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====== The "Desistance" Myth: Debunking Flawed Research on Transgender Youth ======

===== The "Desistance" Claims =====

==== The Transmisic Narrative ====

**Claim 1:** "Studies show that 60-90% of transgender children 'desist'—stop identifying as transgender." [[#ref1|[1]]]

**Claim 2:** "Most kids who think they're trans are actually just gender-nonconforming or going through a phase." [[#ref2|[2]]]

**Claim 3:** "The high desistance rates prove that we shouldn't affirm young people's gender identities." [[#ref3|[3]]]

Any claim suggesting:

  * Most trans-identified youth "desist" and return to identifying with their sex assigned at birth
  * Childhood gender dysphoria rarely persists into adulthood
  * Early social transition leads to regret
  * Gender diversity in childhood is typically a phase or confusion

All of these claims rely on the same misapplication of outdated research, conflation of different populations, and misreading of study findings. We'll break down how this narrative distorts the actual evidence.

==== 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. [[#ref4|[4]]]

**What the early studies actually examined:** [[#ref5|[5]]] Earlier research recruited children who showed "gender-variant behavior"—not necessarily children with persistent gender dysphoria. [[#ref6|[6]]] These studies classified gender identities using initial visit data, which displayed signs of gender identification and preferences, along with parent-reported cross-gender preferences.

**The distinction matters enormously:**

  * **Gender-nonconforming behavior** = acting in ways stereotypically associated with a different gender (e.g., an effeminate boy, a masculine girl)
  * **Gender dysphoria** = persistent distress from incongruence between gender identity and assigned sex
  * **Gender identity** = one's internal sense of gender

These are **not the same thing.** [[#ref7|[7]]]


===== Myth 1: "Studies Show 60-90% of Trans Kids Desist" =====

==== The Claim ====

Anti-trans advocates frequently cite old studies showing that "most gender-variant children" don't maintain a cross-gender identification into adulthood, claiming this proves most "trans kids" are going through a phase.

==== What the Evidence Actually Shows ====

**The actual finding from desistance studies:**

**Most children in these studies were NOT persistently dysphoric in the first place.** [[#ref8|[8]]] By retrospective reports, fewer than 17% of participants met DSM-5 diagnostic criteria for Gender Dysphoria in Childhood. [[#ref9|[9]]] 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. [[#ref10|[10]]]

**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.**


===== Myth 2: "Intensity of Dysphoria Doesn't Matter" =====

==== The Claim ====

The desistance narrative suggests that childhood gender dysphoria is inherently unstable and most children will grow out of it.

==== What the Research Actually Shows ====

**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."** [[#ref11|[11]]]

**What this actually means:** [[#ref12|[12]]] Children with stronger, more persistent gender dysphoria were more likely to maintain their gender identity into adulthood. The studies themselves show intensity matters.

**The contrast is striking:**

  * **Non-socially-transitioned boys who didn't persist:** Most had mild gender dysphoria
  * **Persisters:** Had significantly higher intensity of dysphoria and gender-variant behavior

If you examine the actual data: **[[#ref13|[13]]] "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.


===== Myth 3: "Social Transition Doesn't Predict Persistence" =====

==== The Claim ====

Some versions of the desistance narrative suggest social transition is irrelevant to whether gender dysphoria persists.

==== What Steensma Actually Found ====

This is where the desistance narrative completely falls apart.

**The actual Steensma finding:** [[#ref14|[14]]] Research indicated that social transition is the most powerful predictor of persistence of childhood gender dysphoria.

**This is the opposite of what opponents claim.** Social transition—not medicalization, not puberty blockers—is the strongest factor predicting persistence. [[#ref15|[15]]] The findings showed that 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, and varied among natal boys and girls.

The desistance studies show that **social affirmation strengthens gender identity persistence**, not weakens it.


===== Myth 4: "Modern Research Contradicts This" =====

==== The Claim ====

Recent studies must show higher desistance rates, justifying caution about affirming youth.

==== What Modern Research Actually Shows ====

**The Trans Youth Project provides the most rigorous modern data:**

**[[#ref16|[16]]] "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**.

**The actual finding:** [[#ref17|[17]]] We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once.

**This means: 92.7% of socially transitioned youth maintained their gender identity 5 years later.** [[#ref18|[18]]]

**Compare the populations:**

| Population | Time Period | Dysphoria Criteria | Socially Transitioned | Persistence Rate |
| **Early desistance studies** | 1970s-1990s | DSM-III/IV (no distress requirement) | No | ~20% |
| **Trans Youth Project** | 2010s-2020s | Modern standards | Yes | 92.7% |

The difference isn't methodology—it's the population being studied. [[#ref19|[19]]]


===== Myth 5: "Desistance Concept Is Valid" =====

==== The Claim ====

"Desistance" is a legitimate scientific concept for understanding gender development.

==== What Recent Scholarship Shows ====

**A 2024 systematic review concluded the opposite:**

**"Desistance should no longer be used in clinical work or research."** [[#ref20|[20]]] Desistance is a concept that has been poorly defined in the literature, yet greatly impacts the arguments for and against providing gender-affirming care.

**Why?**

  - **Poorly defined:** Different studies define "desistance" differently (stopped identifying trans? No longer met criteria? Changed presentation?)
  - **Conflates populations:** Mixes children with actual dysphoria with gender-nonconforming children
  - **Cherry-picks outcomes:** Focuses on "desistance" while ignoring sexual orientation findings (many became LGB)
  - **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 False Analogy: Comparing Different Eras =====

==== The Misleading Comparison ====

Critics argue: "If 80% desisted in the 1980s, the same should be true today."

==== Why This Comparison Fails ====

**The populations are fundamentally different:**

**1970s-1990s studies:** [[#ref21|[21]]]
  - Examined children referred for "gender identity concerns"
  - Primarily measured "gender deviant behavior" (effeminate boys, masculine girls)
  - Used DSM-III/IV criteria that did NOT require distress or dysphoria
  - Children were **not socially transitioned** (no medical pathway existed)
  - Most were later classified as gay/lesbian (not dysphoric)

**Modern context:** [[#ref22|[22]]]
  - Examines children with **persistent, clinically significant gender dysphoria**
  - Uses DSM-5 criteria requiring documented distress
  - Children are **socially transitioned** (affirmed in their identity)
  - Most maintain their identity over 5+ years

**The key distinction:** [[#ref23|[23]]] Prior to the late 1990s, treatment of children or adolescents with gender dysphoria was not considered. [[#ref24|[24]]] If one had to choose a year from which puberty blockers became generally available in the U.S., it would be 2009.

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.

===== Bottom Line =====

| Claim | Reality |
| "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 |
| "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 |
| "Desistance is a valid concept" | 2024 review: Should no longer be used; poorly defined and conflates populations |
| "Modern care contradicts old studies" | Not a contradiction—different populations (gender-nonconforming vs. dysphoric, non-transitioned vs. transitioned) |

**When you examine the actual research carefully:**

  - Children with persistent gender dysphoria maintain their identity at high rates when affirmed
  - Social transition (not medicalization) predicts persistence
  - The old "desistance" studies were examining different children entirely
  - Modern, rigorous research shows affirmation works

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.


====== References ======

[[#ref1|[1]]] 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.

[[#ref2|[2]]] McGuire, J. K., Kuvalanka, K. A., Catalpa, J. M., & Testa, R. J. (2016). [[https://pubmed.ncbi.nlm.nih.gov/33854450/|A follow-up study of boys with gender identity disorder]]. //Developmental Psychology//, 52(3), 234–244.

[[#ref3|[3]]] Glover, J. A., 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.

[[#ref4|[4]]] 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.

[[#ref5|[5]]] Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). [[https://pubmed.ncbi.nlm.nih.gov/26921285/|Mental health of transgender children who are supported in their identities]]. //Journal of the American Academy of Child & Adolescent Psychiatry//, 55(12), 1120–1127.

[[#ref6|[6]]] Littman, L., O'Malley, S., Kerschner, H., et al. (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.

[[#ref7|[7]]] Steensma, T. D., 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.

[[#ref8|[8]]] Littman, L., O'Malley, S., Kerschner, H., et al. (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.

[[#ref9|[9]]] Ibid.

[[#ref10|[10]]] McGuire, J. K., Kuvalanka, K. A., Catalpa, J. M., & Testa, R. J. (2016). [[https://pubmed.ncbi.nlm.nih.gov/33854450/|A follow-up study of boys with gender identity disorder]]. //Developmental Psychology//, 52(3), 234–244.

[[#ref11|[11]]] Steensma, T. D., 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.

[[#ref12|[12]]] Ibid.

[[#ref13|[13]]] McGuire, J. K., Kuvalanka, K. A., Catalpa, J. M., & Testa, R. J. (2016). [[https://pubmed.ncbi.nlm.nih.gov/33854450/|A follow-up study of boys with gender identity disorder]]. //Developmental Psychology//, 52(3), 234–244.

[[#ref14|[14]]] Steensma, T. D., 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.

[[#ref15|[15]]] Ibid.

[[#ref16|[16]]] Olson, K. R., Durwood, L., & McLaughlin, K. A. (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.

[[#ref17|[17]]] Olson, K. R., Durwood, L., Baams, L., Cassinat, J. E., Deutsch, M. B., & Pfaff, C. W. (2022). [[https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/|Gender identity 5 years after social transition]]. //Pediatrics//, 150(2), e2021056082.

[[#ref18|[18]]] Ibid.

[[#ref19|[19]]] Olson, K. R., Durwood, L., Baams, L., Cassinat, J. E., Deutsch, M. B., & Pfaff, C. W. (2022). [[https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/|Gender identity 5 years after social transition]]. //Pediatrics//, 150(2), e2021056082.

[[#ref20|[20]]] Glover, J. A., 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.

[[#ref21|[21]]] Carswell, J. M., 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.

[[#ref22|[22]]] Ibid.

[[#ref23|[23]]] Carswell, J. M., 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.

[[#ref24|[24]]] Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., 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.
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