The Controversial Research on 'Desistance' in Transgender ...

In 2013, Steensma co-authored an oft-cited study that examined 127 adolescents, all of whom had displayed various levels of gender dysphoria as ... 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Fordecades,follow-up studiesoftransgenderkidshaveshownthatasubstantialmajority--anywherefrom65to94percent--eventuallyceasedtoidentifyastransgender. Onestudyfoundthatolderchildren,girls,andthosekidswhoreportedmoreintensegenderdysphoriaweremorelikelytostickwiththeirtransgenderidentityasadolescents. Thesefindingshavebecomepartandparcelofthe"Howyoungistoo young?"debateover"socialtransitioning,"thetermforallowingkidstopubliclyliveastheiridentifiedgenderineverywayshortofmedicaltreatment. Ifmostkidswilleventuallyceasetobetransgender,someclinicianshavereasoned,isn’titmoreprudenttotaketheleastdisruptivepathincopingwithachild'sgenderdysphoria?Thatway,iforwhenkidslaterstopidentifyingastransgender,theywillhavelessto“undo.” Inrecentyears,though,anewschoolofthoughthasemerged.Manygenderspecialistsnowbelievethatthebestcourseforatransgenderchildisoften“socialtransition,”wherekidsasyoungasthreeareallowedtochangetheirnames,pronounsandstyleofdresstomatchthegendertheyidentifywith. Sponsored LookingattheResearch Onereasonmanyresearchersbelieveit’sunnecessarytodelaythesocialtransitionofachildisthattheydon’tthinktheresearchondesistanceisvalid.Inotherwords,theythinkthenumberofchildrenwho"growoutof"theirtransgenderidentityhasbeenvastlyoverblown. 'TheonlyevidenceIhavefromstudiesandreportsintheliterature...isthatnotalltransgenderchildrenwillpersistintheirtransgenderidentity'ThomasSteensma,VUUniversityMedicalCenter,CenterofExpertiseonGenderDysphoria Thisschoolofthoughtholdsthatbecausethecriteriaforadiagnosisofgenderdysphoria(previouslycalledgenderidentitydisorder)waslessstringentinthepast,theearlierdesistancestudiesincludedalargecohortofchildrenwhotodaywouldnotbediagnosedwithgenderdysphoria,gayboyswhomayhavebeenexperimentingwithdifferentwaysofexpressinggenderbutwhowereneverreallytransgenderinthefirstplace. “Themethodologyofthosestudiesisveryflawed,becausetheydidn'tstudygenderidentity,”saidDianeEhrensaft,directorofmentalhealthatUCSF’sChildandAdolescentGenderClinic.“Thosedesistorswere,agoodmajorityofthem,simplyproto-gayboyswhoseparentswereupsetbecausetheywereboyswearingdresses.Theywerebroughttotheclinicsbecausetheyweren'tfittinggendernorms.” InAmsterdam,cliniciansattheCenterofExpertiseonGenderDysphoriaaremuchmorecautiousaboutrecommendingsocialtransitionsbecauseofthestatisticsondesistance.ThomasSteensma,aresearcherandclinicianatthecenter,acknowledges thesestudiesprobablyincludedsomekidswhowouldnotbediagnosedwithgenderdysphoriatoday.Nevertheless,despitetheproblemswiththewaytheyclassifiedchildren,"theonlyevidenceIhavefromstudiesandreportsintheliterature ...isthatnotalltransgenderchildrenwillpersistintheirtransgenderidentity,"Steensmasaid. 'Whyareweaskingachildtoconformtosomethingthatisnotthembecausesocietyhasn'tdoneitslearningyet?'DianeEhrensaft,UCSF In2013,Steensmaco-authoredanoft-citedstudythatexamined127adolescents,allofwhomhaddisplayedvariouslevelsofgenderdysphoriaaschildren.Theresearchersfoundthat80ofthechildrenhaddesistedbytheagesof15and16.Thatworksoutto63percentofkidswhobasicallystoppedbeingtransgender--alowerratethaninpreviousstudies,butstillamajority. Someclinicianscriticizethisstudy,however,onmethodologicalgrounds,becausetheresearchersdefinedanyonewhodidnotreturntotheirclinicasdesisting.Fifty-twoofthechildrenclassifiedasdesistorsortheirparentsdidsendbackquestionnairesshowingthesubjects'presentlackofgenderdysphoria.But28neitherrespondednorcouldbetrackeddown. “Youcan'tdothatinscientificstudies,”Ehrensaftsaid.“Youhavetohaveyoursubjectsinfrontofyouandknowwhotheyare.Youcan'tjustassumesomebodyisinacategorybecauseyoudon'tseethemanymore.” Inaddition,38ofthe127kidswereoriginallydesignated“subthreshold”forgenderidentitydisorder,meaningtheydidnotfulfillallthecriteriaformeetingtheofficialdiagnosis. This,accordingtoEricaAnderson,agenderclinicianatUCSF,makesthedesistancefindingsevenmoresuspect."[It]begsthequestionofwhetherthesekidswereactuallydivergent[intheirgenderidentity]beforethestudyselectedthem,”shesaid. Steensmastandsbythestudy’smethodology.Butinterestingly,headdedthatcitingthesefindingsasameasureofdesistanceiswrongheaded,becausethestudywasneverdesignedwiththatgoalinmind. “Providingthese[desistance]numberswillonlyleadtowrongconclusions,”hesaid. DianeEhrensaft,directorofmentalhealthatUCSF'sgenderclinic.(LaurenHanussak/KQED) Rather,hesays,theresearcherswantedtoseeiftheycouldfindpredictorsofpersistence.Whichtheydid:Thestudyfoundthattransgenderchildrenwhowereolder,bornfemale,andreportedmoreintensegenderdysphoriaweremorelikelytostickwiththeirtransgenderidentitythanyoungerchildren,natalboysandthosewithlesspronouncedgenderdysphorictraits. Steensmaandcolleaguesalsoculledoneveryspecificindicatoroffuturepersistence:Whenaskedwhentheywerechildren,“Areyouaboyoragirl?”thosewhoansweredtheoppositeoftheirbirthsexwerefoundmorelikelytohaveretainedtheirgenderidentityinadolescence.Thedesistors,ontheotherhand,tendedtomerelywishtheyweretheoppositesex. “(E)xplicitlyaskingchildrenwithGD(genderdysphoria)withwhichsextheyidentifyseemstobeofgreatvalueinpredictingafutureoutcomeforbothboysandgirlswithGD,”thestudysays. Today,Steensmacautionsthatthisquestionisnotalitmustestforwhichchildrenwillpersistintheirtransgenderidentity.Hebelievesthatgenderidentityinkidsisstilldeveloping,andthatit’sresponsivetowhatoccursatdifferentlifestages.Healsosaysit’spossiblethatasocialtransitioncouldleadtopersistencewhereitotherwisemightnothaveoccurred. “That'snotsomethingwecananswer,”hesaid.“It'ssomethingwehavetostudyandfindout.” ‘It’sTimetoTeachSociety’ Anothercontentioustopicinthetransgendercommunityiswhattheliteraturecalls“detransitioning,”orrevertingbacktoone'snatalgender. ThecurrentStandardsofCarewrittenbytheWorldProfessionalAssociationforTransgenderHealthcautionsthat“achangebacktotheoriginalgenderrolecanbehighlydistressing”Theguidelinesusethatassertionasareasontobecautiousaboutearlysocialtransitioning. Butthecautionarylanguage,Ehrensaftpointsout,isbasedononequalitativestudy,coauthoredbySteensma,whichlookedatthedilemmaofjusttwoDutchgirlswho’dtransitionedwhentheywereinelementaryschoolandwantedtoswitchback.Shedoesn’tthinkit’sparticularlyrelevant. “Thestress[ofdetransitioning]comesfrommicroaggressionsandlackofacceptanceintheenvironment,”shesaid.“Ifweoffersocialsupportandopportunitiesforchildrenovertime,wedon’thaveanyevidencethat[detransitioning]willbedamagingforthem.” Ehrensaftbelievestheconventionaltreatmentoftransgenderchildrenhasbeenbased,forthemostpart,ontraditionallynegativeviewsofgendernonconformity.So,she believes,theburdenisnowontheculturetoseetransgenderchildrenastheyreallyare. “Whyareweaskingachildtoconformtosomethingthatisnotthembecausesocietyhasn'tdoneitslearningyet?”shesays.“It'stimetoteachsociety.” TowardtheNonbinary OneofthemoreinterestingtakesIheardonpersistenceanddesistancecamefromUCSFgenderclinicianEricaAnderson,whoistransgenderherself.Sheviewstheverynotionofmeasuringpersistence/desistanceassomethingofafool’serrand,becausesuchdefinitionsaremediatedbychangingculturalnorms,theself-perceptionsofchildrenandthewaysthatresearchersinterpretthem. “We’vegotkidsofvaryingsophisticationlevelsoflanguagetryingtoexplaintootherpeoplewhohavenoexperience[beingtransgender],"Andersonsaid,"andit’sbeingdrivenbyshiftingprofessionalunderstandingorconsensusandculture.You’vegotmovingparts.Inthatcontextwe’vegotadynamicsituationwherekidswhomightsay‘I’magirl’mighthavesaidfiveyearsago‘maybeI’magirl.’” Ehrensaftherselfdoesn’tevenliketousethetermspersistenceanddesistance.Thosewordsimplysomethingfixed—abinarystateofyesorno.Butyoungergenerationsoftransgenderpeople—andevenyoungergenerationsinthegeneralpopulation—seegenderasmoreprotean,evencustomizable.Ofnearly28,000respondentstothe2015U.S.TransgenderSurvey,morethanone-thirdsaidtheyweresomeformofnonbinary.Thatmeanstheymayidentifyasbothmaleandfemale,neithermalenorfemale,orsometimesmale,sometimesfemale. Sponsored This,intheory,couldsolvealotofproblems.Afterall,ifthegenderfluiditytrendcontinues,perhapsmanypeoplewillhavenounitarygenderto"persist"or"desist"from. KQEDGetthebestofKQED’ssciencecoverageinyourinboxweekly.EnterEmailAddressSignUpSignedup.