Teenagers

Puberty blockers are more than a ‘pause button’: roughly 98% of children who take them go on to take cross-sex hormones.

Puberty blockers are more than a ‘pause button’: roughly 98% of children who take them go on to take cross-sex hormones. Expand
Puberty blockers are more than a ‘pause button’: roughly 98% of children who take them go on to take cross-sex hormones.

A 2021 study from the UK [1] found that only 1 out of 44 children placed on puberty blockers did not continue to take cross-sex hormones.

Similarly, a Dutch study [2] reported that only 1.9% of adolescents who started puberty suppression treatment abandoned this course and did not take cross-sex hormones.

In fact, in a different Dutch study [3], “[n]o adolescent withdrew from puberty suppression, and all started cross‐sex hormone treatment, the first step of actual gender reassignment.”

Puberty blockers are drugs which change young bodies in ways we have yet to understand, and may be permanent. This is an experimental treatment program: puberty blockers have never been licensed to treat children with gender dysphoria, in any country.

REFERENCES

[1] Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., Skageberg, E. M., Khadr, S., & Viner, R. M. (2021). Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLOS ONE 16 (2). [Link]

[2] Wiepjes, C.M., Nota, N.M., de Blok, C.J.M., Klaver, M., de Vries, A.L.C., Wensing-Kruger, S.A., de Jongh, R.T., Bouman, M.B., Steensma, T.D., Cohen-Kettenis, P., Gooren, L.J.G., Kreukels, B.P.C. & den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. Journal of Sexual Medicine 15 (4). [Link]

[3] de Vries, A.L.C., Steensma, T.D., Doreleijers, T.A. & Cohen-Kettenis, P.T. (2011). Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 8 (8): 2276-83. [Link]

Young people who desist from a trans identity are disproportionately likely to grow up to be non-heterosexual.

Young people who desist from a trans identity are disproportionately likely to grow up to be non-heterosexual. Expand
Young people who desist from a trans identity are disproportionately likely to grow up to be non-heterosexual.

A Dutch paper [1] notes that, for gender dysphoric children, the more likely psychosexual outcome in adulthood is a homosexual sexual orientation without gender dysphoria.

Evidence [2] suggests that many boys whose childhood gender dysphoria recedes with puberty will grow up to be bisexual or homosexual. Another study of males [3] indicates that bisexual/homosexual orientation is far greater than base rates in the general male population, with 63.6% of boys with gender identity disorder being same-sex attracted.

This suggests that a non-heterosexual orientation is particularly likely among gender dysphoric boys.

REFERENCES

[1] Wallien, M.S. & Cohen-Kettenis P.T. (2008) Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47 (12): 1413-23. [Link]

[2] Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link]

[3] Singh, D. (2012). A follow-up study of boys with gender identity disorder. Doctoral thesis, University of Toronto. [Link]

Gender-related distress will alleviate for around 80% of pre-teen children once they become teenagers.

Gender-related distress will alleviate for around 80% of pre-teen children once they become teenagers. Expand
Gender-related distress will alleviate for around 80% of pre-teen children once they become teenagers.

Evidence from 10 available prospective follow-up studies [1] from childhood to adolescence indicates that childhood gender dysphoria will recede with puberty in ~80% of cases. A Dutch paper [2] notes that follow-up studies show the persistence rate of gender identity disorder to be about 15.8%, or 39 out of the 246 children who were reported on in the literature.

In one study [3] of 54 children referred to a clinic in childhood because of gender dysphoria and then later investigated by a follow-up study, only 21 (39%) still had gender dysphoria.

A different study [4] of Canadian boys with gender identity disorder showed that 87.8% desisted, with only 12.2% — fewer than 1 in 8 — persisting in their transgender identity.

An ~80% desistance is not universally found [5]. Thorough investigations of the claims and counter-claims appear in two 2018 studies [6, 7].

REFERENCES

[1] Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link]

[2] Steensma, T.D. & Cohen-Kettenis, P.T. (2011). Gender Transitioning before Puberty? Archives of Sexual Behavior 40 (4): 649-50. [Link]

[3] Wallien, M.S. & Cohen-Kettenis P.T. (2008) Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47 (12): 1413-23. [Link]

[4] Singh, D., Bradley, S.J. & Zucker, K.J. (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychology 12. [Link]

[5] Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M., Jamieson, A., & Picket, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender non-conforming children. International Journal of Transgenderism 19 (2). [Link]

[6] Steensma, T.D. & Cohen-Kettenis, P.T. (2018). A critical commentary on “A critical commentary on follow-up studies and “desistence” theories about transgender and gender non-conforming children”. International Journal of Transgenderism. [Link]

[7] Zucker, K. J. (2018). The myth of persistence. International Journal of Transgenderism 19 (2): 231-45. [Link]

Studies on gender dysphoric young people often suffer from high rates of loss to follow-up – which could skew transition satisfaction rates.

Studies on gender dysphoric young people often suffer from high rates of loss to follow-up – which could skew transition satisfaction rates. Expand
Studies on gender dysphoric young people often suffer from high rates of loss to follow-up – which could skew transition satisfaction rates.

In one study [1] of 77 pre-teen participants, 30% were lost to follow up by their teenage years: either they did not respond to the recruiting letter, or were not traceable. In another study [2], as many as 75% of participants were lost to follow up.

An excellent précis of this problem can be found in a 2018 paper [3], which gives further detail:

Smith et al. report that sex reassignment is effective, based on a study of 162 adults who had undergone SRS. They were able to obtain follow-up data from only 126 (78%) of subjects because a significant number were “untraceable” or had moved abroad.

De Cuypere et al. report that sex reassignment surgery is an effective treatment for transsexuals. Of 107 patients who had undergone SRS between 1986 and 2001, 30 (28%) could not be contacted and 15 (14%) refused to participate.

Johannson et al. reported good outcomes for SRS. Of 60 patients who had undergone SRS, 42 (70%) agreed to participate in the follow up research. Of the non-participants, 1 had died of complications of SRS, 8 could not be contacted and 9 refused to participate.

Salvador et al. reported that SRS has a positive effect on psychosocial functioning. Only 55 of the 69 patients (80%) could be contacted as 17 were lost to follow-up

Van de Grift et al. reported 94–96% of patients are satisfied with SRS and have good quality of life. A total of 546 patients with Gender Dysphoria who had applied for SRS at clinics in Amsterdam, Hamburg and Ghent were contacted to complete an online survey. Only 201 (37%) responded and completed the survey. 

A good example of how this phenomenon can affect satisfaction and regret statistics comes from a 2018 paper [4], which is often cited as proof of low regret rates. The loss to follow up rate in this paper is 36%. The authors also state:

In addition, in our population the average time to regret was 130 months, so it might be too early to examine regret rates in people who started with HT [hormonal treatment] in the past 10 years.

REFERENCES

[1] Wallien, M.S. & Cohen-Kettenis P.T. (2008) Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47 (12): 1413-23. [Link]

[2] Rauchfleisch, U., Barth, D. & Battegay, R. (1998). Resultate einer Langzeitkatamnese von Transsexuellen. Der Nervenzart 69: 799-805. [Link]

[3] D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry 26 (5): 460-463. [Link]

[4] Wiepjes, C.M., Nota, N.M., de Blok, C.J.M., Klaver, M., de Vries, A.L.C., Wensing-Kruger, S.A., de Jongh, R.T., Bouman, M.B., Steensma, T.D., Cohen-Kettenis, P., Gooren, L.J.G., Kreukels, B.P.C. & den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. Journal of Sexual Medicine 15 (4). [Link]

One study found that, in almost two-thirds of cases, internet and social media usage seemed to go up just before a young person came out as trans.

One study found that, in almost two-thirds of cases, internet and social media usage seemed to go up just before a young person came out as trans. Expand
One study found that, in almost two-thirds of cases, internet and social media usage seemed to go up just before a young person came out as trans.

Lisa Littman’s 2018 study [1] found that 63.5% of adolescents and young adults who came out as trans seemed to exhibit an increase in their internet and social media usage before coming out.

REFERENCES

[1] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

One study showed that, in 36.8% of trans-identifying young people’s friendship groups, the majority of members identified as trans.

One study showed that, in 36.8% of trans-identifying young people’s friendship groups, the majority of members identified as trans. Expand
One study showed that, in 36.8% of trans-identifying young people’s friendship groups, the majority of members identified as trans.

Lisa Littman’s 2018 study [1] investigated the role of friendship groups in transgender identification, and found that the majority of the members in the friendship group became transgender-identified in 36.8% of cases – almost 2 in 5.

REFERENCES

[1] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

In one study, two thirds of trans-identifying young people had one or more friends who were also trans.

In one study, two thirds of trans-identifying young people had one or more friends who were also trans. Expand
In one study, two thirds of trans-identifying young people had one or more friends who were also trans.

Lisa Littman’s 2018 study [1] found that 66.8% of adolescents and young adults who identified as trans belonged to a friend group where at least one other person became gender dysphoric and came out as transgender.

REFERENCES

[1] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

In one study, almost 9 in 10 young people questioning their gender appear seemed to be subject to social influence.

In one study, almost 9 in 10 young people questioning their gender seemed to be subject to social influence. Expand
In one study, almost 9 in 10 young people questioning their gender appear seemed to be subject to social influence.

86.7% of the young people in Lisa Littman’s 2018 study [1] belonged to a friend group where one or more friends came out as trans at the same time, and/or had an increase in their use of social media.

Social contagion – the involuntary “catching” of behaviors and attitudes across connected individuals [2] – is a well-accepted phenomenon in psychological literature [3]. It is well-documented that adolescents — and females in particular — are prone to social contagion effects, from cutting [4] to eating disorders [5]. Social network analyses suggest that peer contagion underlies the influence of friendship on obesity, unhealthy body images, and expectations [6].

REFERENCES

[1] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

[2] Levy, D. A., & Nail, P. R. (1993). Contagion: A theoretical and empirical review and reconceptualization. Genetic, Social, and General Psychology Monographs 119 (2): 233-284. [Link]

[3] Burgess, L.G., Riddell, P.M., Fancourt, A. & Murayama, K. (2018). The Influence of Social Contagion Within Education: A Motivational Perspective. Mind, Brain, and Education 12: 164-174. [Link]

[4] Hermansson-Webb, E. B. (2014). ‘With Friends Like These…’: The Social Contagion of Non-Suicidal Self-Injury Amongst Adolescent Females. Thesis, Doctor of Philosophy: University of Otago. [Link]

[5] Allison, S., Warin, M. & Bastiampillai, T. (2013). Anorexia nervosa and social contagion: Clinical implications. Australian and New Zealand Journal of Psychiatry 48 (2): 116-120. [Link]

[6] Dishion, T. J., & Tipsord, J. M. (2011). Peer contagion in child and adolescent social and emotional development. Annual review of psychology 62: 189–214. [Link]

Between 2007 and 2017, the number of transgender youth clinics in the US went from 1 to at least 41 – and the number continues to increase.

Between 2007 and 2017, the number of transgender youth clinics in the US went from 1 to at least 41 – and the number continues to increase. Expand
Between 2007 and 2017, the number of transgender youth clinics in the US went from 1 to at least 41 – and the number continues to increase.

A 2017 paper [1] notes that

The first transgender youth clinic in the United States opened in Boston in 2007. Since then, 40 other clinics have opened that cater exclusively to children, with new clinic openings being announced frequently.

REFERENCES

[1] Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives 60 (3): 345-366. [Link]

The profile of people seeking transition has shifted drastically, from overwhelmingly middle-aged males to predominantly adolescent females.

The profile of people seeking transition has shifted drastically, from overwhelmingly middle-aged males to predominantly adolescent females. Expand
The profile of people seeking transition has shifted drastically, from overwhelmingly middle-aged males to predominantly adolescent females.

A 2017 paper [1] notes that “in adolescents, there has been a recent inversion in the sex ratio from one favouring birth-assigned males to one favouring birth-assigned females.” By contrast, over 90% of transsexual adults in the 1960s were male [2].

In fact, there was hardly any scientific literature before 2012 on girls ages 11 to 21 ever having developed gender dysphoria at all. Yet of the young people described in Lisa Littman’s 2018 seminal paper on young people [3], 82.8% were female.

The data for the UK’s Gender Identity Development Service [4] show that 138 children were referred in 2011, and most of those children were boys. By 2021, however, a complete sex ratio reversal had occurred, and the clinic saw 2383 children that year, with almost 70% being female.

A 2017 article by Lisa Marchiano [5] collated data from different clinics around the world and found international evidence for this shift in distribution.

REFERENCES

[1] Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health 14 (5): 404-411. [Link]

[2] Barrett, J. (2015). Written evidence submitted by British Association of Gender Identity Specialists to the Transgender Equality Inquiry. data.parliament.uk [Link]

[3] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

[4] Gender Identity Development Service (2021). Referrals to GIDS, financial years 2010-11 to 2020-21. [Link]

[5] Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives 60 (3): 345-366. [Link]

The District of Columbia has three and a half times more people who identify as trans than any State in the US, per head of the population.

The District of Columbia has three and a half times more people who identify as trans than any State in the US, per head of the population. Expand
The District of Columbia has three and a half times more people who identify as trans than any State in the US, per head of the population.

A Williams Institute survey [1] found that 2.77% of the population of DC identified as trans – more than three and a half times as many as Hawaii, which (at 0.78%) had the highest proportion of trans people of all fifty States.

REFERENCES

[1] Flores, A.R., Herman, J. L.; Gates, G. J. & Brown, T.N.T. (2016). How many people are lesbian, gay, bisexual, and transgender? Los Angeles, CA: The Williams Institute. [Link]

In 2018, one study noted that the estimated number of young people who identified as transgender ranged between 0.17% and 1.3%.

In 2018, one study noted that the estimated number of young people who identified as transgender ranged between 0.17% and 1.3%. Expand
In 2018, one study noted that the estimated number of young people who identified as transgender ranged between 0.17% and 1.3%.

A 2018 paper [1] presented the results of North American studies using short (one to three item) self-reports of gender identity and its variance. The studies suggested that 0.17%–1.3% of adolescents and young adults identified as transgender.

Statistics for the transgender population are almost impossible to quantify as different definitions are used to describe the term ”transgender”. We have chosen this study for its reliability and its reasonable understanding of the term “transgender” in the twenty-first century.

REFERENCES

[1] Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link]

There has been a roughly twenty-fold rise in the number of people seeking transition, with teenagers hugely over-represented.

There has been a roughly twenty-fold rise in the number of people seeking transition, with teenagers hugely over-represented. Expand
There has been a roughly twenty-fold rise in the number of people seeking transition, with teenagers hugely over-represented.

A 2017 paper [1] reports that “the prevalence of a self-reported transgender identity in children, adolescents and adults ranges from 0.5 to 1.3%, markedly higher than prevalence rates based on clinic-referred samples of adults.”

This is reflected in data from gender clinics. The UK’s Gender Identity Development Service reported [2] a twenty-fold increase in referrals over the course of the last decade:

This surge was primarily driven by adolescents, with 15 being the most common age of referral:

Similarly, a Dutch gender identity clinic reported [3] a twenty-fold increase, albeit over a longer time span: from 34 in 1980 to 686 in 2015:

New Zealand [4], Finland [5] and Canada [6] have recorded similar dramatic exponential increases.

REFERENCES

[1] Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health 14 (5): 404-411. [Link]

[2] Gender Identity Development Service (2021). Referrals to GIDS, financial years 2010-11 to 2020-21. [Link]

[3] Wiepjes, C.M., Nota, N.M., de Blok, C.J.M., Klaver, M., de Vries, A.L.C., Wensing-Kruger, S.A., de Jongh, R.T., Bouman, M.B., Steensma, T.D., Cohen-Kettenis, P., Gooren, L.J.G., Kreukels, B.P.C. & den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. Journal of Sexual Medicine 15 (4). [Link]

[4] Delahunt, J.W., Denison, H.J., Sim, D.A., Bullock, J.J. & Krebs, J.D. (2018). Increasing rates of people identifying as transgender presenting to Endocrine Services in the Wellington region. N Z Med J 131: 33-42. [Link]

[5] Kaltiala-Heino, R., Sumia, M., Työläjärvi, M. & Lindberg, N. (2015). Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health 9 (1). [Link]

[6] Aitken, M., Steensma, T.D., Blanchard, R., VanderLaan, D.P., Wood, H., Fuentes, A., Spegg, C., Wasserman, L., Ames, M., Fitzsimmons, C.L., Leef, J.H., Lishak, V., Reim, E., Takagi, A., Vinik, J., Wreford, J., Cohen-Kettenis, P.T., de Vries, A.L., Kreukels, B.P. & Zucker, K.J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J Sex Med 12 (3): 756-63. [Link]