A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

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


“In the media, among the lay public, and in medical and scientific journals, it has been widely suggested that over 80% of transgender children will come to identify as cisgender once they reach adolescence or early adulthood. This statement largely draws on estimates from four follow-up studies conducted with samples of gender-nonconforming children in one of two clinics in Canada or the Netherlands… This article outlines methodological, theoretical, ethical, and interpretive concerns regarding these studies. We clarify the cultural, historical, and clinical contexts within which these studies were conducted to understand and to deconstruct the embedded foundational assumptions of the research as well as the widespread interpretations of the results.”

“While this commentary offers critiques of desistance research and its clinical and popular interpretations, these studies have also made contributions to the literature worthy of recognition:

“1. qualitative data on trans and gender diverse adolescents in clinical care, and

“2. factors in anticipating medical transition for gender-nonconforming children accessing clinical care…”


“We have identified the following methodological concerns in these four studies:

“1.the potential misclassification of child research participants

“2. the lack of acknowledgement of social context for research participants

“3.the age of participants at follow-up, and

“4.the potential misclassification of adolescent andyoung adult participants lost to follow-up…”


“We have identified the following theoretical concerns in the four studies:

“1.assumptions inherent in “desistance” terminology

“2.binary gender framework, and

“3. presumption of gender stability as a positive outcome…”


“We have also identified ethical concerns in these four studies:

“1. intensive treatment and testing of child participants,

“2.questionable goals of treatment, and

“3.lack of consideration of children’s autonomy…”


“We also have concerns with the authors’ interpretation in these four studies, including:

“1.the assumption that unknown future adult needs should supersede known childhood needs, and

“2.the underestimation of harm when attempting to delay or defer transition…”


“In this critical review of four primary follow-up studies with gender-nonconforming children in Toronto, Canada and the Netherlands (Table 1), we identify a total of 12 methodological, theoretical, ethical, and interpretive concerns as well as two often-overlooked contributions of this literature. We conclude that, while our understanding of gender diversity in adults has progressed, the tethering of childhood gender identity to the idea of “desistance” has stifled similar advancements in our understanding of children’s gender diversity. As we progress towards a fuller understanding of children’s gender in all its complexity, it will be important to move beyond longitudinal studies of identity that seek to predict children’s futures, and instead prioritize respect for children’s autonomy in the present. For all the resources devoted to studying these children, we have much more to learn by listening to them.”