Weekend Reads: Are Children 'Re-Transitioning' Later in Life After a Social Transition?

by Kevin Schofield

This week, we're reading an article from the journal Pediatrics: a longitudinal study by researchers at Princeton University and the University of Washington looking at children's gender identity five years after making a social transition.

Social transition, in which persons typically change their pronouns, first name, hairstyle, and clothing (and potentially other social cues) to live in line with their gender identity, is distinct from medical transition, in which medicinal treatments, such as gender-affirming hormones, may be combined with surgical procedures to make a person's body more reflective of their gender identity. Children who socially transition before reaching puberty may receive reversible puberty-blocking medicine to forestall the onset of puberty for some period of time to allow time for the child and their family to ensure that transitioning is the right direction while preventing irreversible physical changes.

Not surprisingly, concerns have been raised about whether a large number of the children who decide to socially transition at an early age will later "re-transition" back to their assigned gender at birth. The Princeton and UW researchers conducted a long-term study of 317 children who made a binary transition before age 12 to see how many had re-transitioned — or made a further transition to nonbinary — five years later.

They found that 7.3% of the children had re-transitioned at least once. At the five-year point, 94% were binary transgender, 2.5% were cisgender, and 3.5% were nonbinary. For those who had initially made their social transition before age 6, the number of re-transitions was only slightly higher: At year five, 90.3% were binary transgender, 5.6% had returned to cisgender, and 4.0% were nonbinary. On the other hand, among those who had socially transitioned at age 6 or later, 96.4% were binary transgender five years later, while only 0.5% — 1 in 193 — were cisgender and 3.1% were nonbinary. The researchers found that few of the children who had begun medical interventions had re-transitioned back to cisgender.

This is not a perfect study; there are some sampling issues in particular that must be taken into consideration. The 317 study subjects were disproportionately trans girls, though the researchers didn't observe statistically significant differences between trans boys and trans girls, so they doubt this changed the overall results. But the study also underrepresents Black and Asian children, and the children who participated tended to be economically better off than the general population. There may also be some selection bias in those who dropped out of the study over the five years, if it tended to be those who re-transitioned (though the researchers say they saw no evidence of this happening).

That said, the main finding is still strong: The vast majority of children who make a complete social transition at an early age to align with their gender identity don't transition back to their gender assigned at birth. Children and their families seem to be making good decisions that stand the test of time. Though those who do re-transition, or who choose to further transition from binary transgender to nonbinary as they come to better understand their own gender identity, will continue to need understanding and support; as the researchers suggest, "Parents and clinicians should be informed that not all youth will continue on the same trajectory over time. Further understanding of how to support youth's initial and later transitions is needed."

Gender Identity 5 Years After Social Transition

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