Developmental Pathway Choices of Young People Presenting to a Gender Service with Gender Distress: A Prospective Follow-Up Study

Abstract

This prospective case-cohort study examines the developmental pathway choices of 79 young people (13.25–23.75 years old; 33 biological males and 46 biological females) referred to a tertiary care hospital’s Department of Psychological Medicine (December 2013–November 2018, at ages 8.42–15.92 years) for diagnostic assessment for gender dysphoria (GD) and for potential gender-affirming medical interventions. All of the young people had attended a screening medical assessment (including puberty staging) by paediatricians. The Psychological Medicine assessment (individual and family) yielded a formal DSM-5 diagnosis of GD in 66 of the young people. Of the 13 not meeting DSM-5 criteria, two obtained a GD diagnosis at a later time. This yielded 68 young people (68/79; 86.1%) with formal diagnoses of GD who were potentially eligible for gender-affirming medical interventions and 11 young people (11/79; 13.9%) who were not. Follow-up took place between November 2022 and January 2023. Within the GD subgroup (n = 68) (with two lost to follow-up), six had desisted (desistance rate of 9.1%; 6/66), and 60 had persisted on a GD (transgender) pathway (persistence rate of 90.9%; 60/66). Within the cohort as a whole (with two lost to follow-up), the overall persistence rate was 77.9% (60/77), and overall desistance rate for gender-related distress was 22.1% (17/77). Ongoing mental health concerns were reported by 44/50 (88.0%), and educational/occupational outcomes varied widely. The study highlights the importance of careful screening, comprehensive biopsychosocial (including family) assessment, and holistic therapeutic support. Even in highly screened samples of children and adolescents seeking a GD diagnosis and gender-affirming medical care, outcome pathways follow a diverse range of possibilities.

The U.S. Transgender Survey of 2015 Supports Rapid-Onset Gender Dysphoria: Revisiting the “Age of Realization and Disclosure of Gender Identity Among Transgender Adults”

“…The clinical presentation associated with ROGD has become internationally recognized (Bonfatto & Crasnow, 2018;Elkadi et al, 2023;Hutchinson et al, 2020;Zucker, 2019), with even the World Professional Association for Transgender Health now recognizing "the increased number of adolescents seeking care who have not seemingly experienced, expressed (or experienced and expressed) gender diversity during their childhood years" (Coleman et al, 2022). Turban et al claim to find evidence against ROGD in USTS-15, but a more accurate analysis of that sample actually supports the ROGD hypotheses.…”

Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future

“…While halting puberty for a short time (i.e., several months) might be expected to have a negligible impact on a child’s development (Biggs, 2023 ), many children remain on puberty blockers for years (Brik et al, 2020 ; Carmichael et al, 2021 ; de Vries et al, 2011 ; Elkadi et al, 2023 ), and the reversibility of puberty blockers in this setting has never been proven. Moreover, in practice, puberty suppression is not a distinct, time-limited intervention, but instead the first step in a series of increasingly invasive medical interventions.…”

Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada

“…Current data estimating the prevalence of detransition associated with a change in gender identity are lacking due to methodological limitations. However, recent studies with clinical samples have found that between 8.1%-9.8% of children, adolescents, and young adults may detransition to their birth-assigned gender or to nonbinary after initially being assessed and referred for gender care medical interventions and/or medically transitioning [16][17][18]. Those who reverse a gender transitionsome of whom self-label as detransitioners or detrans-have been presented as reason to safeguard adolescents from hasty medical decisions [11,18,19].…”