Few transgender children change their minds five years after transition, study finds

Young children who transition into a new gender with social changes — taking on new names, pronouns, haircuts and clothing — will likely continue to identify with that gender five years later, according to a report published Wednesday. , the first study of its kind.

The data comes from the Trans Youth Project, a renowned initiative that tracks 317 children in the United States and Canada who have gone through the so-called social transition between the ages of 3 and 12. Participants transitioned, on average, at six and a half years.

According to the study, the vast majority of the group still identified with their new gender five years later, and many began taking hormone medications in their teens to bring about biological changes to suit their gender identity. The study revealed that only 2.5% of participants re-identified as the gender they were assigned at birth.

As tension mounts in US courts and state legislatures over appropriate health care for transgender children, there is little hard data on their long-term development.

The new study provides one of the first large datasets on this group. The researchers intend to continue following the participants for 20 years after the beginning of their social transition.

“There’s a thesis that kids are going to start this thing and then change their minds,” said Kristina Olson, a psychologist at Princeton University who led the study. “And at least in our sample we’re not finding that.”

Olson and other researchers pointed out, however, that the study may not be generalizable to all transgender children. Two-thirds of participants were white, for example, and parents tended to have higher incomes and more education than the general population. All parents provided support to facilitate the full social transition.

As the study began nearly a decade ago, it’s unclear whether it reflects current patterns, when far more children identify as trans. Two-thirds of study participants were transgender girls who were assigned boys at birth.​

In recent years, however, gender clinics for youth around the world have reported an increase in adolescents assigned girls at birth who had recently been identified as trans or non-binary boys.

This group also has a high rate of mental health problems, including autism and ADHD (Attention Deficit Hyperactivity Disorder), noted Laura Edwards-Leeper, a clinical psychologist who specializes in caring for transgender children in Oregon. “It’s really the group I’m most concerned about right now,” she said.

“I would say this study tells us nothing about these children,” Edwards-Leeper added. “That’s the difference.”

Trans Youth Project researchers began recruiting participants in 2013, traveling to more than 40 US states and two Canadian provinces to interview families. Such in-depth data is rare in this type of research, which is usually obtained from online surveys or from children referred to gender clinics, who are generally older and from more limited geographic areas.

Previously published project work showed that children who were supported by their parents during social transition were roughly equal to cisgender children in terms of rates of depression, with slightly elevated rates of anxiety.

The new study, published in the journal Pediatrics, followed these children as they reached a milestone about five years after the initial social transition. The study found that 94% of the group still identified as transgender five years later. Another 3.5% were identified as non-binary, meaning they did not identify as boys or girls. That label wasn’t 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 how many adolescent participants underwent gender surgeries, Olson said.

Eight children, or 2.5%, reverted to the gender assigned to them at birth. Seven of them made the social transition before the age of six and returned before the age of nine. The eighth child, aged 11, reversed the process after starting to use puberty-blocking drugs.

The new study may suggest that transgender children, when supported by their parents, thrive on their identities. But it’s also possible that some children who still identified as transgender at the end of the study — or their parents — felt some pressure to continue down the path they started.

“I think, depending on perspective, people are likely to interpret this data differently,” said Amy Tishelman, a clinical psychologist at Boston College and lead author of the World Professional Association for Transgender Health’s chapter on child care standards.

“Some people might say that kids get on this developmental trajectory and can’t get out, and that medical interventions might be irreversible and they might regret it,” she said. “Other people will say that children know their gender, and when they are supported in their gender they are happy.”

While most clinicians agree that social transition can be helpful for some children who question their assigned gender, it’s also important to support those who change their minds, Tishelman said.

“It’s really important for kids to be able to keep feeling that it’s okay to be fluid, to keep exploring,” she said.

Translated by Luiz Roberto M. Gonçalves