Watchful Waiting for Gender Dysphoria

Watchful waiting is a clinical approach in which children with gender dysphoria are monitored without early medical or social intervention, in order to observe how the dysphoria develops around puberty.

Background

Watchful waiting is a clinical approach in which children with gender dysphoria are monitored without early medical or social intervention, in order to observe how the dysphoria develops around puberty. It is based on observations (Steensma 2013 and earlier studies) that, in a significant proportion of young children with gender dysphoria, the dysphoria disappears before or during adolescence—a trajectory known as desistance.

Debate

Advocates of the gender-affirmative model criticize watchful waiting because they argue that it amounts to denying the child’s feelings. Advocates of a more cautious approach—including the Cass Review—call for an exploratory, non-affirmative, non-suppressive approach that allows time to identify possible comorbidities and social factors.

Place in policy

Since the Scandinavian and British policy changes, watchful waiting (or similar “exploratory” approaches) has gained a greater role in youth gender care, particularly before puberty. A brief description of the term and its history can be found in the glossary of transethiek.nl.

Three approaches

The literature distinguishes three approaches for young children. For a long time, the Amsterdam clinic advised parents to wait, give the child space, and postpone a full social transition until it became clear how the dysphoria developed during puberty. The clinic in Toronto went further and actively tried to help the child reconcile with their body. The affirmative model from the United States follows the child’s stated identity, including social transition at a young age. The AAP called waiting outdated in 2018.

Social transition

An important point in the debate is social transition: using a different name, different pronouns, and different clothing. The Cass Review says this is not a neutral step, because it can influence the child’s further development. The study by Steensma found that social transition in childhood was associated with the persistence of dysphoria. Whether one causes the other is not known.

Frequently asked questions