
33/45
trans-/crossdress
uncertain
gay
Zuger, B. (1984). Early effeminate behavior in boys: Outcome and significance for homosexuality. Journal of Nervous and Mental Disease, 172, 90–97.
1/10
2/10
3/10
4/10
trans-
gay
uncertain
straight
Davenport, C. W. (1986). A follow-up study of 10 feminine boys.  Archives of Sexual Behavior, 15, 511–517.
1/44
43/44
trans-
cis-
Green, R. (1987). The "sissy boy syndrome" and the development of homosexuality. New Haven, CT: Yale University Press.
0/8
8/8
trans-
cis-
Kosky, R. J. (1987). Gender-disordered children: Does inpatient treatment help? Medical Journal of Australia, 146, 565–569.
21/54
33/54

trans-
cis-

Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413–1423.

3/25
6/25
16/25
trans-
lesbian/bi-
straight
Drummond, K. D., Bradley, S. J., Badali-Peterson, M., & Zucker, K. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34–45.
17/139
122/139
trans-
cis-
Singh, D. (2012). A follow-up study of boys with gender identity disorder. Unpublished doctoral dissertation, University of Toronto.
47/127
80/127
trans-
cis-
Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 582–590.


*For brevity, the list uses “gay” for “gay and cis-”, “straight” for “straight and cis-”, etc.


20 comments:

  1. Thank you. This is a wonderful resource.

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  2. Thanks for posting the evidence. What a shame identity politics trumps science.

    Ray Hames

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    1. Evidence? I'd prefer to see the studies and their methodologies. My understanding is that these were studies of gender non-conforming children, most of which wouldn't be trans anyway. That there as large a percentage of these kids who do turn out to be trans should be an indicator that the issue is real and deserves to be taken seriously.

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  3. Thanks for the nice info at a glance

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  4. Hello Dr Cantor, Could you provide any links to the studies so that we can have a more in-depth understanding of the data collection and analysis? Many thanks

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  5. Hello Dr Cantor, I was wondering if you could provide any links to the entire studies? I'm interested to find out more. Many thanks, Sian

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  6. Without access to the original data, informed analysis is of course impossible.But I can't help thinking of the long-standing received wisdom that virtually all homosexual males are "effeminate" as children, two thirds of them losing those attributes by adulthood--but NOT changing their homosexual orientation. The first thought that this brings to mind, then, is that (in today's constant blather over such things) that many children who find their traits on one side of the gender-spread may leap to the conclusion that they are trans--only to discover the error in later years. Perhaps at least a partial explanation?
    F. Christensen
    Professor Emeritus

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  7. These are studies of GNC children, not 'trans.' This is the kind of thing that got Zucker in trouble.

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    1. The five most recent studies make reference to gender identity disorder/gender dysphoria in their titles, so I don't think the subjects were simply GNC children.

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  8. If you look at the actual studies, they were done with gender-nonconforming children, not children who expressed that they actually were the other gender. This article is no more than clickbait trying to mislead people for political gain.

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  9. Much of this summary doesn't even add up - literally.

    Straight / gay / bi: sexual orientation

    Cis / trans/cd: gender identity/presentation

    Two separate things (cis can be gay or straight, trans can be gay or straight), so the numbers for each need to total 100% of the population separately.

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    1. According to a trans organization (Mermaids) 'cis' people are happy with gender AND attracted to opposite sex

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  10. "regular gay or lesbian folks"
    :-/

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  11. For the early studies, it is probably a fair criticism to say that the children may not have had gender dysphoria. They may have been in treatment because they were gender non-conforming and their parents were concerned about it.

    However, the more recent studies talk about children who feel they should be or are a different gender.

    In addition, Wallien et al. and Steensma et al. are studies from the Amsterdam clinic. This is the clinic that pioneered the use of puberty blockers in adolescents with gender dysphoria; they are not at all anti-trans.

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  12. People are mixing up Gender Non Conforming Only Children, GNC Only, (usually as defined by their parents) and transgender children (those who show strong cross gender desires and associated Gender Dysphoria, GD).

    Now GNC Only (little or no transgender desires and the associated GD) will fairly often, but not always by any means, end up bi-sexual, gay or lesbian as adolescents and adults.

    GNC with strong GD will retain that into adolescence and adulthood and at some stage transition or die, that 30%-40% suicide attempt rate is no mistake.

    So it is important to separate them, which to be fair for a young child can take a few years to work out, hence the WPATH ’support and wait and see’ approach.

    The longer a child expresses transgender desires and has GD the more likely they will retain that. But, an important but, a child with strong GD may not be a ‘typical’* ‘sissy boy’ or ‘tomboy’. though they will almost certainly show some clear GNC behaviour of some kind and strongly express transgender wishes and show suffering if they are thwarted.

    The other issue is the treatment of some GNC Only kids, who if you do the ‘drop the Barbie’ stuff to them means you are making them act ‘straight’, which is cruel and if not actual SOCE is pretty close.

    GNC Only behaviour by itself will not ‘make’ someone transgender, which seems to be the fear by some.
    GD plus GNC means they are transgender and almost certainly will not change and if you try you are playing Russian roulette with their lives. There is only one treatment for GD that works.

    So the issue is selection and that is not that hard. A 2012 study on CAMH children showed the only statistically significant factor (logistic regression) was the strength of (their combined GNC/GD) scores. So their own tests showed good measures to predict outcomes, which were a lot higher that the commonly stated ‘80% desist’ (based on lumping the two groups together).

    A rough ‘back of the envelope’ calculation shows that maybe only 5% of GNC Only kids will become transgender. BUT, maybe as much as 80% to 90% of GNC + strong GD ones will persist.

    The majority, by far, are of course GNC Only with transgender children being a small minority.

    *And what is a typical ‘sissy boy’ or ‘tomboy’ anyway? This is usually just parent paranoia and their absurd social ‘norms’.

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  13. Cannot use this level of analysis as having any scientific validity. Must dig into methods and clarify integrity of diagnosis, especially noting the year span of the studies. Then submit it for peer review. At most, this begs for further examination which of course, it always good!

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  14. A debunking for the last study listed: https://gidreform.wordpress.com/2014/02/25/methodological-questions-in-childhood-gender-identity-desistence-research/

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  15. I've reviewed the first Cohen-Kettenis study and their definition of "persistence" was if the person reported for for transitional surgery as an adult. They also included in desisters, those who dropped out of the study. So methods and operational definitions need to be carefully looked at. I'd like to see the numbers for those who were insistent, persistent and consistent since the mid 90's and see what their follow up outcome was.

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  16. What I take from these studies is that it would appear that as time as gone on, we narrow down the defintions of GNC+GD, we get greater diagnostic specificity and reliability for 'persistence'. This is a hopeful sign that we may yet have a set of diagnostic criteria that reliably differentiate the two populations. Dr. Kelly Winters noted in her talk on the subject, referenced in the link above by "no", that anatomic dysphoria correlated with persistence. I have noted this anecdotally, talking to a number of parents of GNC kids, both desisters and persisters. This needs to be explored further.

    The other item that the listed research shows is that desisting seems to slow down, if not stop entirely around the ages ten to thirteen, suggesting that a rethink of the puberty blocking protocols now in vogue is in order. It may be more desirable to phase in cross-sex HRT at an earlier age with properly screened clients:

    https://sillyolme.wordpress.com/2011/02/28/age-of-innocence/

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  17. The most important part of the Steensma study is that he identified two groups and the the main characteristic of the "desisters" were being gender non-conforming (wanting to have the role of the other sex - being able to behave like a boy/girl) and the persisters felt they were in the "wrong body" (I am simplifying the study).
    So, what we have is a difficult in diagnosing a children with less than 13 yo - we can say that they are gender non-conforming, but not transgender.

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