Teach your parents and providers well: Call for refocus on the health of trans and gender-diverse children

Published in: Canadian Family Physician.  May, 2018. Authors Julia Temple Newhook, Kelley Winters, Jake Pyne, Ally Jamieson, Cindy Holmes, Stephen Feder, Sarah Pickett and Mari-Lynne Sinnott

“Today, however, we are witnessing a substantial progression of the field—what some have termed a paradigm shift. Globally, health care providers acknowledge that gender is “a matter of diversity, not pathology,” and gender identity is being formally recognized as a deeply personal and fundamental human right... We argue that this narrow focus on prediction is misplaced. An understanding of the developmental trajectory of gender identity is important. However, our main priority is not predicting children’s adult identities; it is supporting children’s present and future health and well-being.”

“Directives regarding the care of gender-diverse children have derived primarily from a small body of research… interpreted to suggest that about 80% of children who we might think of as transgender will not identify as transgender as adults. It has become common to see these studies cited as a reason to discourage children’s assertion of a non–birth-assigned gender, framing transgender children as “confused.” Yet recent reviews suggest the utility of the concept of desistance is limited, and have raised the following 7 critiques:

  • “Many children never asserted a transgender identity…”

  • “Consistency often leads to continuance…”

  • “Assumptions were made about loss to follow-up…”

  • “Some assert a transgender identity later in life…”

  • “Some assert a nonbinary identity…”

  • “There is no evidence of being ‘trapped’...”

  • “Studies do not examine harm of suppression…”

“In moving past the desistance myth, researchers and clinicians are then able to focus instead on the more crucial question: How do we foster optimal health outcomes for gender-diverse children? Emerging research indicates that children who are not permitted to express their gender freely within their key developmental contexts, including family and school, might be at risk of negative psychosocial outcomes, both in the short-term and into adolescence and adulthood. These include low self-esteem, low life satisfaction, poor mental health, lack of adequate housing, posttraumatic stress, and suicidal thoughts and attempts.”


“Every child is unique. To thrive, every child needs to be seen, valued, and loved for who they are—not for who we expect them to be. Rather than attempting to “fix” gender-diverse children, medical providers have a key leadership role to play in the acceptance of the gender spectrum as a fundamental element of our human diversity. Through affirmation in the present, and celebration of whatever the future might hold, our goal is for all children to reach their full potential in all aspects of their lives.”