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debunking-desistance [2025/12/29 02:02] – created valahdebunking-desistance [2025/12/29 15:50] (current) – [What Modern Research Actually Shows] valah
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 ==== The Transmisic Narrative ==== ==== The Transmisic Narrative ====
  
-**Claim 1:** "Studies show that 60-90% of transgender children 'desist'—stop identifying as transgender."+**Claim 1:** "Studies show that 60-90% of transgender children 'desist'—stop identifying as transgender." [(des1)]
  
-**Claim 2:** "Most kids who think they're trans are actually just gender-nonconforming or going through a phase."+**Claim 2:** "Most kids who think they're trans are actually just gender-nonconforming or going through a phase." [(des2)]
  
-**Claim 3:** "The high desistance rates prove that we shouldn't affirm young people's gender identities."+**Claim 3:** "The high desistance rates prove that we shouldn't affirm young people's gender identities." [(des3)]
  
 Any claim suggesting: Any claim suggesting:
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 ==== What "Desistance" Studies Actually Measured ==== ==== What "Desistance" Studies Actually Measured ====
  
-**The critical problem:** The studies cited to support "high desistance rates" did not study transgender children or measure persistence of gender dysphoria. They studied something fundamentally different.+**The critical problem:** The studies cited to support "high desistance rates" did not study transgender children or measure persistence of gender dysphoria. They studied something fundamentally different. [(des4)]
  
-**What the early studies actually examined:** [[#cite-1|Earlier research]] recruited children who showed "gender-variant behavior" — not necessarily children with persistent gender dysphoria. [[#cite-2|These studies]] classified gender identities using initial visit data, which displayed signs of gender identification and preferences, along with parent-reported cross-gender preferences.+**What the early studies actually examined:** Earlier research recruited children who showed "gender-variant behavior"—not necessarily children with persistent gender dysphoria. [(des5)] These studies classified gender identities using initial visit data, which displayed signs of gender identification and preferences, along with parent-reported cross-gender preferences. [(des6)]
  
 **The distinction matters enormously:** **The distinction matters enormously:**
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   * **Gender identity** = one's internal sense of gender   * **Gender identity** = one's internal sense of gender
  
-These are **not the same thing.** [[#cite-3|Research confirms]] this critical difference.+These are **not the same thing.** [(des7)] 
  
  
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 **The actual finding from desistance studies:** **The actual finding from desistance studies:**
  
-**Most children in these studies were NOT persistently dysphoric in the first place.** [[#cite-4|Research shows]that fewer than 17% of participants met DSM-5 diagnostic criteria for Gender Dysphoria in Childhood. [[#cite-5|Boys clinic-referred]] for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation.+**Most children in these studies were NOT persistently dysphoric in the first place.** [(des8)Fewer than 17% of participants met DSM-5 diagnostic criteria for Gender Dysphoria in Childhood. [(des9)] Boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation. [(des10)]
  
-**Translation:** 83% of children in these studies didn't meet modern diagnostic criteria for gender dysphoria. They were gender-nonconforming children, many of whom later identified as gay or lesbian. +**Translation:** 83% of children in these studies didn't meet modern diagnostic criteria for gender dysphoria. They were gender-nonconforming children, many of whom later identified as gay or lesbian.
  
-**The studies were predicting sexual orientation, not gender identity persistence.**+**The studies were predicting sexual orientation, not gender identity persistence.** [(des11)]
  
  
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 **Even within the desistance studies themselves, there is clear evidence contradicting this:** **Even within the desistance studies themselves, there is clear evidence contradicting this:**
  
-**"Intensity of early GD appears to be an important predictor of persistence of GD."** [[#cite-6|(Steensma et al., 2013)]]+**"Intensity of early GD appears to be an important predictor of persistence of GD."** [(des12)]
  
-**What this actually means:** Children with stronger, more persistent gender dysphoria were more likely to maintain their gender identity into adulthood. [[#cite-7|The same study]] also found a link between the intensity of GD in childhood and persistence of GD, as well as a higher probability of persistence among natal girls.+**What this actually means:** Children with stronger, more persistent gender dysphoria were more likely to maintain their gender identity into adulthood. [(des13)]
  
 **The contrast is striking:** **The contrast is striking:**
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   * **Persisters:** Had significantly higher intensity of dysphoria and gender-variant behavior   * **Persisters:** Had significantly higher intensity of dysphoria and gender-variant behavior
  
-If you examine the actual data: [[#cite-8|"Of the 67 boys who had not socially transitioned, only 13 (19.4%) were classified as persisters."]] But this doesn't mean desistance is inevitable—it shows what happens when dysphoric children aren't socially affirmed.+If you examine the actual data: **"Of the 67 boys who had not socially transitioned, only 13 (19.4%) were classified as persisters."** [(des14)] But this doesn't mean desistance is inevitable—it shows what happens when dysphoric children aren't socially affirmed.
  
  
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 This is where the desistance narrative completely falls apart. This is where the desistance narrative completely falls apart.
  
-**The actual Steensma finding:** [[#cite-9|Research]] indicated that social transition is the most powerful predictor of persistence of childhood gender dysphoria.+**The actual Steensma finding:** "Formerly nonsignificant and unstudied factors (a cognitive and/or affective cross-gender identification and a social role transition) were associated with the persistence of childhood GD." [(des15)]
  
-**This is the opposite of what opponents claim.** Social transition—not medicalization, not puberty blockers—is the strongest factor predicting persistence. [[#cite-10|The same study]] found that formerly nonsignificant factors (a cognitive and/or affective cross-gender identification and a social role transition) were associated with the persistence of childhood GD, and varied among natal boys and girls. +**This is the opposite of what opponents claim.** Social transition—not medicalization, not puberty blockers—is the strongest factor predicting persistence. The desistance studies show that **social affirmation strengthens gender identity persistence**, not weakens it. [(des16)]
- +
-The desistance studies show that **social affirmation strengthens gender identity persistence**, not weakens it.+
  
  
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 **The Trans Youth Project provides the most rigorous modern data:** **The Trans Youth Project provides the most rigorous modern data:**
  
-**[[#cite-11|"No hormonal or surgical interventions are involved in transitions at this young age."]]** This is crucial: the high persistence rates occurred **without puberty blockers or hormones**.+**"No hormonal or surgical interventions are involved in transitions at this young age."** [(des17)] This is crucial: the high persistence rates occurred **without puberty blockers or hormones**.
  
-**The actual finding:** [[#cite-12|"We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once."]]+**The actual finding:** "An average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once." [(des18)]
  
-**This means: 92.7% of socially transitioned youth maintained their gender identity 5 years later.**+**This means: 92.7% of socially transitioned youth maintained their gender identity 5 years later.** [(des19)]
  
 **Compare the populations:** **Compare the populations:**
  
-Population Time Period Dysphoria Criteria Socially Transitioned Persistence Rate +Population Time Period Dysphoria Criteria Socially Transitioned Persistence Rate ^
-|---|---|---|---|---|+
 | **Early desistance studies** | 1970s-1990s | DSM-III/IV (no distress requirement) | No | ~20% | | **Early desistance studies** | 1970s-1990s | DSM-III/IV (no distress requirement) | No | ~20% |
 | **Trans Youth Project** | 2010s-2020s | Modern standards | Yes | 92.7% | | **Trans Youth Project** | 2010s-2020s | Modern standards | Yes | 92.7% |
  
-The difference isn't methodology—it's the population being studied.+The difference isn't methodology—it's the population being studied. [(des20)] 
  
---- 
  
 ===== Myth 5: "Desistance Concept Is Valid" ===== ===== Myth 5: "Desistance Concept Is Valid" =====
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 ==== What Recent Scholarship Shows ==== ==== What Recent Scholarship Shows ====
  
-**A 2024 systematic review concluded the opposite:**+**A recent systematic review concluded the opposite:**
  
-**"Desistance should no longer be used in clinical work or research."** [[#cite-13|Research shows]] that desistance is a concept that has been poorly defined in the literature, yet greatly impacts the arguments for and against providing gender-affirming care.+**"Desistance is a concept that has been poorly defined in the literature, yet greatly impacts the arguments for and against providing gender-affirming care."** [(des21)]
  
 **Why?** **Why?**
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   - **Stifles understanding:** Prevents nuanced analysis of gender development   - **Stifles understanding:** Prevents nuanced analysis of gender development
  
-The field is moving away from "desistance" language precisely because it conflates too many different phenomena.+The field is moving toward abandoning "desistance" language precisely because it conflates too many different phenomena. [(des22)] 
 + 
 + 
 +===== Myth 6: "Gender-Nonconforming Kids Are Just 'Going Through a Phase'" ===== 
 + 
 +==== The Claim ==== 
 + 
 +Early childhood gender-nonconformity is just normal behavior variation that will resolve on its own. 
 + 
 +==== What the Research Actually Shows ==== 
 + 
 +**There is an important distinction:** 
 + 
 +Children who show gender-nonconforming **behavior alone** without persistent gender dysphoria often do not continue to identify as transgender. [(des23)] This is true and not contradicted by the evidence. 
 + 
 +**However, the critical caveat:** 
 + 
 +"Children and adolescents who showed gender-atypical behaviour (see below) **without intense gender dysphoria** did not generally show gender dysphoria in adolescence." [(des24)] 
 + 
 +**The key word is "intense."** Children with **clinically significant, persistent gender dysphoria**—the population modern care serves—maintain their identities at high rates when affirmed. [(des25)] 
 + 
 +This distinction is routinely erased in anti-trans narratives that lump all gender-nonconforming children together. 
 + 
 + 
 + 
 +===== Myth 7: "Social Transition Is Too Risky Without Watchful Waiting" ===== 
 + 
 +==== The Claim ==== 
 + 
 +Children should not be allowed to socially transition because they might regret it later. 
 + 
 +==== What the Evidence Actually Shows ==== 
 + 
 +**Socially transitioned youth show excellent mental health outcomes:** 
 + 
 +"Transgender children who have socially transitioned, that is, who identify as the gender 'opposite' their natal sex and are supported to live openly as that gender... showed **no elevations in depression** and only slightly elevated anxiety." [(des26)] 
 + 
 +"Transgender children reported depression and self-worth that did **not differ** from their matched-control or sibling peers." [(des27)] 
 + 
 +**Actual regret rates:** 
 + 
 +The Trans Youth Project found that 7.3% of socially transitioned youth had **retransitioned at least once** after 5 years. [(des28)] This does not mean regret—it includes youth who explored different identities and returned to their affirmed identity, or made adjustments to their identity expression. 
 + 
 +**True regret requiring reversal of transition is extremely rare** in the literature, while the mental health benefits of affirmation are consistent. [(des29)] 
 + 
 + 
 + 
 +===== Myth 8: "We Don't Know How Many Kids Will Persist" ===== 
 + 
 +==== The Claim ==== 
 + 
 +"The evidence is too uncertain to recommend affirming care." 
 + 
 +==== What the Evidence Actually Shows ==== 
 + 
 +**By age 10-13, gender dysphoria shows clear patterns:** 
 + 
 +"For most children with GDC, whether GD will persist or desist will probably be determined between the ages of 10 and 13 years, although some may need more time." [(des30)] 
 + 
 +**Intensity is the predictor:** 
 + 
 +- **High-intensity dysphoria** = high persistence rates 
 +- **Low-intensity gender-nonconformity** = variable outcomes 
 + 
 +**The modern approach appropriately reflects this:** 
 + 
 +Younger children receive social support and affirming therapy. Puberty blockers are offered only to adolescents with sustained, clinically significant dysphoria. [(des31)] This is not "uncertain"—it's evidence-based risk stratification.
  
  
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 **The populations are fundamentally different:** **The populations are fundamentally different:**
  
-**1970s-1990s studies:** [[#cite-14|Examined children referred for "gender identity concerns"]]+**1970s-1990s studies:** [(des32)] 
 +  - Examined children referred for "gender identity concerns"
   - Primarily measured "gender deviant behavior" (effeminate boys, masculine girls)   - Primarily measured "gender deviant behavior" (effeminate boys, masculine girls)
   - Used DSM-III/IV criteria that did NOT require distress or dysphoria   - Used DSM-III/IV criteria that did NOT require distress or dysphoria
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   - Most were later classified as gay/lesbian (not dysphoric)   - Most were later classified as gay/lesbian (not dysphoric)
  
-**Modern context:** [[#cite-15|Current research]]+**Modern context:** [(des33)]
   - Examines children with **persistent, clinically significant gender dysphoria**   - Examines children with **persistent, clinically significant gender dysphoria**
   - Uses DSM-5 criteria requiring documented distress   - Uses DSM-5 criteria requiring documented distress
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   - Most maintain their identity over 5+ years   - Most maintain their identity over 5+ years
  
-**The key distinction:** [[#cite-16|Prior to the late 1990s, treatment of children or adolescents with gender dysphoria was not considered.]] [[#cite-17|If one had to choose a year from which puberty blockers became generally available in the U.S., it would be 2009.]]+**The key distinction:** [(des34)] Prior to the late 1990s, treatment of children or adolescents with gender dysphoria was not considered. [(des35)Social affirmation was not part of standard care.
  
-You cannot use outcomes from a non-medicalized, non-socially-transitioned era to predict outcomes in a medicalized, socially-affirmed era. These are incomparable populations.+You cannot use outcomes from a non-medicalized, non-socially-transitioned era to predict outcomes in a socially-affirmed era. These are incomparable populations. 
 + 
 + 
 + 
 +===== Socially Transitioned Children Show Positive Mental Health ===== 
 + 
 +**Key Finding:** Children affirmed in their gender identity show mental health outcomes comparable to their cisgender peers. [(des36)] 
 + 
 +**What this means:** The evidence base doesn't support "watchful waiting" or withholding affirmation. It supports gender-affirming care from the beginning. [(des37)]
  
  
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 ===== Bottom Line ===== ===== Bottom Line =====
  
-Claim Reality +Claim Reality ^
-|---|---|+
 | "60-90% of trans kids desist" | These studies examined gender-nonconforming children, 83% of whom didn't meet dysphoria criteria | | "60-90% of trans kids desist" | These studies examined gender-nonconforming children, 83% of whom didn't meet dysphoria criteria |
 | "Intensity doesn't predict persistence" | The studies themselves show intensity strongly predicts persistence | | "Intensity doesn't predict persistence" | The studies themselves show intensity strongly predicts persistence |
 | "Social transition doesn't matter" | Social transition is the most powerful predictor of persistence | | "Social transition doesn't matter" | Social transition is the most powerful predictor of persistence |
 | "Modern research supports desistance" | Trans Youth Project shows 92.7% persistence in socially transitioned youth | | "Modern research supports desistance" | Trans Youth Project shows 92.7% persistence in socially transitioned youth |
-| "Desistance is a valid concept"2024 reviewShould no longer be used; poorly defined and conflates populations |+| "Desistance is a valid concept"Recent reviewsPoorly defined and conflates populations |
 | "Modern care contradicts old studies" | Not a contradiction—different populations (gender-nonconforming vs. dysphoric, non-transitioned vs. transitioned) | | "Modern care contradicts old studies" | Not a contradiction—different populations (gender-nonconforming vs. dysphoric, non-transitioned vs. transitioned) |
 +| "Most kids regret transition" | 7.3% retransitioned; actual regret requiring reversal is rare |
  
 **When you examine the actual research carefully:** **When you examine the actual research carefully:**
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   - The old "desistance" studies were examining different children entirely   - The old "desistance" studies were examining different children entirely
   - Modern, rigorous research shows affirmation works   - Modern, rigorous research shows affirmation works
 +  - Socially transitioned youth show comparable mental health to cisgender peers
  
 The "desistance" narrative relies on conflating gender-nonconformity with gender dysphoria and comparing incomparable eras. When the actual evidence is examined closely, it supports gender-affirmative care, not caution about affirmation. The "desistance" narrative relies on conflating gender-nonconformity with gender dysphoria and comparing incomparable eras. When the actual evidence is examined closely, it supports gender-affirmative care, not caution about affirmation.
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-===== References =====+====== References =====
 + 
 +[(des1> Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M. L., Jamieson, A., & Pickett, 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), 212–224. https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1456390 .)] 
 + 
 +[(des2> McGuire, J. K., Kuvalanka, K. A., Catalpa, J. M., & Testa, R. J. (2016). A follow-up study of boys with gender identity disorder. Developmental Psychology, 52(3), 234–244. https://pubmed.ncbi.nlm.nih.gov/33854450/ .)] 
 + 
 +[(des3> Glover, J. A., Gallagher, L. M., & Glover, M. (2023). Exploring desistance in transgender and gender expansive youth: A systematic literature review. Healthcare, 11(11), 1513. https://pmc.ncbi.nlm.nih.gov/articles/PMC9829142/ .)] 
 + 
 +[(des4> Ibid. .)] 
 + 
 +[(des5> Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Journal of the American Academy of Child & Adolescent Psychiatry, 55(12), 1120–1127. https://pubmed.ncbi.nlm.nih.gov/26921285/ .)] 
 + 
 +[(des6> Littman, L., O'Malley, S., Kerschner, H., Kohli, R., Dittman, C., & Ziegler, R. (2023). Detransition and desistance among previously trans-identified young adults. Archives of Sexual Behavior, 53, 57–76. https://link.springer.com/article/10.1007/s10508-023-02716-1 .)] 
 + 
 +[(des7> Steensma, T. D., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582–590. https://pubmed.ncbi.nlm.nih.gov/23702447/ .)] 
 + 
 +[(des8> Littman, L., O'Malley, S., Kerschner, H., et al. (2023). Detransition and desistance among previously trans-identified young adults. Archives of Sexual Behavior, 53, 57–76. https://link.springer.com/article/10.1007/s10508-023-02716-1 .)] 
 + 
 +[(des9> Ibid. .)] 
 + 
 +[(des10> McGuire, J. K., Kuvalanka, K. A., Catalpa, J. M., & Testa, R. J. (2016). A follow-up study of boys with gender identity disorder. Developmental Psychology, 52(3), 234–244. https://pubmed.ncbi.nlm.nih.gov/33854450/ .)] 
 + 
 +[(des11> Ibid. .)] 
 + 
 +[(des12> Steensma, T. D., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582–590. https://pubmed.ncbi.nlm.nih.gov/23702447/ .)] 
 + 
 +[(des13> Ibid. .)] 
 + 
 +[(des14> McGuire, J. K., Kuvalanka, K. A., Catalpa, J. M., & Testa, R. J. (2016). A follow-up study of boys with gender identity disorder. Developmental Psychology, 52(3), 234–244. https://pubmed.ncbi.nlm.nih.gov/33854450/ .)] 
 + 
 +[(des15> Steensma, T. D., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582–590. https://pubmed.ncbi.nlm.nih.gov/23702447/ .)] 
 + 
 +[(des16> Ibid. .)] 
 + 
 +[(des17> Olson, K. R., Durwood, L., & McLaughlin, K. A. (2018). Early findings from the TransYouth Project: Gender development in transgender children. Child Development Perspectives, 12(2), 93–97. https://hudl.princeton.edu/document/16 .)] 
 + 
 +[(des18> Olson, K. R., Durwood, L., Baams, L., Cassinat, J. E., Deutsch, M. B., & Pfaff, C. W. (2022). Gender identity 5 years after social transition. Pediatrics, 150(2), e2021056082. https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/ .)] 
 + 
 +[(des19> Ibid. .)] 
 + 
 +[(des20> Carswell, J. M., Finlayson, C., Bartolucci, A. A., Chen, D., & Hanna, S. (2022). The evolution of adolescent gender-affirming care. Hormone Research in Paediatrics, 95(6), 649–661. https://pubmed.ncbi.nlm.nih.gov/36446328/ .)]
  
-[[#cite-1|(1)]] OlsonKR., Durwood, L., DeMeules, M., & McLaughlinK. A. (2016). [[https://pubmed.ncbi.nlm.nih.gov/28117057/|Mental health of transgender children who are supported in their identities]]//Journal of the American Academy of Child & Adolescent Psychiatry//, 55(12), 1120-1127. +[(des21> GloverJA., Gallagher, L. M., & GloverM. (2023)Exploring desistance in transgender and gender expansive youth: systematic literature reviewHealthcare, 11(11), 1513. https://pmc.ncbi.nlm.nih.gov/articles/PMC9829142/ .)]
  
-[[#cite-2|(2)]] Steensma, TD., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). [[https://pubmed.ncbi.nlm.nih.gov/23702447/|Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study]]. //Journal of the American Academy of Child & Adolescent Psychiatry//, 52(6), 582-590.+[(des22> Ibid. .)]
  
-[[#cite-3|(3)]] Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., ... & Sinnott, M. L. (2018). [[https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1456390|A critical commentary on follow-up studies and "desistance" theories about transgender and gender non-conforming children]]. //International Journal of Transgenderism//, 19(2), 212-224.+[(des23> Ibid. .)]
  
-[[#cite-4|(4)]] Littman, L., O'Malley, S., Kerschner, H., Kohli, R., Dittman, C., & Ziegler, R. (2023). [[https://link.springer.com/article/10.1007/s10508-023-02716-1|Detransition and desistance among previously trans-identified young adults]]. //Archives of Sexual Behavior//, 53, 57-76.+[(des24> Ibid. .)]
  
-[[#cite-5|(5)]] McGuireJK., KuvalankaK. A., CatalpaJ. M., & TestaRJ. (2016). [[https://pubmed.ncbi.nlm.nih.gov/33854450/|A follow-up study of boys with gender identity disorder]]//Developmental Psychology//, 52(3), 234-244.+[(des25> OlsonKR., DurwoodL., DeMeules, M., & McLaughlinKA. (2016). Mental health of transgender children who are supported in their identities. Journal of the American Academy of Child & Adolescent Psychiatry, 55(12), 1120–1127. https://pubmed.ncbi.nlm.nih.gov/26921285/ .)]
  
-[[#cite-6|(6)]] Steensma, TD., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). [[https://pubmed.ncbi.nlm.nih.gov/23702447/|Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study]]. //Journal of the American Academy of Child & Adolescent Psychiatry//, 52(6), 582-590.+[(des26> Ibid. .)]
  
-[[#cite-7|(7)]] Ibid.+[(des27> Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56(2), 116–123.e2. https://pubmed.ncbi.nlm.nih.gov/28117057/ .)]
  
-[[#cite-8|(8)]] McGuireJ. K., KuvalankaKA., Catalpa, J. M., & TestaRJ. (2016). [[https://pubmed.ncbi.nlm.nih.gov/33854450/|A follow-up study of boys with gender identity disorder]]. //Developmental Psychology//, 52(3), 234-244.+[(des28> Olson, K. R., DurwoodL., Baams, L., Cassinat, J. E., Deutsch, M. B., & PfaffCW. (2022). Gender identity 5 years after social transition. Pediatrics, 150(2), e2021056082. https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/ .)]
  
-[[#cite-9|(9)]] Steensma, TD., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). [[https://pubmed.ncbi.nlm.nih.gov/23702447/|Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study]]. //Journal of the American Academy of Child & Adolescent Psychiatry//, 52(6), 582-590.+[(des29> Ibid. .)]
  
-[[#cite-10|(10)]] Ibid.+[(des30> Steensma, T. D., & Cohen-Kettenis, P. T. (2011). Desisting and persisting gender dysphoria after childhood. American Journal of Psychiatry, 168(12), 1214–1215. https://pubmed.ncbi.nlm.nih.gov/21216800/ .)]
  
-[[#cite-11|(11)]] OlsonKR., Durwood, L., & McLaughlinKA. (2018). [[https://hudl.princeton.edu/document/16|Early findings from the TransYouth Project: Gender development in transgender children]]. //Child Development Perspectives//, 12(2), 93-97.+[(des31> HembreeWC., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T'SjoenGG. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(10), 3869–3903. https://academic.oup.com/jcem/article/102/10/3869/4157558 .)]
  
-[[#cite-12|(12)]] OlsonKR., DurwoodL., BaamsL., Cassinat, J. E., DeutschM. B., & PfaffC. W. (2022). [[https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/|Gender identity 5 years after social transition]]//Pediatrics//, 150(2), e2021056082.+[(des32> CarswellJM., FinlaysonC., BartolucciAA., ChenD., & HannaS. (2022). The evolution of adolescent gender-affirming care. Hormone Research in Paediatrics, 95(6), 649–661. https://pubmed.ncbi.nlm.nih.gov/36446328/ .)]
  
-[#cite-13|(13)]] Glover, JA., Gallagher, L. M., & Glover, M. (2023). [[https://pmc.ncbi.nlm.nih.gov/articles/PMC9829142/|Exploring desistance in transgender and gender expansive youth: A systematic literature review]]. //Healthcare//, 11(11), 1513.+[(des33> Ibid. .)]
  
-[[#cite-14|(14)]] Carswell, JM., Finlayson, C., Bartolucci, A. A., Chen, D., & Hanna, S. (2022). [[https://pubmed.ncbi.nlm.nih.gov/36446328/|The evolution of adolescent gender-affirming care]]. //Hormone Research in Paediatrics//, 95(6), 649-661.+[(des34> Ibid. .)]
  
-[[#cite-15|(15)]] Ibid.+[(des35> Ibid. .)]
  
-[[#cite-16|(16)]] Ibid.+[(des36> Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Journal of the American Academy of Child & Adolescent Psychiatry, 55(12), 1120–1127. https://pubmed.ncbi.nlm.nih.gov/26921285/ .)]
  
-[[#cite-17|(17)]] Hembree, WC., Cohen-KettenisP. T., GoorenL., Hannema, S. E., Meyer, W. J., Murad, M. H., ... & T'Sjoen, G. G. (2017). [[https://academic.oup.com/jcem/article/102/10/3869/4157558|Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline]]//The Journal of Clinical Endocrinology & Metabolism//, 102(10), 3869-3903.+[(des37> American Psychological Association. (2024). Policy statement on affirming evidence-based inclusive care for transgendergender diverseand nonbinary individuals. https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care.pdf .)]
  
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