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Desistance
Desistance is a central concept in youth gender care that refers to what has been the rule for decades: the majority of children who show gender dysphoria or gender variance come, without medical intervention, to acceptance of their body. Generally these children develop a homosexual or bisexual orientation at a later age. Desistance research thereby forms one of the weightiest arguments against early medicalisation in minors.
What the classical studies show
Eleven prospective follow-up studies from the Netherlands, Canada, the UK and the US consistently report that 61 to 98% of children with early childhood gender variance or dysphoria no longer experience persistent dysphoria by the end of adolescence. The most frequently cited Dutch study is Steensma et al. (2013), conducted at Amsterdam UMC's own clinic: of the children with gender variance only a minority still reported persistent dysphoria in adolescence. The vast majority developed acceptance of their own body, often in combination with a homosexual or bisexual orientation. Comparable percentages were reported by Drummond, Wallien, Singh and Zucker.
A striking biological and clinical fact
The fact that so many children "spontaneously" come to acceptance of their sex, despite sometimes intense dysphoria in childhood, is a strong signal that early, far-reaching medical interventions in this phase are not only unnecessary but can also be harmful. Puberty itself appears for the majority to be a phase in which dysphoria decreases or disappears, possibly because the adolescent body and the associated identity development help the child to reconcile with his or her sex. Puberty blockers interrupt precisely this crucial period.
Criticism of the desistance figures and what remains
Activist critics argue that the older studies were "broadly" inclusive — including not only DSM dysphoria but also less marked gender variance. That is technically correct, but it does not undermine the main finding: even with narrower redefinitions the majority of children remain non-persistent. More importantly, the current adolescent cohorts have not yet been adequately followed up methodologically — partly because the affirmative model uses "social transition" as an intervention (new name, pronouns, clothing style), which in observational research has produced indications that this itself increases the likelihood of persistence. The Cass Review (2024) explicitly speaks of social transition as an active psychosocial intervention whose outcomes have been insufficiently investigated.
Implications for the care model
The desistance findings support "watchful waiting" — observational support with psychotherapy — as first-line treatment in prepubertal children. Early medicalisation fails to recognise that the natural course in most children leads to acceptance without irreversible interventions. It is moreover striking that many so-called "desisters" turn out in retrospect to be gay or lesbian; among some critics, including gay rights organisations, this feeds the concern that affirmative transition functions as de facto conversion therapy for future homosexual children.
Adolescents with late-onset dysphoria
The desistance literature concerns prepubertal children. For adolescents who first develop dysphoria in their teenage years — the current main group of presenters — comparable longitudinal data does not exist. But here too figures from detransition research suggest that a substantial proportion reverses the identification. See ROGD and detransition.