Talk:Gender dysphoria in children

Persistence

The introduction to this paragraph alleges a persistence rate of 12-27%. This seems to contradict other parts of the article which recognize that gender identity is generally fixed. Moreover, the reference used cites Bonifacio. Bonifacio in turn cites Holt, Skagerberg and Dunsford (2014), but this study makes no reference to this number, and does not discuss the issue of persistence.

In short, the paragraph seems poorly written and, barring any objections, I will make some revisions. HenrikHolen (talk) 21:24, 29 September 2024 (UTC)

@HenrikHolen I added most of that section (to contradict the 12-27% originally stated in wikivoice), so I'll take a crack at re-organizing and trimming it right now! Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:53, 29 September 2024 (UTC)

It seems to me that there are varying definitions of persistence depending on how you define the study cohort. Some will include only those that pursued medical treatments, others include anyone who displays gender variant behavior. I think the most objective approach is this; rather than writing about the persistence of gender dysphoria, which can be a bit vague and hard to define, we might write about the percentage of those receiving treatment in childhood who will continue to identify as transgender in adulthood. HenrikHolen (talk) 22:43, 29 September 2024 (UTC)

That seems an unwarranted change - we are talking about the persistence of a diagnosis of gender dysphoria.

Treatment is not uniform or universal even with a diagnosis, and some receive treatment without. Bringing treatment into the picture muddles an already uncertain area.

Right now the material on persistence has been completely removed with no cause, and recent referencing to the Cass Review removed, with no cause. Void if removed (talk) 09:56, 9 October 2024 (UTC)

Persistence is discussed in the Cass Review, why did you remove this:

Later studies where a greater number of individuals had socially transitioned prior to assessment show higher rates of persistence of 37%. Void if removed (talk) 10:03, 9 October 2024 (UTC)

Because that study was using dsm4-tr and wasfrom before dsm 5, so it's "high" persistence rate is still subject to the same problems as others.

Also referenced in Cass is this source From 2024 that says a persistence rate of 97.6% (found by searching persistence in the Cass review). Which may be more appropriate given it's recency meaning of it's using up to date definitions LunaHasArrived (talk) 14:22, 9 October 2024 (UTC)

These are problems that should be described in the article, not removed entirely.

Which may be more appropriate

You're speculating - there are many differences in this study (half socially transitioned prior to first meeting, DSM-5 diagnosis not required for inclusion, wide age range and short followup, etc etc). What you need is a HQ secondary source to do the assessment of the evidence. Void if removed (talk) 14:39, 9 October 2024 (UTC)

We have HQ secondary sources that say that studies tracking desistance (or persistence conversely) using old definitions are not appropriate. We have a systematic review including this 2013 Steensma et al, that rates it as poor quality due (along other reasons) a fall off of over 20%. In fact Steensma et al says that "children who expressed cross-gender identification had a greater chance of persisting GD", meaning that an updated definition which requires this cross gender identification (i.e DSM-V) would be expected to have higher persistence rates.

To include this old data serves no purpose but to mislead about present day persistence rates and if included at all should be included in the following part : "these studies tracked gender nonconforming children due to relying on older definitions of dysphoria which didn't require identification with the opposite sex".

Primarily, this is not a later study it is an older study because that part that matters here the most is the definition it relied upon. LunaHasArrived (talk) 15:11, 9 October 2024 (UTC)

And we have the Cass Review, saying it is. I'm well aware that some claim the changing criteria mean old studies don't apply, but this is not a unanimous opinion, it is something for which all viewpoints should be neutrally presented.

To include this old data serves no purpose but to mislead about present day persistence rates

And you know this, how? The Cass Review says:

The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist.

This is a significant, well-sourced POV that should be present. Not the only POV, but absolutely not one that should be removed, as has been done. Void if removed (talk) 15:37, 9 October 2024 (UTC)

Per Medrs, we have a systematic review on the area that says all of what I said above. That you prefer Cass (which did not have any systematic review on persistence) does not mean it outranks a systematic review. LunaHasArrived (talk) 15:47, 9 October 2024 (UTC)

What you said is To include this old data serves no purpose but to mislead about present day persistence rates

That isn't what that review says.

What it says is there's no decent research, and the tiny number of low quality quantitative studies - which give a desistance rate of 83% - are at high risk of bias.

There is no definitive answer here, and no justification for removing the existing sourced-material. Void if removed (talk) 16:11, 9 October 2024 (UTC)

We should not cite this summary of a single primary source from a government report as it goes against WP:MEDREV. Flounder fillet (talk) 16:07, 9 October 2024 (UTC)

Not a government report. The Cass Review is itself a high quality secondary WP:MEDRS. Void if removed (talk) 16:14, 9 October 2024 (UTC)

If the final report of the Cass Review cannot be accurately described as a government report, what kind of document is it? Flounder fillet (talk) 16:51, 9 October 2024 (UTC)

It's an independent review commissioned by NHS England. Void if removed (talk) 17:05, 9 October 2024 (UTC)

We should not cite this summary of a single primary source from the final report of an independent review commissioned by NHS England as doing so goes against WP:MEDREV because it is still a summary of a single primary source. Flounder fillet (talk) 18:47, 9 October 2024 (UTC)

You're just repeating yourself now.

Controversies or uncertainties in medicine should be supported by reliable secondary sources describing the varying viewpoints

The Cass Review is arguably the highest quality secondary source describing the varying viewpoints of this area. Void if removed (talk) 21:00, 9 October 2024 (UTC)

The Cass review repeatedly says "most kids desist" based on one reference to a study whose own authors note it was based on outdated diagnostic criteria. It doesn't address any other viewpoints. The best quality source we have on desistence is the systematic review of desistence research, not Cass's non-peer reviewed claim criticized in actual peer reviewed literature. Please WP:DROPTHESTICK. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:37, 9 October 2024 (UTC)

based on one reference

Several studies from that period (Green et al., 1987; Zucker, 1985) suggested that in a minority (approximately 15%) of pre-pubertal children presenting with gender incongruence, this persisted into adulthood. The majority of these children became same-sex attracted, cisgender adults. These early studies were criticised on the basis that not all the children had a formal diagnosis of gender incongruence or gender dysphoria, but a review of the literature (Ristori & Steensma, 2016) noted that later studies (Drummond et al., 2008; Steensma & Cohen-Kettenis, 2015; Wallien et al., 2008) also found persistence rates of 10-33% in cohorts who had met formal diagnostic criteria at initial assessment, and had longer follow-up periods. It was thought at that time that if gender dysphoria continued or intensified after puberty, it was likely that the young person would go on to have a transgender identity into adulthood (Steensma et al., 2011).

It doesn't address any other viewpoints

One study (Olson et al, 2022) [...] found that 93% of those who socially transitioned between three and 12 years old continued to identify as transgender at the end of the study (about 5.4 years later). Of the remainder, 2.5% were living as cisgender, 3.5% as non-binary and 1.3% had retransitioned twice.

Another study (Steensma et al., 2013b) found that childhood social transition was a predictor of persistence of gender dysphoria for those birth-registered male, but not those birth-registered female. In this study 96% of those birth-registered male and 54% of those birth-registered female who later desisted had not socially transitioned at point of referral and none had fully socially transitioned (see Table 8). The study noted that the possible impact of the social transition on cognitive representation of gender identity (that is, how the child came to see themself) or on persistence had not been studied.

The best quality source we have on desistence is the systematic review of desistence research, not Cass's non-peer reviewed claim criticized in actual peer reviewed literature

The University of York carried out a systematic review and narrative synthesis of the international care pathways of children and young people referred to specialist gender or endocrinology clinics (Taylor et al: Care pathways). This places GIDS data in a wider context. 13.17 The systematic review aimed to synthesise information on numbers referred, assessed, diagnosed and considered eligible for medical intervention, numbers who later desist or detransition, reasons for leaving the service/ pathway and provision of psychological care.

What this found is that the evidence was too poor to say how many desist, and simply gave a narrative summary of the reasons, while calling for longer term followup.

Less than half of the studies (n11) reported the reasons why individuals either discontinued during the assessment process or did not receive a diagnosis, with studies that reported these often not distinguishing between these two outcomes. Reasons included the following: being referred for other reasons than gender dysphoria/incongruence, experiencing resolution of gender dysphoria or acceptance of gender incongruence with ongoing counselling, no longer seeking medical treatment, not attending clinic after the first visit, coexisting problems interfering with the diagnostic process and/or might interfere with successful treatment, confusion about their gender identity and sexual orientation, being referred to mental health professionals, and being prepubertal and continuing with psychological counselling.

There is no basis for removing background discussion of earlier research on this topic cited to the Cass Review, which is a high quality MEDRS that considers it relevant. Cass continues to discuss older numbers, highlights criticisms and flaws, and places them in the context of the uncertainty and lack of followup of later research, and that is how things should be presented here.

Can you please stop misrepresenting this source. Void if removed (talk) 13:16, 10 October 2024 (UTC)

1) Multiple studies from pre-1980 and a few studies from later that also had many issues (conveniently, Cass leaves out all issues with those later studies)

2) Those aren't "other viewpoints": Olson didn't track if participants met DSM-V GD criteria and Steensma 2013 is what she cites for her persistence rates

3.1) According to Taylor et al Care Pathways: Studies consistently report small proportions of adolescents who discontinue medical treatment; and Discontinuation of medical treatments was similar across reviewed studies. In the seven studies reporting data for puberty suppression, discontinuation ranged from no patients to 8%. IE, they didn't track DSM-5 GD diagnoses and their own data doesn't support "only 37% persist". Not only that, they lump together adolescents and pre-pubertal children, so the data isn't usable for GDIC. This is a better source than Cass's final report, but still unsuitable for focusing on different cohorts.

3.2) The systematic review of desistance research is a better source and provides more data and context than that.

So Cass did base "37% persist" of one study, whose own authors have noted that figure is outdated and doesn't apply to the DSM-5, and ignored her own review finding 92-100% persistence in treatment.

There is no basis for removing background discussion of earlier research on this topic cited to the Cass Review - the only thing you added cited to the Cass review was the "only 37% persist". Cass's final report, a non-peer reviewed source, ignoring all the issues with that noted by its authors, the Endocrine Society, and more recent systematic reviews doesn't mean we're going just put it in credulously. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 14:33, 10 October 2024 (UTC)

Void, the quality of the Cass review (by necessity of being a 200+pg document which mentions a wide range of topics) varies depending on what it talks about. When it is quoting and using the systematic reviews it commissioned, I agree it is high quality. When the Cass Review says (in 8.5 pg 114) without citation that "for many centuries transgender people have been predominantly trans females" I can't say in good faith that the Cass review is a high quality source for the history of trans people.

When we look at the area of persistence of gender dysphoria it cites one study using an outdated definition of gender dysphoria, this does not strike me as high quality research. LunaHasArrived (talk) 17:42, 9 October 2024 (UTC)

It does not cite "one study". Void if removed (talk) 21:06, 9 October 2024 (UTC)

1) The report itself wasn't peer reviewed, and Cass gives no citations for that claim

2) Cass ignoring all recent literature on persistence v desistence was in fact one of the criticisms[1]

3) I think it speaks volumes that most major medical organizations and peer-reviewed literature at a minimum, lay out all the flaws in the "most kids desist narrative" and agree it's heavily flawed, while we have Cass and the American College of Pediatricians agreeing When this occurs in the pre-pubertal child, GD resolves in the vast majority of patients by late adolescence[2] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:11, 9 October 2024 (UTC)

1) Cass says that based on one study, not multiple: Later studies, which showed higher rates of persistence at 37% (for example Steensma et al., 2013) did use formal diagnostic criteria, but by that time a greater proportion of the referrals had socially transitioned prior to being seen. p 163

2) What you need is a HQ secondary source to do the assessment of the evidence - We have one, the systematic review in the section states The remaining quantitative study, by Steensma et al., explored possible predictive factors for persistence versus desistance.53 It was also ranked as poor quality as items 7, 13, and 14 were not met. Predictive factors found included higher intensity of GD at diagnosis, history of childhood social transition, and stating that one was a sex that was not designated at birth (e.g., a child who was designated male at birth saying she is a woman rather than saying she wished she was a woman). This study also focused solely on binary transgender identities.

3) Steensma 2018 said We have clearly described the characteristics of the included children (clinically referred fulfilling childhood DSM criteria) and did not draw con- clusions beyond this group, as has wrongly been done by others. The broadness of the earlier DSM criteria was also acknowledged by the American Psychiatric Association and World Health Organization. This was, among other things, a reason to tighten the diagnostic childhood criteria for DSM-5 and the proposed criteria for ICD-11. As we have stated elsewhere (Hembree et al., 2017; Steensma, 2013), we expect that future follow-up studies using the new diagnostic criteria may find higher persistence rates and hopefully shed more light on developmental routes of gender variant and transgender children.[3]

4) Hembree et al 2017 is the Endocrine Society's clinical guidelines, saying In adolescence, a significant number of these desisters identify as homosexual or bisexual. It may be that children who only showed some gender nonconforming characteristics have been included in the follow-up studies, because the DSM-IV text revision criteria for a diagnosis were rather broad. However, the persistence of GD/gender incongruence into adolescence is more likely if it had been extreme in childhood (41, 42). With the newer, stricter criteria of the DSM-5 (Table 2), persistence rates may well be different in future studies.[4] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:00, 9 October 2024 (UTC)

It seems that Bonifacio's numbers do not come from Holt, Skagerberg and Dunsford (2014) but from Steensma, Biemond, De Boer, & Cohen-Kettenis (2011), which is cited in Holt.

However, Steensma, Biemond, De Boer, & Cohen-Kettenis (2011) (Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study) simply claims that 2-27% (notice the absence of 1 before the first 2) is the range of persistence rates in the following studies:

Bakwin, 1968; Davenport, 1986; Drummond, Bradley, Peterson-Badali & Zucker, 2008; Green, 1987; Kosky, 1987; Lebovitz, 1972; Money & Ruso, 1979; Wallien & Cohen-Kettenis, 2008; Zucker & Bradley, 1995; Zuger, 1984

This would not be a usable source on it's own and the fact that someone writing a review included these numbers while also citing in a weird way and making a typo probably does not make this data worthy of inclusion. Flounder fillet (talk) 22:27, 29 September 2024 (UTC)

I agree with Void here. The version before the recent edits was not perfect but the new edits have made it worse, including detailing some validly sourced information such as the persistence figures and privileging one view over another. Anywikiuser (talk) 18:17, 9 October 2024 (UTC)

Transgender in lead

@Void if removed, there is a clear consensus against you here. @HenrikHolen, @Snokalok, @DanielRigal, @Maddy from Celeste, and I supported noting the diagnosis is aimed to transgender children. We provided sources. You have refused to WP:DROPTHESTICK and are doing plain WP:IDHT. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:13, 6 October 2024 (UTC)

As such I reverted your change to the lead.[5] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:13, 6 October 2024 (UTC)

You have made a change to longstanding, neutral, consensus text with no source.

When challenged you supplied two sources which do not support the change. They say:

The DSM-5-TR defines gender dysphoria in children as a marked incongruence between one’s experienced/expressed gender and assigned gender, lasting at least 6 months, as manifested by at least six of the following

And

Gender incongruence of childhood : Gender incongruence of childhood is characterised by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children.

Neither say "transgender children" as part of the definition. Only one mentions "transgender children" at all, and that is in the context of bullying.

I reverted, and supplied a high quality citation inline.

You are engaging in WP:SYNTH and misrepresenting sources and should self-revert. Void if removed (talk) 16:36, 6 October 2024 (UTC)

Unlike Cass, who has been criticized for leaving the word transgender completely out of a review of trans healthcare, the APA and WHO defined these terms and are a lot more authoritative.

The DSM-II listed "homosexuality" defined as a "sexual deviation" and did not once use the word "gay people" in it's definition. Unless the homosexuality diagnosis wasn't referring to gay people, this is a silly line of argument.

You keep purposefully omitting all the parts around the diagnosis where they specify they are no longer making trans the diagnosis but the distress associated with it. The APA said some trans people experience GD. It didn't say "GD is experienced by cis and trans people". The WHO said they moved the diagnosis to highlight being trans isn't a mental health disorder, stating they were retaining a diagnosis to provide coverage to trans people. The 2 organizations that defined these terms explicitly discuss their relation to the trans community.

Yes or no question: Do the WHO and APA refer to the diagnosis in relation to transgender people? I am not asking "do the diagnoses use the word trans" I am asking "did the orgs who defined these terms say they are related to transgender people" Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:00, 6 October 2024 (UTC)

Yes or no question: does the WHO source you yourself cited say:

Gender incongruence of childhood : Gender incongruence of childhood is characterised by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children.

Void if removed (talk) 17:41, 6 October 2024 (UTC)

I am not asking "do the diagnoses use the word trans" I am asking "did the orgs who defined these terms say they are related to transgender people" - you are evading the question Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:54, 6 October 2024 (UTC)

"Related to transgender people" is not the same as "this is a diagnosis which only applies to transgender children".

You are applying your own interpretation rather than sticking with what the sources actually say.

So, I repeat, did the source you actually cited simply say - as I quoted - that this applied straightforwardly to children, not "transgender children"? Void if removed (talk) 09:29, 9 October 2024 (UTC)

I'll add that the chapter on children in SOC8 also does not use the wording "transgender children". We are talking about a diagnosis, and to whom it applies, it is quite straightforward - presupposing that it only applies to transgender children (rather than applying to children) is not supported by WP:RS.

Your inline quotes you've added to the citations don't support your change, and you've - for the second time - removed well-sourced information on persistence rates with no justification. All POVs should be present and you cannot simply elide one you dislike. Void if removed (talk) 17:38, 6 October 2024 (UTC)

1) The APA and WHO, not WPATH, define GD/GI (though WPATH was involved)

2) The SOC 8 chapter on children says These Standards of Care pertain to prepubescent gender diverse children ... The term, "gender diverse", includes transgender binary and nonbinary children, as well as gender diverse children who will ultimately not identify as transgender later in life p 67 - this supports the current lead which says pre-pubescent transgender and gender diverse children

3) That wasn't well sourced, at all, and I did provide justification - the paper was outdated and based on the DSM-4, which set much looser criteria for diagnosis, in addition to being full of notes about how the kids who explicitly said they were trans (ie, matching the modern definition) were incredibly likely to "persist". Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:53, 6 October 2024 (UTC)

Also, please discuss persistence in the section above, not this one which is focused on the lead Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:54, 6 October 2024 (UTC)

None of this is responsive - we're talking about the definition of a diagnosis, and to whom it applies. You added "transgender" initially and now "transgender and gender-diverse" when none of that is in the sources you cited for this actual definition, I get why you think it is relevant, and I don't disagree with expanding on this in the body, but in the lede, it should not outright say this in wikivoice because that is not what the sources say. This is a new change you've made to longstanding wording without any new source to justify it. Void if removed (talk) 09:48, 9 October 2024 (UTC)

I don't see a need for it to say "some transgender and gender-diverse children" specifically, when it could just say that it is found in children. The former doesn't add anything useful and this isn't the article for deciding what those labels mean. Anywikiuser (talk) 18:39, 9 October 2024 (UTC)

A potential mistake in the phrasing?

Quick note: I am referring to both Gender dysphoria and Gender incongruence here, I got them a little mixed up. This will primarily focus on the gender incongruence, and indirectly applies to gender dysphoria as well. — Preceding unsigned comment added by Nitroxy (talk • contribs) 13:50, 6 June 2025 (UTC)

"[Gender dysphoria] considered a physical rather than psychiatric condition.[1]". The source and any connected source state that gender dysphoria has been reclassified and changed to a "Condition related to sexual health". But so far every source has explicitly avoided acknowledging whether it also changed from a mental to physical condition. The new category doesn't seem to be implicitly physical in nature. Any additional sources for Gender Dysphoria also seem to have treated it like a mental condition

I believe this statement to be an assumption, not actually a backed up fact.

I am not actually proficient with this field of science, so can someone please make sure that any of the sources properly claim it to be a physical condition? Nitroxy (talk) 13:45, 6 June 2025 (UTC)