Childhood gender dysphoria is strongly associated with gay, lesbian, or bisexual outcomes, and most children resolve dysphoria during maturation. We ask that you carefully explore the body of evidence which shows, prior to the current era of affirmation-only, that children with persistent gender dysphoria are in the minority, and that the majority of children resolved their gender dysphoria as they matured through adolescence.

 

1.1   A review of 10 studies by Ristori and Steensma found that 61% - 98% of children diagnosed with gender dysphoria (GD) desisted (did not continue to experience dysphoria at follow-up):

“The conclusion of these studies is that childhood GD is strongly associated with lesbian, gay or bisexual outcomes and that for the majority of the children...the gender dysphoric feelings remitted around or after puberty” (Ristori 2016)

 

1.2 The strong correlation between gender non-conformity and dysphoria in childhood and people who grow up to be gay, lesbian or bisexual.

 

We ask APS to examine:

• In the era before transgender identities, children who gravitated towards toys and activities typical of the opposite sex were far more likely to grow up to be gay or lesbian (e.g. Rieger et al. 2008). This demonstrated in a large-scale longitudinal study of children born in 1991-92 (Li, Kung, and Hines 2017).

• A longitudinal study of boys presenting to a gender clinic during the era of ‘watchful waiting’, which shows only 12.2% persisted with gender dysphoria, 87.8% desisted (resolved gender dysphoria), and 63.6% grew up to be gay (Singh 2021).   

• UK research showing 66% of girls presenting with gender dysphoria were lesbian, 21% bisexual, and only 8.5% heterosexual. Of the boys, only 19% were heterosexual (Holt 2014).

• A study that show homophobic bullying preceding adolescents identifying as trans (DeLay 2018).

• Gender Health Query: Anti-gay/lesbian/bisexual, tomboy and female attitudes can fuel trans identification
   

1.3 Puberty blockers disrupt resolution of gender dysphoria - this is consequential for children likely to grow up to be gay or lesbian

In most western countries, the era in which the majority of children resolved gender dysphoria as they matured has ended, because the widespread model now is linear affirmation (social transition followed by medicalisation). This is significant for LGB* youth who would normally resolve gender dysphoria as they move through puberty.

Although puberty blockers are presented as ‘reversible’, research shows that the great majority of children who are given puberty blockers go on to cross-sex hormones. This is hugely significant for LGB* youth who would normally resolve gender incongruence and dysphoria. Instead of normal resolution through developmental stages, puberty blockers set them on course for lifetime pharmacological dependence and increased risk of cardiovascular disease, osteoporosis, thrombosis, sterility and likelihood of sexual dysfunction.

 

We ask you to examine:

• Brik et al, Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria, 2020. The ‘vast majority’ of children on puberty blockers went on to cross-sex hormones.

• Carmichael et al, Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK, 2021 ….98% of children on puberty blockers went on to cross-sex hormones.

• Social transition itself is an intervention that sets children on course for medicalisation. As WPATH board member and trans surgeon Dr Marci Bowers noted “You’re going to go socially to school as a girl, and you’ve made this commitment. How do you back out of that?”
   

1.4 Social transition disrupts resolution of gender dysphoria - this is consequential for children likely to grow up to be gay or lesbian

Evidence suggests that social transition impedes natural developmental processes whereby most children resolve gender dysphoria. Since most of these children would normally grow up to be gay or lesbian, this is very significant. It can lock them into a ‘trans the gay away’ trajectory and lifetime medical dependence.

In "Time to Hit Pause on 'Pausing' Puberty in Gender-Dysphoric Youth", Dr. William Malone a board-certified endocrinologist. He is a graduate of Stanford University (B.A., Human Biology) and New York University Medical School. 

"We don't yet know the long-term trajectories of socially transitioned minors, but emerging evidence suggests that they may be more likely to persist with gender-related distress rather than outgrow it, as previously observed. This in turn necessitates decades of invasive and risky medical interventions. In fact, the Dutch researchers who pioneered the protocol used to medically transition minors (see A Brief history of the Dutch Protocol) explicitly and strongly discouraged social transition of children and early adolescents."
 

We ask APS to examine:
 

• That social transition is a psychosocial intervention that might be characterized as iatrogenic.     Zucker, K. J. (2019). Debate: Different strokes for different folks.

• Evidence that social transition by the child is strongly correlated with persistence in natal boys. Steensma et al (2013). Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study.

• Social transition health risks from binding and tucking

• The caution from Dutch doctors on social transition can be found in de Vries et al 2012