Gender nonconformity in childhood linked to diverse sexual orientation later

Key takeaways:

• A study found an association between gender nonconformity in childhood and diverse sexual orientation as an adult.
• More than 1,100 participants who enrolled as children participated in a follow-up 27 years later.

Gender role nonconformity in childhood and adolescence was associated with diverse sexual orientation beginning in young adulthood, a decades-long study in Australia found.

The researchers measured gender nonconformity in childhood or adolescence using parent or teacher reports stating that a child “behaves like the opposite sex” or “wishes to be the opposite sex.”

“These items have been used in research to measure gender diversity, but we wanted to know whether they actually related to gender or sexuality diversity in adulthood,” Jennifer L. Marino, PhD, a senior research fellow in the department of obstetrics and gynecology at the Royal Women’s Hospital in Parkville, Australia and co-author of the study, told Healio.

Marino said they became interested in the topic through tools commonly used in clinical and research settings to measure childhood mental health: the Achenbach System of Empirically Based Assessment (ASEBA) and Child Behavior Checklist (CBCL).

Marino and colleagues examined data from the Raine study, which began recruiting large numbers of pregnant women living in and around Perth, Australia, between 1989 and 1991. Their 2,868 infants were referred to as the Generation 2 cohort, and the researchers followed up with the parents at ages 5, 8, 10 and 17; with teachers at ages 10 and 14; and the participants themselves at years 14, 17 and 27.

“We looked at responses to these items completed multiple times over childhood and adolescence by the parents, mostly moms, as well as by the Gen2 participants themselves at ages 10 and 14,” Marino said. “We related these answers statistically to the Gen 2 participants’ self-reports of gender identity and sexual orientation at age 27.”

Of the 1,154 members of the Generation 2 cohort who participated in the year-27 follow up, 52.7% were recorded female at birth and 47.3% were recorded male at birth. Of the cisgender participants, 95.7% of the recorded-female subjects continued to identify as female, 94.3% of the recorded-male subjects continued to identify as male, and 4.1% did not complete that portion of the questionnaire.

Among the cisgender participants, 12.6% of women and 9.6% of men reported a diverse sexual identity, whereas 33.8% of the women and 14.3% of men were same-gender attracted, and 18.6% of women and 7.2% of men reported ever having engaged in same-gender sexual behavior.

After adjusting for gender, the researchers found that participants with nonconforming gender role behavior were more than twice as likely to report diverse sexual identity (adjusted OR [aOR] = 2.8; 95% CI, 1.9-4.2) or behavior (aOR = 2.4; 95% CI, 1.6-3.5) later one.

They also found that self-reported gender role wish was consistently associated with diverse sexual identity (aOR = 2.3; 95% CI, 1.4-3.8) attraction (aOR = 1.7; 95% CI, 1.1-2.5) or behavior (aOR = 1.9; 95% CI, 1.2-2.9).

“We found that the items were related to diverse sexual orientation at age 27, but we didn’t really see a relationship with gender identity,” Marino said. “Some of that is because there were not very many gender-diverse young people in the study. But it was clear to us that although these items are measuring something, since they are consistently related to measures of sexual orientation, they don’t seem to be closely related to gender identity in adulthood.”

The CBCL and ASEBA tools are commonly used in research settings to measure gender diversity, and have been used in clinical settings as well, Marino said, “but they shouldn’t be.”

“We know that the best way to measure gender identity in childhood and adolescence is to ask the child directly in clear, age-appropriate terms,” Marino said. “This is important because children need appropriate access to care and because we need a clearer understanding of how gender identity develops over time.”

She added that the tools should not be used to measure sexual orientation.

“We think that these items are measures of whether a child conforms to stereotypical gender roles, and children who grow into sexuality-diverse adults may have more trouble conforming to expectations around those gender roles,” Marino said. “We need to understand much more about this, because we know that gender-diverse and sexuality-diverse young people are subject to bullying and discrimination and that this starts in primary school.”

“Part of the reason this happens may be gender role nonconforming behavior,” Marino continued. “This stigma may be why this group has worse health and educational outcomes. Understanding these relationships is crucial to understanding how we can better support these young people.”