Methodological Questions in Childhood Gender Identity ‘Desistence’ Research

Kelley Winters, Ph.D.
GID Reform Advocates

An expanded presentation to the 23rd World Professional Association for Transgender Health Biennial Symposium, Feb. 16, 2014, Bangkok, Thailand. (Presented remotely, from Loveland, Colorado, USA)

It is frequently repeated in mental health literature and popular media that the vast majority of children whose gender identity differs from their assigned birth-sex, or who are severly distressed by their birth-sex, will “desist” in their gender identities and gender dysphoria by adolescence. As a consequence, gender dysphoric children are pressed to remain in their birth-assigned roles throughout the world. But are gender dysphoria and diverse gender identities just a phase?

This presentation reexamines research in Canada and The Netherlands that underlies the “desistence” axiom, with respect to methodological rigor and validity of claims.


(1) Evidence from these studies suggests that the majority of gender nonconforming children are not gender dysphoric adolescents or adults.

(2) It does not support the stereotype that most children who are actually gender dysphoric will “desist” in their gender identities before adolescence.

(3) These studies do acknowledge that intense anatomic dysphoria in childhood may be associated with persistent gender dysphoria and persistent gender identity through adolescence.

(4) Speculation that allowing childhood social transition traps cisgender youth in roles that are incongruent with their identities is not supported by evidence.

(5) These studies fail to examine the diagnostic value of Real Life Experience in congruent gender roles for gender dysphoric children.

[Correction 2016.01.12]

Slide 1 should read–
Feb. 16, 2014

Slide 27 should read–
Clarification: More than half, 55%, of 53 children meeting GIDC criteria sought medical transition in adolescence. Only 19% were confirmed at followup to identify with birth-assignment. 25% were unknown at followup and one identified as “50% male and 50% female.”

American Psychiatric Association (2014). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Byne, W., Bradley, S.J., Coleman, E., Eyler, A.E., Green, R., Menvielle, E.J., Meyer-Bahlburg, H.F.L., Pleak, R.R. & Tompkins, D.A. (2012). Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Archives of Sexual Behavior, 41(4):759-796.

Drescher, J. (2013) “Sunday Dialogue: Our Notions of Gender,” New York Times, June 29,

Drummond, Kelley D.; Bradley, Susan J.; Peterson-Badali, Michele; Zucker, Kenneth J. (2008), “A follow-up study of girls with gender identity disorder,” Developmental Psychology. Vol 44(1), Jan 2008, 34-45.

Kennedy, N. (2012) “Transgender children: more than a theoretical challenge,” Goldsmiths College, University of London,

Reed, B., Rhodes, S., Schofield, P., Wylie, K., (2009) “Gender variance in the UK. Prevalence, incidence, growth and geographic distribution,” GIRES – the Gender Identity Research and Education Society,

Steensma, T.D., Biemond, R., de Boer, F. & Cohen-Kettenis, P.T. (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology & Psychiatry, 16(4):499-516.

Wallien, M.S.C. & Cohen-Kettenis, P.T. (2008). Psychosexual outcome of gender-dysphoric children. J American Academy Child & Adolescent Psychiatry, 47:1413-1423.

Winters, K. (2013) Response to Dr. Jack Drescher and the NY Times About Childhood Transition, GID Reform Weblog, July 5,

World Professional Association for Transgender Health (2011), Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People: Author.

Response to Dr. Jack Drescher and the NY Times About Childhood Transition: Part 8, by Karen Adams

Coy Mathis

GID Reform Advocates respond to the question, “When a child identifies with the other gender, what to do?” Dr. Jack Drescher’s commentary on the Coy Mathis Civil Rights Case in Colorado appeared in the Sunday Dialogues Feature of the June 29, 2013 New York Times. Here is the discussion that the Times did not publish.

A Guest Post by
Karen Adams,
a Colorado Mother
Founder, Transgender Youth Education & Support
PFLAG Boulder County

Early in July, the New York Times ran a feature by Dr. Jack Drescher in response to the Coy Mathis case in Colorado. We were disappointed by Dr. Drescher’s lack of understanding of the experiences of families with transgender children. His suggestions, that families are “encouraging” early transition, and that, once transitioned, children are discouraged from transitioning back to their birth roles was outrageous. In the six years that Trans-Youth Educaton & Support of Colorado (TYES) has been in existence, over 70 families have participated in our group in some fashion. Not once have we met a family that encouraged transition.

Our families spend a great deal of time learning about gender identity and expression. They meet other families and ask many questions. This is not an easy decision or a fad for any of them. They worry for their children and work hard to make life as easy as possible for them. Of many untold stories are the parents who give up their personal big dreams in support of their kids. For one family, it was the dream of watching their athletically gifted child from the stands of the Olympics. Instead, it became painfully clear that early transition was a life-saving necessity for their child.

I have not met a parent yet that would not feel great relief and joy, if their child came to them and said they needed to transition back to their birth gender. It would mean that their child would more likely be safe and face less discrimination. Families have come to our group with children who were uncertain of their gender identity. After interacting our transgender and gender creative children, some have realized that they are comfortable in their birth sex. One experimented with transition and then chose to return to his birth gender, though he was still gender nonconforming. Years later, these families have told us their children were comfortable in their experienced gender fluid identities and remained close to their families who supported them in their process.

Dr. Drescher needs to actually spend time with families of transgender children, rather than writing articles based on theory. He would find here some of the most amazing, intelligent, and loving families. Their love is stronger than their fear of the ignorance shown by these psychiatric stereotypes. Their love is unconditional, and I’m proud to call them my friends.

Transgender Youth Education & Support (TYES) is a Colorado-based group supporting children on the gender spectrum and their families. TYES is dedicated to helping parents support their gender-variant children, and to help families find the information, resources, and the understanding that they need. Our meetings offer parents a supportive forum to discuss the social, educational, and medical needs of their youth, and to explore the journey to acceptance and celebration of each child’s unique gender expression. Youth are provided the opportunity to engage in activities with their children across the gender spectrum and their siblings. In addition to group and individual support, we offer guest speakers and educational, mental health & medical resources.

TYES supports all families of gender variant youth, not just those who are transitioning or considering transition. TYES supports families anywhere in the state. If you would like to join us, please email us at or call our support line at (720) 443-7708. Please know that we recognize that privacy is critical for our families and we work hard to protect the privacy of everyone in the group.

Response to Dr. Jack Drescher and the NY Times About Childhood Transition: Part 7, by Halle Sheppard

Coy Mathis

GID Reform Advocates respond to the question, “When a child identifies with the other gender, what to do?” Dr. Jack Drescher’s commentary on the Coy Mathis Civil Rights Case in Colorado appeared in the Sunday Dialogues Feature of the June 29, 2013 New York Times. Here is the discussion that the Times did not publish.

A Guest Post by
Halle Sheppard,
a Colorado Mother
Transgender Youth Education & Support
PFLAG Boulder County

A little girl!! My husband and I so wanted this girl. We had a son and all our siblings had sons, and as long as we had decided to adopt, why not have a girl?! All her aunts bought her the cutest girlie clothes, and I loved to dress her in them. But as soon as our daughter was 3 years old and could tell us what she preferred, she wore her brother’s hand me downs, definitely not dresses, and a boy’s bathing suit. Though my husband struggled with this a bit, it made little difference to me. This was a child with some pretty big attachment issues. All I wanted was a happy kid who would sleep at night.

Imagine my surprise, when during a routine follow up 15 minutes at the end of my 6 year old child’s therapy appointment (which she attended to deal with some attachment issues), the therapist mentioned that she suspected that my child was transgender. She said she had no formal training in diagnosing this but did have some experience working with another family.

What does that mean to be transgender?? As a well educated 40 something living in liberal Boulder, CO you’d think I should know. And maybe I knew a bit or heard about it, but not really. Not really what it meant to have a child who didn’t just dress and act like a boy, but who wanted to be a boy.

We did not treat our daughter any differently after the mention of this from his therapist. At first we were definitely in denial. Eventually, after suggestions from the therapist (so we could be more prepared), my husband and I bought some recommended books and started reading. It was certainly possible our “tomboy” was in fact transgender: the boy’s bathing suits and boxer shorts; the toys and play mates; the absolute distress at being told she would have to wear a dress to a friend’s wedding. The therapist was specific that our child would come to us with her feelings, so we followed that advice and did nothing and just waited.

We did not have to wait long. A few weeks after school (1st grade) was over in June, about 3 to 4 months after the first mention from the therapist, my daughter marched into the kitchen and declared “I would like to be a boy. Not just dress as one, but really be one.” (Oh, did I mention when he was almost 4, he asked me “when do I grow up to be a boy, mom?”) It was all coming together now. Because I was so prepared for this day, and my husband and I had read enough and discussed enough to understand where our kiddo was coming from, I was able to look him (from here on as I write I will use male gender pronouns) in the eye and tell him that this was fine. We could find a new name immediately and make the transition. I hugged him and held him, but as a parent what I really wanted to do was cry (which I did often privately) and tell him what a difficult life choice this would be; how I would always worry about him being socially accepted…..but of course, not something to worry your 7 year old with.

Why would a parent choose a difficult path for their child? And not just for that child but for the whole family. Difficult decisions, awkward conversations with parents on the little league field and your child’s older sibling having to face his 10 year old friends with this news. Life was pretty rough for all of us for a while. We face strife all of the time. Each time we travel and have to use our son’s legal name, which is a girls’ name, or walk into a doctor’s office and worry they will call him the wrong name. Often, friends and relatives we do not see regularly still use the old name. My husband and I have spent considerable time and energy learning about medications and hormone treatments. It stresses our marriage and our finances! We have both had to have considerable talks with our family members to help them understand. It is a huge burden and some days I want to cry and say “It isn’t fair!!! Why me?! Why do I have to deal with this?!”

But we have also learned the alternative to not letting your child transition and be who he or she wants is devastating and can be fatal. So if you love your child and want them to be happy, why wouldn’t you let them transition? That is our plan. We will help with this, support him, allow the use of blockers to prolong the time until a more permanent decision has to be made. We will share all the options with our child. When he seems unsure, we remind him that he does not need to make any decision yet and that we are ready to help him either way. And that if he chooses to be a boy we will love him the same as the girl we adopted.

He is now 9 years old and has socially transitioned to being a boy. He uses the boy’s restroom and a family changing room. His school mates and friends have been 100% accepting. We know it will get harder and more challenging when we leave our small, open elementary school, but this is his choice and we, as his parents, are here to support him.

Response to Dr. Jack Drescher and the NY Times About Childhood Transition: Part 6, by Sam Winter

Coy Mathis

GID Reform Advocates respond to the question, “When a child identifies with the other gender, what to do?” Dr. Jack Drescher’s commentary on the Coy Mathis Civil Rights Case in Colorado appeared in the Sunday Dialogues Feature of the June 29, 2013 New York Times. Here is the discussion that the Times did not publish.

A Guest Post from
Sam Winter, Ph.D.
Associate Professor
Faculty of Education, University of Hong Kong

Generation G Paranoia.

Coy Mathis clearly identifies as a girl. It was a matter of continuing pain to her that she was not fully recognized and respected as one. The decision of the Colorado civil rights division that she be allowed to use the girls’ bathroom at school went a long way to providing that recognition and respect.

The child’s perspective is entirely missing in Dr. Drescher’s commentary. What, one may ask, would Coy have preferred her parents and school to do about her female identity? Would she have preferred them to allow her to express her femaleness and to be the person she so deeply felt herself to be? Or would she have preferred them to discourage, even prevent, her from expressing her femaleness and add to her pain.

The Times piece reflects an anxiety that the world is full of trans affirmative parents who, seeing the slightest sign of gender-nonconformity in their children, overzealously egg them on into a full transition. This line of reasoning promotes a fear that we may lose a whole generation of youngsters who, if only they had not been so enthusiastically pressed into transitioning, would have turned out to be happily adjusted ‘cisgender’ (that is to say, NOT transgender) gays and lesbians.

What we have here is the fear of a lost gay generation… Generation ‘G’.

When I see them on television, I wonder what will happen when the little boy who is socially transitioned with the mother’s encouragement at the age of 9 decides that he wants to be a boy after all but that he still likes other little boys.
–E mail from Senior WHO HQ Staff, 5th Jan 12013

As this quote illustrates, fear about a lost Generation ‘G’ influences international medical policymakers, who continue to argue that kids like Coy have a disorder that requires medical intervention to put a brake on “overzealous” parents and ensure that more of these kids will grow up to be cisgender gays or lesbians.

Generation ‘G’ fear has little basis in reality. It is more like a paranoia. First, one wonders where these overzealously trans affirmative parents are. Parents like Coy’s agonise long and hard over what they should do to help their transgender children. They don’t make these decisions lightly. Second, kids like Coy spend years pressing for their identities to be respected. There is no reason to think they would hesitate, if ever there was a need, to express a desire to ‘go back’ to their birth-assigned roles. To prevent Coy from  enjoying, right now, the fullest possible recognition of who she is would have been cruel, inhuman and degrading. To do so, just because of some hypothetical fear that she may later want to live as a boy and mysteriously lose her ability to tell anyone, would have been irresponsible. The Colorado civil rights division made the right decision.

Dr Sam Winter is an Associate Professor at the University of Hong Kong and a member of the board of directors of the World Professional Association for Transgender Health (WPATH) and the World Health Organization (WHO) Working Group on Sexual Disorders and Sexual Health. He has been working in rights and health for transgender people for more than 13 years.

Response to Dr. Jack Drescher and the NY Times About Childhood Transition: Part 5, by Mary van Balen

Coy Mathis

GID Reform Advocates respond to the question, “When a child identifies with the other gender, what to do?” Dr. Jack Drescher’s commentary on the Coy Mathis Civil Rights Case in Colorado appeared in the Sunday Dialogues Feature of the June 29, 2013 New York Times. Here is the discussion that the Times did not publish.

A Guest Post from
Mary van Balen
Mother, Author, Columnist, Speaker

The New York Times publication of Dr. Jack Drescher’s letter in its July 30 print edition under the headline: Sunday Dialogue: Our Notions of Gender, has generated much response in the paper, on websites, and on blogs, including this one. I have followed the conversation, appreciated the clinical expertise, and would like to add my perspective. I am the mother of a transsexual daughter, now an adult, who lived for twenty-five years with her “secret” telling me only when she had to choose between suicide or finally accepting herself as she was. We spent hours in the family room as she summoned the courage to speak the truth she had known for so long but had kept hidden: “I hate my body. I always have. Do you know what gender dysphoria is? Well, that’s what I have.”

The words stunned. I had imagined other possibilities, but not that. My knowledge of GID was rudimentary. Images that came to mind were of make-up slathered characters in movies or television shows, generally sleazy types. And there was a person I had seen singing in Provincetown whose male face and female attire who made me uncomfortable. “Not my quiet son, the bright physicist,” I thought. This didn’t happen to people like “us.” I had a steep learning curve ahead.

That process included long talks with my daughter, who once out to me, was willing to share stories of her growing up years. Many of them broke my heart. I thought of them as I read Dr. Drescher’s letter and the responses.

“If only I had known,” I thought when my now twenty-something daughter told me that she knew she was a girl since she was three and in first grade at a Catholic school dreamed of a “magic uniform” that would change her into one. As she talked I remembered her playing dress-up with her younger sisters and loving to clomp around the house in glittering silver high heels. I didn’t know that she had also been making up ballets wearing a pink tutu. I didn’t know she was suicidal in sixth grade.

But what if I had known? In the early 80’s what kind of advice would have been given to me? What would I have done? I like to think I would have been accepting, encouraging even. At home, we gave dolls and trucks to all the kids. We encouraged our daughters and son to explore the creek, climb the trees and experiment with chemistry sets as well as cookie recipes. But having a child tell you “he” is a girl stretches a parent well beyond those attempts at gender-neutral play. Would I have stood up against the social norms of the day?

As my daughter and I continued sharing, she lamented not having had the chance to grow up as a girl. She missed all that socializing. “It would’ve helped a lot,” she said as she struggled to move into the world of women with a history of trying to fit into the world of men.

Dr. Drescher’s statement that “Currently experts can’t tell apart kids who outgrow gender dysphoria (desisters) from those who don’t (persisters)…” seems strange to me. My transsexual daughter’s feelings and her positive sense of gender identity by the age of three, are not the same as the desires and feelings of a boy who likes to play with girls toys or dress up.

I read the story of Coy Mathis and applaud the Colorado Civil Rights Division for ruling that she be allowed to use the girl’s restroom. California’s move to allow children K-12 to use the bathroom that matches their gender identity is a step in the right direction. We should listen to the children and follow their lead. Perhaps then there will be fewer who will lament not having had the opportunity to grow up as the person they know themselves to be and fewer adult transsexuals who look at life and consider opting out of it a good choice.

Mary van Balen is an author, columnist, and speaker with a B.S.S.W. and M.A. in Theology. She has worked with abused, single mothers in a family literacy program and served as a curriculum director for an afterschool program for at risk students. She speaks on issues of transsexuality from a parent’s perspective and will be presenting on issues of transgender youth at the national convention of the Catholic Association for Lesbian and Gay Ministries in New Orleans. She was a resident scholar the Collegeville Institute for Ecumenical & and Cultural Research where she worked on her current writing project: “Julia All Along: A Mother’s Journey with her Transsexual Daughter.”

Response to Dr. Jack Drescher and the NY Times About Childhood Transition: Part 4, from the Child and Adolescent Gender Center Clinic

Coy Mathis

GID Reform Advocates respond to the question, “When a child identifies with the other gender, what to do?” Dr. Jack Drescher’s commentary on the Coy Mathis Civil Rights Case in Colorado appeared in the Sunday Dialogues Feature of the June 29, 2013 New York Times. Here is the discussion that the Times did not publish.

A Guest Post from the
Child and Adolescent Gender Center
San Francisco, CA

To the NYT Editors:
June 26, 2013
Dear Editors:

We celebrate the landmark decision by the Colorado Civil Rights Division which allows children to use school facilities in accordance with the gender they know themselves to be. Their decision is consistent with the goals of the affirmative model of gender health–to facilitate a child’s opportunity to live in the gender that feels most real or comfortable to that child and to express that gender with freedom from restriction, aspersion, or rejection. So many of us confuse gender identity–who we are on the spectrum of male to female or another gender entirely–with gender expressions–how we show our gender to the world. There are a small number of children, like Coy Mathis, who let us know at a very early age that they are not the sex that was assigned to them on their birth certificate; that their gender identity is different. Like Coy, these children are persistent, consistent, and insistent about who they are. They are to be distinguished from the children who accept their gender label assigned to them but don’t accept our social rules about boys and girls and how they should act, dress, and play—their gender expressions are unique. Can we tell those two groups of children apart? Not perfectly, but with pretty good accuracy if we spend the time to listen to them and translate what they are saying to us. The Colorado Civil Rights Division did just that in listening to at least one of those children, and in its ruling blazing the trail for children to live authentically in the gender they know themselves to be. When we consider the alternative, that a child sits home because school won’t let them be themselves, how could we do otherwise?

Joel Baum, M.S., Director of Education
Diane Ehrensaft, Ph.D., Director of Mental Health
Stephen Rosenthal, M.D., Medical Director
Ilana Sherer, M.D., Assistant Medical Director
Child and Adolescent Gender Center
San Francisco, CA

The Child and Adolescent Gender Center (CAGC), a collaboration between UCSF and community organizations, offers comprehensive medical and psychological care, as well as advocacy and legal support, to gender non-conforming/transgender youth and adolescents.

400 Parnassus Ave., Second Floor
San Francisco, CA 94143
Appointments: (415) 353-7337
Fax: (415) 476-8214 (Attention: Dr. Stephen Rosenthal)