transgender Ella
© BBCElla, a 17-year-old transgender girl interviewed for the documentary Transgender Kids: Who Knows Best?
The National Post recently covered the CBC's cancellation of a BBC documentary about transgender children (Why CBC cancelled a BBC documentary that activists claimed was 'transphobic'). In that coverage, the Post shared claims made by some activists criticizing some scientific studies, but did not apparently fact-check those claims, so I thought I would outline the studies here. For reference, in a previous post, I listed the results of every study that ever followed up transgender kids to see how they felt in adulthood (Do trans-kids stay trans when they grow up?). There are 12 such studies in all, and they all came to the very same conclusion: The majority of kids cease to feel transgender when they get older.

The Post conveyed criticisms alleged about two of those: "One study of Dutch children, in particular, assumed that subjects had 'desisted' purely because they stopped showing up to a gender identity clinic." Although unnamed, the claim appears to be referring to Steensma et al. (2013), which followed up on 127 transgender kids. Of them: 47 said they were still transgender; 56 said they were no longer transgender (46 said so directly, 6 said so via their parents, and 4 more said so despite not participating in other aspects of the study); and 24 did not respond to the invitation to participate in the study or could not be located.

Because all the medical services for transition are free in the Netherlands and because there is only one clinic providing those services, the researchers were able to check that none of the 24 had actually transitioned despite having the opportunity to do so. Steensma therefore reported that (80/127 =) 63% of the cases desisted. The alleged criticism is that one should not assume that the 24 who did not respond or could not be found were desisters. Regardless of whether one agrees with that, the irrelevance of the claim is clearly seen simply by taking it to its own conclusion: When one excludes these 24, one simply finds a desistance rate of (56/103 =) 54% instead of 63%. That is, although numerically lower, it nonetheless supports the very same conclusion as before. The majority of kids cease to feel transgender when they get older.

The other alleged criticism was that a study "cast too wide a net on which children were legitimately displaying gender dysphoria." Although also unnamed, this seems to refer to Drummond et al. (2008), which followed up on 25 kids assessed in childhood for gender issues: 15 of the 25 received official diagnoses for their gender dysphoria, and 10 were judged to be experiencing the feelings, but to be "subthreshold" for an official diagnosis. That is, the alleged criticism is that including "subthreshold" cases would water down the results from cases who are formally diagnosed. The irrelevance of that claim is again easily seen by looking at it directly: Of the 15 kids who received a diagnosis, two continued to be transgender in adulthood (13/15 = 87% desistance), and of the 10 without a diagnosis, one continued to be transgender (9/10 = 90% desistance). Drummond thus reported their combination, that (22/25 =) 88% desisted. That is, both the "too wide" net and the narrow net each support the very same conclusion: The majority of kids cease to feel transgender when they get older.

I am personally of the opinion that the studies' authors were correct in their original methods, but the numbers indicate that it simply does not matter. Even if the criticisms were valid, the studies conclusions would remain the same.

The state of the science is made clear simply by listing the results of the studies on the topic. Despite coming from a variety of countries and from a variety of labs, using a variety of methods, all spanning four decades, every single study without exception has come to the identical conclusion. This is not a matter of scientists disagreeing with one another over relative strengths and weaknesses across a set of conflicting reports. The disagreement is not even some people advocating for one set of studies with other people advocating for a different set of studies: Rather, activists are rejecting the unanimous conclusion of every single study ever conducted on the question in favour of a conclusion supported by not one.

Importantly, these results should not be exaggerated in the other direction either: The correct answer is neither 0% nor 100%. Although the majority of transgender kids desist, it is not a large majority. A very substantial proportion do indeed want to transition as they get older, and we need to ensure they receive the support they will need. Despite loud, confident protestations of extremists, the science shows very clearly and very consistently that we cannot take either outcome for granted.

The BBC documentary pulled from CBC is viewable here.

References:

Drummond, K. D., Bradley, S. J., Badali-Peterson, M., & Zucker, K. J. (2008). "A follow-up study of girls with gender identity disorder." Developmental Psychology, 44, 34-45.

Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). "Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study." Journal of the American Academy of Child and Adolescent Psychiatry, 52, 582-590.