As debate rages over how best to care for children who are gender nonconforming, a group of Canadian scholars are working to change the way families and care providers respond. Rather than worrying about who a child might someday be, the experts argue, it’s more important to support the child now.
Julia Temple Newhook, a professional associate at Memorial University of Newfoundland, joined with several other professors and researchers to publish a new critical commentary in the International Journal of Transgenderism encouraging their peers to move beyond the “desistance myth.” The desistance myth refers to the belief that some 80 percent of gender nonconforming kids will grow up to not be trans — in other words, that they will “desist,” or not persist, in their gender nonconformity. Critiquing the research behind that myth, they noted both methodological flaws in the studies as well as ethical concerns about assumptions the researchers made.
Focusing on four of the most recent studies often cited by proponents of the desistance myth, they outlined 12 different critiques, some of which ThinkProgress previously investigated:
- Children included in the studies were counted as being trans even when they did not actually meet the diagnostic criteria for gender dysphoria.
- The studies were limited to children brought to two specific clinics in Toronto and the Netherlands, which suggests that parents who objected to their children’s gender nonconformity were over-represented.
- When researchers followed up with the studies’ participants, they were still quite young. Given the increased probability of having rejecting parents, it’s very possible they might still transition later in life.
- Some of the studies counted children who did not follow up with researchers as having “desisted,” without providing evidence to confirm that theory.
- Researchers inherently frame cisgender identity “as the healthy opposite of a problematic transgender identity,” validating any demonstration of a cisgender identity and doubting any demonstration of a transgender identity.
- Researchers assume a boy/girl gender binary with no room for affirming children who identify as nonbinary.
- Researchers assume that gender is static and that “stability” in a gender identity is preferable to fluidity.
- The “intensive treatment and testing” performed on children participating in the studies may have had adverse effects on the children (and may have impacted the results as well).
- The Toronto studies were conducted at a clinic that openly admitted its goal was to decrease the likelihood that children grow up to be transgender.
- Researchers neglected children’s autonomy by imposing their own language over how the children in the studies were expressing their gender identity for themselves.
- Researchers assume without evidence that if a child socially transitions but later “desists,” it will be traumatic to undergo another transition.
- Researchers assume that children are best off if their childhood, adolescent, and adult needs all “match,” justifying treatment delays instead of affirming what a child is expressing in the present.
In related commentary published in the Canadian Family Physician, Temple Newhook and her colleagues urged treatment providers to worry less about who children might group up to be. “We argue that this narrow focus on prediction is misplaced,” they wrote. “[O]ur main priority is not predicting children’s adult identities; it is supporting children’s present and future health and well-being.”
Responses from the researchers
The International Journal of Transgenderism invited the primary researchers of the desistance studies to respond to the critiques. Both Kenneth Zucker, formerly of the Toronto clinic, and Thomas Steensma and Peggy Cohen-Kettenis of the Dutch clinic agreed to do so. Their responses, however, do little to undermine the legitimacy of the critiques.
Kenneth Zucker, considered by many as the father of gender conversion therapy, proved in his reply that he still supports efforts to try to correct a child’s gender. His overall argument was that he believed Temple Newhook, et al, were trying to suppress research on persistence and desistance, a strawman that they never actually espoused. In a follow-up response, they clarified that they in no way call for abandoning or erasing longitudinal studies of gender diverse children; they just believe the focus should move away from trying to predict the children’s identities when they grow up.
Ignoring their concerns about the research’s gaping flaws, Zucker insisted that the data still supported desistance and that it was valid to have such biases against children transitioning. He even admitted that, despite the connotation of the word “desistance” implying a bad thing coming to an end, he chose the term because it “sounded pretty cool to me.”
Zucker defended what he called a “psychotherapeutic” response “designed to reduce a child’s gender dysphoria.” This included sharing a troubling anecdote about a child who’d been conditioned to say what their parents wanted them to say:
One birth-assigned male who I assessed at the age of 7 had transitioned socially around a year prior, in a sort of passive way. This child’s mother asked: “So, do you want to be a boy or a girl?” The child’s response was “What do you want me to be?” In my view, exploration of this child’s “true” or authentic self could be explored in a psychotherapeutic safe space.
It didn’t even seem to occur to Zucker that this anecdote might demonstrate that the parents had been trying to police the child’s gender. Instead, he believed this example justified his biases against transitioning because it proved that some children are not capable of expressing a “stable” or “authentic” gender identity.
In their follow-up, the researchers called out Zucker for supporting gender conversion therapy and refer back to the same child to make their point about empowering children to be whoever they currently are:
What led this child to believe that there was only one version of themselves that would be “wanted,” accepted, and embraced? Why did this child not feel comfortable or perhaps safe enough to express their inner feelings about their gender? What consequence did they fear from allowing their hearts to speak truthfully? The affirmative approach strives to create an environment within which the child does feel free to use the “I” word in expressing their gender and have the security of knowing that the adults in the room will listen. As the field of care for gender diverse children progresses, we look forward to a time when we not only ask children who they are, but truly learn to listen.
Kelley Winters, one of the researchers who helped write the desistance critiques, also told ThinkProgress that Zucker and his supporters have tried to cover up his use of gender-corrective approaches by using “a red herring deception” to confuse the language.
“First, they mis-defined the terms, ‘conversion’ and ‘reparative,’ to pertain only to sexual orientation and not gender identity,” she explained. “Then they claimed that trans-suppressive psychotherapies that do not intend to change
sexual orientation are not ‘conversion” treatments.'”
Though the language of conversion therapy has its roots in the ex-gay movement, most advocates — and legislation — refer to any attempt to suppress any LGBTQ identity.
Dutch researchers Steensma and Cohen-Kettenis were more concessional in their response. Though they stood by their research and downplayed some of the critiques, they acknowledged the validity of many of the flaws the Canadian scholars outlined. “[W]e want to stress that we do not consider the methodology used in our studies as optimal…or that the terminology used in our communications is always ideal,” they admitted.
Rather than rehashing the critiques of their studies, they seemed more interested in generating more reliable research. “Instead of polarization and accusations that can be read so often in the literature, collaboration in gathering more (and better) information about the development of gender variant children in different social contexts will better serve the quality of life of transgender children,” they wrote. “Children and their families do not need arguing clinicians, but responsible care that is based on good evidence.”
In a separate recent interview, Steensma admitted that his research should not be used to reinforce the desistance myth because the studies weren’t actually designed to measure desistance rates. Instead, their goal was to find indicators of future persistence, which they did find. Children who asserted they had a different gender than they were assigned at birth — as opposed to those who merely wished they were a different gender — were, in fact, more likely to persist in having a transgender identity.
(Winters, however, noted that whatever Steensma might now be saying, the study does contain language claiming that “for the majority of children… the [gender dysphoria] desisted.”)
Moreover, Steensma in that interview and Zucker in his commentary both seem to agree that it’s possible that children can be encouraged to be trans. If parents affirm a child’s social transition, they both believe that this could make it more likely that the child “persists” in being trans. Not only do they provide no evidence to support this belief, but it confirms the bias the scholars allege: the assumption that turning out trans would somehow be a less favorable outcome.
Winters referred to such claims as “ad hoc hypotheses” that were “constructed after the fact to dismiss inconvenient evidence that counters the 80 percent ‘desistance’ hypothesis.” She argued that these are nothing but invented attempts to render that myth “unfalsifiable” that “cross the fine line that separates science from dogma.”
While this debate plays out among researchers, it is also playing out in the media and among parents across the globe. The Atlantic’s most recent cover story by Jesse Singal defends the concerns many parents have about letting their children transition and encouraging others to have the same doubts. Singal has long defended the “desistance myth,” and his concern-trolling approach — that it’s in kids’ best interests not to be allowed to transition — depends entirely upon that myth.
In fact, Singal made his first big foray into writing about trans kids at New York Magazine by defending Zucker’s work and downplaying the allegations that he engages in conversion therapy. He subsequently wrote a defense of the desistance myth, shrugging off all their flaws in the same fashion Zucker did.
In March, Singal insisted that most people — himself included — had misread the Steensma research by not paying heed to follow-up questionnaires researchers sent to some of the children who did not return to the clinic. Of the 80 who chose not to continue with the clinic, 24 never returned their follow-up questionnaires and researchers were unable to track them down. Fifty-two of those who did return the questionnaire — six of whom had their questionnaires filled out by parents — provided feedback that Singal claimed supported the myth, however experts have noted since then that, because no follow-up examinations actually took place, his claim was flawed.
Singal’s comments also directly contradicted how Steensma himself has talked about the study.
Singal’s reporting also lifts up the voices of parents involved in online parent groups who regularly discuss justifications for not allowing their kids to transition — though he neglects to mention those affiliations. These groups have even invented a fake diagnosis called “Rapid Onset Gender Dysphoria” (ROGD), which they apply to teenagers assigned female at birth who they think have come out as transgender too quickly for it to be a legitimate identity. This imagined phenomenon depends upon the desistance myth, and these groups likewise share Zucker and Steensma’s belief that kids can be encouraged to become trans.
One of these sites, Transgender Trend, a U.K.-based parent group, insists, “We don’t have any evidence that children really are trans,” that trans adults who say they knew they were trans when they were kids are just inventing memories, and that kids who claim to be trans just want attention. “We know that in fact around 80 percent of children do ‘grow out of it’ and come to accept and be happy as the sex they were born,” the site claims, directly referencing the desistance myth.
The founder of 4thwavenow, another anti-trans parent group, explains, “It is my contention that the medical and psychological establishments are letting us all down in their rush to diagnose young people as ‘transgender,’ then to give the message that medical treatment is the answer.”
One of the parents featured in Singal’s piece, Jenny Cyphers, has published a blog post on 4thwavenow, and complained that The Atlantic “censored” her references to the group, which she considered an important resource when she made the decision not to let her child transition.
Yet another group, ParentsOfROGDKids, tells parents that “identifying as the opposite gender is NOT normal,” that kids are “subjected to strong cultural influences that promote transitioning,” and that affirming trans people for who they are is an “unproven” and “unethical” form of experimentation. The site’s top recommendation for therapists is none other than Zucker.
This desistance propaganda is trying to convince parents that they are justified in rejecting their transgender kids’ identity, even though such family rejection is the biggest factor contributing to trans kids’ mental health concerns. The research does not support skepticism over the legitimacy of their gender identities, and the medical consensus is moving past these assumptions.
The World Professional Association of Transgender Health (WPATH) is currently working to update its Standards of Care, and one of the considerations is lowering age-of-consent minimums for certain transition treatments. The groundbreaking new research on how affirmed transgender children are thriving will be incorporated into the standards for the first time.
Though the WPATH standards are generally followed worldwide, Australia isn’t waiting for them to be updated. The country announced last week that it would adopt new guidelines that recommend personalized assessments of children instead of restricting their options with arbitrary ages of consent. Winters praised the team that developed the standards because they “affirm the benefits of social role authenticity for trans children.”
The editors of The Lancet, one of the world’s most prestigious medical journals, also endorsed Australia’s new guidelines, describing them as a “a framework for provision of respectful, gender-affirming care of transgender and gender diverse children and adolescents.”
As Steensma noted, it is unfortunate that parents are being caught in the middle of the debate over how best to support gender nonconforming children. The reality, however, is that those defending the desistance myth are using it to reinforce their biases against transitioning. Those advocating for an affirmative model — one that respects kids for however they express their gender — are responding to what the research actually shows about how best to support children’s well-being.
Overcoming the desistance myth is no small feat either. As Winters explained, it has “long been stated as fact in the literature, media, and medical and public policy that discourage social authenticity for trans youth.” Unfortunately for its proponents, it’s fallen short of its burden of proof.
“Listening to the needs of trans and gender dysphoric children and providing for their well-being in the present should take priority over such tenuous speculation about future ‘desistant’ outcomes,” she said.
As Temple Newhook, Winters, and their colleagues concluded in their commentary, “Through affirmation in the present, and celebration of whatever the future might hold, our goal is for all children to reach their full potential in all aspects of their lives.”
CORRECTION: An earlier version of this article referenced child and adolescent psychiatrist Scott Leibowitz and his colleague Laura Edwards-Leeper in a context that misrepresented their work. It has been updated to remove reference to them.