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Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study
Abstract and Figures
The aim of this qualitative study was to obtain a better understanding of the developmental trajectories of persistence and desistence of childhood gender dysphoria and the psychosexual outcome of gender dysphoric children. Twenty five adolescents (M age 15.88, range 14-18), diagnosed with a Gender Identity Disorder (DSM-IV or DSM-IV-TR) in childhood, participated in this study. Data were collected by means of biographical interviews. Adolescents with persisting gender dysphoria (persisters) and those in whom the gender dysphoria remitted (desisters) indicated that they considered the period between 10 and 13 years of age to be crucial. They reported that in this period they became increasingly aware of the persistence or desistence of their childhood gender dysphoria. Both persisters and desisters stated that the changes in their social environment, the anticipated and actual feminization or masculinization of their bodies, and the first experiences of falling in love and sexual attraction had influenced their gender related interests and behaviour, feelings of gender discomfort and gender identification. Although, both persisters and desisters reported a desire to be the other gender during childhood years, the underlying motives of their desire seemed to be different.
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... With the word desistance now introduced, the focus of the more recent literature in the late 2000s is interested in rates of desistance and determining childhood factors before puberty, which can be used to predict desistance after puberty commences, [30][31][32][33] often seen as a way to help clinicians decide on whether GAC should be provided. From all of these collections of studies emerged the commonly used statistic stating that *80% of TGE youth will desist after puberty, a statistic that has been critiqued by other works based on poor methodologic quality, the evolving understanding of gender and probable misclassification of nonbinary individuals, and the practice of attempting to dissuade youth from identifying as transgender in some of these studies. ...
... One qualitative study was found, by Steensma et al., exploring factors associated with desisting and persisting. 32 Twenty-five total participants were included, 14 of whom were considered persisters and 11 of whom were considered desisters. Factors associated with persistence included distress at ''anticipated feminization or masculinization of the body during puberty,'' 32 There is an arrow pointing to the right of this box toward a box that details the number of records removed based on full text screening with a breakdown of why these studies were excluded. ...
... 32 Twenty-five total participants were included, 14 of whom were considered persisters and 11 of whom were considered desisters. Factors associated with persistence included distress at ''anticipated feminization or masculinization of the body during puberty,'' 32 There is an arrow pointing to the right of this box toward a box that details the number of records removed based on full text screening with a breakdown of why these studies were excluded. The fifth box from the upper left corner has the total number of studies included in this review. ...
... Dans le souci de respecter les personnes concernées que nous avons consultées sur ce point via les associations comme de ne pas induire des contre-sens par des associations lexicales malheureuses nous avons décidé de ne pas traduire pour ne pas employer ces signifiants dans la traduction de cet article. D'après différentes études, le pourcentage d'enfants qui garderont une identification transgenre à l'adolescence se situe entre 10 et 39% [24,25]. En revanche, les études montrent qu'une identité trans' présente à l'adolescence est le plus souvent stable [19,24,26,27]. ...
... D'après différentes études, le pourcentage d'enfants qui garderont une identification transgenre à l'adolescence se situe entre 10 et 39% [24,25]. En revanche, les études montrent qu'une identité trans' présente à l'adolescence est le plus souvent stable [19,24,26,27]. Pour ces jeunes autour de la puberté, les changements corporels peuvent s'avérer insupportables d'où l'intérêt d'un accompagnement médical pouvant agir sur ces changements inhérents à la puberté physiologique. ...
Aujourd'hui, les progrès dans les biotechnologies et dans le champ de la médecine défient les lois de la biologie pour permettre à des hommes et des femmes transgenres d'advenir en tant que sujet et d'accéder à la parentalité. Ces avancées soulèvent dans de nombreux pays de vifs débats sociétaux, mais aussi de vraies questions éthiques l'enjeu majeur in fine étant pour la plupart des auteurs le bien-être des enfants à naître. Nous avons ainsi cherché à comparer le développement cognitif, la santé mentale, l'identité de genre, la qualité de vie et la dynamique familiale à l'aide d'instruments standardisés et de protocoles expérimentaux chez 32 enfants conçu·e·s par IAD en France dont le père est un homme transgenre et la mère une femme cisgenre (identifiée au genre féminin qui lui a été assigné à la naissance), la transition féminin vers masculin du père ayant eu lieu avant la conception. Nous avons constitué deux groupes témoins appariés pour l'âge, le sexe et la situation familiale : le premier composé d’enfants né·e·s de parents cisgenres hétérosexuels ayant eu recours à l’IAD pour concevoir, le second composé d’enfants conçu·e·s par rapport sexuel de parents hétérosexuels cisgenres.Nous n'avons trouvé aucune différence significative entre les groupes en ce qui concerne le développement cognitif, la santé mentale et l'identité de genre, ce qui signifie que ni la paternité transgenre ni l'utilisation des IAD n'ont eu d'impact sur ces caractéristiques. Les résultats de l'analyse descriptive ont montré un développement psycho-affectif positif. De plus, lorsque nous avons demandé à des groupe d’évaluateur·trice·s de différencier les dessins de famille du groupe d'enfants de pères trans’ de celleux qui étaient conçu·e·s par rapport sexuel de parents cisgenres, aucun n'a pu différencier ces groupes au-dessus des niveaux du hasard, ce qui signifie que ce que les enfants ont exprimé à travers le dessin de famille n'indiquait pas d’indices liés à la paternité transgenre. Cependant, lorsque nous avons étudié les émotions exprimées par les mères et les pères à partir d’un extrait de discours de 5 minutes (Five Minute Speech Sample), nous avons constaté que les émotions exprimées par les pères transgenres étaient plus intenses que celles des pères cisgenres qui ont conçu par rapport sexuel ou par IAD.Nous concluons que ces premières données empiriques sur le développement de l'enfant dans le contexte de la trans-parentalité sont rassurantes. Nous pensons que cette recherche améliorera également les soins aux couples transgenres et ceux de leurs enfants dans une société où les projections sociétales comme l'accès aux soins restent difficiles pour cette population. Cependant, des recherches transdisciplinaires complémentaires sont nécessaires, en particulier avec les adolescents, les jeunes adultes et en périnatalité.
... 13,14,16 Most available studies addressing the gender-affirming care offered to GD children and adolescents were based in individual clinics and included relatively small numbers (range: 25-187) of participants and nonuniformity in the design of subjects studied. [19][20][21] Moreover, little is known about the typical time course from initial presentation of GD behavior in children to initiation of gender-affirming care. 18,[20][21][22][23][24][25][26][27][28] With the knowledge that the GD population is growing and increasing proportions of GD individuals are presenting at an earlier age, there is a need for largescale longitudinal studies investigating patterns and determinants of GD-specific care in children and adolescents. ...
... [19][20][21] Moreover, little is known about the typical time course from initial presentation of GD behavior in children to initiation of gender-affirming care. 18,[20][21][22][23][24][25][26][27][28] With the knowledge that the GD population is growing and increasing proportions of GD individuals are presenting at an earlier age, there is a need for largescale longitudinal studies investigating patterns and determinants of GD-specific care in children and adolescents. [29][30][31][32][33] The purpose of this study was to examine the likelihood and predictors of receiving a GD-specific diagnosis and GAHT among youth who express gender-variant behavior. ...
Background and objectives:
The progression of gender-expansive behavior to gender dysphoria and to gender-affirming hormonal treatment (GAHT) in children and adolescents is poorly understood.
Methods:
A cohort of 958 gender-diverse (GD) children and adolescents who did not have a gender dysphoria-related diagnosis (GDRD) or GAHT at index were identified. Rates of first GDRD and first GAHT prescription were compared across demographic groups.
Results:
Overall, 29% of participants received a GDRD and 25% were prescribed GAHT during the average follow-up of 3.5 years (maximum 9 years). Compared with youth assigned male sex at birth, those assigned female sex at birth were more likely to receive a diagnosis and initiate GAHT with hazard ratio (95% confidence interval) estimates of 1.3 (1.0-1.7), and 2.5 (1.8-3.3), respectively. A progression to diagnosis was more common among those aged ≥15 years at initial presentation compared with those aged 10 to 14 years and those aged 3 to 9 years (37% vs 28% vs 16%, respectively). By using the youngest group as a reference, the adjusted hazard ratios (95% confidence interval) for a GDRD were 2.0 (1.3-3.0) for age 10 to 14 years and 2.7 (1.8-3.9) for age ≥15 years. Racial and ethnic minorities were less likely to receive a diagnosis or be prescribed GAHT.
Conclusions:
This study characterized the progression of GD behavior in children and adolescents. Less than one-third of GD youth receive an eventual GDRD, and approximately one-quarter receive GAHT. Female sex at birth, older age of initial GD presentation to medical care, and non-Hispanic white race and ethnicity increased the likelihood of receiving diagnosis and treatment.
... Their increasing awareness of transphobic discourses presented in their families, peer groups, media, and/or communities may lead to shame and distress (Y€ uksel et al., 2017). In addition, secondary sex characteristics develop, potentially exacerbating gender dysphoria (Drescher & Byne, 2012;Steensma et al., 2011). Without supportive resources, many youth may be left managing stigma, discrimination, and distress from gender dysphoria on their own. ...
... Though not all TGD youth are interested in physical transition, significant advances in gender-affirming care (e.g., puberty suppression, cross-sex hormones, affirming surgeries) have allowed many TGD youth to feel more congruent with their gender experience (Steensma et al., 2011). The World Professional Association for Transgender Health (WPATH) (2012) provides standard of care guidelines when working with TGD youth. ...
Suicide is a growing public health issue among adolescents. While the majority of transgender and gender diverse (TGD) youth are healthy, many experience suicidal thoughts and behavior (STB). Due to discrimination and stigma, TGD youth attempt suicide at higher rates then heterosexual, cisgender and even cisgender, LGBQ youth. Despite this vulnerability to suicide, few treatments have been developed and tested for this population. One treatment, attachment-based family therapy (ABFT) has been adapted to work with LGBQ youth and may be promising for TGD adolescents at risk for suicide. This article provides an overview of our ABFT modifications for TGD youth with thoughts of suicide. Specifically, we illustrate how treatment outcomes, in a single case study, relate to processes within clinical treatment tasks. The case study demonstrates the application of these ABFT modifications with a self-identified, gender nonconforming adolescent (who had recently attempted suicide) and his caregivers. Treatment evaluation measures were collected over the course of 24 weeks to illustrate the youth's clinical progress. The youth's suicidal symptoms diminished markedly by the end of treatment. Further, the family reported an increased ability for problem solving and more open communication by treatment conclusion.
... Adolescence is a crucial time for many sexual and gender minorities in terms of "coming out" and is also a time when many mental health (MH) difficulties emerge ONS, 2017). Furthermore, when puberty starts creating bodily changes, this has the potential to increase the distress of TGD youth (Steensma et al., 2011). One UK-based study reported that between 21.7% and 47.8% of 16-25 year-old TGD participants were struggling with a MH condition, compared to 18.8% in the general population (Rimes et al., 2019; Office for National Statistics [ONS], 2017). ...
Gender minority stress refers to social stressors such as discrimination and stigma that gender minorities are subject to. This study examines the relationship between gender minority stress and psychological well-being in trans and gender diverse young people (TGDYP). We used a cross-sectional design to investigate the relationship between gender minority stress and mental well-being in TGDYP aged 16–25. We measured anxiety, depression, general psychological well-being, gender dysphoria, gender minority stress (distal and proximal), resilience and heteronormative beliefs in cisgender ( n = 135) and trans and gender diverse (TGD) ( n = 106) participants. Hierarchical regression was used to analyse the data. TGD participants had significantly higher levels of anxiety and depression, and poorer general well-being, than cisgender participants. Although the direction of the relationship cannot be determined through our analysis, TGD participants who experienced more minority stress and were assigned female at birth had higher levels of depression and anxiety. TGD participants with higher resilience scores and were assigned male at birth had better well-being overall. Our findings suggest that we should pay attention to minority stress when thinking about how to reduce anxiety and depression in TGDYP. The responsibility for improving well-being lies not just with services but instead should be held by our whole society.
... An explanation for the discrepancy between prepubertal children and adolescents is the heterogeneity of the prepubertal group. According to biographical interviews, childhood gender dysphoria does not always persist into adolescence, and the ages 10-13 are critical for the developmental trajectory of gender dysphoria (Steensma et al., 2011). ...
Gender identity (an individual's perception of being male or female) and sexual orientation (heterosexuality, homosexuality, or bisexuality) are programmed into our brain during early development. During the intrauterine period in the second half of pregnancy, a testosterone surge masculinizes the fetal male brain. If such a testosterone surge does not occur, this will result in a feminine brain. As sexual differentiation of the brain takes place at a much later stage in development than sexual differentiation of the genitals, these two processes can be influenced independently of each other and can result in gender dysphoria. Nature produces a great variability for all aspects of sexual differentiation of the brain. Mechanisms involved in sexual differentiation of the brain include hormones, genetics, epigenetics, endocrine disruptors, immune response, and self-organization. Furthermore, structural and functional differences in the hypothalamus relating to gender dysphoria and sexual orientation are described in this review. All the genetic, postmortem, and in vivo scanning observations support the neurobiological theory about the origin of gender dysphoria, i.e., it is the sizes of brain structures, the neuron numbers, the molecular composition, functions, and connectivity of brain structures that determine our gender identity or sexual orientation. There is no evidence that one's postnatal social environment plays a crucial role in the development of gender identity or sexual orientation.
... As noted above, the 'Dutch protocol' recommends commencing endocrine treatment at Tanner stage II-III, which 'almost always precedes the age of consent.' 24 However, it also precedes the age at which many children 'desist' in their experience of incongruence between their sex and gender identity: in one study, both those adolescents whose GD persisted and those whose GD desisted reported that 'they considered the period between 10 and 13 to be crucial'. 17 The pathway dilemma is thus further complicated by the difficulty in establishing meaningful consent. Wren outlines three problems arising here: ...
Both the diagnosis and medical treatment of gender dysphoria (GD)—particularly in children and adolescents—have been the subject of significant controversy in recent years. In this paper, we outline the means by which GD is diagnosed in children and adolescents, the currently available treatment options, and the bioethical issues these currently raise. In particular, we argue that the families and healthcare providers of children presenting with GD currently face two main ethical dilemmas in decision making regarding treatment: the pathway dilemma and the consent dilemma.
Objective
Despite known health disparities, there is limited training in lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) health, particularly in pediatric graduate medical education (GME). We aimed to develop a longitudinal LGBTQ curriculum for a pediatrics residency program tailored to the needs and interests of our trainees.
Methods
We developed a year-long curriculum based on a formal needs assessment and evaluated changes in provider knowledge, comfort, and self-reported clinical impact through pre- and post-surveys.
Results
The needs assessment was completed by 78 out of 110 providers (70.9% response rate); 60 (54.5%) and 70 (63.6%) completed the pre- and post-curriculum surveys, respectively. Post-curriculum implementation, there was an increase in mean comfort level asking about sexual orientation (4.1 to 4.5, p<0.01), gender identity (3.5 to 3.8, p=0.02), and sexual practices (3.4 to 3.8, p<0.01), psychosocial screening (3.2 to 4.2, p<0.01), applying medical/preventive screening guidelines (2.4 to 3.6, p<0.01), and medically managing transgender patients (1.9 to 3.1, p<0.01). Knowledge-based assessments increased from 25.2% correct to 38.5% (p=0.01). Faculty felt significantly more comfortable teaching this material to trainees (21.7% to 70.0%, p<0.01). Providers reported high scores regarding impact on clinical practice (4.0/5), intent to change practice (4.5/5), importance of (4.8/5) and satisfaction with (4.5/5) the curriculum.
Conclusion
There is a need to incorporate formal LGBTQ health training in GME. Our curriculum improved provider knowledge, comfort, self-reported clinical practice, and faculty preparedness to teach this material. It can serve as a framework for other pediatric programs to develop their own curricula.
Objective
We conducted a meta-synthesis of qualitative research on subjective experiences of gender dysphoria (GD) amongst transgender and gender non-conforming (TGNC) youth in order to improve clinical encounters, complement existing knowledge and potentially influence future research.
Methods
We systematically searched for qualitative studies on GD in English, German, Spanish and Scandinavian languages in seven databases. Starting with 2,000 articles, we finally included 12 papers in the meta-synthesis, following Noblit and Hare’s (1988) seven steps for qualitative meta-synthesis research.
Results
Through the consistent comparison of key concepts, we were able to cluster the findings from the 12 included studies into four meta-themes: (1) the emerging understanding and awareness of GD was described as navigation in the dark, (2) the importance of relationships and societal norms, (3) the role of the body and the exploration of one’s own body and (4) sexuality and sexual impulses. The young person’s relation with his or her own body and sexuality influences subjective experiences of GD. The experiences are always mediated in relation with other people and societal norms, and they are both long-lasting and changing.
Conclusion
The phenomenological analysis indicated that GD is a complex phenomenon involving manifold factors that changes across time and place for each individual. GD is not a static phenomenon but an expression of continuous negotiation amongst the body, its impulses, sexual desire and the relationships in which each person participates. Therefore, clinicians who treat TGNC youth should help them to reflect on this developmental process over time as a complement to medical approaches.
Em 2013, o Conselho Federal de Medicina publicou o Parecer n. 8/2013, autorizando intervenções hormonais em menores de 18 anos com diagnóstico do até então denominado “transtorno de identidade de gênero”. Essas diretrizes foram ampliadas pela Resolução n. 2.265/2019, do mesmo órgão, que autorizou cirurgias irreversíveis a partir dos 18 anos de idade e não mais 21. Em 2018, consonante, o Conselho Federal de Psicologia emitiu a Resolução n. 1/2018, na qual exige, sob pena de punição disciplinar, que os profissionais validem identidades trans e travestis, independentemente de suas idades. Este artigo visa a despertar uma reflexão sobre o impacto da abordagem de “afirmação de gênero” no geral e dessas normas, em particular, nos direitos já conquistados das crianças e adolescentes.
Due to his high public profile, Harry Benjamin was often the first contact for those who identified as transsexual in the 1960s and 1970s, until his retirement in 1976. Among the over 800 letters from transsexuals written to Benjamin, 21 were from youth seeking his medical assistance. These letters, written from 1963–1976, provide a rare window into the lives and subjectivities of transsexual youth before the modern transgender movement took shape. Often taking the form of short autobiographies, these pioneers wrote about the meaning of their genders and sexualities, sometimes in great detail. Narrative analyses of these letters focused on narrative explanations for their transsexual desire; how Benjamin, his colleagues, and transsexual correspondents co-constructed transsexual narratives; and the rejection of these youth by their families and peers.
CHOICE MAGAZINE Outstanding Academic Title for 2007 The field of "transgender" and "transpositionality" has been carved out as a new field of inquiry in the past decade, showing the fragmentation and diversification of masculinities and feminities - along with the error of any sharp polarisation. Dave King and Richard Ekins are the leading world sociologists in this field and have mined it richly since the 1970's. The book brings together a brilliant synthesis of history, case studies, ideas and positions as they have emerged over the past thirty years, and brings together a rich but always grounded account of this field, providing a state of the art of critical concepts and ideas to take this field further during the twenty first century. This is a must read for all interested in this new area of inquiry ' - Ken Plummer, Professor of Sociology, University of Essex. Editor of Sexualities. Author of Intimate Citizenship An outstanding survey of the evolution of trans phenomena, splendidly written, highly informative, scholarly at its best, yet easy to read even for those neither trans nor sociologist. Drs Ekins and King, experts in the field, unroll the panoramas of sex, gender, and transgendering that have evloved during the last decades. For everyone wanting to understand the interaction of women and men and of those who cannot or will not identify with either of these two cataegories, reading this book is a must, and a real pleasure' - Professor Friedmann Pfaefflin, University of ULM In a work destined to be a classic, Ekins and King offer a comprehensive overview of the diversity of contemporary transgender expression, along with an impressive conceptual framework for making sense of that diversity. The abundant case vignettes bring the authors' concepts to life and make the book a pleasure to read' - Dr Anne Lawrence, Clinical Sexologist in Private Practice, Seattle An outstanding survey of the evolution of trans phenomena, splendidly written, highly informative, scholarly at its best, yet easy to read even for those neither trans nor sociologist. Drs Ekins and King, experts in the field, unroll the panoramas of sex, gender, and transgendering that have evloved during the last decades. For everyone wanting to understand the interaction of women and men and of those who cannot or will not identify with either of these two cataegories, reading this book is a must, and a real pleasure' - This groundbreaking study sets out a framework for exploring transgender diversity for the new millennium. It sets forth an original and comprehensive research and provides a wealth of vivid illustrative material.Based on two decades of fieldwork, life history work, qualitative analysis, archival work and contact with several thousand cross-dressers and sex-changers around the world, the authors distinguish a number of contemporary transgendering stories' to illustrate:" the binary male/female divide;" the interrelations betwen sex, sexuality and gender;" the interrelations between the main sub-processes of transgendering. Wonderfully insightful, The Transgender Phenomenon develops an original and innovative conceptual framkework for understanding the full range of the transgender experience.
This is a long term follow-up of 55 boys with early effeminate behavior. It was possible to determine the outcome in sexual orientation in 38 of the boys, which included homosexuality or variants of it in 35 (63.6 per cent) of the total of 55 and heterosexuality in three (5.5 per cent). In 10 boys the outcome was uncertain, and seven were lost to follow-up. An analysis of the uncertain cases suggests that the overall outcome in terms of homosexuality may prove to have been higher than 63.6 per cent. These results agree with those of previous prospective and retrospective studies, which are reviewed. From both types of such studies, the prospective ones starting out with instances of early effeminate behavior and the retrospective with cases of established homosexuality, the conclusion is ventured that all male homosexuality begins with early effeminate behavior. This has implications for future research on homosexuality.
Verbatim data are presented from transsexual patients—children and adults—and their parents and partners. The emphasis is on men who wish to become women and to a lesser extent on women who wish to become men. The male "feels himself more woman than man," he "cannot bear to live as a man," seeking "full acceptance by society as a woman," requesting female hormones to bring his body contours closer to female proportions, pleading for "genital surgery to remove male anatomic insignia," and "a birth certificate designating female status."
"Feminine boys" are sissies, and "masculine girls" are tomboyish. The former often dress in female clothing, are poor mixers, take feminine identity in their own fantasies, choose toys usually selected by girls, avoid rough-and-tumble play and sports, and show considerable interest in play acting. This pattern is frequently recognized by the child and his parents at or before age 5. Psychological test studies
In the literature on gay and lesbian people, it is commonly stated that gay men and women differ in the expression of their sexualities. Self-identified lesbians are said to be more bisexual than gay men with respect to their feelings and behavior—that is, to have more heterosexual fantasies and attractions, and also more sexual experiences with the opposite gender. Lesbians are also reported to self-acknowledge their gay identity (“come out” to themselves) at a later age than gay men. The data commonly used to back up these beliefs is reviewed. Studies are fraught with methodologic errors, and much of the data are inconclusive. Thus the issue is far from resolved, and statements implying that gender differences are proved fact are unfounded. Methodologic difficulties and the complexity of attempting to measure dimensions of sexual cognition and behavior are discussed.
Nine of 11 boys with prepubertal discordance of gender identity/role have been maintained in follow-up until young adulthood.
All are known to be homosexual or predominantly so. None is known to be either a transvestite or transexual, though one formerly
began the real-life test for transexualism and quit after 6 weeks. All nine have completed some postsecondary education, and
all are well-achieved or better, occupationally. Secondary psycho-pathology in adulthood has not been obviously manifest.
There was a consensus in adulthood that the nonjudgmentalism of those responsible for their follow-up over the years had had
a strongly positive therapeutic effect on the boys' personal development.