Most transgender children do not retransition, study finds

A study found that only 7.3% of children who socially transitioned before age 12 years chose to retransition within 5 years, suggesting that it is uncommon.

Social transitioning “typically involves changing a child’s pronouns, first name, hairstyle, and clothing,” Kristina R. Olson, PhD, a professor of psychology at Princeton University, and colleagues wrote in Pediatrics.

“Some concerns about childhood social transitions have been raised, including that these children may not continue to identify as transgender, rather they might “retransition” (also called a “detransition” or “desistence”), which some suggest could be distressing for the youth,” they wrote.

Olson and colleagues found, however, that 94% of study participants continued to identify as binary transgender youth an average of 5 years after their initial social transition, including 1.3% who retransitioned to another identity before returning to their binary transgender identity.

The multi-institution study was conducted as part of the Trans Youth Project. It included 317 binary socially transitioned transgender children aged between 3 and 12 years — 208 initially transgender girls and 109 initially transgender boys — who were observed between July 2013 and December 2017.

The children initially socially transitioned at age 6.5 years, on average, to live in accordance with their gender and not the gender assumed by their sex at birth.

“As part of the larger longitudinal study, parents and youth were regularly asked about whether they had begun using puberty blockers and/or gender-affirming hormones,” Olson and colleagues wrote. “At most visits, they were not asked about whether puberty had begun, although our available data suggest that because these youth had socially transitioned at such early ages, most participants were followed by an endocrinologist well before puberty began.”

Endocrinologists also helped families identify first stages of puberty, with 37 of the children (11.7% of the group) beginning puberty blockers before the study.

Based on pronouns at follow-up appointments, the researchers classified participants as binary transgender, nonbinary, or cisgender.

They found that, among the 7.3% of children who retransitioned after 5 years, around 2.5% identified as cisgender, whereas the rest identified as nonbinary.

The researchers noted a slightly higher rate of retransition, particularly to a cisgender identity, among youth who initially socially transitioned before age 6 years. However, even among these participants, retransition rates were very low.

When youth retransitioned to a cisgender identity, it nearly always occurred before age 10 years and before medical transition. Among those making a medical transition with puberty blockers or gender-affirming hormones, only one had retransitioned.

Olson and colleagues noted that some youth in the study were not eligible for blockers because they were prepubertal, and that participants who have not begun puberty and who identify as binary transgender or nonbinary “likely will.” They anticipated following the cohort into adolescence and adulthood, noting their identities could change as they mature.

“Though we can never predict the exact gender trajectory of any child, these data suggest that many youth who identify as transgender early, and are supported through a social transition, will continue to identify as transgender 5 years after initial social transition,” they wrote. “These results also suggest that retransitions to one’s gender assumed at birth (cisgender) might be likely to occur before age 10 amongst those who socially transition at the earliest ages (before age 6), though retransitions are still unlikely in this group.”