Health & Fitness

94% of Trans Youth Maintain Gender Identity After Social Transition

New research finds that a very large majority of transgender young people maintain their gender identity five years after childhood social transition.

During a time when transgender rights and gender-affirming healthcare seem under attack, a new study offers new insights into trans youth and their relationships to their gender identity.

A new study published in the journal Pediatrics found that the majority of transgender youth maintain their gender identity five years after their social transition during childhood.

Experts say research like this is important in painting a nuanced picture of the complex realities of young people’s gender identities.

For this new paper, researchers looked at the current gender identities and rate of retransition — meaning retransitioning to another gender identity after their initial transition — among 317 youth who identified as transgender at the start of the study period.

This included 208 transgender girls, 109 transgender boys, with the average age of 8.1 years old at the start of their participation in the TransYouth Project out of Princeton University.

The results?

The researchers found that after an average five years following their initial social transition during childhood, 7.3 percent retransitioned at least once.

At the end of that five-year period, 94 percent of these young people identified as binary transgender people. That number includes 1.3 percent of participants “who retransitioned to another identity before returning to their binary transgender identity,” according to the study.

The researchers report that 2.5 percent of the youth identified as cisgender, while 3.5 percent identified as nonbinary. They also found that cisgender identities were more commonly found in young people whose “initial social transition” took place before the age of 6. Retransition often occurred before 10 years old.

When asked if anything was particularly surprising about these results, lead study author Kristina Olson, PhD, a psychologist at Princeton, told Healthline that she and her team “didn’t have strong expectations” heading into the research “because there has been so little data reported about children who socially transition at early ages.”

“Perhaps one unexpected finding back when the study started in 2013, was that there would be a much more widely understood and used term ‘nonbinary’ and that a number of the youth in our study would come to use that label,” Olson explained. “We couldn’t predict that because at the beginning of the study that was not a commonly used term, nor were any of the study participants using they/them pronouns. Today some are.”

Given how little has been done to examine the gender identities of trans people at these young ages, Olson said this research occupies an important place in offering a more comprehensive understanding of trans children and youth.

“This is a study of youth who came out as trans at very early ages — before age 12 and often at far younger ages. On average, these kids were 6.5 years old when they socially transitioned. To me, this study provides further evidence that there are some trans youth who are clear about their gender identity early and they maintain that identity over time,” Olson said.

“While some trans adults have been reporting these experiences for a long time, this is the first large cohort that we’ve tracked prospectively and the first large cohort who had the experience of socially transitioning early in development,” she added.

Dr. Jack Turban, a fellow in child and adolescent psychiatry at Stanford University School of Medicine where he researches the mental health of transgender youth, said that a common refrain is that “prepubertal transgender children will grow up to identify as cisgender.” Studies like this, prove that isn’t the case.

“This is a misinterpretation of the literature. Past studies didn’t actually follow transgender kids over time, they followed kids referred to gender clinics, many of whom were never transgender to begin with,” said Turban, who is not affiliated with this research out of Princeton. This new study is important because it only included kids who identified as transgender and followed them over time. It found that for the vast majority, their gender identity was stable over a five-year follow up period.”

During a time when policy rhetoric has veered in extreme transphobic directions — like that out of Texas in late February that declared the act of providing gender-affirming care to trans and nonbinary teens should be investigated along the lines of “child abuse” — medical experts say research like this is of vital importance.

“These data suggest that there is a cohort of trans youth who are socially transitioning in childhood who maintain these identities over time. People sometimes suggest that a five or six-year-old who is insisting that they are a gender that does not align with their sex at birth can’t possibly know their gender, or that this is just a ‘phase,’ ” Olson explained.

“While of course we see gender fluidity in some youth, these data suggest for a large number of these youth, this is a longer-term identity. Importantly, this is also consistent with what many trans adults have been telling us for a long time,” she said.

Turban echoed those thoughts, pointing to the fact that many politicians and pundits at the moment who are attacking gender-affirming care and even simple discussions over gender identity among young people are pointing to “old research” that suggests that transgender youth will ultimately “identify as cisgender.”

This line of thought feeds the rhetoric that these young people “should thus be denied access to gender-affirming medical care,” he said.

“There are several problems with this. First, the studies they’re referencing are of prepubertal children, who are not candidates for gender-affirming medical interventions under any existing guidelines,” Turban stressed. “Once a young person reaches adolescence — the first stage at which medical interventions are considered — and identifies as transgender, all existing research suggests they’re unlikely to identify as cisgender later in life.”

Turban went on to explain that outdated studies right-wing politicians are relying on were often “of kids who were referred to gender clinics, but those studies don’t establish that those kids were transgender.”

“Many may have been cisgender ‘tomboys’ or cisgender boys who liked dolls or other things that their parents considered ‘feminine.’ Because the kids weren’t transgender at the beginning of the study, it’s not surprising that they weren’t transgender at follow up,” Turban said. “This new study is novel in that it established at time point one that the children were transgender. With this important change in methodology, the researchers found that gender identity, at least over a 5-year period, was quite stable.”

What about the young people who ultimately retransitioned after that five-year period in the study? Olson said it’s important to note that not all trans and nonbinary children — and for that matter cisgender children — are a monolith. Gender can fall on a spectrum of experiences that varies greatly from person to person.

She said there are a wide range of reasons why a young child or teen might retransition. For one example, Olson cited that a child might feel that their “sense of identity has changed.” They once might have felt like a boy at one age and then may now “feel more like a girl.”

“Another example is that a child might feel that another label better describes their experience. For instance, a child may not have known about the category ‘nonbinary’ but upon learning of it, may feel it better describes them than ‘boy’ does,” Olson added. “Then of course there’s the experience of prejudice and discrimination that can cause a child to retransition — for example, being misgendered regularly or being excluded from one’s peer group.”

Turban said “gender identity is a complex, multidimensional construct.”

He said he often points out to cisgender adults “that the way they think of their gender identity now is probably not exactly the same as the way they thought about it when they were children.”

“For example, a 40-year-old mother probably thinks about her gender identity in very different terms than how she thought of herself when she was a 10-year-old girl. It’s normal and non-pathological for gender identity to evolve over time, as it involves the ways in which we related to gender roles, the ways in which we related to our physical bodies, and feelings of gender identity that are difficult to put into words and appear to have a strong biological basis,” he explained.

He also pointed out that one important element to keep in mind is that nonbinary and transgender people face high rates of discrimination, harassment, and bullying.

“For some people, what looks like a change in gender identity to the outside world may actually represent them going back in the closet because it was too hard to live in the world as their authentic selves. It’s vital that mental health professionals provide support to these young people so they can explore themselves freely, and that these professionals also work with their communities and schools to ensure support and safety,” he added.

The reality that transgender and nonbinary youth face elevated levels of stress, discrimination, anxiety, bullying, and negative mental health outcomes like suicidal ideation and suicide are well documented.

Recently, The Trevor Project released its 2022 National Survey on LGBTQ Youth Mental Health. Among the findings, the nonprofit reports that nearly 1 in 5 transgender and nonbinary youth attempted suicide in the past year.

Turban and Olson both believe that more research like the Princeton study that aims to paint a comprehensive picture of trans youth and their gender identities can play a big role in creating an environment that is more understanding of — and empathetic toward — these young people.

Jonah DeChants, PhD, research scientist for The Trevor Project, told Healthline that the 2022 national survey findings “support what we have seen previously in our research. When transgender and nonbinary young people feel supported and affirmed in their identities by those around them, their risk of attempting suicide can significantly decrease.”

“LGBTQ youth who felt high social support from their family reported attempting suicide at less than half the rate of those who felt low or moderate social support,” added DeChants, who was not part of the Princeton study. “It’s also important to note that this study found transgender and nonbinary youth, who already report the highest rates of anxiety and depression symptoms, said that they were worried about anti-transgender legislation.”

He cited that 93 percent reported they have worries about trans people being denied access to gender-affirming medical care.

“We urge lawmakers to focus on advancing policies that protect these young people, not work to further restrict their rights,” he said.

The Trevor Project survey also revealed that fewer than 1 in 3 transgender and nonbinary youth found their home to be gender-affirming.

DeChants explained it’s important all parents and families treat these young people “with dignity and respect.” The reason is simple: “affirming them for who they are can be life-saving,” he said.

“In many cases, doing so does not require much effort. The most common supportive actions taken by parents or caregivers — according to the youth who responded to our survey — included being welcoming to their LGBTQ friends or partners, talking with them respectfully about their LGBTQ identity, using their names and pronouns correctly, supporting their gender expression, and educating themselves about LGBTQ people and issues,” DeChants added.

For her part, Olson said she and her research team are currently working on a new paper that explores the experience of retransitioning amongst those in the study cohort. Additionally, they are planning to continue to follow this cohort “as they move into adolescence to understand the unique challenges and opportunities that those years present to the youth in our study.”

“We are eager to understand how their gender identities and well-being unfold as they move through adolescence and into adulthood,” she added.

Any efforts to better understand and depict the varied realities of how young people — especially those who are transgender and nonbinary — approach, embrace, and evolve in their gender identities is crucial.

Turban said it’s necessary that this push to greater understanding extends outside of research to people’s homes.

“At the end of the day, the most important thing is that parents love and support their children. For children who want to explore their gender identity through new names, pronouns, or dress, we generally recommend allowing them to explore this freely, while working to make sure they’re in an environment where that exploration will be safe,” Turban added.

“Refusing to allow a child to undergo a social transition risks instilling shame in the child, which can drive anxiety, depression, and relationship difficulties within the family.”

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