Summary

Researchers at Toronto's gender clinic re-contacted boys first seen in childhood, at about age 7, and assessed them again at about age 21. Of 139 boys, 12.2% still had gender distress and 87.8% no longer did. Most grew out of it even among boys who had met the full diagnosis (86.4%). Most grew up attracted to men or to both sexes. Boys whose distress continued tended to be older when first seen, from poorer families, and more strongly gender non-conforming as children. It is the largest study of its kind, and 95.9% of those approached took part. But more than half of eligible patients were never contacted, and the ways of measuring changed over time. The boys were also seen in an era when early social transition was rare and therapy often tried to reduce cross-gender behaviour. So its rates may not apply to children seen at clinics today.

Key findings

• 子どものときに性自認の懸念で診察を受けた男児139人のうち、約21歳で性別への苦痛が続いていたのは17人（12.2%）、もう苦痛がなかったのは122人（87.8%）でした。
• 子どものときに診断基準を完全に満たした88人の男児でも、大半は違和感がなくなりました。12人（13.6%）に苦痛が続いており、満たさなかった51人のうち5人（9.8%）と比べて、その差は偶然でも十分に起こりうるものでした。
• 若い成人になって、大半は男性、または両方の性に惹かれていました。空想では129人の63.6%、性生活では108人の47.2%で、25.9%は性的な活動がないと報告しました。
• 苦痛が続いた男児は、男性に惹かれ苦痛が薄れた男児と比べて、初診時の年齢が高く、貧しい家庭の出身で、子どもの頃の性別に非同調的な傾向が強い傾向がありました。
• 声をかけた145人の患者のうち、断ったのは6人だけでした（95.9%が参加）。ただし、対象となる患者163人は、研究に資源がなかったために連絡されず、19人は見つかりませんでした。
• 思春期前に社会的トランジションをした男児は1人だけだったため、この研究が示すのは、現在の肯定的ケアの下ではなく、主にトランジションをしない、しばしばセラピーを中心としたアプローチの下で何が起きたかです。
• 著者らは、この結果は、クリニックで診察を受けた男児の大半が性別への苦痛が消えていくことを示した過去の追跡研究と一致していると述べています。

Abstract

This study reports follow-up data on the largest sample to date of boys clinic-referred for gender dysphoria (n = 139) with regard to gender identity and sexual orientation. In childhood, the boys were assessed at a mean age of 7.49 years (range, 3.33-12.99) at a mean year of 1989 and followed-up at a mean age of 20.58 years (range, 13.07- 39.15) at a mean year of 2002. In childhood, 88 (63.3%) of the boys met the DSM-III, III-R, or IV criteria for gender identity disorder; the remaining 51 (36.7%) boys were subthreshold for the criteria. At follow-up, gender identity/dysphoria was assessed via multiple methods and the participants were classified as either persisters or desisters. Sexual orientation was ascertained for both fantasy and behavior and then dichotomized as either biphilic/androphilic or gynephilic. Of the 139 participants, 17 (12.2%) were classified as persisters and the remaining 122 (87.8%) were classified as desisters. Data on sexual orientation in fantasy were available for 129 participants: 82 (63.6%) were classified as biphilic/androphilic, 43 (33.3%) were classified as gynephilic, and 4 (3.1%) reported no sexual fantasies. For sexual orientation in behavior, data were available for 108 participants: 51 (47.2%) were classified as biphilic/androphilic, 29 (26.9%) were classified as gynephilic, and 28 (25.9%) reported no sexual behaviors. Multinomial logistic regression examined predictors of outcome for the biphilic/androphilic persisters and the gynephilic desisters, with the biphilic/androphilic desisters as the reference group. Compared to the reference group, the biphilic/androphilic persisters tended to be older at the time of the assessment in childhood, were from a lower social class background, and, on a dimensional composite of sex-typed behavior in childhood were more gender- variant. The biphilic/androphilic desisters were more gender-variant compared to the gynephilic desisters. Boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation. The implications of the data for current models of care for the treatment of gender dysphoria in children are discussed.

Conclusion

This study provided follow-up data on the largest sample to date of boys clinic-referred for gender dysphoria (n = 139). Three key findings emerged: (1) The persistence of gender dysphoria was relatively low at 12.2% (17 persisters), while desistance was 87.8% (122 desisters); (2) A high percentage had a biphilic/androphilic sexual orientation—in fantasy, 63.6% (82 of 129 participants), and in behavior, 47.2% (51 of 108 participants); (3) Predictors of outcome included childhood age at assessment, social class, and degree of childhood gender-variant behavior. Specifically, biphilic/androphilic persisters tended to be older at childhood assessment, from lower social class backgrounds, and more gender-variant in childhood. Biphilic/androphilic desisters were more gender-variant than gynephilic desisters. The threshold vs. subthreshold GID diagnostic status in childhood did not significantly predict persistence. The authors note that these data were collected during a period when gender social transition prior to puberty was not commonly recommended, contrasting with more recent clinical approaches. The findings support prior research showing that desistance from gender dysphoria is the more common outcome in childhood-referred boys, and that dimensional measures of childhood sex-typed behavior provide added nuance in predicting long-term trajectories. The implications of these data for current models of care for treating gender dysphoria in children are discussed, particularly in light of contemporary approaches that may include earlier social transition and puberty-blocking interventions.