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Study: Few transgender children retransition to cisgender

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Most transgender children who socially transition by age 12 continue to identify that way five years later, according to a new study from the American Academy of Pediatrics.

The findings may provide new context to state lawmakers debating restrictions on medical care, sports participation and bathroom use for transgender youths.

The study, “Gender Identity 5 Years After Social Transition” (Olson KR, et al. Pediatrics. May 4, 2022), included 317 youths enrolled in the TransYouth Project, a longitudinal study that plans to follow them for 20 years. The youths identified as binary transgender (identifying as a single sex other than the one assigned at birth) when they were enrolled in the study at ages 3-12 years. The participants had socially transitioned, meaning they were using pronouns, names, hairstyles and clothing associated with a gender other than the one they were assigned at birth.

When researchers checked in with the group about five years after their social transition, only about 7% had changed their gender identify (retransition). That figure includes children who changed to cisgender (identifying as the sex assigned at birth) or nonbinary and some who made multiple changes.

At the five-year mark, about 94% continued to identify as binary transgender, 3.5% identified as cisgender and 3.5% identified as nonbinary (using they/them pronouns).

“I think it’s important for pediatricians to know there is this cohort that emerges early and seems to be very consistent over time,” said lead author Kristina R. Olson, Ph.D., professor of psychology at Princeton University.

These percentages were similar when looking only at youths who had not started puberty blockers before the study. While the study included more transgender girls than boys, researchers also did not find differences based on sex at birth.

Children who socially transitioned to binary transgender before age 6 were more likely to retransition to cisgender than older children, but the rates of retransitioning still were small. About 6% of this younger group retransitioned to cisgender compared to 0.5% of the older group.

Among the eight youths in the study who retransitioned to cisgender, all but one did so by age 9. Among 11 youths who retransitioned to nonbinary, six did so between ages 10-13.

Dr. Olson said some people assume retransitioning is common and/or traumatic, but preliminary findings not published in this paper have not found either to be the case.

“A clear message here is there are youth who identify really early and are very consistent and that can benefit from social support,” Dr. Olson said. “Also, there’s clear indication parents can and should … talk to their kids about the fact gender identity can change and that they remain open to how to identify in the future.”

The study is limited in that some youths may have retransitioned before having a chance to join the study, and participants who volunteered may not reflect the general population. The study also doesn’t address the experiences of those who socially transition after age 12.

Debates over gender identity at state legislatures are likely to continue, as are studies of the experiences of transgender youths. The AAP has long supported gender-affirming care and has stepped up efforts to protect transgender youths in recent months.

“All patients must have access to evidence-based health care, regardless of their gender identity or sexual orientation,” the AAP and other medical groups said in a joint statement earlier this year. “Our organizations will not stand for any efforts that discriminate against transgender and gender-diverse individuals and cause harm to their health and well-being. We will continue to advocate to ensure their health needs are met and supported, not put in danger.”

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