Why do these Children and Adolescents Desist?

An investigation into desistance with trans children and youth.

Republished with permission from Jason’s substack.

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Background: The first main-stream experiment with children in what we now call “gender affirming care” occurred in The Netherlands in 2012. The team in the VU Hospital in Amsterdam started treating pre-pubescent boys diagnosed with Gender Dysphoria (GD) with Puberty Blockers (PB’s). The theory was that if puberty could be delayed, then these children would have time to receive therapeutic support to manage this distress. This is now known as the ‘Dutch Approach’. The first study started with just a few carefully selected boys, since then the numbers of children and youth treated on the gender pathway has avalanched.

Now the gender pathway refers to the treatment pathway for all children and youth who identify as Transgendered. The first step in the pathway is social affirmation which is the term often used when someone is affirming their identified gender in the social sphere. After this comes medical affirmation such as prescription of PB Hormones, then Cross Sex Hormones then gender affirming surgeries in order to alter their physical sexual characteristics to match their gender identity.

The premise behind these interventions is simple. These children and youth are born different, born not fitting into the binary sex or gender world around them, and thus need to be treated and supported in an appropriate manner to help manage the dysphoria and distress they experience. This premise is controversial however and is not universally accepted by society in general and health professionals in particular.

It is clear that the debate about the truths of Transgender Healthcare (TGH) is polarised and it is fought on a toxic battlefield (1). Some authors state that the science of the TGH field is well known and settled, (2) and that the ‘Trans-Critical’ activist creates confusion with the weaponizing of scientific-sounding language to dispute and challenge long established Transgender research (3). That the detractors that challenge the validity of Transgender research or TGH are dangerous, violent (4), and are spreading poisonous lies (5). Transphobic narratives and interruptions increase the likelihood of suicide (6), negatively affect other mental health issues such as body image and self-esteem (7, 8), binge drinking and drug use, overall health lifestyle, depression, anxiety, ADHD, and deliberate self-harm (9).

However trans-critical authors challenge the validity of the Transgender Ideology, which has been created by scholars with backgrounds in sociology, philosophy, law, literature or other humanities, but not in health. It is argued these ideologues regard access to gender affirming treatments as primarily a human rights issue, rather than a mental health clinical concern (10). Dr Hilary Cass who wrote the Cass Review which is “the most detailed, most thorough and most extensive review of the treatment of gender disturbance in children undertaken anywhere in the world at any time” (38). She states that there is a dearth of robust research regarding gender-affirming care, that the research is of disappointingly poor quality, built on shaky ground and is ideologically rather than scientifically based (11,12,13).

Every point or issue in this field seems to exist on a bed of conflict and emotive posturing. The existence, validity and relevance of Desistance is no different. One author (14) summed this up when he said “We can’t have an intelligent, informed discussion about these tricky issues if we’re going to ignore what is, at the moment, a solid scientific consensus (regarding Desistance).” It has also been said that “I have never encountered a movement (Transgenderism) that has spread so swiftly and successfully and has so fiercely rejected any challenge to its orthodoxy. The only thing more extraordinary than the rapid spread of this new orthodoxy is how little scrutiny it has faced, and the aggressive intolerance directed towards those who question it (15, 16).”

First of all, before we look at the differing views regarding Desistance, we need to define it. In the field of TGH, Desistance is defined as the natural resolution of gender-related distress typically during or after puberty, without medical or social intervention. And a change in gender identity from trans to cisgender along with the disappearance of the desire for medical intervention (17).

The ‘pro-trans’ narrative regarding Desistance states that once trans, always trans. That Desistance does not exist, that gender identity is immutable (18, 19, 20) and that any contradictory narrative is an example of a transphobic cis-dominant healthcare system which lacks accountability to trans communities (21), controls the economic environment (22), and “has systemic hierarchical barriers which need to be destroyed” (23). This narrative insists that trans children and adolescents will go on to be trans adults (24). This is the notion at the very heart of the ethical justification of social and medical affirmation (the gender pathway).

The trans-critical narrative states that “adolescents do desist” and that this is scientifically supported (25, 26, 27, 14, 39) and that if not ‘treated’ in a gender pathway, desistance will occur in most patients (28, 29, 30, 31). On this point even the authors of the ‘Dutch Protocol’ agree, saying it is ‘rare’ for a child to stay identifying as trans in post puberty (32). One 2023 study states this (55) even more absolutely that, “GD (Gender Dysphoria) is not a permanent diagnosis.” Another author (33) states that if a 4 per cent (current) prevalence of GD in children falls to 0.002 per cent in adults (as seen in their study), it means, mathematically, that over 99 per cent will “desist” from transitioning and revert to natal sex before adulthood as a natural process of life. Only a tiny minority would “persist” in their GD. Different researchers have recorded different rates of Desistance. One states 94% continued on to identify as binary gender (34). One of the lowest Desistance rates was about two thirds (37).

Why do these children and adolescents desist?

There is such a lot unknown about this field. “The etiology of gender incongruence remains unknown” (48), but some of the reasons these individuals desist are known.

1. Many researchers state that the majority of trans children desist and end up identifying as gay or bi-sexual as youth or young adults (35, 36, 39). So, when stating that they have GD and are trans, it appears they actually are in the process of discovering they are same sex attracted.

2. Social contagion appears to play a significant role and it is very common to see GD develop within friendship groups, which is statistically unusual and unlikely to be occurring spontaneously (40, 41, 42, 43, 44, 45, 46, 47).

3. A Fad: John Whitehall who is Foundation Chair and Professor of Paediatrics and Child Health at the University of Western Sydney states that Transgenderism has the hallmarks of a psychological fad, fanned by an uncritical, sensationalist media, given direction by private websites and even government funded programmes of ‘education’ (48). And with all fads, people grow out of it.

4. Co-Morbidity. “A large proportion of adolescents with GD have a substantial concomitant history of psychosocial and psychological vulnerability…” (49). Over 70% of young people diagnosed with GD had at least one other psychiatric diagnosis (67% of males and 76% of females). In order of decreasing frequency, co-morbid diagnoses were depressive disorders, anxiety disorders, borderline personality disorders, attention deficit/hyperactivity disorder, and post-traumatic stress disorders. (50). They were described as presenting with multiple co-morbidities and complex backgrounds (51). When these co-morbid problems are addressed, desistance is very common.

5. GD can be related to the typical discomfort/distress often experienced in puberty. The merits of the treatment used to delay the onset of puberty had been “oversold” and there was “very limited” evidence they were of use (52). Fortunately most children with GD as they get used to living in their new bodies will not remain gender dysphoric post puberty (53).

6. One study went into more detail about desisting (55). The factor with the highest rating of importance regarding Desistance was the participant’s “own thought processes” changed.

7. That “feeling that the causes for [their] gender dysphoria were more complicated than [they] previously understood them to be.”

8. And the participant’s “personal definition of ‘female’ and ‘male’ changed and [they] now felt comfortable identifying as natal sex”.

9. The authors noted that factors that might be described as ‘external pressures’ to desist or detransition obtained the lowest ratings of importance scores from these individuals. Including…

A. Transphobia or discrimination while transgender identified.

B. Pressure from family.

C. Religion or religious beliefs.

D. Peer pressure.

10. Some studies (56, 57) state that participants in gender research may feel disappointed that the results of their medical transition (e.g., hormone therapy or surgeries) do not align with their expectations, leading to disengagement and Desistance.

11. Some participants in this study (57) reported that they no longer felt that their gender dysphoria was alleviated by treatments like hormone therapy or surgery, leading to discontinuation of follow-up participation and Desistance.

12. Some participants expressed concerns about the long-term health impacts (57) of gender-affirming treatments, leading to discontinuation of these treatments and follow-up study participation.

13. Distrust in healthcare providers or dissatisfaction with the quality of care were mentioned as barriers to continued participation in follow-up studies (57).

While it seems clear that Desistance is typical with children or youth with GD this is only when they have not been socially and medically affirmed. If they are directed down the gender pathway this significantly increases the permanence of the GD (54).Unfortunately this pathway remains that endorsed by Clinical Health services.