“Trans Desistance” — Real or Fake?

Summary

• Many attempts have been made in the past to determine what percentage of transgender people grow out (“desist”) of gender dysphoria. Previous studies have been flawed and usually had a low sample size and a very loose definition of “transgender”. Many people who “desisted” were simply gender non-conforming.
• The Steensma study (Steensma, et al. 2013) is the strongest study conducted on transgender desistance yet. Its strengths were having a larger sample size (127) than many others, and followed the participants long term.
• The Steensma study, while better than others, was still incredibly flawed. Its sample size was still not sufficient for reliability in such a variable topic, it used an old diagnostic manual for gender dysphoria, assumed all who didn’t respond to the study had desisted, many of the participants were subthreshold for gender dysphoria and the authors failed to adjust for certain factors, making the study misinterpreted by those who didn’t read very far in.
• The Steensma study is often misinterpreted by transphobes trying to push an argument against transgender treatment such as hormone therapy and puberty blockers. Assessing what percentage of transgender people desisted was not the study’s intention, but rather what factors make desistance and persistence more or less likely.
• Upon removing non-responders and those who were sub-threshold for gender dysphoria, the persistence rate significantly increases, making a strong argument FOR transgender treatment. For natal boys, the desistance rate went from 70.89% to 8.7%, and for natal girls it went from 50% to 20.69% (mean: 14.7%).

Introduction

There have been many attempts to determine and calculate the percentage of those with gender dysphoria who “grew out” or desisted from their dysphoria. Many of these former studies had various methodological flaws and very loosely defined transgenderism and many were not actually transgender in these studies. Furthermore, many had small sample sizes and weren’t necessarily reliable sources of information to extrapolate to the whole transgender community. These studies fail to adjust for confounding factors or provide significant information. Many used outdated diagnostic criteria for gender dysphoria which ended up lumping transgender individuals in with gender non-conforming individuals such as effeminate boys or masculine girls.

The Steensma study is the first study to actually provide significant information on confounding factors, had a larger than usual sample size (albeit still not substantial to reliably make a conclusion) and followed the participants long term. It is the closest thing to a “reliable” study on desistance or persistence of gender dysphoria.

However, regardless of its strengths, it is still commonly misinterpreted, misrepresented and fails to state the results upon removing certain factors associated with desistance and persistence from the data set.

Many people incorrectly assume that the study is about the percentage of transgender people who desist, but rather, it is a study on factors contributing to predicting whether an individual will desist or persist.

Misrepresentation

The Steensma study is often misrepresented, misinterpreted or taken out of context. Many transphobes have incorrectly cited this study as “evidence” that transgender people will usually desist in their gender dysphoria, without considering the actual study intent. The goal of the study was to evaluate factors associated with desistance and persistence, which many people ignore and wrongly assume that it just means that a majority of transgender people will desist. That is not the case, but rather, that transgender people who did not meet the threshold for gender dysphoria were more likely to desist.

Misrepresenting a study in this way is incredibly dangerous. It spreads misinformation without any regard for accuracy and makes people doubt themselves or be afraid to transition out of fear of regretting it, even if such is unlikely for them given they meet the attributes which contribute to a high likelihood of persistence.

Those who DO persist are incredibly unlikely to regret gender affirming treatment (USTS, 2015). The misrepresentation of the study by those in opposition to gender affirming healthcare is incredibly dangerous and disregards the results that conflict with the agenda they are trying to push with the help of a study they are taking out of context. Denying the potential of a medical and social transition to those who require it puts their life in danger, because individuals who cannot transition have a higher suicide attempt risk, higher rates of suicidal behavior and are generally more depressed (What does the scholarly research say about the effect of gender transition on transgender well-being?, Cornell University), (Travers, et al. 2012), (Olson, et al. 2016), (Trujillo, et al. 2016), (Durwood, et al. 2017), (Nobili, et al. 2018), (Murad, et al. 2010), (Vries, et al. 2014).

Methodological Flaws

The Steensma study suffered from having various methodological flaws making it unreliable to make a strong conclusion from. It had a small sample size, had many confounding factors (which, due to a small sample size, makes adjustment very difficult and unreliable), mostly assessed those who did not meet the threshold for gender dysphoria and assumed that all who did not respond to the follow-up had desisted. This is problematic because you cannot make such bold assumptions in science, and it is extremely difficult to determine whether other factors are at play. Non-responders may have not been present when required to respond to the followup survey, simply not been inclined to respond, may have died, may have moved to another country or simply not wished to return to that specific clinic and may have sought treatment elsewhere either outside of the Netherlands or from alternative treatment methods such as non-prescribed hormones or puberty blockers, which is not exceptionally rare within transgender communities (Rotondi, et al. 2013).

“As the Amsterdam clinic is the only gender identity service in the Netherlands where psychological and medical treatment is offered to adolescents with GD, we assumed that for the 80 adolescents (56 boys and 24 girls), who did not return to the clinic, that their GD had desisted, and that they no longer had a desire for gender reassignment.”

Adjusting for Methodological Flaws

The study calculated the desistance rate for all participants and made various assumptions. Upon removing those who did not respond to the followup survey and those who did not meet the threshold for gender dysphoria, the desistance rates significantly decreased. I calculated the sample size after removing the percentage of each group who did not meet the threshold and then subtracted the amount of non responders to find the new percentage. The desistance rate for natal boys went from 70.89% to 8.7%, and for natal girls it went from 50% to 20.69% (mean: 14.7%).

• 21 persisters upon removing sub-threshold, 22 desisters upon removing sub-threshold. 2 desisters upon removing non-responders (8.7% desistance rate for boys).
• 23 persisters upon removing sub-threshold, 14 desisters upon removing sub-threshold. 6 desisters upon removing non-responders (20.69% desistance rate for natal girls).

Conclusion

“Desistance” is a highly over-represented concept and is much rarer than the scientific literature makes it appear due to various methodological flaws. Using the Steensma paper to argue for an anti-transgender treatment position is an incoherent, illogical and scientifically unfounded idea. The study does not suggest that transgender people with gender dysphoria are likely to desist, or, as it is often misinterpreted as, detransition. The results are often, dangerously, attributed to all transgender people, rather than simply those lacking gender dysphoria.

Resources

1. Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., 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://doi.org/10.1016/j.jaac.2013.03.016
2. Tannehill, B. (2017, January 1). The End of the Desistance Myth. HuffPost. https://www.huffpost.com/entry/the-end-of-the-desistance_b_8903690.
3. James, Sandy E., Herman, Jody, Keisling, Mara, Mottet, Lisa, and Anafi, Ma’ayan. 2015 U.S. Transgender Survey (USTS). Inter-university Consortium for Political and Social Research [distributor], 2019–05–22. https://doi.org/10.3886/ICPSR37229.v1
4. Cornell University. (n.d.). What does the scholarly research say about the effect of gender transition on transgender well-being? What We Know. https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/.
5. Travers, R., Bauer, G., Pyne, J., Bradley, K., Gale, L., & Papadimitriou, M. (2012, October 2). Impacts of Strong Parental Support for Trans Youth. Trans PULSE. https://transpulseproject.ca/wp-content/uploads/2012/10/Impacts-of-Strong-Parental-Support-for-Trans-Youth-vFINAL.pdf.
6. Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3). https://doi.org/10.1542/peds.2015-3223
7. Trujillo, M. A., Perrin, P. B., Sutter, M., Tabaac, A., & Benotsch, E. G. (2016). The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample. International Journal of Transgenderism, 18(1), 39–52. https://doi.org/10.1080/15532739.2016.1247405
8. 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). https://doi.org/10.1016/j.jaac.2016.10.016
9. Nobili, A., Glazebrook, C., & Arcelus, J. (2018). Quality of life of treatment-seeking transgender adults: A systematic review and meta-analysis. Reviews in Endocrine and Metabolic Disorders, 19(3), 199–220. https://doi.org/10.1007/s11154-018-9459-y
10. Murad, M. H., Elamin, M. B., Garcia, M. Z., Mullan, R. J., Murad, A., Erwin, P. J., & Montori, V. M. (2010). Hormonal therapy and sex reassignment: A systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology, 72(2), 214–231. https://doi.org/10.1111/j.1365-2265.2009.03625.x
11. de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. PEDIATRICS, 134(4), 696–704. https://doi.org/10.1542/peds.2013-2958
12. Rotondi, N. K., Bauer, G. R., Scanlon, K., Kaay, M., Travers, R., & Travers, A. (2013). Nonprescribed Hormone Use and Self-Performed Surgeries: “Do-It-Yourself” Transitions in Transgender Communities in Ontario, Canada. American Journal of Public Health, 103(10), 1830–1836. https://doi.org/10.2105/ajph.2013.301348