According to a report published on Wednesday, the first study of its kind.
The data comes from the Trans Youth Project, a well-known effort that tracked 317 children across the United States and Canada who underwent a so-called social transition between the ages of 3 and 12. Participants made the transition, on average, at age 6.5.
The vast majority of the group still identified with their new gender five years later, the study found, and many had started hormone medication as teenagers to bring about biological changes to align with their gender identity. The study found that 2.5% of the group reverted to identifying the sex they had been assigned at birth.
As tension mounts in courtrooms and statehouses across the country over proper health care for transgender children, there is little hard data to back up on their long-term development. term. The new study provides one of the first large sets of data on this group. The researchers plan to continue following this cohort for 20 years later their social transitions have begun.
“There’s this kind of idea that kids are going to start these things and they’re going to change their minds,” said Kristina Olson, a psychologist at Princeton University who led the study. “And at least in our sample, we don’t find that.”
Dr. Olson and other researchers cautioned, however, that the study may not be generalized to all transgender children. Two-thirds of the participants were white, for example, and the parents tended to have higher incomes and more education than the general population. All parents were supportive enough to facilitate complete social transitions.
And because the study began nearly a decade ago, it’s unclear whether it reflects trends today, as many more children identify as trans. Two-thirds of the study participants were transgender girls who were assigned boys at birth. But in recent years, gender clinics for young people around the world reported a swell adolescent patients assigned girls at birth who had recently identified as trans or non-binary boys.
This group also has a high rate of mental health problems, including autism and ADHD, noted Laura Edwards-Leeper, a clinical psychologist from Oregon who specializes in the care of transgender children. “It’s really the group that worries me the most these days,” she said.
“I would say that this study tells us nothing about these children,” Dr. Edwards-Leeper added. “It’s just so different.”
Trans Youth Project researchers began recruiting participants in 2013, traveling to more than 40 states and two Canadian provinces to interview families. Such in-depth data is rare in this type of research, which often comes from online surveys or from children referred to gender-specific clinics, who are typically older and often from more limited geographies.
Previously published work of the project showed that children who were supported by their parents during social transitions were roughly equal to non-transgender children in terms of depression rates, with slightly elevated anxiety rates.
The new study, published in the journal Pediatrics, followed this cohort as they reached a milestone about five years into their initial social transitions. The study found that 94% of the group still identified as transgender five years later. Another 3.5% identified as non-binary, meaning they did not identify as a boy or a girl. This label was not as widely used when the researchers began the study as it is today.
By the end of the study period in 2020, 60% of children had started taking puberty-blocking drugs or hormones. Researchers are still collecting data on the number of teens who have had sex surgeries, Dr. Olson said.
Eight children, or 2.5%, had reverted to the sex assigned to them at birth. Seven of them had made a social transition before the age of 6 and had returned before the age of 9. The eighth child, 11, regressed after starting puberty-blocking drugs.
To research of 1990s and 2000s had suggested that many children diagnosed with gender identity disorder (a psychological diagnosis that no longer exists) would resolve their gender difficulties after puberty, usually by 10 to 13 years old. Some of these earlier studies have been criticized because children’s doctors advised their parents to distance them from a transgender identity.
In the decades since this work, societal acceptance of gender diversity has grown, medical practice has changed, and the number of transgender children has increased dramatically.
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For those reasons, it doesn’t make sense to compare the new study with older research, said Russ Toomey, professor of family studies and human development at the University of Arizona.
“It’s really comparing apples to oranges,” Dr. Toomey said. Many of the children in previous studies were effeminate boys whose parents were upset by their behavior, they said. “Many of these children in these early studies that are frequently cited never even labeled themselves or were labeled as transgender.”
The new study may suggest that transgender children, when supported by their parents, thrive in their identity. But it’s also possible that some of the children who still identified as transgender at the end of the study — or their parents — felt pressure to continue on the path they started.
“I think depending on your perspective, people will probably interpret this data differently,” said Amy Tishelman, a clinical psychologist at Boston College and lead author of the World Professional Association of Transgender Health’s standards of care chapter on children. .
“Some people may say that children follow this developmental trajectory and they can’t get out of it and that medical interventions can be irreversible and they may come to regret it,” she said. . “Other people will say that kids know their gender, and when they’re supported in their gender, they’re happy.”
While most clinicians agree that social transitions can be helpful for some children who are questioning their gender, Dr. Tishelman said, it’s also important to support those who change their minds. “It’s really, really important that kids can continue to feel good about being free-flowing, continuing to explore,” she said.
More data on the cohort as it continues through adolescence could reveal how many children choose to detransition after starting hormone therapy.
Dr Olson said his group would soon publish an additional qualitative study describing the experiences of the relatively small number of children in the cohort who reverted to their original gender identity. These children did well, she said, when supported by their families.
“In our work, we don’t just want to know what category they are in today versus tomorrow,” Dr. Olson said.
“I think all of these kids are gender diverse in different ways,” she added, “and we want to figure out how to help their lives be better.”