A collection of studies and other published articles demonstrating the evidence that affirmative approaches yield happier, healthier, and better adjusted youth, and contradicting the principles of "Rapid Onset Gender Dysphoria".  We believe these to be representative of current thinking and research.

Please be sure to also se our BLOG page where we are continuing to post additional publications.


1. Mental Health of Transgender Children Who Are Supported in Their Identities

Published in: Pediatrics, February, 2016.  Authors: Kristina R. Olson, Lily Durwood, Madeleine DeMeules, Katie A. McLaughlin.  

"Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group… socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex."


2. The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets.

Published in: The Journal of Sexual Medicine.  April 15, 2018.  Authors: Wiepjes CM, Nota NM, de Blok CJM, Klaver M, de Vries ALC, Wensing-Kruger SA, de Jongh RT, Bouman MB, Steensma TD, Cohen-Kettenis P, Gooren LJG, Kreukels BPC, den Heijer M.

"6,793 people (4,432 birth-assigned male, 2,361 birth-assigned female) visited our gender identity clinic from 1972 through 2015. .... Only 0.6% of transwomen and 0.3% of transmen who underwent gonadectomy were identified as experiencing regret."


3. Analysis Finds Strong Consensus on Effectiveness of Gender Transition Treatment

Published in: The Cornell Chronicle.  April 9, 2018.

  • "Of 56 peer-reviewed studies, 52 (93 percent) found that gender transition improves the overall well-being of transgender people. The other 7 percent reported mixed or null findings. None of the reviewed studies showed that gender transition harms well-being."

  • "The positive outcomes of gender transition and related medical treatments include improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidal tendencies and substance use."

  • "The positive impact of gender transition has grown considerably in recent years, as surgical techniques and social support have improved."

  • "Regrets following gender transition are extremely rare and have become increasingly rarer."


4. Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment

Published in: Pediatrics.  October, 2014.  Authors: Annelou L.C. de Vries, MD, PhD, Jenifer K. McGuire, PhD, MPH, Thomas D. Steensma, PhD, Eva C.F. Wagenaar, MD, Theo A.H. Doreleijers, MD, PhD, and Peggy T. Cohen-Kettenis, PhD

"Results of this study provide first evidence that, after CSH [cross-sex hormones] and GRS [gender reassignment surgery], a treatment protocol including puberty suppression leads to improved psychological functioning of transgender adolescents. While enabling them to make important age-appropriate developmental transitions, it contributes to a satisfactory objective and subjective well-being in young adulthood. Clinicians should realize that it is not only early medical intervention that determines this success, but also a comprehensive multidisciplinary approach that attends to the adolescents’ GD [gender dysphoria] as well as their further well-being and a supportive environment."


5. The Gender Affirmative Model: What We Know and What We Aim to Learn

Published in: Human Development.  October, 2013.  Authors: Marco A. Hidalgo, Diane Ehrensaft, Amy C. Tishelman, Leslie F. Clark, Robert Garofalo, Stephen M. Rosenthal, Norman P. Spack, Johanna Olson

"Children not allowed these freedoms by agents within their developmental systems (e.g., family, peers, school) are at later risk for developing a downward cascade of psychosocial adversities including depressive symptoms, low life satisfaction, self-harm, isolation, homelessness, incarceration, posttraumatic stress, and suicide ideation and attempts [D’Augelli, Grossman, & Starks, 2006; Garofalo, Deleon, Osmer, Doll, & Harper, 2006; Roberts, Rosario, Corliss, Koenen, & Bryn Austin, 2012; Skidmore, Linsenmeier, & Bailey, 2006; Toomey, Ryan, Díaz, Card, & Russell, 2010; Travers et al., 2012]."


6. Statement on Gender Affirmative Approach to Care from the Pediatric Endocrine Society Special Interest Group on Transgender Health

Published by: Pediatric Endocrine Society Transgender Health Special Interest Group.  October 20, 2016.  Authors: Lopz, X, Marinkovic, M, Eimicke, T, Rosenthal, SM, Olshan, JS.

"The purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals, as well as to improve the understanding of the rights of transgender youth..."

"In conclusion, transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care. For this reason, the Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender-nonconforming/transgender youth, as well as adequate mental health and medical care."


7. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents

Published By: The American Academy of Pediatrics. September, 2018. Committee on Psychosocial Aspects of Child and Family Health, Committee on Adolescence, Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness

“Supportive involvement of parents and family is associated with better mental and physical health outcomes. Gender affirmation among adolescents with gender dysphoria often reduces the emphasis on gender in their lives, allowing them to attend to other developmental tasks, such as academic success, relationship building, and future-oriented planning. Most protocols for gender-affirming interventions incorporate World Professional Association of Transgender Health and Endocrine Society recommendations and include ≥1 of the following elements:

  • “Social Affirmation: This is a reversible intervention in which children and adolescents express partially or completely in their asserted gender identity by adapting hairstyle, clothing, pronouns, name, etc. Children who identify as transgender and socially affirm and are supported in their asserted gender show no increase in depression and only minimal (clinically insignificant) increases in anxiety compared with age-matched averages…

  • “Legal Affirmation: Elements of a social affirmation, such as a name and gender marker, become official on legal documents, such as birth certificates, passports, identification cards, school documents, etc…

  • “Medical Affirmation: This is the process of using cross-sex hormones to allow adolescents who have initiated puberty to develop secondary sex characteristics of the opposite biological sex…

  • “Surgical Affirmation: Surgical approaches may be used to feminize or masculinize features… These changes are irreversible. Although current protocols typically reserve surgical interventions for adults, they are occasionally pursued during adolescence on a case-by-case basis, considering the necessity and benefit to the adolescent’s overall health…”


8. National Transgender Discrimination Survey Report on Health and Health Care: Findings of a Study by the National Center for Transgender Equality and the National Gay and Lesbian Task Force

National Center for Transgender Equality and the National Gay and Lesbian Task Force.  October, 2010.  Authors: Jaime M. Grant, Ph.D., Lisa A. Mottet, J.D., Justin Tanis, D.Min., Jody L. Herman, Ph.D., Jack Harrison, and Mara Keisling

"A staggering 41% of respondents reported attempting suicide compared to 1.6% of the general population"


9. Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults

Published in: LGBT Health.  May 25, 2016.  Authors: Augustus Klein & Sarit A. Golub

"42.3% of [transgender adults] reported a suicide attempt and 26.3% reported misusing drugs or alcohol to cope with transgender-related discrimination… family rejection was associated with increased odds of both behaviors. Odds increased significantly with increasing levels of family rejection."


10. Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults - Comparisons of Nonsurgical and Postsurgical Cohorts

Published in: Journal of the American Medical Association.  May 2018.  Authors: Johanna Olson-Kennedy, MD, Jonathan Warus, MD, Vivian Okonta, MPH, et al

"In this cohort study, chest dysphoria was significantly higher in the nonsurgical vs postsurgical cohort. Among the nonsurgical cohort, 94% perceived chest surgery as very important; among the postsurgical cohort, serious complications were rare, and 67 of 68 reported an absence of regret."


11. Learning to Listen to Trans and Gender Diverse Children: A Response to Zucker (2018) and Steensma and Cohen-Kettenis (2018).

Published in: International Journal of Transgenderism.  June 18, 2018.  Authors: Kelley Winters, Julia Temple Newhook, Jake Pyne, Stephen Feder, Ally Jamieson, Cindy Holmes, Mari-Lynne Sinnott, Sarah Pickett & Jemma Tosh

"Childhood social transition is not aboutencouraging a child towards any particular path, but about removing the obstacles that have been preventing them from living fully and freely. Accepting and affirming non-birth-assigned gender identities with respectful, congruent names, pronouns, and documentation is a matter of basic human dignity (Grinspan et al., 2017; Winter, Riley, Pickstone-Tay-lor, Suess, & Winters, 2016) and no more a medical intervention than afrming and respecting birth-assigned gender identities of cisgender children."

"... [W]e have concerns about the longstanding  “Dutch Approach” of advising parents that“young children not yet make acomplete social transition (different clothing, a different given name, referring to a boy as ‘her’ instead of ‘him’ )before the very early stages of puberty" (de Vries & Cohen-Kettenis, 2012, p. 308). We are troubled by the misgendering language in this statement. This advice is unequivocally rooted in the 80% “desistance” axiom(p. 308; Steensma & Cohen-Kettenis, 2011, p. 649), and disregards evidence that intensity of gender dysphoria, “expressed cross-gender identification,” and childhood social transition itself are significant predictors of persistence (Steensma, et al., 2013, pp. 587, 589). Most importantly, it dismisses children's profound internal experiences of their own gender. Though labelled as watchful waiting and carefully observing, such discouragement of congruent gender expression and authentic participation in childhood life experience is not a neutral clinical choice. In our experience, childhood closets canhave lifelong consequences."


12. Affirming Gender, Affirming Lives: A Report of the 2011 Transition Surgery

Published by: Gender Advocacy, Training & Education.  July, 2012.  Author: Colin Close

  • "Almost all participants reported feeling less gender dysphoria than before they transitioned."

  • "More than two‐thirds of participants reported improvements in four personality traits associated with happiness and life satisfaction. [Openness to Experience, Social Involvement, Agreeableness, and Being Conscioensious.] "

  • "Almost all participants reported improvements in their quality of life compared to before they transitioned."

  • "Most participants reported feeling more emotionally stable after transition. Additionally, about two‐thirds reported feeling less depression, anxiety, and excessive anger."

  • The majority of participants reported feeling more joy, hope, love and safety, and less sadness, despair, anger, and fear after they transitioned."

  • "Almost all participants had no regrets or would repeat the steps they took to transition even if the results were not perfect."


13. The Development and Psychometric Evaluation of the Trans Discrimination Scale: TDS-21

Published in: Journal of Counseling Psychology.  Authors: Laurel B. Watson, Luke R. Allen, Mirella J. Flores, Christine Serpe, and Michelle Farrell

"Mental health professionals should recognize that trans people often face discrimination in educational settings, which may result in school truancy, poorer academic performance, dropouts, and lower intentions of pursuing higher education. Mental health providers in schools are encouraged to work with school administrators to provide trainings on ways to create safe and affirming environments for trans and gender nonconforming youth, which may include use of true gender pronouns, developing gender-inclusive antidiscrimination policies, providing inclusive restrooms, and developing a gay-straight alliance."

14. Demographic and Psychosocial Factors Associated With Psychological Distress and Resilience Among Transgender Individuals

Published in: The American Journal of Public Health. October, 2015. Authors: Emily Bariola, BA, Anthony Lyons, PhD, William Leonard, BSc, BA, Marian Pitts, PhD, Paul Badcock, PhD, and Murray Couch, BA.

“The findings indicated that, relative to other sources, family of origin may have the most influence in protecting against psychological distress… our findings support a need to encourage family members to be open and receptive sources of support.”

“…frequent contact with LGBT peers was revealed as a significant [protective] factor… for transgender individuals, frequent peer contact may be particularly important for developing individual resilience, as gender transitioning can be a complex and challenging process and having peers who share similar experiences may provide not only a sense of support and understanding, but also a sense of belonging.”


15. When “desisters” aren’t: De-desistance in childhood and adolescent gender dysphoria

Published in: Gender  October 31, 2017.  Author: Zinnia Jones

"It is disconcerting that hypothetical cases of transition regret among trans youth continue to receive outsized attention… even as actual observed cases of regret for not transitioning in adolescence appear to be far more common.”