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Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study

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Objective

To examine the factors associated with the persistence of childhood gender dysphoria (GD), and to assess the feelings of GD, body image, and sexual orientation in adolescence.

Method

The sample consisted of 127 adolescents (79 boys, 48 girls), who were referred for GD in childhood (<12 years of age) and followed up in adolescence. We examined childhood differences among persisters and desisters in demographics, psychological functioning, quality of peer relations and childhood GD, and adolescent reports of GD, body image, and sexual orientation. We examined contributions of childhood factors on the probability of persistence of GD into adolescence.

Results

We found a link between the intensity of GD in childhood and persistence of GD, as well as a higher probability of persistence among natal girls. Psychological functioning and the quality of peer relations did not predict the persistence of childhood GD. Formerly nonsignificant (age at childhood assessment) and unstudied factors (a cognitive and/or affective cross-gender identification and a social role transition) were associated with the persistence of childhood GD, and varied among natal boys and girls.

Conclusion

Intensity of early GD appears to be an important predictor of persistence of GD. Clinical recommendations for the support of children with GD may need to be developed independently for natal boys and for girls, as the presentation of boys and girls with GD is different, and different factors are predictive for the persistence of GD.

Section snippets

Participants and Procedure

The study sample consisted of 127 adolescents (79 boys, 48 girls), who were referred and diagnosed in childhood (< 12 years of age) at the Center of Expertise on Gender Dysphoria at the Vrije Universiteit (VU) University Medical Center in Amsterdam, the Netherlands. This sample differs from the previous persistence study from the Amsterdam clinic.3 The diagnostic procedure in childhood consisted of several sessions with the child and/or the parents, including an psychodiagnostic assessment of

Combination of Response Groups

For the 3 desister groups, no significant differences were observed between the responders, parents who responded, and nonresponders for the demographic variables, except for childhood diagnosis (χ2[2] = 6.90, p < .05). The adolescents for whom the parents responded were more likely to have a subthreshold diagnosis for GID than the responders and nonresponders. However, in their scores on the childhood measures of GD and psychological functioning, the 3 groups were not significantly different.

Discussion

The present study aimed to identify associated factors with the persistence of GD into adolescence, and to assess the current feelings of GD, body image, and sexual orientation. Our findings regarding the gender identity of the adolescents were in line with the earlier findings; the persisters reported higher intensities of GD, more body dissatisfaction, and higher reports of a same-sex sexual orientation compared to the desisters.3, 4 As for the factors associated with the persistence of GD,

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    This article is discussed in an editorial by Dr. Peter T. Daniolos on page 569.

    Disclosure: Drs. McGuire, Kreukels, Steensma, and Cohen-Kettenis, and Ms. Beekman report no biomedical financial interests or potential conflicts of interest.

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