Desistance

Desistance is a central concept in youth gender care, referring to what has proven to be the norm for decades: the majority of children who exhibit gender dysphoria or gender variance come to accept their bodies without medical intervention. These children typically develop a homosexual or bisexual orientation later in life. Desistance research is therefore one of the strongest arguments against early medicalization of minors.

Subtopics can be found in Steensma 2013 — desistance in children.

What the classic 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 the Amsterdam UMC’s own clinic: among children with gender variance, only a minority still reported persistent dysphoria in adolescence. The vast majority developed acceptance of their bodies, often in combination with a homosexual or bisexual orientation. Comparable percentages were reported by Drummond, Wallien, Singh, and Zucker.

A remarkable biological and clinical fact

The fact that so many children “naturally” come to accept their sex, despite sometimes severe dysphoria in childhood, is a strong indication that early, invasive medical interventions at this stage may be not only unnecessary but also harmful. Puberty itself appears to be a phase in which dysphoria decreases or disappears for the majority, possibly because the adolescent body and the identity development associated with it help the child come to terms with their sex. Puberty blockers interrupt precisely this crucial period. The difference between persistence and desistance is explained further at transgenderidentiteit.nl.

Criticism of the desistance figures and what remains of them

Activist critics argue that the older studies used overly broad inclusion criteria—not only DSM dysphoria but also less pronounced gender variance. This is technically correct, but it does not undermine the main finding: even with narrower redefinitions, the majority of children still do not persist. More importantly, current adolescent cohorts have not yet been adequately followed up methodologically—partly because the affirmative model treats “social transition” as an intervention (a new name, pronouns, and clothing style), which observational research has provided indications may itself increase the likelihood of persistence. The Cass Review (2024) explicitly describes social transition as an active psychosocial intervention whose outcomes have not been sufficiently studied.

Implications for the care model

The findings on desistance support “watchful waiting”—observational support with psychotherapy—as a first-line treatment for prepubertal children. Early medicalization overlooks the fact that, for most children, the natural course leads to acceptance without irreversible interventions. It is also noteworthy that many so-called “desisters” later turn out to be gay or lesbian; this raises concerns among some critics, including gay rights organizations, 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 during their teenage years—the current main group of referrals—there are no comparable longitudinal data. However, figures from detransition research also suggest that a substantial proportion reconsider their identification. German insurance data show that the diagnosis is not very stable among young people: after five years, only 36.4 percent still had it. See ROGD and detransition.