15 December 2017

Statistics faulty on how many trans- kids grow up to stay trans-?

The National Post recently covered the CBC’s cancellation of a BBC documentary about transgender children (Why CBC cancelled a BBC documentary that activists claimed was ‘transphobic’).  In that coverage, the Post shared claims made by some activists criticizing some scientific studies, but did not apparently fact-check those claims, so I thought I would outline the studies here.  For reference, in a previous post, I listed the results of every study that ever followed up transgender kids to see how they felt in adulthood (Do trans- kids stay trans- when they grow up?).  There are 12 such studies in all, and they all came to the very same conclusion: The majority of kids cease to feel transgender when they get older.

National Post, 13 December 2017
The Post conveyed criticisms alleged about two of those:  “One study of Dutch children, in particular, assumed that subjects had ‘desisted’ purely because they stopped showing up to a gender identity clinic.”  Although unnamed, the claim appears to be referring to Steensma et al. (2013), which followed up on 127 transgender kids.  Of them: 47 said they were still transgender; 56 said they were no longer transgender (46 said so directly, 6 said so via their parents, and 4 more said so despite not participating in other aspects of the study); and 24 did not respond to the invitation to participate in the study or could not be located.  Because all the medical services for transition are free in the Netherlands and because there is only one clinic providing those services, the researchers were able to check that none of the 24 had actually transitioned despite having the opportunity to do so.  Steensma therefore reported that (80/127 =) 63% of the cases desisted.  The alleged criticism is that one should not assume that the 24 who did not respond or could not be found were desisters.  Regardless of whether one agrees with that, the irrelevance of claim is clearly seen simply by taking it to its own conclusion: When one excludes these 24, one simply finds a desistance rate of (56/103 =) 54% instead of 63%.  That is, although numerically lower, it nonetheless supports the very same conclusion as before. The majority of kids cease to feel transgender when they get older.

The other alleged criticism was that a study “cast too wide a net on which children were legitimately displaying gender dysphoria.”  Although also unnamed, this seems to refer to Drummond et al. (2008), which followed up 25 kids assessed in childhood for gender issues: 15 of the 25 received official diagnoses for their gender dysphoria, and 10 were judged to be experiencing the feelings, but to be “subthreshold” for an official diagnosis.  That is, the alleged criticism is that including “subthreshold” cases would water down the results from cases who are formally diagnosed.  The irrelevance of that claim is again easily seen by looking at it directly: Of the 15 kids who received a diagnosis, two continued to be transgender in adulthood (13/15 = 87% desistance), and of the 10 without a diagnosis, one continued to be transgender (9/10 = 90% desistance).  Drummond thus reported their combination, that (22/25 =) 88% desisted.  That is, both the “too wide” net and the narrow net each support the very same conclusion: The majority of kids cease to feel transgender when they get older.

I am personally of the opinion that the studies' authors were correct in their original methods, but the numbers indicate that it simply does not matter.  Even if the criticisms were valid, the studies conclusions would remain the same.

The state of the science is made clear simply by listing the results of the studies on the topic.  Despite coming from a variety of countries and from a variety of labs, using a variety of methods, all spanning four decades, every single study without exception has come to the identical conclusion.  This is not a matter of scientists disagreeing with one another over relative strengths and weaknesses across a set of conflicting reports.  The disagreement is not even some people advocating for one set of studies with other people advocating for a different set of studies:  Rather, activists are rejecting the unanimous conclusion of every single study ever conducted on the question in favour of a conclusion supported by not one.

Importantly, these results should not be exaggerated in the other direction either: The correct answer is neither 0% nor 100%.  Although the majority of transgender kids desist, it is not a large majority.  A very substantial proportion do indeed want to transition as they get older, and we need to ensure they receive the support they will need.  Despite loud, confident protestations of extremists, the science shows very clearly and very consistently that we cannot take either outcome for granted.

References

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. 

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.



The BBC documentary pulled from CBC is viewable here:




24 comments:

  1. Thank you very much for this clear debunking of the criticisms levelled at the desistance figures.

    The insistence of some trans activists that any study which finds against their claims must be either biased, fraudulent, have a badly designed methodology or have interpreted the results erroneously without actually doing a proper analysis of what they are saying reveals their ideological motivations.

    It's like this tobacco industry who spent a great deal of time and money questioning whether smoking caused cancer because to admit that it did - which they knew long ago, would result in less profits.

    Now we have a situation where pharmaceutical companies set to gain by the idea that children who identify as the opposite sex are never mistaken or never change their mind. Because then all can be immediately put on hormones for a lifetime. And no one has to worry about that actually being a heinous error.

    ReplyDelete
    Replies
    1. Here we go.... Another Big Pharma meme. No, the number of transkids that would be using hormones even if every single one of them never desisted would be so small as to not even register on the profit margin numbers in their tax reports. Please focus on the real issue, that of the actual science vs. science denial.

      Delete
    2. used them as a kid still using them and i'm 59

      Delete
  2. Edit - potentially being a heinous error. For a minority of course it might be the right decision. However the problem is no one can tell who would have desisted without treatment and who wouldn't.

    ReplyDelete
  3. Do the studies take into account affirmative treatment versus wait and see treatment? Wouldn't affirmative treatment make it harder to detransition?

    ReplyDelete
    Replies
    1. I'm not aware of anyone on early-transition side ever gathering data on the results of what they're doing, never mind publishing it. The basis for it is purely philosophical. Much it boils down to extremists saying that what would have been best for them is what's best for everyone else. At the same time as demanding their lived experiences be respected, they deny the lived experiences of others. That reflexive early transition might make detransition harder is exactly why the issue is so important. Primum non nocere.

      Delete
  4. This was an informative read, Dr. Cantor. Thank you for also including this fascinating documentary. - From another clinical psychologist in the U.S.

    ReplyDelete
  5. I agree with Anonymous (12/16/17 at 12:45). Although it is true that not all of them desist, the problem is that there is no way to sort those who will desist from those who won't. Whether the breakdown of desisters/non-desisters - determined in hindsight - is 90/10, 50/50, or 10/90, that issue is that there is no way of determining which child is in which group. Therefore, none of them should be getting hormone blockers. You can't justify permanently damaging a child's body in order to satisfy the cosmetic preferences of others.

    ReplyDelete
    Replies
    1. This is absolute child abuse as a result of false science.
      Why is it that this aspect of the trans issue is seldom, if ever mentioned

      Delete
  6. Recently there was a court case in Australia to determine if court permission was required for minors to undertake cross hormone treatment. During that case the representative for the Royal Children's hospital claimed:

    The Royal Children's Hospital has received more than 230 patient referrals this year, and more than 700 since 2003. Of these, 96 per cent diagnosed with gender dysphoria continued to identify as transgender into late adolescence.
    No patient who commenced stage two treatment has sought to transition back to their birth sex.
    I was wondering if you knew anything about this case and these statistics. I can't find any data on this, it may be based on the RCH records. Is it too small a sample or short a period of time to show desistance or is it that the RCH have known which children to transistion. I would like to know your thoughts it seems odd that there has been no desistance. Thanks

    ReplyDelete
    Replies
    1. It would certainly be important should any clinic show such a dramatically different result from the others. As is clear from the discussions about the existing studies, however, many people are highly motivated to make the numbers look how they want. So, I wouldn't automatically accept what one side said in a court case; I'd need to see the full research report on how the numbers were collected. If they are seeing something different from the rest of the world, they need to report it!

      Delete
  7. As always, Dr. Cantor is a voice of reason, advocating for science/facts/evidence over ideology--all for the sake of the public's well-being.

    ReplyDelete
  8. These are really impressive ideas in on the topic of
    blogging. You have touched some fastidious points here. Any way keep up
    wrinting.

    ReplyDelete
  9. A good balanced movie. Too bad the CBC lost their nerve and chose not to broadcast it. Especially when 60-80% o fchildhood gender dysphoria suffers DO NOT continue to transition as adults... the minority of the minority are dictating the acceptable norms... I quite liked young Warner who we see at the beginning and end of the movie. I think warner's mom is being very supportive... and yet I am curious to see how that story works itself out in the future...

    ReplyDelete
    Replies
    1. Ms. McGillivray, It is NOT a minority of a minority that are dictating norms... the transactivists that are demanding these results be ignored by maligning them in various ways were NEVER transkids. They are "late transitioners". In MTF transsexuality/transgenderism there are two completely separate medical conditions/etiologies that lead to "gender dysphoria". The non-transkid population seeks to control the narrative by subsuming the transkid experience as a subset of their own as a route to greater legitimacy... they wish to create the false idea that they were themselves transkids... when in fact, as children, they were very gender typical boys... but boys with a specific unusual sexual interest in transforming their bodies. This is a paraphilia known as "autogynephilia". In the English Speaking nations, perhaps 80% to 90% of MTF transsexuals are of this autogynephilic (AGP) "late transitioning" population. Because they are the majority of those who seek and obtain transition services and because they have a history of pre-transition socio-economic status greater than transkids, their voice dominates the transactivists, drowning out those of "former" transkids.

      For more information on the this issue:

      http://sillyolme.wordpress.com/faq-on-the-science/


      Delete
  10. Could you please list the 12 studies. I'd like to read the others. Thank you.

    ReplyDelete
    Replies
    1. The link to that list is in the post, but here it is again: http://www.sexologytoday.org/2016/01/do-trans-kids-stay-trans-when-they-grow_99.html

      Delete
  11. The latest argument by the trans activists is that these studies don't count anymore, because the DSM V has now tightened the criteria for gender dysphoria. Thus, they say, some portion of the children in these studies who were diagnosed with GID or dysphoria would not get any diagnosis under DSM V, and thus the desistance rates would be lower or non-existent. Thus, they conclude, desistance is a "myth."An example of this argument can be found here: http://transadvocate.com/the-new-york-magazine-lies-to-parents-about-trans-children_n_18875.htm

    As far as I can tell, such an argument fails for 3 reasons. First, if it is true that the criteria have been tightened as of 2014, that doesn't mean that desistance was "mythical" under the prior standards, which reigned for decades. Second, if the criteria are now tightened, that would argue for new desistance studies employing the new criteria or a re-crunching of the data in the prior surveys using the new criteria. But there is no way to say now that the results wouldn't hold up even under tighter criteria. Third, looking at the Drummond study discussed above, which involved a group of diagnosed children and a second group which was not diagnosed, there was no real difference in the desistance rates. So there is no reason to assume that there would be a difference using the DSM V criteria.

    I would greatly appreciate a post from you directly addressing this latest trans activist argument.

    ReplyDelete
  12. I already see some serious problems within this article. It clearly states 12 studies, but only reports the findings of two. Only two references are given as well. which is hardly conclusive when the two studies referenced could be cherry-picked, and the ten others could proffer completely different conclusions. Also, in most countries, children aren't allowed to access hormones until the age of 16-18, so how does this affect anything? Children are given puberty blockers, not HRT. So there's nothing irreversible or damaging about being diagnosed as a child and later desisting.


    Laying this out:

    1 - Quoting two studies out of twelve is hardly a definitive assessment

    2 - Children aren't given access to cross-gender hormones until the ages of 16-18 (which I completely agree with), so regardless of any desistance rate it causes no problems if they decide that transition is wrong for them.

    3 - There is absolutely no tracking or study of how desistance rates might be affected by social and/or peer pressure, so there could very well be transitions that occur after the data is published. Many. MANY transgender people detransition from social pressures, family disapproval. and an inability to find jobs due to discrimination levels present in society and employment.


    Given these three points, I can't see how the information presented in this article should affect current protocols and procedures for the treatment of individuals displaying symptoms of GID in any way, whether adult or child.

    In conclusion, many more studies need to be conducted in a provably unbiased manner if they are to affect any proposed changes to existing treatment protocols. Those studies need to take into account: persistence and desistance rates, measurable social factors, employment rates, familial and religious discriminatory factors, and any geographical data on discrimination factors that may occur in the areas where the studies are conducted. Obviously, sample sizes and time factors must be addressed as well. Only then can any reliable and provable conclusions be reached.

    ReplyDelete
    Replies
    1. These are good points! Also, the amount of people studied in the studies that are listed are generally not considered reflective of anything. The sample size is too small (127 kids and 25 kids) to be valid.

      The author here attempts to debunk people's claims the author asserts that he knows what people are referring to (as stated). There are articles out there which cite their claims. Here's one that you can actually see what they're referencing:
      http://www.cbc.ca/news/opinion/transgender-kids-documentary-2-1.4450918

      Also, how do you respond to the 13 groups--including the UK Council for Psychotherapy, the Royal College of GPs, the British Psychoanalytic Council and the British Association of Counselling and Psychotherapy--who condemned the documentary?
      https://www.linkedin.com/pulse/trans-kids-bbc-documentary-condemned-13-mental-health-hannah/

      Delete
    2. 1. The size of a sample is not determined by consensus. It is a mathematical association between the size of the effect one is looking for and the variance within the samples. The procedure for calculating the necessary sample size is called a power analysis. It is indeed true that some of the studies are small, and if that's all we had, it wouldn't be much. The larger studies, however, were demonstrably adequate in size. And more importantly, because the smaller studies turned out to see exactly the same thing as the larger studies, we have direct evidence of the entire argument being completely moot.

      I have no idea what the second paragraph is trying to express.

      Actually, I do not have to respond to anyone. I merely cite the existing evidence. If any number of political/social groups want to contest a scientific conclusion (in this case, a unanimous one), it is up to those political groups to justify why they break with the science.

      Delete
    3. > I already see some serious problems within this article.

      Well, that would certainly save you the trouble of having to actually read it all.

      > It clearly states 12 studies, but only reports the findings of two.
      > Only two references are given as well. which is hardly conclusive
      > when the two studies referenced could be cherry-picked, and the
      > ten others could proffer completely different conclusions.

      Yeah. Easy to miss. It’s all the way in sentence number three until I say “I listed the results of every study” and link to the list of all 12.

      And cherry-picking: the selection of only a subset of studies that happen to support me. Not only have I not cherry-picked citation, but because every single study said the same thing: It is simply NOT POSSIBLE for one to cherry-pick. (!) All subsets of the studies say the same thing!

      But I can see how you might miss that. I didn't say that all the studies got the same result until sentence number four, and, as you say, you already saw some serious points by then.


      > Also, in most countries, children aren't allowed to access
      > hormones until the age of 16-18, so how does this affect
      > anything? Children are given puberty blockers, not HRT.
      > So there's nothing irreversible or damaging about being
      > diagnosed as a child and later desisting.

      > Children aren't given access to cross-gender hormones
      > until the ages of 16-18 (which I completely agree with),
      > so regardless of any desistance rate it causes no problems
      > if they decide that transition is wrong for them.

      No. The evidence suggests that by age 16-18, the desisters have already desisted. Prepubescent children, however, desist more often than not (but not always). The studies showing high desistance were from children generally under 12, not 16-18.


      > 1 - Quoting two studies out of twelve is hardly a definitive
      > assessment

      Correct. This blog post was a response to correct two claims made in the National Post article. I hesitate to call anything “definitive,” but I already wrote a full review of all 12 studies, and I linked it here. That’s about all I can do.


      > 3 - There is absolutely no tracking or study of how desistance
      > rates might be affected by social and/or peer pressure, so
      > there could very well be transitions that occur after the data
      > is published. Many. MANY transgender people detransition
      > from social pressures, family disapproval. and an inability
      > to find jobs due to discrimination levels present in society
      > and employment.

      Yes, there are lots of possibilities we can imagine. There’s just no evidence to suggest any of them. Plus, do you seriously want to question these people’s lived experiences of desistance to match your politics? I mean, don't you want to retain the moral authority by which to demand others to accept your lived experience of persistence despite their politics?


      > In conclusion, many more studies need to be conducted
      > in a provably unbiased manner if they are to affect any
      > proposed changes to existing treatment protocols. Those
      > studies need to take into account: persistence and
      > desistance rates, measurable social factors, employment
      > rates, familial and religious discriminatory factors,
      > and any geographical data on discrimination factors that
      > may occur in the areas where the studies are conducted.
      > Obviously, sample sizes and time factors must be
      > addressed as well. Only then can any reliable and
      > provable conclusions be reached.

      Do please go ahead. If such a study shows something different than the current studies, then we have learned something. But until then, every single study on the topic has found the identical result, and you want to reject every single study on the topic in favour of a study that exists only in your imagination.

      Delete
  13. As acceptance for trans lives increases, more and more children are seeing they have a future, and more support, if they continue to present as trans. Especially in a country like Australia where their rights are protected in adult life and they aren't scrutinised. I think a lot of studies from the past have not followed whether these desistors had a change of heart in adulthood and retransitioned, this is quite common. If so many desist then why are there so many today? Why such an investment in making access to treatment so difficult for genuine trans children? What you need to state is your position on whether you approve puberty blockers for the "wait and see" strategy, and whether you believe trans kids need to be discouraged.

    ReplyDelete
    Replies
    1. The point is that there is no definitive test that confirms who is "truely trans". If someone (a child) feels they are trans there can be more than one option. While waiting and seeing you can affirm the belief or affirm the sex. Affirming the sex does not mean demanding certain toys or clothes, etc.

      There is an awful lot to consider when making this determination that could include a life on medication and surgeries. Puberty blockers are not without risk nor are cross sex hormones or surgery. No child can begin to understand that. Half of the parents and half of the patients don't understand this. One person's best treatment is not necessarily the best treatment for all, that's why options should remain open.

      Delete