This is a fascinating study of a group of children with gender dysphoria. The authors interviewed them as teenagers when some of them had lost their gender dysphoria and some of them had not.
Most children diagnosed with gender dysphoria do not go on to transition; their gender dysphoria goes away. Gender dysphoria faded at puberty for 84% of the children in previous follow-up studies.*
In this study, the authors identified 53 Dutch speaking teenagers that their clinic had diagnosed with gender identity disorder before age 12.** Among these 53 teenagers, 55% had reapplied to the clinic for transition while 45% had not. The authors do not address the question of why their patients were more likely to still have gender dysphoria than in past studies.***
The authors interviewed only 25 of the 53 teenagers; 14 teenagers who applied for sex reassignment (7 male and 7 female) and 11 who did not (6 male and 5 female). They say that:
All adolescents were approached, orally or in writing, to participate in the study. Based on the principle of saturation in information (Glaser & Strauss, 1967), 25 adolescents were interviewed.
This limits the conclusions that can be drawn from the data, however, this is a qualitative study. It uses interviews to explore the development of gender dysphoria in these teenagers. This allows the authors to find directions for future research.****
Based on their interviews with the teenagers the authors found:
1. There were no differences in childhood behavior between the group that lost their gender dysphoria and the group that did not.
2. Both groups identified as the other gender as children, but when they were interviewed as teenagers, they explained it differently.
3. Both groups were uncomfortable with their bodies as children, but they explained it differently as teenagers.
4. The teenagers who requested transition were all attracted to people of their natal sex while the teenagers who no longer had gender dysphoria were mostly attracted to the opposite sex.
5. The years 10-13 were critical in the children’s development; this was when they either lost their gender dysphoria or became more dysphoric.
6. Important factors related to the development of adolescent feelings about gender were: changes in the social environment, the physical development of their bodies at puberty, and falling in love and discovering their sexual orientation.
7. For some of the girls whose gender dysphoria had faded, it was hard to transition back because they had worn boys’ clothing and been perceived as boys.
8. One of the teenagers they interviewed felt half female, half male. He did not want to transition.
The authors of the study conclude:
“Based on the significance most adolescents attribute to the period between 10 and 13, we suggest that clinicians should concentrate clearly on what happens in this phase of development.
It is recommended to specifically address the adolescents’ feelings regarding the factors that came up as relevant in our interviews (i.e. the effects of the changing social environment, the response to anticipated or actual puberty, and the emerging romantic/sexual feelings and sexual partner choice), before any medical steps are taken (e.g. to suppress further pubertal development).
As for the clinical management of children before the age of 10, we suggest a cautious attitude towards the moment of transitioning. Given our finding that some girls, who were almost (but not even entirely) living as boys in their childhood years, experienced great trouble when they wanted to return to the female gender role, we believe that parents and caregivers should fully realize the unpredicatability of their child’s pychosexual outcome.
They may help their child to handle their gender variance in a supportive way, but without taking social steps long before puberty, which are hard to reverse. This attitude may guide them through uncertain years without the risk of creating the difficulties that would occur if a transitioned child wants to return to his/her original gender role.”
(Paragraphs and bold added by George Davis.)
Short version: Children should probably not transition socially before age 10. Parents and teachers should understand that the children may lose their gender dysphoria.
Therapists should work carefully with children who have gender dysphoria in the years between 10 and 13. Before giving them puberty blockers therapists should address the teenagers’ feelings about changing social relationships, puberty, and sexual development.
End of Part I of the Review of this study.
Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study by Steensma TD, Biemond R, de Boer F, Cohen-Kettenis PT in Clin Child Psychol Psychiatry. 2011 Oct;16(4):499-516
*The studies the authors cite followed a total of 246 children; only 39 of them had gender dysphoria after puberty, thus the overall persistence rate for the dysphoria was 16%. The persistence rate varied among the different studies from 2% to 27% (i.e. 73%-98% of the children stopped having gender dysphoria).
**The teenagers in the study were chosen from a total of 198 children who applied to their clinic between 2000-2007. The rest of the children did not meet the criteria for the study, although the authors don’t say if this was due to not being a teenager at the time of the study, not being diagnosed with GID, or not speaking Dutch.
***A few possibilities would be: a difference in the therapy given to the children (some therapies might be more effective than others), cultural differences in the countries where the studies were done (some cultures might make it harder to be gender non-conforming while others might make it easier to transition), a difference in the diagnostic methods (perhaps this clinic did a better job of diagnosing gender dysphoria), cultural differences in different eras, environmental differences in different eras (perhaps hormones are affecting children more now), or something about the way this study chose the 53 teenagers (this seems unlikely).
****A more serious question is that the authors do not say if they heard back from all of the teenagers they contacted. They cannot be sure that all of the teenagers who did not request further treatment were no longer dysphoric if they did not speak to them. This does not effect the results of their interviews, but it is an important issue.