More Than Two Developmental Pathways in Children With Gender Dysphoria? – Review

There is a short but important piece about the persistence of gender dysphoria in children.

In this Dutch clinic, they found that:

70% of the children they diagnosed with gender dysphoria did not return to the clinic and transition; they “desisted” in their gender dysphoria.

95% of the children who desisted as teens did not return to the clinic as adults.

27% of the children they diagnosed with gender dysphoria transitioned as teenagers, 3% did so as adults.

Of the children who returned to the clinic before adulthood, 75% came back before they were 14 years old and 25% came back when they were between 14 and 18.

Boys were more likely to desist from their gender dysphoria than girls; 73% versus 61,5%. Conversely, more female children with gender dysphoria went on to transition; 38.5% versus 27%.

This is in line with earlier studies that have found that most children diagnosed with gender dysphoria change their minds when they are older, usually at puberty.

It also provides a follow-up to the question of whether or not the children who changed their minds still had gender dysphoria. They had access to a free medical transition, but did not return for it. It is possible that some of them may still return, but so far 95% have not.

This data also demonstrates what the authors call a third “developmental pathway” for children with gender dysphoria. This group seems to go through a “period of questioning sexual identity” as adolescents before deciding to transition as adults.

The clinic looked at the records of 150 adults who were diagnosed with gender dysphoria as children. The adults were now between 19 and 38 years old (average age = 25.9, SD 4.03). The sample was the first 150 consecutive patients the clinic had diagnosed who were now adults.

The authors discuss past studies of persistence of gender dysphoria in children. In the past, the persistence rate has been only 16% across studies, however, the diagnoses of gender dysphoria may have included some children who were simply gender non-conforming in their behavior. They suggest that in the future persistence rates may be higher as clinicians use a stricter definition of gender dysphoria.

In addition, they suggest that persistence rates might be higher if we include patients who choose to transition as adults. In this study, the persistence rate would only have been 27% if they did not include the 3% who transitioned as adults.

I would add that this data on persistence includes children who had access to puberty blockers and early transition. We need studies to determine if this affects rates of persistence and desistance.

We also need more studies of the children who did not return to the clinic and transition. Why didn’t they return? Did they completely lose their gender dysphoria? Are they happy? If they lost their gender dsyphoria, how did that happen? If they didn’t lose it, how are they dealing with it?

We have one study of children who desisted in their gender dysphoria, but we need more. (Desisting and persisting gender dysphoria after childhood.)

Finally, the authors provide an interesting discussion of the patients who did not transition as teenagers but returned to transition as adults:

“The average age of the 5 individuals who re-entered the clinic in adulthood was 24 years (range 21–37). Despite their knowledge of the availability of treatment for adolescents and the fact that treatment is covered by insurance, they did not apply for treatment during adolescence. Four (3 natal males and 1 natal female) tried to live as gay or lesbian persons for a long time, and 1 natal male had autism spectrum disorder. He reported that he needed to solve other problems in his life before he could address his GD. The others reported not having any problems with being homosexual. Yet, after having intimate and sexual experiences with same (natal) sex partners, they came to realize that living as a homosexual person did not solve their feelings of GD, and they felt increasingly drawn toward transitioning. All also mentioned that they were somewhat hesitant to start invasive treatments, such as hormone therapy and surgeries.”


“It would be worthwhile to know whether the GD of these “persisters-after-interruption” differs qualitatively or quantitatively from the GD of straight persisters and whether the groups differ in other respects. For instance, has the GD in the persisters-after-interruption group actually disappeared for some years or, as the reports of our young adults suggest, did they make a more or less conscious choice not to live according to their experienced gender? Knowing more about this developmental route would be clinically useful when counseling young people with GD.”

This data was presented in a letter to the editor.


More Than Two Developmental Pathways in Children With Gender Dysphoria? by Steensma TD, Cohen-Kettenis PT in J Am Acad Child Adolesc Psychiatry. 2015 Feb;54(2):147-8.

1 thought on “More Than Two Developmental Pathways in Children With Gender Dysphoria? – Review

  1. Pingback: Eleven-year follow up of boy with Asperger’s syndrome and comorbid gender identity disorder of childhood – Review of a case study | TRANS RESEARCH

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