Gender variant children are not ill, and do not “desist”

What does it mean to say that gender variant children are not ill? What are the problems with studies which assume they are, and can we learn anything from those studies?

Some studies purport to show that trans children “desist”, and become cis as they mature, so should on no account be treated as trans. “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender-nonconforming children” by Julia Temple Newhook and others shows the problems with these studies and their assumptions. Nine academics in diverse disciplines including medicine, psychology, social work, gender advocacy, education and paediatrics considered and tore apart those studies, and gave an alternative way forward.

Based on the studies, the media suggest that 80% of trans children will identify as cis in adolescence or adulthood, so should not be treated as trans as children. However, the research is flawed. It is based on a definition of “Gender Identity Disorder in Children” from DSM IV, which included behaviour, rather than “Gender Dysphoria”, diagnosed by cross-gender identification and distress with physical sex characteristics and associated gender roles. It failed to recognise the WPATH principle that transgender identity is a matter of diversity, not pathology.

Behaviour: in DSM IV, “intense desire to participate in the stereotypical games and pastimes of the other sex” was one of the criteria. So, a little boy who liked skipping, and playing with “playmates of the other sex”, might be whisked off to the gender clinic for an assessment, and, suitably shamed and frightened, two years later he would report that indeed he had desisted.

We are not ill. We do not need to be made well. We certainly do not need to be made normal. So much of our treatment attempts to make us fit in, to be acceptable to “normal” people. However, there are huge advantages to being “normal”: being seen or treated as weird sucks. Seeing us as ill can mean wanting to make us well: wanting us to be happy conforming to gender stereotypes, ideally those assigned at birth, and if that proves impossible, gender stereotypes and an approximation of the sex characteristics of the other sex. Wanting to be accepted, we may go along with that.

Children exploring gender in a transphobic society face great pressures, and the older studies incidentally describe that. They show that statements of gender identity or gender dysphoria in childhood may indicate similar feelings in adulthood.

Three of the four defective studies included children who did not have a diagnosis of GID, but had simply been referred to a gender clinic. Three assumed any participant who could not be assessed for follow-up had desisted, even though it was possible that they still considered themselves trans, but did not want to medically transition with hormones or surgery. All reassessed children in their teens, one as early as 14, which gives no idea what they will be like as adults. Perhaps they felt unable to transition by that age, but transitioned later. Therefore, the reported desistance rate is hugely inflated.

The parents of the children in the studies brought them to a clinic, indicating they thought there was a problem, but where parents validate their children’s gender identity the children are likely to have a different, arguably healthier, life-course.

The studies used the term “desistence”, which originates in criminology. Gender variance was seen as sick. Being cis was seen as normal. So transgender identity was only viewed as valid if static and unwavering throughout life. Few trans people do not waver sometimes, in the face of family and societal pressure to be normal.

The studies referred to the children as “boys and girls” based on their assigned gender. Their identity was less important. There was no acknowledgment of nonbinary identity. They were too keen to call people “desisters”- for example, an AMAB person aged 18 “still desired to be a woman, with breasts and the possibility of giving birth. However, he (sic) considered himself 50% male and 50% female.”

The studies assumed a stable gender identity is a positive health outcome, so pushed children towards that, but where gender identity is fluid or slower to develop the child may still be developing in a healthy way. Different identities are a different way of seeing onesself, under different levels of self-knowledge and differing vulnerability to differing pressures from others. The journey of self-discovery may be lifelong.

The language to describe identities improves. I had not heard of nonbinary when I transitioned.

Some people imagine that desisters grow up to be gay and not trans. Again this is a way of seeing a person who may be nonbinary and androphile or gynephile. If people do not fit categories, then it is the categories that must change.

There was intensive treatment of the children, with questionable goals. Healthy children may have their self-esteem damaged by being brought into stigmatising diagnostic and treatment settings. Treatment was often designed to lower the odds that they would grow up transgender, or to “reduce GID persistence”, claiming transsexualism, with social stigma and a lifetime of medical treatment, is undesirable.

However, as some children become trans adults, these efforts to make us fit a more normal box can be traumatic. The Netherlands clinic discouraged social transition before puberty, though it can make children happier. Children’s rights to autonomy and self-determination were subordinated to clinicians’ concepts, beliefs and desired outcomes.

Did the children feel some obligation to go along with treatment and participation in the research, as a condition of having their gender variance taken seriously?

Temple-Newhook and others say,

These ethical concerns raise questions about the validity of research with children whose parents believe they have a medical problem, who are subjected to a high level of testing and treatment, who are disallowed or discouraged from asserting their own gender identity, and who are being raised in a broader society that often punishes perceived transgressions of male and female boundaries.

When children think being gay or trans is seen as bad, they often pretend not to be. The social pressure is intense, and cruelly shaming.

The older studies did not consider that attempting to delay or prevent transition could be harmful to the patient’s self-respect and sense of self. They assumed unknowable future adult needs should supersede known childhood needs. Contradicting that, the older research mentions “a de-transitioning girl and her mother who expressed gratitude for her opportunity to live as a boy for a time, and felt that if she had been forced to live as a girl for her entire childhood, that her mental health would have suffered.”

It is not true to suggest that “a potential future shift in a child’s gender identity is a justification for suppressing or redirecting their assertion of identity in childhood”.

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.

Trans children and adults are not sick. We need affirmed for our innate worth as diverse humanity.

The study, by Julia Temple Newhook, Jake Pyne, Kelley Winters, Stephen Feder, Cindy Holmes, Jemma Tosh, Mari-Lynne Sinnott, Ally Jamieson & Sarah Pickett, is available here.

Hat tip to Reubs J Walsh.