People who are transgender as children stay transgender as adults. Often this identity starts to manifest in preschool or kindergarten and it is usually resolutely stays that way. It isn't a passing fancy.
They almost never change their minds. But postponing gender affirming treatment until after puberty greatly reduces the quality of the physical transition because puberty hormones lead to irreversible changes in the body that these individuals very much do not want.
The quoted text is from a Facebook post of a friend who is a medical doctor sourced from the Lancet article whose abstract and citation are found below it:
Transgender teens aren't "confused," nor do they "change their mind" upon reaching adulthood.
Nearly all individuals with gender dysphoria who initiated hormone treatment as adolescents continued that treatment into adulthood, according to this Dutch observational study.Among 720 people who started puberty suppressing hormones prior to the age of 18, 704 (98%) continued to use gender-affirming hormones after turning 18.
Out of the 16 individuals who stopped using prescription gender-affirming hormones by the end of the study at an average age of 19 to 20, nine were assigned male at birth (4% of 220) and seven were assigned female at birth (1% of 500). A total of 12 of these 16 individuals (75%) underwent gonadectomy during this follow-up period.
N.B. "Gonadectomy" is a generic term referring to the surgical removal of either the testes in males or the ovaries in females, which results in a loss of gonadal production of sex steroids. It is an alternative approach to gender-affirming hormone treatments. So, 99.4% of 720 subjects (all but 4 of them) continued to take active medical action consistent with a transgender identity after reaching adulthood.
The summary of the source article and its citation are below:
SummaryBackgroundIn the Netherlands, treatment with puberty suppression is available to transgender adolescents younger than age 18 years. When gender dysphoria persists testosterone or oestradiol can be added as gender-affirming hormones in young people who go on to transition. We investigated the proportion of people who continued gender-affirming hormone treatment at follow-up after having started puberty suppression and gender-affirming hormone treatment in adolescence.MethodsIn this cohort study, we used data from the Amsterdam Cohort of Gender dysphoria (ACOG), which included people who visited the gender identity clinic of the Amsterdam UMC, location Vrije Universiteit Medisch Centrum, Netherlands, for gender dysphoria. People with disorders of sex development were not included in the ACOG. We included people who started medical treatment in adolescence with a gonadotropin-releasing hormone agonist (GnRHa) to suppress puberty before the age of 18 years and used GnRHa for a minimum duration of 3 months before addition of gender-affirming hormones. We linked this data to a nationwide prescription registry supplied by Statistics Netherlands (Centraal Bureau voor de Statistiek) to check for a prescription for gender-affirming hormones at follow-up. The main outcome of this study was a prescription for gender-affirming hormones at the end of data collection (Dec 31, 2018). Data were analysed using Cox regression to identify possible determinants associated with a higher risk of stopping gender-affirming hormone treatment.Findings720 people were included, of whom 220 (31%) were assigned male at birth and 500 (69%) were assigned female at birth. At the start of GnRHa treatment, the median age was 14·1 (IQR 13·0–16·3) years for people assigned male at birth and 16·0 (14·1–16·9) years for people assigned female at birth. Median age at end of data collection was 20·2 (17·9–24·8) years for people assigned male at birth and 19·2 (17·8–22·0) years for those assigned female at birth. 704 (98%) people who had started gender-affirming medical treatment in adolescence continued to use gender-affirming hormones at follow-up. Age at first visit, year of first visit, age and puberty stage at start of GnRHa treatment, age at start of gender-affirming hormone treatment, year of start of gender-affirming hormone treatment, and gonadectomy were not associated with discontinuing gender-affirming hormones.InterpretationMost participants who started gender-affirming hormones in adolescence continued this treatment into adulthood. The continuation of treatment is reassuring considering the worries that people who started treatment in adolescence might discontinue gender-affirming treatment.
Maria Anna Theodora Catharina van der Loos, MD, Sabine Elisabeth Hannema, PhD, Daniel Tatting Klink, PhD, Prof Martin den Heijer, PhD, Chantal Maria Wiepjes, PhD, "Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: a cohort study in the Netherlands" The Lancet (October 20, 2022). DOI:https://doi.org/10.1016/S2352-4642(22)00254-1
If I can try to sum up what the abstract is telling me: out of several hundred Dutch kids who were put on puberty blockers between the ages of 13 and 17, almost all of them were taking hormones in their early 20s.
ReplyDelete@Mitchell
ReplyDeletePretty much, and a good share of those who weren't taking hormones were not doing so because they had their testes or ovaries removed.
The theory of puberty blockers is that if you don't take them, as a child, then a gender transition as an adult will be defective because puberty blockers will have caused irrevocable gender specific transitions in the gender you don't identify with. But, adults who are making the decision don't want to gender transition a child who isn't old enough to consent for most purposes. Then, when the person whose puberty was blocked becomes an adult, they either gender transition using hormones and/or surgery, or they allow long delayed puberty to take its course - in which case the adults have deferred the physical puberty process by four or five years, but otherwise not made permanent changes to the child's physical gender in the meantime.
It only makes sense for the adults to delay puberty for children (at considerable expense and seriously fucking with the normal course of development for the child) if a large share of children whose puberty is delayed with want to do the gender transition that the puberty blockers facilitated working more smoothly.
This study validates that when those children whose puberty was delayed were indeed ultimately given a choice to gender transition or not using hormones and/or surgery, without adults in their lives having a say in the matter because they were now adults themselves, that they overwhelmingly, almost all, did indeed want to do what the puberty blockers facilitated, which is something they would only do if they had a stable transgender identity and it was no just some passing fancy (as opponents of puberty blocking frequently suggest is the reason to be wary of doing it). If the naysayers about puberty blocking were correct, you would expect some significance proportion of puberty blocked children to decide upon becoming adults in the early 20s that gender transitioning isn't what they really wanted and to allow a delayed puberty to run its course - not necessarily 50% but perhaps at least 5% or 10%.
Moreover, if the strong desire of 12-14 year olds to make it possible to have a smooth gender transition once they become adults is something that 99%+ of them continue to want (and perhaps some of the 0.3% or whatever who don't continue aren't doing so not due to a change of mind about gender identity but because something else prevents it like a drug addiction or childhood cancer or who knows what else), then this also casts doubt on the legal system's assumption that 12-14 year olds are not mature enough to consent to gender transition then, rather than having to do puberty blockers for all of late middle school and high school so that they can legally consent as adults, which is why puberty blocking is done at all. If transgender identity is that stable as illustrated not just with surveys but with the revealed preferences of adult conduct, it would make more sense to routinely immediately gender transition kids who now get puberty blockers at that age and to specifically authorize them to consent to doing it if the conditions for consent to puberty blockers in the existing system are met.