94% ainda se identificavam como trans 5 anos após a transição social precoce — mas não havia grupo de comparação

Identidade de gênero 5 anos após a transição social

Estudos de coorte e registros Desistência na infância

Authors: Kristina R. Olson, Lily Durwood, Rachel Horton, Natalie M. Gallagher, Aaron Devor
Journal: Pediatrics
Year: 2022
Source: https://doi.org/10.1542/peds.2021-056082

Summary

The Trans Youth Project followed 317 US and Canadian children who had fully socially transitioned (changed name, pronouns and presentation) between ages 3 and 12. About five years later, 94% still identified as trans, 3.5% as nonbinary and 2.5% as their birth sex; 7.3% had changed identity at least once. By the end, about 60% had started puberty blockers or cross-sex hormones. The authors concluded that switching back is uncommon. Children in supportive, mostly well-off volunteer families usually kept their new identity. But there was no comparison group of similar children who did not transition, so the study cannot say whether this reflects the children or the transition itself. Zucker and others argue early social transition may itself lock in identity, a question the Cass Review's evidence review treated as unresolved.

Key findings

317 crianças (208 meninas trans, 109 meninos trans) que haviam feito a transição social completa ingressaram no estudo aos 3 a 12 anos (média de 8) entre 2013 e 2017.
Cerca de 5,4 anos após a primeira transição, 94% se identificavam como meninos ou meninas trans, 3,5% como não binárias e 2,5% (8 jovens) com o sexo de nascimento.
7,3% haviam mudado de identidade pelo menos uma vez, incluindo 1,3% que depois voltaram a uma identidade trans.
As crianças que fizeram a transição antes dos 6 anos tinham mais probabilidade de depois se identificar com o sexo de nascimento (5,6% contra 0,5%); a maioria dessas mudanças ocorreu antes dos 10 anos.
Ao final, 92 haviam iniciado bloqueadores da puberdade (medicamentos que pausam a puberdade) e 98 haviam iniciado hormônios cruzados, cerca de 60% do grupo em um caminho médico.
As famílias ingressaram em média 1,6 ano após a transição da criança, e 26 famílias (8%) não haviam dado notícias nos dois anos anteriores.
Apenas 70 tinham 14 anos ou mais no acompanhamento, de modo que a maioria dos resultados foi medida antes da adolescência ou no início dela.

Abstract

BACKGROUND AND OBJECTIVES: Concerns about early childhood social transitions among transgender youth include that these youth may later change their gender identification (ie, retransition), a process that could be distressing. The current study aimed to provide the first estimate of retransitioning and to report the current gender identities of youth an average of 5 years after their initial social transitions. METHODS: The current study examined the rate of retransition and current gender identities of 317 initially transgender youth (208 transgender girls, 109 transgender boys; M = 8.1 years at start of study) participating in a longitudinal study, the Trans Youth Project. Data were reported by youth and their parents through in-person or online visits or via e-mail or phone correspondence. RESULTS: We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once. At the end of this period, most youth identified as binary transgender youth (94%), including 1.3% who retransitioned to another identity before returning to their binary transgender identity. A total of 2.5% of youth identified as cisgender and 3.5% as nonbinary. Later cisgender identities were more common among youth whose initial social transition occurred before age 6 years; their retransitions often occurred before age 10 years. CONCLUSIONS: These results suggest that retransitions are infrequent. More commonly, transgender youth who socially transitioned at early ages continued to identify that way. Nonetheless, understanding retransitions is crucial for clinicians and families to help make retransitions as smooth as possible for youth.

Conclusion

These results suggest that retransitions are infrequent. More commonly, transgender youth who socially transitioned at early ages continued to identify that way. Nonetheless, understanding retransitions is crucial for clinicians and families to help make retransitions as smooth as possible for youth. The authors caution against over-interpreting differences from older desistance studies, note that identities 'should not be interpreted as final', and say parents and clinicians should be informed that not all youth will continue on the same trajectory.

Methodological limitations

No comparison group: There was no group of similar gender-nonconforming children who did not socially transition, so the study cannot show whether transition changes how likely children are to stay trans. The Cass Review's evidence review (Hall and colleagues, 2024) noted no study in this area had a suitable comparison group.
Transition may cause persistence: Zucker (2020) and others argue that full early social transition is itself a powerful intervention that likely makes children more likely to stay trans. The high rate fits that concern as well as the authors' reassuring reading.
Hand-picked volunteers: Families signed up through community networks. 66% earned over $75,000 a year and 68% were white, and the children's depression levels were near normal, unlike children seen at clinics.
Early switchers missed: Families joined on average 1.6 years after transition, so children who switched back quickly were unlikely to be included, as the authors admit.
No diagnosis: Children were not assessed for gender dysphoria (distress about one's sex), so comparing with older clinic studies, where many children grew out of it, is not like-for-like.
Identity judged by pronouns: Identity was mainly judged by the pronouns the child used, as reported by parents and children, not by a standard or clinical assessment.
Short follow-up, young children: Follow-up averaged about 5 years after transition (3.8 years after joining), and only 70 were 14 or older. Past research suggests many children stop feeling trans during or after puberty, and adult detransition is not captured.
Lost contact: 26 families (8%) had no contact in the two years before data ended. If families of children who changed course were less likely to stay in touch, switching back would be undercounted.
Medical steps muddy the picture: About 60% had started blockers or hormones by the end, which may further fix identity. The study cannot separate the effects of social and medical steps.
Parents' support and expectations: All parents had approved and supported a full social transition, and many rejected treating it as a diagnosis. This setting may shape both what children say and how they develop.
Funding and research focus: Funders included the NIH, NSF, the Arcus Foundation (an LGBT-advocacy funder) and the MacArthur Foundation. The authors declare no conflicts, but the lead author's research program is built around socially transitioned children.

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Summary

Key findings

Abstract

Conclusion