CA — Toronto, Ontario. A long-term follow-up of male children with gender dysphoria has found that most study participants desisted over time and accepted themselves as boys. The groundbreaking study used the largest sample to date of boys referred to clinics for gender dysphoria.

“A Follow-Up Study of Boys With Gender Identity Disorder” was published in the peer-viewed journal Frontiers in Psychology, and the research protocol was reviewed and approved by Clarke Institute of Psychiatry (now the Centre for Addiction and Mental Health) and the University of Toronto.

Study participants were 139 male children assessed in the Gender Identity Service, Child, Youth, and Family Program at the Centre for Addiction and Mental Health (CAMH) in Toronto between 1975 and 2009. 63.3% of the boys met DSM-III, III-R, or IV criteria for gender identity disorder (GID), while the rest of the 36.7% were subthreshold for a DSM diagnosis.

Researchers first assessed the children at approximately age 7, following up with participants when they reached adolescence and again in early adulthood.

At follow-up, researchers classified participants as persisters (which the study defines as “boys who continued to have gender dysphoria”) or desisters (boys who did not continue to have gender dysphoria), and deduced their sexual orientation based on fantasy and behavior.

Researchers found that 17 (12.2%) of the participants persisted in their gender dysphoria, and the remaining 122 (87.8%) desisted.

82 (63.6%) of the participants were ascertained to be bisexual or gay and 43 (33.3%) were heterosexual. The remaining 4 (3.1%) reported no sexual fantasies.

The study concluded that “boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation.”

Social class stood out as the most important indicator of whether a bisexual or gay boy would persist or desist in his gender dysphoria. Biphilic/androphilic (bisexual/gay) persisters were 13% more likely to come from a lower social class background compared to the biphilic/androphilic desisters, the study found. Gynephilic (heterosexual) desisters and biphilic/androphilic desisters “did not differ significantly from each other.” The study authors speculated that this is possibly because “acceptance of a gay or homosexual sexual identity is less in ‘working class’ subculture.”

Researchers additionally “did not find that persistence was more common among boys who were threshold for the diagnosis of GID when compared to the boys who were subthreshold (13.6% vs. 9.8%).”

The authors noted that the boys in the study were seen “during a period of time when treatment recommendations, if such were made, often aimed to reduce the gender dysphoria between the child’s felt gender identity and biological sex.” Recommendations often included “psychotherapy or psychoanalysis, behavior therapy, group therapy, parent-counseling, and interventions in the naturalistic environment, such as encouragement of same-sex peer relations.”

In contrast to this therapeutic approach, “in recent years, it has become more common for some clinicians to recommend a gender social transition prior to puberty,” the authors noted.

The authors postulated that children who transition prior to puberty may be more likely to persist. The study “Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study,” published in Journal of the American Academy of Child and Adolescent Psychiatry in 2003, “found the highest rate of persistence” of any study of gender dysphoric children. That study “included some patients who had made a partial or complete gender social transition prior to puberty and this variable proved to be a unique predictor of persistence.” Unlike in that study, only one participant in “A Follow-Up Study of Boys With Gender Identity Disorder,” had transitioned prior to puberty.

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