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

• 어린 시절 성 정체성 문제로 진료받은 남아 139명 중 17명(12.2%)은 약 21세에 여전히 성별 불쾌감이 있었고 122명(87.8%)은 더 이상 없었습니다.
• 어린 시절 전체 진단 기준을 충족한 남아 88명 중에서도 대부분 벗어났습니다. 12명(13.6%)이 여전히 고통이 있었고, 충족하지 않은 51명 중에서는 5명(9.8%)으로, 이 차이는 우연일 가능성이 충분합니다.
• 청년이 되었을 때 대부분은 남성 또는 양성에게 끌렸습니다. 환상에서는 129명 중 63.6%, 성생활에서는 108명 중 47.2%였고, 25.9%는 성적 활동이 없다고 보고했습니다.
• 고통이 이어진 남아는 고통이 사라진 남성에게 끌리는 남아보다 처음 진료받을 때 나이가 더 많았고, 더 가난한 가정 출신이었으며, 어린 시절 성별 비순응이 더 컸습니다.
• 접촉한 환자 145명 중 6명만 거절했지만(95.9%가 참여), 자격이 되는 환자 163명은 연구에 자원이 부족해 연락받지 못했고 19명은 찾을 수 없었습니다.
• 사춘기 전에 사회적 전환을 한 남아는 한 명뿐이었으므로, 이 연구는 오늘날의 확정적 진료가 아니라 대부분 전환하지 않고 흔히 치료에 기반한 접근에서 무슨 일이 일어났는지를 보여줍니다.
• 저자들은 결과가 클리닉에서 진료받은 대부분의 남아가 성별 불쾌감에서 벗어난다는 이전 추적 연구와 일치한다고 말합니다.

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.