Importance of being persistent. Should transgender children be allowed to transition socially?

Abstract

Studies suggest that the majority of gender diverse children (up to 84%) revert to the gender congruent with the sex assigned at birth when they reach puberty. These children are now known in the literature as ‘desisters’. Those who continue in the path of gender transition are known as ‘persisters’. Based on the high desistence rates, some advise being cautious in allowing young children to present in their affirmed gender. The worry is that social transition may make it difficult for children to de-transition and thus increase the odds of later unnecessary medical transition. If this is true, allowing social transition may result in an outright violation of one of the most fundamental moral imperatives that doctors have: first do no harm. This paper suggests that this is not the case. Studies on desistence should inform clinical decisions but not in the way summarised here. There is no evidence that social transition per se leads to unnecessary medical transition; so should a child persist, those who have enabled social transition should not be held responsible for unnecessary bodily harm. Social transition should be viewed as a tool to find out what is the right trajectory for the particular child. Desistence is one possible outcome. A clinician or parent who has supported social transition for a child who later desists will have not violated, but acted in respect of the moral principle of non-maleficence, if the choice made appeared likely to minimise the child’s overall suffering and to maximise overall the child’s welfare at the time it was made.

Not social transition status, but peer relations and family functioning predict psychological functioning in a German clinical sample of children with Gender Dysphoria

“…A clinical approach that considers children to explore their identity without strict criteria, but with an open mind, may allow for a discussion of all possible outcomes and individual strategies of exploring gender identity during childhood. This may include both persisting and desisting pathways (Giordano, 2019), possibilities of living in another (non-binary) gender, as well as the possibility that there are more than two future developmental pathways (Steensma & Cohen-Kettenis, 2015).…”

“…Children may be encouraged in taking a lead in discussing possible social transitions and retransitions with their parents (Ehrensaft et al, 2018; Hidalgo et al, 2013; Olson et al, 2019). This is particularly important since transitioning socially should not only be viewed as a form of treatment, but can be understood as a possibility for children to explore their own individual developmental pathways (Giordano, 2019).…”

“…Clinicians follow a diagnostic and treatment protocol that was developed and in the past referred to as the “Dutch Model” (Cohen-Kettenis et al, 2011; Delemarre-van de Waal & Cohen-Kettenis, 2006; de Vries & Cohen-Kettenis, 2012). This clinical management approach suggests a watchful-waiting approach which differentiates counseling in contrast to a more gender affirmative treatment approach during adolescence (Cohen-Kettenis et al, 2008; Edwards-Leeper, 2016; Giordano, 2019). Sessions may include clinical diagnostics, counseling, psychotherapy and psychoeducation during childhood, as well as the possibility of referral to an endocrinology specialist for medical interventions after the onset of puberty.…”

“…To this date, the possible benefits or disadvantages of an “early” social transition for a child’s future development are among the most controversially discussed topics in Transgender Health Care (Coleman et al, 2012; Giordano, 2019; Steensma & Cohen-Kettenis, 2015; Wong et al, 2019); especially bearing in mind the developmental trajectories of persistence versus desistence into adolescence and adulthood (Ristori & Steensma, 2016). Children with either a GD diagnosis or so-called gender nonconforming or gender variant experiences often do not continue to experience a clinical GD as adolescents and adults (Ristori & Steensma, 2016; Steensma et al, 2013).…”

“…For example, de Vries and Cohen-Kettenis (2012) recommended for young children to not yet make a complete social transition before the very early stages of puberty. In contrast to this clinical management, a more gender affirmative approach freely endorses social transitions when they are perceived as appropriate (Ehrensaft et al, 2018; Giordano, 2019).…”