Trans kids are the hottest topic right now. So its natural that we have this burning question and that its asked quite a lot. I see it almost daily in my talks to anti-trans people, a lot of them are working from the assumption that its “just a phase” and that trans kids “desist 80% of the time” and a lot of this is incredibly bogus information.
A friend of mine linked me this page by James Cantor — a clinical psychologist who mostly takes a Blanchardian view to trans people. If you’re unfamiliar with Blanchard’s typology the short story is that he either views us (trans women only) as people who are sexually fetishising the female form upon ourselves — or that we’re gay men who couldn’t quite face up to being gay in society, so obviously…. trans was the next best way to express that? Somehow? There are many problems with this we can get into another time if you like, back to Cantor for now.
Cantor has been making the rounds on YouTube talking about his view of trans with some other psychologists, who also appear to believe his view of things. He’s definitely well supported by the anti-trans crowd, specifically the TERFs who were the ones who led me to find his videos in the first place as they had tweeted about them.
I had a brief look over his list last night and the conclusions he’s drawing from that… and yeeeeeesh, its a bit of a mess. So I’m going to go over it a bit more in depth in this article — though most of the studies he links to are behind paywalls and I am too poor to actually buy them, so its not going to be in mad depth at all. Here’s what I found and remember — The questions is “Do trans kids stay trans?”
…all the studies have come to a remarkably similar conclusion: Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 60–90% of trans- kids turn out no longer to be trans by adulthood.
This is Cantor’s opening statement and conclusion based on the studies he has linked. So lets see if the studies actually match up to what he’s saying! (and yes, don’t think I didn’t notice the awful “turn out to be regular gay or lesbian folks” bit. Ew.)
First up we have Lebovitz, P. S. (1972). Feminine behavior in boys: Aspects of its outcome. American Journal of Psychiatry, 128, 1283–1289. Which Cantor claims of 16, 2 were gay, 4 were trans or crossdressers and 10 were straight or uncertain. The problem is that this study doesn’t actually answer our question at all “Do trans kids stay trans?” Since what the study actually looks at is effeminate behaviour in boys in the 1960s.
As the article is behind a paywall, I can’t look deeper into the study to see exactly what was considered effeminate behaviour in the 1960s — but I doubt that its comparable to what we consider effeminate behaviour today. Also, we don’t pathologise effeminate behaviour into being a deviance — as most of these studies during this time did. So its a totally unfair comparison to our modern understanding of trans kids.
Our modern understanding of trans kids, which can be seen in the ICD 10 — published 30 years after this study took place in the early 1990s. The ICD 11 is due out in 2018. Here’s the excerpt for trans kids in 10, which clearly specifies that “mere girlishness in boys is not sufficient for diagnosis.”
So not only does this study not actually look at trans kids to see if they stay trans into adulthood — it strawmans what trans even is by making it just about ‘being effeminate’ which is totally contrary to the actual medical definition of the condition in kids. Short story being, its utter garbage — but get used to it… it’s not the only study in this list which does this! Hoorah.
Next study is Zuger, B. (1978). Effeminate behavior present in boys from childhood: Ten additional years of follow-up.Comprehensive Psychiatry, 19, 363–369. Which from the name alone you can see runs into the exact same problems as the study beforehand. Oops.
This one actually has an interesting quote in its abstract:
Gender dysphoria appears to be a necessary but not sufficient factor in a transsexual outcome. The strength, rigidity, and persistence of cross-gender behavior through latency may be a good predictor of transsexual outcome.
See that? Strength. Rigidity. Persistence. That’s more commonly known today as insistent, persistent and consistent gender identity. Go read the diagnostic criteria I posted above again and you’ll see it written there too. This study doesn’t work against trans people like how Cantor and his supporters would like to believe — it actually works for us. Helping to narrow down how to best diagnose it, to the point where we now have detransition rates of below 4%.
Next up we have Money, J., & Russo, A. J. (1979). Homosexual outcome of discordant gender identity/role: Longitudinal follow-up. Journal of Pediatric Psychology, 4, 29–41. Which looks at children who were “discordant with their gender identity/role” — I again, can’t tell you to what extent that would have been because paywalls. But its another study from the 60s and 70s. People were hardly woke™ on gender roles to the same extent we are today. Merely being homosexual was considered deviant, and perhaps is the reason they were considered discordant at all.
Again though, this study doesn’t look at trans kids. It looks at slightly effeminate boys and this is not the same thing. Actually, this study did mention one child who tried to transition but gave it up:
None is known to be either a transvestite or transsexual, though one formerly began the real-life test for transsexualism and quit after 6 wks.
“Real life test” means the child was made to crossdress and live “in role” as a girl without any medical treatment or support for that… in the 1970s… No shit you had a lot of people giving up on trying to fix their dysphoria back then. The study doesn’t follow this particular child to see if they ended up transitioning later in life either— the mean age of transition during this time period was about 40.
Onto Green, R. (1987). The “sissy boy syndrome” and the development of homosexuality. New Haven, CT: Yale University Press. Which provides a lot more nuance and intrigue into femininity amongst boys and looks at the link between this and gay boys. Again, falling into the same pitfalls as the above studies and not answering the question posited at all.
The next study Kosky, R. J. (1987). Gender-disordered children: Does inpatient treatment help? Medical Journal of Australia, 146, 565–569. Remarks on the mess that is the field of gender medicine for children at this point and aims to clear it up a little. Since any kind of effeminate behaviour was deemed to be a bad its hard to really know whether this study was actually looking at kids who were genuinely saying they were trans — or just ones who liked wearing dresses.
This is the final study on this list which takes place before the ICD 10’s release which helped clear up a lot of these misconceptions. Its also interestingly the last time a study would take place where conditions pertaining to homosexuality were still in the DSM. Which probably explains the bias in all of these studies so far…
We’re onto the final four. Starting with Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413–1423. This study looked at 77 children in actual gender clinics across about 10 years.
30% of the group did not respond at follow up and only 27% were in the persistent group. 43% were in the desistance group. If we discount the 30% who did not respond, then these percentages should be adjusted to about 39% persistance and 61% desistance. Interesting to note about our desistance group is:
in the desistance group, all of the girls and half of the boys reported having a heterosexual orientation. The other half of the boys in the desistance group had a homosexual or bisexual sexual orientation.
So much for that whole “they’re just regular gay kids!!!!!!” bit. The study concludes:
Most children with gender dysphoria will not remain gender dysphoric after puberty. Children with persistent GID are characterized by more extreme gender dysphoria in childhood than children with desisting gender dysphoria. With regard to sexual orientation, the most likely outcome of childhood GID is homosexuality or bisexuality.
This conclusion includes the 21% trans kids as homosexual or bisexual. If you don’t include these straight girls and boys as being homosexual then the whole study changes drastically, as does its support for the conclusions Cantor draws.
Trying to apply the typical rules of sexuality to a group who are very much atypical in this area is kinda stupid really. I mean… yes, in the strictest of scientific definitions, trans women are males and a male having sex with a male is homosexual — but this still completely ignores our perspective and the idea that sexuality isn’t quite as simple as this. I’m pretty sure that not many gay men are wanting to have sex with trans women since you know… we aren’t men and dont tend to look like men either:
Next study is Drummond, K. D., Bradley, S. J., Badali-Peterson, M., & Zucker, K. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34–45. Which is one of few studies to follow female to male trans people. Always nice to see one though, since the trans conversation is almost entirely dominated by trans women and how we’re all sexual deviants and perverts.
The study followed 25 female children of whom 60% qualified for a diagnosis. This references the DSM-IV which had a narrower understanding of dysphoria than the most recent update to the book, the DSM V. Here’s the criteria used when this study was done. (Note: I’m using the adult diagnostic criteria — as the study seems to apply this one & not GIDC, ie the one for children.)
A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following:
1. repeatedly stated desire to be, or insistence that he or she is, the other sex
2. in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
3. strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
4. intense desire to participate in the stereotypical games and pastimes of the other sex
5. strong preference for playmates of the other sex
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.
C. The disturbance is not concurrent with a physical intersex condition.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
So that’s any four of the options in A and also B, C and D. So what changed between this and the newest DSM edition, the DSM-V? The most important one and the one that is relevant to us right now? Is the addition of this:
1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics). 3
3. A strong desire for the primary and/or secondary sex characteristics of the other gender
Number 1 is also included as absolutely mandatory for the diagnosis. The whole of the diagnosis criteria seems to have moved entirely away from whether you’re a bit tomboyish/girlish and is now more fixated on sex dysphoria, a marked discomfort with one’s anatomical sex. This is a major difference, if you imagine gender dysphoria to be a tree. The DSM IV was looking at the leaves to diagnose it, the end result of dysphoria. Where as the DSM V is looking at the seeds which grew the tree.
This means that the children in the study fulfilled a very faulty diagnostic criteria and are hardly comparable to the trans kids we have now, over 10 years later with a whole new and better understanding of the condition.
Which brings us to Singh, D. (2012). A follow-up study of boys with gender identity disorder. Unpublished doctoral dissertation, University of Toronto. A study which has exactly the same problems and even remarks on this issue and most of the issues I’ve covered here within the study itself. This is the study where the infamous 80% desistance figure comes from and its a terrible bit of misinformation that seems to get everywhere.
In short though, all studies up to this point have been a mess of non-standardised language, vague terms, and misunderstandings of both trans as a condition and which pathologise feminine behaviour in boys. In essence, any kind of gender non-conformity, where gender refers to social stereotypes and expectations of sex, could land you with being able to get a diagnosis for GID. This is exactly why the DSM-V released later updated its condition to focus more on anatomical sex, to help dispell the focus on gender non conformity.
and the final study we’re looking at today is Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 52,582–590.
This study looked at the persistence and desistance of GD in children with the intention of making the diagnostic criteria better. What it noted is that persistence of GD is more likely amongst those with severe symptoms than those with less severe symptoms. What a big shock that is for everyone!
Some of the people involved with this study were also involved in other studies as quoted by the NHS in theirs GIDs evidence base for trans children.
Steensma and Cohen-Kettenis (2011) report from a clinical based sample that between 2000 and 2004, out of 121 pre-pubertal children, 3.3% had completely transitioned (clothing, hairstyle, change of name, and use of pronouns) when they were referred, and 19% were living in the preferred gender role in clothing style and hairstyle, but did not announce that they wanted a change in name and pronoun. Between 2005 and 2009, these percentages increased to 8.9% and 33.3% respectively.
So is Cantor’s conclusion fair? Is it really true that most with dysphoria will desist and become gay or lesbian? Well… no. The actual conclusion we can draw from looking at this and other studies relating to this area of study is that this area of study is an absolute mess.
First and foremost we need to standardise the language being used, as that’s all over the place and makes reading these studies very difficult unless you have inside information which can give you the much needed context of the words being used. Second, we need studies which actually look at kids who are believed to not just qualify for the diagnostic criteria — as we’ve shown they are not always that good. But also are making the effort to transition in some regard — only then can we answer the question “do trans kids stay trans” because as almost all of the studies in this article have mentioned. Dysphoria doesn’t automatically equal trans.
Finally we would also need to look at the reasons for desistance, as I’m sure there are many trans adults who will tell you they knew as a child, but never spoke about it. I’m one of them. I googled how I felt and found the condition as a 14 year old but never told anyone or did anything about it until I was 20.
All of this lack of information means that so far we absolutely dont have a solid desistance rate figure at all — and even if we did…. it would only prove that the way our clinics are run right now is the right way to do it. If we have statistics which show under current clinical conditions — 80% desist — then surely our current clinical conditions are doing the right thing. We can’t be “TURNING THE GAY FROGS TRANS!!!!!” as it were if we have evidence to suggest most in the clinics desist. That’s mind bogglingly stupid.
Not to mention the evidence which shows that the supportive environment which allows these kids to work out their dysphoria and see if its genuinely a cause to transition for them or not is actually hugely beneficial for trans kids mental health outcomes. Which is significantly better than causing those kids to repress and experience mental distress because you’d rather them not be trans at all, as is Zucker’s “sex affirmative” method.