A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

Abstract

Background: It has been widely suggested that over 80% of transgender children will come to identify as cisgender (i.e. desist) as they mature, with the assumption that for this 80%, the trans identity was a temporary "phase." This statistic is used as the scientific rationale for discouraging social transition for pre-pubertal children. This article is a critical commentary on the limitations of this research and a caution against using these studies to develop care recommendations for gender non-conforming children. Methods: A critical review methodology is employed to systematically interpret four frequentlycited studies that sought to document identity outcomes for gender non-conforming children (often referred to as "desistance" research). Results: Methodological, theoretical, ethical, and interpretive concerns regarding four "desistance" studies are presented. The authors clarify the historical and clinical contexts within which these studies were conducted to deconstruct assumptions in interpretations of the results. The discussion makes distinctions between the specific evidence provided by these studies versus the assumptions that have shaped recommendations for care. The affirmative model is presented as a way to move away from the question of, "How should children's gender identities develop over time?" toward a more useful question: "How should children best be supported as their gender identity develops?" Conclusion: The tethering of childhood gender diversity to the framework of "desistance" or "persistence" has stifled advancements in our understanding of children's gender in all its complexity. These follow-up studies fall short in helping us understand what children need. As work begins on the 8 th version of the Standards of Care by the World Professional Association for Transgender Health, we call for a more inclusive conceptual framework that takes children's voices seriously. Listening to children's experiences will enable a more comprehensive understanding of the needs of gender non-conforming children and provide guidance to scientific and lay communities.

Medically assisted gender affirmation: when children and parents disagree

“…Recently, the AAP has reaffirmed this position specifically in the transgender population 11. Children ‘reverting’ to their gender assigned at birth is a controversial concern that some parents may have in pre-pubertal children that has recently been denounced by the AAP and a systemic review 11 28…”

Fiction, Empathy, and Gender Diversity

“…Instead, gender is understood to have multiple manifestations that may not be in line with one's sex assigned at birth, and that may also be fluid and change over time (Ehrensaft, 2016;Pyne, 2014Pyne, , 2016Temple Newhook et al, 2018;Travers, 2018). The gender affirmation model is grounded in the idea of gender diversity, denounces pathologizing gender nonconformity, and works to follow the lead of young people as they reveal their genuine gendered selves (Ehrensaft, 2016;Pyne, 2014Pyne, , 2016Temple Newhook et al, 2018;Travers, 2018). By utilizing the gender affirmative model, the possibilities for expression, affirmation, acceptance, and authenticity open onto a spectrum of gender identities and explorations.…”

A critical commentary on “A critical commentary on follow-up studies and “desistence” theories about transgender and gender non-conforming children”

“…Important to mention here is that in the calculation of the overall persistence rate in the literature the two studies by Steensma et al ( , 2013 were never used. Including the two Steensma et al studies in the discussion about persistence rates by the authors (particularly in Table 1 in Temple Newhook et al 2018) is in our view an odd choice and a methodologically incorrect one. The reason why both studies were not included is obvious: both studies did not aim to report on the prevalence of desistence or persistence of GD.…”