Pre-teens

One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria.

One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria. Expand
One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria.

A British study [1] found that puberty blockers used to treat children aged 12 to 15 who have severe and persistent gender dysphoria had no significant effect on their psychological function, thoughts of self-harm, or body image.

However, as expected, the children experienced reduced growth in height and bone strength by the time they finished their treatment at age 16.

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]

Puberty blockers and cross-sex hormones negatively impact bone health in a significant number of cases.

Puberty blockers and cross-sex hormones negatively impact bone health in a significant number of cases. Expand
Puberty blockers and cross-sex hormones negatively impact bone health in a significant number of cases.

There is little long-term evidence on bone mass density in relation to puberty blockers. However, in a significant minority of cases of long-term puberty suppression related to gender identity, bone mass density scores qualify as “low for age” [1]. Low bone mass density increases risk of osteoporosis and fractures.

Adolescents who enter puberty at an older age have persistently lower bone mass density than their peers [2]: in one case study [3], an adolescent had a bone mass density -2 standard deviations below the mean after three years of blocking puberty.

It has also been noted [4] that:

In early-pubertal transgender youth, BMD [bone mass density] was lower than reference standards for sex designated at birth. This lower BMD may be explained, in part, by suboptimal calcium intake and decreased physical activity–potential targets for intervention.

Bone metabolism is also decreased as a result of taking cross-sex hormones, for both males and (in later life) females [5].

REFERENCES

[1] Biggs, M. (2021). Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria. Journal of Pediatric Endocrinology and Metabolism 34 (7): 937-939. [Link]

[2] Elhakeem, A., Frysz, M., Tilling, K., Tobias, J.H. & Lawlor, D.A. (2019). Association Between Age at Puberty and Bone Accrual From 10 to 25 Years of Age. JAMA Netw Open; 2(8). [Link]

[3] Pang, K.C., Notini, L., McDougall, R., Gillam, L., Savulescu, J., Wilkinson, D., Clark, B.A., Olson-Kennedy, J., Telfer, M.M. & Lantos, J.D. (2020). Long-term Puberty Suppression for a Nonbinary Teenager. Pediatrics 145 (2). [Link]

[4] Lee, J. Y., Finlayson, C., Olson-Kennedy, J., Garofalo, R., Chan, Y. M., Glidden, D. V., & Rosenthal, S. M. (2020). Low Bone Mineral Density in Early Pubertal Transgender/Gender Diverse Youth: Findings From the Trans Youth Care Study. Journal of the Endocrine Society 4 (9). [Link]

[5] Vlot, M.C., Wiepjes, C.M., de Jongh, R.T., T’Sjoen, G., Heijboer, A.C. & den Heijer, M. (2019). Gender-Affirming Hormone Treatment Decreases Bone Turnover in Transwomen and Older Transmen. J Bone Miner Res, 34: 1862-1872. [Link]

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]

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]

One study showed that, without social transition, nearly two-thirds of pre-teen gender-dysphoric males grow up to be gay or bisexual.

One study showed that, without social transition, nearly two-thirds of pre-teen gender-dysphoric males grow up to be gay or bisexual. Expand
One study showed that, without social transition, nearly two-thirds of pre-teen gender-dysphoric males grow up to be gay or bisexual.

A University of Toronto study [1] found that 63.6% of boys with early onset gender dysphoria, who received ‘watchful waiting’ treatment and no pre-pubertal social transition, grew up to be gay or bisexual. 

Only 12% of the study participants continued to identify as transfeminine. 

REFERENCES

[1] Singh, D., Bradley, S.J. & Zucker, K.J. (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychology 12. [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 adulthood homosexuality was 8 to 15 times higher for participants with a history of gender variance.

One study found that adulthood homosexuality was 8 to 15 times higher for participants with a history of gender variance. Expand
One study found that adulthood homosexuality was 8 to 15 times higher for participants with a history of gender variance.

In a 20-year follow-up [1] of children, it was found that adulthood homosexuality was 8 to 15 times higher for participants with a history of gender variance.

REFERENCES

[1] Steensma, T.D., van der Ende, J., Verhulst, F.C. & Cohen‐Kettenis, P.T. (2013). Gender Variance in Childhood and Sexual Orientation in Adulthood: A Prospective Study. J Sex Med 10 (11): 2723-2733. [Link]

According to a long-range study, around 6% of children in the population are gender variant.

According to a long-range study, around 6% of children in the population are gender variant. Expand
According to a long-range study, around 6% of children in the population are gender variant.

Epidemiological study [1] based on data from 1983-2007 shows that 6% of children in the population are gender variant.

REFERENCES

[1] Steensma, T.D., van der Ende, J., Verhulst, F.C. & Cohen‐Kettenis, P.T. (2013). Gender Variance in Childhood and Sexual Orientation in Adulthood: A Prospective Study. J Sex Med 10 (11): 2723-2733. [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]