Desistance Articles

The four publications central to the notion that 80% of gender dysphoric youth will 'desist', and a sampling of the relevant critique.  

1. Excerpted from:

The End of the Desistance Myth

Published in: The Huffington Post.  January, 2016.  Author: Brynn Tannehill

"Over the past few years, an endless parade of “concerned” people (trolls) have trotted out the same statistic over and over again: 84 percent of transgender kids stop being transgender on their own. They have used this to justify everything from reparative therapy, to denying medical care to transgender teens, to suggesting that reparative therapy on adults will work."

"The problem is that the desistance narrative is built upon bad statistics, bad science, homophobia and transphobia."

"For starters, the most cited study (Steensma) which alleges a 84 percent desistance rate, did not actually differentiate between children with consistent, persistent and insistent gender dysphoria, kids who socially transitioned, and kids who just acted more masculine or feminine than their birth sex and culture allowed for. In other words, it treated gender non-conformance the same as gender dysphoria. Worse, the study could not locate 45.3 percent of the children for follow up, and made the assumption that all of them were desisters. "

"In other words, the children who actually met the clinical guidelines for gender dysphoria as children generally ended up as transgender adults."

"For the past decade, the biggest promoter of the desistance myth was Dr. Kenneth Zucker at the Center for Addiction and Mental Health (CAMH) in Toronto... He denied practicing reparative therapy, despite a 2003 report in the Journal of the American Academy of Child and Adolescent Psychiatry which called his techniques “something disturbingly close to reparative therapy for homosexuals.”"

"He felt that this was for the best, because, “a homosexual lifestyle in a basically unaccepting culture simply creates unnecessary social difficulties.” In other words, force children to change, rather than working to change a homophobic culture."

"But, the most outrageous piece of information coming out of CAMH was Dr. Zucker’s claims that gender dysphoria desisted in 80 percent of cases. However, when investigators reviewed the files of children admitted to CAHM, 72 percent of them never met the clinical criteria for juvenile gender dysphoria in the first place."

"In short, 90 percent of the kids Dr. Zucker claimed to “cure” were never transgender in the first place."

https://www.huffingtonpost.com/brynn-tannehill/the-end-of-the-desistance_b_8903690.html

2. Excerpted From:

Teach your parents and providers well: Call for refocus on the health of trans and gender-diverse children

Published in: Canadian Family Physician.  May, 2018.  Authors: Julia Temple Newhook, Ph.D., Kelley Winters, Ph.D., Jake Pyne, MSW, Ally Jamieson, MSW, Cindy Holmes, Ph.D., Stephen Feder, MD, CM, CCFP, FRCPC, Sarah Pickett, MA PsyD RPsych, Mari-Lynne Sinnott, MD

"...These studies have been interpreted to suggest that about 80% of children who we might think of as transgender will not identify as transgender as adults. It has become common to see these studies cited as a reason to discourage children’s assertion of a non–birth-assigned gender, framing transgender children as “confused.” Yet recent reviews suggest the utility of the concept of desistance is limited, and have raised the following 7 critiques."

1. Many children never asserted a transgender identity.

2. Consistency often leads to continuance.

3. Assumptions were made about loss to follow-up.

4. Some assert a transgender identity later in life.

5. Some assert a nonbinary identity.

6. There is no evidence of being “trapped.”

7. Studies do not examine harm of suppression...

8. Validation and support in the present

"Our practice recommendations, based on literature review and our own practice experience, are as follows:

• Listen to and respect the child’s own description of who they are. This includes inquiring about and respecting the child’s chosen name and pronouns. It is not our role as providers to tell children who they are or who they will be. Instead, our role is to help children feel valued and supported.
• Direct most of the intervention and support to parents rather than the child, in the case of prepubescent children. Children who are happy and well often do best without having their diversity addressed by a clinical provider. Invest substantial time in meeting with parents alone. Even supportive parents generally need space to share concerns and worries and ask questions.
• Educate parents that gender diversity is a healthy and normal aspect of life, and that identity is a spectrum including nonbinary, male, and female identities. Remind parents that children’s toy and dress preferences do not directly communicate who they know themselves to be—for example, a transgender boy’s enjoyment of dresses does not invalidate his identity as a boy.
• Consult with and refer to other providers and educators as needed.

"Increased access to services within a more inclusive society

• Connect parents to resources such as websites, school inclusion guidelines, and referrals to other providers as needed. Peer support might be of particular importance for parents.
• Map out with parents the potential journey ahead. Remind parents of the importance of avoiding assumptions about how children will experience their own bodies. At the onset of puberty, some youth will not experience the need to transition medically, while for others it might be vital to their well-being. Review the potential role of hormone therapy, including puberty blockers.
• Develop appropriate intake and consent forms that respect chosen names and pronouns, and ensure that front-line staff are well trained and respectful.
• Consult with the child’s school regarding the child’s needs, and provide education and advocate for change in schools as needed."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951646/

3. Excerpted from:

Media Misinformation About Trans Youth: The Persistent 80% Desistance Myth

Published in: GID Reform.  July 26, 2018.  Author: Kelley Winters, Ph.D.

"Gender nonconforming children with no actual evidence of gender dysphoria were very easily misdiagnosed with “Gender Identity Disorder of Children” because of flawed diagnostic criteria the DSM-IV. Those criteria, and, astonishingly, subthreshold fulfillment of them, were used for sample selection in questionable studies that to this day are cited to support the 80% “desistance” myth (Winters 2008, 2014)."

https://gidreform.wordpress.com/2016/07/26/media-misinformation-about-trans-youth-the-persistent-80-desistance-myth/

4. Excerpted from:

A Critical Commentary on Follow-Up Studies and "Desistance” Theories About Transgender and Gender Non-Conforming Children

Published in: International Journal of Transgenderism, April 26, 2018.  Authors: Julie Temple-Newhook, Jake Pyne, Kelley Winters, Stephen Feder, Cindy Holmes, Jemma Tosh, Mari-Lynne Sinnott, Ally Jamieson & Sarah Pickett

"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... 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."

"We have identified the following methodological concerns in these four studies:

1. the potential misclassification of child research participants

2. the lack of acknowledgement of social context for research participants

3. the age of participants at follow-up, and

4. the potential misclassification of adolescent and young adult participants lost to follow- up.

"The first two methodological concerns address the broad inclusion criteria for those studied in childhood. Rather than a representative group of transgender children, which is assumed in many interpretations, this literature focused on small groups of gender non-conforming children in two clinics... these studies included children who, by current DSM-5 standards, would not likely have been categorized as transgender (i.e., they would not meet the criteria for gender dysphoria) and therefore it is not surprising that they would not identify as transgender at follow-up."

"The second concern brings attention to the scope of the four studies discussed. Inferences from clinical research are always bound to specific locations and timeframes. Generalizing from research on gender identity is particularly problematic because notions of gender are highly dependent on social and historic context."

"The third methodological concern centres on the age at which follow-up was conducted... [O]nly a minority of the young people who consented to be re-studied were diagnosed in adolescence with Gender Identity Disorder in Adolescents or Adults (GIDAA) and/ or chose to undergo certain trans-affirming surgeries in early adulthood. Yet in these four studies, the mean age at follow-up ranged from 16.04 (Steensma, et al., 2013) to 23.2 years (Drummond, et al., 2008) and included adolescents as young as 14 years (Steensma et al., 2011). It is important to acknowledge that this represents a very early follow-up point in an individual’s life, and that a trans person might assert or reassert their identity at any point in their life. An assumption has been made that young people not diagnosed with GID (or Gender Dysphoria in the current DSM-5) by late adolescence and/or not pursuing medical transition by a relatively early age, can then by default be “correctly” categorized as cisgender for their lifetime. However, this conclusion is contradicted when an unknown number of those counted as “desisters” may transition later, after the point of follow-up."

"A fourth methodological concern focuses on the misclassification of participants who did not participate in follow-up. [In 3 of the 4 desistance studies] participants who did not respond or did not participate at adolescent follow-up were counted as desisters.  In other words, desistance was assessed based on whether or not participants re-engaged with this specific clinic by a specific time. This methodological choice neglects a number of important considerations: (1) the fact that not all transgender people wish to medically transition, yet still identify as trans; (2) the socio-economic or cultural factors that may influence whether an adolescent seeks psychological or medical treatment; (3) the possibility of a negative perception of the initial clinic experience, which might discourage a youth’s return; (4) the possibility of a youth moving out of the country, being institutionalized in a mental health facility or even the possibility of death (including suicide), none of which negate a trans identity; and, (5) the possibility that some young people might repress their gender identity for a period of time, due to societal transphobia, family rejection, safety, employment and housing security, or pressure from therapies designed to discourage trans identity (Kennedy & Hellen, 2010)."

"We have also identified ethical concerns in these four studies:

1. intensive treatment and testing of child participants,

2. questionable goals of treatment, and

3. lack of consideration of children’s autonomy

"The first theoretical concern pertains to the unnecessary conceptualizing of shifts in gender identity as either “persistence” or “desistance.”  ...In this framework, cisgender identity tends to be seen as the healthy opposite of a problematic transgender identity. Assertion of a cisgender identity at any point in the life cycle is often assumed to be valid and invalidates any previous assertion of transgender identity; yet a transgender identity is only viewed as valid if it is static and unwavering throughout the life course and if it emerges in a particular time period (the period of study)...  A child who has identified as transgender may indeed at some point in their life assert their birth-assigned gender, but this is not necessarily the end of their gender journey."

"A second theoretical concern is that the terminology of “desistance” depends on a binary understanding of gender. Each of the four studies used binary language to refer to children as “boys and girls,” prioritizing the sex they were assigned at birth, as opposed to their own identity... We question here the characterization of a self-described “50% male and 50% female” research participant as “ambiguous,” instead of a term supplied by the participant, and hope that if this study were conducted today, there would be greater recognition of non-binary gender identities."

"A third theoretical concern is the embedded assumption in these studies that “stability” of gender identity is a positive health outcome that should be prioritized for all children...While many individuals experience their gender identity as stable throughout their lifetimes, others find that a gender that “fits” at age four may be different from what fits at age seven, age 18, or age 65. None of these identities are “wrong”; instead they may have been perfectly and precisely the right fit for that person at that moment."

"We have also identified ethical concerns in these four studies, including:

1. intensive treatment and testing of child participants,

2. questionable goals of treatment, and

3. lack of consideration of children’s autonomy

"From an ethical perspective, it is important to consider that research itself is an intervention...Critiques of the practice of diagnosing gender non-conforming children (with the GIDC diagnosis from DSM-III, DSM III-R, DSM IV) began to be published in the late 1990s and argued that healthy children might have their self- esteem damaged and their trust in therapy eroded by being brought into stigmatizing diagnostic and treatment settings (Isay, 1997; Langer & Martin, 2004; Menvielle, 1998; Pickstone-Taylor, 2003; Vanderburgh, 2009)."

"A second ethical concern is that many of the children in the Toronto studies (Drummond et al., 2008; Zucker & Bradley, 1995) were enrolled in a treatment program that sought to “lower the odds” that they would grow up to be transgender (Drescher & Pula, 2014; Zucker, Wood, Singh & Bradley, 2012; Paterson, 2015)... Drescher and Pula (2014) make an ethical inquiry about this approach: “Since no clinician can accurately predict the future gender identity of any particular child, shouldn’t we assume that efforts to discourage cross-gender play and identifications may be experienced as hurtful and possibly even traumatic, since, for some children, gender dysphoria will persist into adolescence and adulthood?” (p. S19)."

"A lack of consideration of children’s autonomy in desistance literature is a third ethical concern... This consideration of children’s own wishes should also extend to their right to decline participation in research. In the four studies, there is an absence of information about whether research participation was optional and if steps were taken to ensure that children could decline research consent while continuing to receive needed services."

"We also have concerns with the authors’ interpretation in these four studies, including:

1. the assumption that unknown future adult needs should supersede known childhood needs, and

2. the underestimation of harm when attempting to delay or defer transition

"Desistance studies are often drawn on to suggest that delaying a young person’s social transition is justified because it may prevent them from having to transition back in the future. There is an assumption that a second transition would be distressing... Yet again, this statement itself acknowledges that future distress is merely “conceivable” and again, not certain. As Ehrensaft, Giammattei, Storck, Tishelman and Keo-Meier (2018) note, the evidence that a second transition would be traumatic is very thin... What is problematic is the assumption that a potential future shift in a child’s gender identity is a justification for suppressing or redirecting their assertion of identity in childhood."

"The underestimation of harm in suppressing or redirecting children’s gender expression, is the most serious concern in interpretations of desistance literature... From a developmental perspective, a child who is repeatedly discouraged when she earnestly insists on being called “she,” is learning, on a fundamental level, that (1) she cannot trust her own knowledge of herself and, (2) the adults she depends on may not value her for who she knows herself to be."

"Lastly, while many clinicians would not propose attempting to alter gender expression, many still interpret desistance research as support for delaying transition, lest a trans identity becomes more likely...Yet we would ask why an increase in the number of transgender people (“persistence”) would be interpreted in a negative light, and how this sentiment could be consistent with the WPATH position that transgender identity is a matter of diversity not pathology (Coleman et al., 2012)."

https://transpolicyreform.files.wordpress.com/2018/06/201803temple-newhookfinala.pdf