Young children who transition to a new gender with social changes — adopting new names, pronouns, haircuts and clothing — are likely to 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 well-known effort that follows 317 children in the United States and Canada who went through the so-called social transition between the ages of 3 and 12. Participants transitioned, on average, at 6.5 years.
The vast majority of the group still identified with their new gender five years later, according to the study, and many had started taking hormonal drugs as teenagers to bring about biological changes that align with their gender identities. The study found that 2.5 percent of the group had re-identified as the gender they were assigned at birth.
As tension mounts in courts and state chambers across the country over proper health care for transgender children, there has been little hard data on their long-term development. The new study provides one of the first large data sets on this group. The researchers plan to continue to follow this cohort for 20 years after their social transitions begin.
“There’s this kind of idea that kids are going to start those things and change their minds,” said Kristina Olson, a Princeton University psychologist who led the study. “And at least in our sample, we’re not finding that.”
However, Dr. Olson and other researchers noted that the study may not generalize 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 provided sufficient support to facilitate full social transitions.
And because the study began nearly a decade ago, it’s unclear whether it reflects current patterns, when far more kids identify as trans. Two-thirds of the study participants were transgender girls who were assigned boys at birth. But in recent years, youth gender clinics around the world have reported a surge of adolescent patients assigned girls at birth who recently identified as trans or non-binary children.
This group also has a high rate of mental health problems, including autism and ADHD, noted Laura Edwards-Leeper, an Oregon clinical psychologist who specializes in caring for transgender children. “That’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,” added Dr. Edwards-Leeper. “It’s that different.”
Trans Youth Project researchers began recruiting participants in 2013 and traveled to more than 40 states and two Canadian provinces to interview families. Such detailed data is rare in this type of research, which is often obtained from online surveys or from children referred to gender-specific clinics, who are typically older and often from more limited geographic areas.
Previously published work from the project showed that children who were supported by their parents during social transitions were roughly equal to non-transgender children in terms of rates of depression, with slightly elevated rates of anxiety.
The new study, published in the journal Pediatrics, followed this cohort as they reached a milestone approximately five years after their initial social transitions. The study found that 94 percent of the group still identified as transgender five years later. Another 3.5 percent identified as non-binary, meaning they did not identify as boys or girls. That label wasn’t used as much when the researchers started the study as it is today.
At the end of the study period, in 2020, 60 percent of the boys had started taking hormones or drugs that block puberty. The researchers are still collecting data on how many of the adolescent participants had undergone gender surgeries, Dr. Olson said.
Eight children, or 2.5 percent, had reverted to the gender they were assigned at birth. Seven of them had socially transitioned before the age of 6 and re-transitioned before the age of 9. The eighth boy, at age 11, reverted after starting puberty-blocking drugs.
Research from the 1990s and 2000s had suggested that many children diagnosed with gender dysphoria or gender identity disorder (a psychological diagnosis that no longer exists) would resolve their gender difficulties after puberty, usually between the ages of 10 and 13. Some of those earlier studies have been criticized because the children’s doctors advised their parents to steer them away from a transgender identity.
In the decades since that work was done, social acceptance of gender diversity has grown, medical practice has changed, and the number of transgender children has increased significantly.
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For those reasons, it doesn’t make sense to compare the new study with previous research, said Russ Toomey, a 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 boys in the earlier studies were effeminate boys whose parents were upset by their behavior, they said. “Many of these children in these frequently cited early studies did not even label themselves or were labeled as transgender.”
The new study could suggest that transgender children, when supported by their parents, thrive in their identities. But it’s also possible that some of the kids who still identified as transgender at the end of the study, or their parents, felt pressure to continue down the path they started.
“I think depending on their 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 for Transgender Health standards of care chapter on children.
“Some people may say that children get on this developmental trajectory and can’t get out and that medical interventions can be irreversible and they can come to regret it,” he said. “Other people will say that children know their gender, and when they are supported in their gender, they are happy.”
While most doctors agree that social transitions can be helpful for some children who question their assigned gender, Dr. Tishelman said, it’s also important to support those who change their minds. “It’s really important that kids can continue to feel like it’s okay to be fluent, to continue to explore,” he said.
More data on the cohort as it progresses through adolescence could reveal how many boys choose to detransition after starting hormone therapy.
Dr. Olson said that her group would soon publish an additional qualitative study describing the experiences of the relatively small number of boys in the cohort who reverted to their original gender identity. These children did well, she said, when they received support from their families.
“In our work, we don’t just want to know what category they fit into today and tomorrow,” Dr. Olson said.
“I think of all these kids as being gender diverse in different ways,” he added, “and we want to understand how to help make their lives better.”