Key Findings

• Intensity of gender dysphoria in childhood is the strongest predictor of persistence into adolescence
• Natal girls have a higher probability of persistence than natal boys
• Psychological functioning and quality of peer relations do not predict persistence of childhood GD
• Cognitive and affective cross-gender identification and social role transition are associated with persistence
• Predictive factors for persistence differ between natal boys and girls
• Persisters report higher gender dysphoria intensity, more body dissatisfaction, and higher same-sex sexual orientation compared to desisters
• Childhood social transitions were important predictors of persistence, especially among natal boys
• Explicitly asking children with GD which sex they identify with is valuable in predicting future outcome

Abstract

To examine the factors associated with the persistence of childhood gender dysphoria (GD), and to assess the feelings of GD, body image, and sexual orientation in adolescence. The sample consisted of 127 adolescents (79 boys, 48 girls), who were referred for GD in childhood (<12 years of age) and followed up in adolescence. We examined childhood differences among persisters and desisters in demographics, psychological functioning, quality of peer relations and childhood GD, and adolescent reports of GD, body image, and sexual orientation. We examined contributions of childhood factors on the probability of persistence of GD into adolescence. We found a link between the intensity of GD in childhood and persistence of GD, as well as a higher probability of persistence among natal girls. Psychological functioning and the quality of peer relations did not predict the persistence of childhood GD. Formerly nonsignificant (age at childhood assessment) and unstudied factors (a cognitive and/or affective cross-gender identification and a social role transition) were associated with the persistence of childhood GD, and varied among natal boys and girls.

Summary

This quantitative follow-up study of 127 adolescents referred for gender dysphoria in childhood examined what factors predict persistence versus desistance into adolescence. The key finding is that the intensity of gender dysphoria in childhood is the most important predictor of persistence, with natal girls showing higher persistence rates than natal boys. Psychological functioning and peer relationships did not predict outcomes, but cognitive cross-gender identification and social role transitions did, with different predictive factors emerging for boys versus girls.

Conclusion

Intensity of early GD appears to be an important predictor of persistence of GD. Clinical recommendations for the support of children with GD may need to be developed independently for natal boys and for girls, as the presentation of boys and girls with GD is different, and different factors are predictive for the persistence of GD.