In the years following their social transition, the vast majority of young transgender children continued to identify as such, a longitudinal study found.
Among 317 transgender children, only 7.3% altered their gender identification -- or retransitioned -- during a 5-year period, according to researchers led by Kristina Olson, PhD, of Princeton University in New Jersey.
This included 94% who identified as binary transgender by the end of the fifth year, 2.5% who identified as cisgender, and 3.5% identifying as nonbinary, they reported in .
"These results suggest that retransitions are infrequent," wrote Olson and coauthors. "More commonly, transgender youth who socially transitioned at early ages continued to identify that way."
At the end of the study period, 1.3% had retransitioned to another identity (nonbinary) but then returned to their binary transgender identity.
Only 0.5% of those who transitioned at age 6 or older retransitioned, while 5.6% of children below 6 retransitioned (most often to their assigned sex at birth). Olson's group emphasized that even among these younger kids, the retransition rate was "very low."
Overall, retransition most often occurred prior to age 10. All but one child who chose to retransition to their assigned sex did so before age 9, with the last retransitioning at age 11.
The researchers noted that there was no link between assigned sex and retransition rate.
"As more youth are coming out and being supported in their transitions early in development, it is increasingly critical that clinicians understand the experiences of this cohort and not make assumptions about them as a function of older data from youth who lived under different circumstances," Olson's group pointed out, adding how it is "crucial" for both clinicians and families to understand transitions to ease the process for youth.
Echoing this sentiment, Jack Turban, MD, MHS, of Stanford University in California, told 鶹ý via email that "a social transition has value regardless of the ultimate gender trajectory."
Turban, who was not involved in the study, noted that "prohibiting a social transition can send the message to a child that their identity is wrong or invalid, and this can drive shame and damage relationships within a family."
"Attempts to force transgender children to be cisgender are associated with suicide attempts," he underscored.
The timely analysis follows a wave of new laws restricting gender-affirming care and other transgender rights, as well as subsequent pushback from the medical community. Despite by some politicians that minors are too young to transition, Olson's group demonstrated that nearly all children who transitioned before age 12 maintained their gender identity.
Additionally, the findings are in contrast with those of from The Netherlands that suggested ages 10 to 13 as a crucial retransition timeframe, as most of the youth in this sample who retransitioned did so prior to age 10.
"Our sample differed from the past work upon which this age range was determined in several key ways," the authors explained. "Our participants socially transitioned at earlier ages ... had undergone complete social transitions including pronouns and names ... and are living at a different historic time in a different country."
The present analysis included 208 initially transgender girls and 109 initially transgender boys ages 3 to 12 years in the U.S. and Canada who were followed through an initiative called the .
Data from the project were self-reported by kids and their caregivers. Kids began their transition at age 6.5 on average. More than two-thirds of participants were white, 17% were multiracial, 9% were Hispanic, and 2% were Black. The researchers also highlighted that the majority of parents in the study had high incomes and attended college.
The analysis didn't measure whether children met criteria for Gender Dysphoria in Children.
Overall, 11.7% of individuals were on puberty blockers when the study began. The researchers predicted that prepubertal study participants who identify as binary transgender or nonbinary will likely seek hormones or puberty blockers when eligible.
While the retransition rate was low, Olson's group emphasized that the value may have been skewed. They mentioned that most participants were 1.6 years into their transition when the study began, suggesting these kids were "fairly content" with their choice. Also, if certain children retransitioned quickly, they would be "unlikely to be enrolled" in the study because their eligibility period would have been "quite short."
The researchers also noted that 26 families dropped out of the study. It is possible that they "were disproportionately those whose children retransitioned and who were therefore hesitant to participate again."
Disclosures
The study was supported by the National Institutes of Health, National Science Foundation, the Arcus Foundation, National Science Foundation Graduate Research Fellowships Program, and the MacArthur Foundation.
Olson and coauthors reported no conflicts of interest.
Primary Source
Pediatrics
Olson KR, et al "Gender identity 5 years after social transition" Pediatrics 2022; DOI: 10.1542/peds.2021-056082.