A Follow-Up Study of Boys With Gender Identity Disorder

Abstract

This study reports follow-up data on the largest sample to date of boys clinic-referred for gender dysphoria (n = 139) with regard to gender identity and sexual orientation. In childhood, the boys were assessed at a mean age of 7.49 years (range, 3.33–12.99) at a mean year of 1989 and followed-up at a mean age of 20.58 years (range, 13.07–39.15) at a mean year of 2002. In childhood, 88 (63.3%) of the boys met the DSM-III, III-R, or IV criteria for gender identity disorder; the remaining 51 (36.7%) boys were subthreshold for the criteria. At follow-up, gender identity/dysphoria was assessed via multiple methods and the participants were classified as either persisters or desisters. Sexual orientation was ascertained for both fantasy and behavior and then dichotomized as either biphilic/androphilic or gynephilic. Of the 139 participants, 17 (12.2%) were classified as persisters and the remaining 122 (87.8%) were classified as desisters. Data on sexual orientation in fantasy were available for 129 participants: 82 (63.6%) were classified as biphilic/androphilic, 43 (33.3%) were classified as gynephilic, and 4 (3.1%) reported no sexual fantasies. For sexual orientation in behavior, data were available for 108 participants: 51 (47.2%) were classified as biphilic/androphilic, 29 (26.9%) were classified as gynephilic, and 28 (25.9%) reported no sexual behaviors. Multinomial logistic regression examined predictors of outcome for the biphilic/androphilic persisters and the gynephilic desisters, with the biphilic/androphilic desisters as the reference group. Compared to the reference group, the biphilic/androphilic persisters tended to be older at the time of the assessment in childhood, were from a lower social class background, and, on a dimensional composite of sex-typed behavior in childhood were more gender-variant. The biphilic/androphilic desisters were more gender-variant compared to the gynephilic desisters. Boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation. The implications of the data for current models of care for the treatment of gender dysphoria in children are discussed.

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners

“…This research adds to the existing evidence that gender dysphoria can be temporary (Ristori & Steensma, 2016;Singh et al, 2021;Zucker, 2018). It has been established that the most likely outcome for prepubertal youth with gender dysphoria is to develop into lesbian, gay, bisexual (LGB) (non-transgender) adults (Ristori & Steensma, 2016;Singh et al, 2021;Wallien & Cohen-Kettenis, 2008;Zucker, 2018). And, temporary gender dysphoria may be a common part of LGB identity development (Korte et al, 2008;Patterson, 2018).…”

“…For these individuals, exploring their distress and discomfort around sexual orientation issues may have been more helpful to them than medical and surgical transition or at least an important part of exploration before making the decision to transition. This research adds to the existing evidence that gender dysphoria can be temporary (Ristori & Steensma, 2016;Singh et al, 2021;Zucker, 2018). It has been established that the most likely outcome for prepubertal youth with gender dysphoria is to develop into lesbian, gay, bisexual (LGB) (non-transgender) adults (Ristori & Steensma, 2016;Singh et al, 2021;Wallien & Cohen-Kettenis, 2008;Zucker, 2018).…”

Predicting Early-Childhood Gender Transitions

“…This pattern was observed even though there are no agreed-on standards or measures to determine whether to support a given child through a social transition. Past work has linked extremity of gender nonconformity in the absence of early social transitions to transgender identification later in life (e.g., Singh, 2012; Steensma et al, 2013; Wallien & Cohen-Kettenis, 2008), so these findings could suggest that the children transitioning at early ages may also be more likely to identify as transgender later in life. Critically, these results were robust to a large number of analytic decisions (e.g., inclusion of covariates or using different prior distributions for our Bayesian analyses) and data-processing decisions (e.g., how we combined the five gender-development measures or handled missing data).…”

“…Past longitudinal work has found that gender-nonconforming children who identify as transgender in adolescence and adulthood tended to show more extreme childhood gender nonconformity than gender-nonconforming children who did not later identify as transgender (Singh, 2012; Steensma et al, 2013; Wallien & Cohen-Kettenis, 2008). Most or all participants in these studies had not completed a full social transition as prepubescent children (i.e., had not changed pronouns), as social transitions are a fairly recent practice.…”

Response to Karen Herdzik and David Solem

“…Second, the evidence supporting their effectiveness in the treatment of GD is extremely poor (NICE 2020). Third, most young people spontaneously desist from their trans identification if left untreated (Cantor 2017;Singh, Bradley & Zucker 2021), while almost 100% given puberty blockers proceed to further medical treatment (Judicial Review 2020: Bell v. The Tavistock & Portman NHS Foundation Trust). Fourth, as outlined in the recent judicial review (ibid.…”