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

• Od 139 dečkov, obravnavanih zaradi skrbi glede spolne identitete kot otroci, jih je 17 (12,2 %) pri približno 21 letih še imelo spolno stisko, 122 (87,8 %) je ni imelo več.
• Večina je to prerasla tudi med 88 dečki, ki so kot otroci izpolnjevali polno diagnozo: 12 (13,6 %) jih je še imelo stisko, v primerjavi s 5 od 51 (9,8 %) dečkov, ki je niso, razlika pa bi lahko bila zlahka naključje.
• Kot mlade odrasle so večino privlačili moški ali oba spola: 63,6 % od 129 v domišljiji in 47,2 % od 108 v spolnem življenju, 25,9 % pa je poročalo o odsotnosti spolne dejavnosti.
• Dečki, katerih stiska se je nadaljevala, so bili ob prvem pregledu običajno starejši, iz revnejših družin in v otroštvu bolj spolno nekonformni kot dečki, ki so jih privlačili moški in je njihova stiska zbledela.
• Od 145 nagovorjenih bolnikov so le 6 zavrnili (sodelovalo je 95,9 %), toda 163 upravičenih bolnikov ni bilo nikoli kontaktiranih, ker je študiji primanjkovalo sredstev, 19 pa jih ni bilo mogoče najti.
• Samo en deček je pred puberteto socialno tranzicioniral, zato študija kaže, kaj se je zgodilo pri večinoma nepotrjevalnem, pogosto terapevtsko zasnovanem pristopu, ne pri današnji oskrbi, ki potrjuje.
• Avtorji pravijo, da se rezultati ujemajo z zgodnejšimi nadaljnjimi študijami, ki kažejo, da večina dečkov, obravnavanih v klinikah, spolno stisko preraste.

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.