Desistance
The "Desister" Debate
Parents may ask whether their child's gender dysphoria will persist or "desist" (i.e., the youth later changes course) — a question The Atlantic explored that some parents may have already read. Several peer-reviewed studies (Drummond et al., 2008; Steensma et al., 2011, 2013; Wallien & Cohen-Kettenis, 2008) found that while a meaningful proportion of youth persist (12–58%, depending on the study), most — over half in three of four studies — do not. This sparked debate over whether emphasizing desistance rates risks overshadowing the needs of youth whose dysphoria does persist, alongside methodological critiques of the underlying studies (Temple Newhook et al., 2018).
A more recent Pediatrics study (Wagner et al., 2021) followed gender-diverse children for an average of 3.5 years and found 29% received a gender dysphoria diagnosis and 25% received hormone therapy — consistent with Wallien & Cohen-Kettenis (2008) and Steensma et al. (2013). A separate follow-up of boys with gender identity disorder found 12.2% remained dysphoric at reassessment (“persisters”) versus 87.8% who did not (“desisters”); persisters tended to be older at assessment, from lower social-class backgrounds, and more gender-variant in childhood (Singh, Bradley, & Zucker, 2021). A secondary analysis of the U.S. Transgender Survey found 13.1% reported a history of detransition, 82.5% of whom cited an external factor (family pressure, social stigma); detransition was also associated with male sex assigned at birth, nonbinary identity, bisexual orientation, and family unsupportive of gender identity (Turban, Loo, Almazan, & Keuroghlian, 2021).
Researchers have called for more study of what distinguishes desisters from persisters (Butler & Hutchison, 2019).
Clinical implications for families:
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Recognize that not everyone with a transgender identity maintains it over time, and help families understand this variability without over- or under-stating it
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Help families manage the uncertainty and anxiety this can create, which may itself precede ambiguous loss (see I’m a Clinician)
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Encourage contact with clergy for support, if the family wants it
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Alongside individual/group psychotherapy, consider that social transition — a reversible step — is increasingly recommended for pre-pubertal youth (Chen, Edwards-Leeper, Stancin, & Tishelman, 2018; Singh et al., 2021)
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Make sure families understand which interventions are reversible and which aren’t, and that exploration can take many months and doesn’t always resolve toward medical intervention — and even medical intervention isn’t always permanent (e.g., a case of starting, then discontinuing, puberty blockers to resume natal puberty; Turban, Carswell, & Keuroghlian, 2018)
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