Social transition
Social transition is the process by which someone begins to live as the opposite sex in everyday life—with a different name, different pronouns, different clothing and presentation. It is often presented as a neutral and risk-free step. The British Cass Review (2024) sees it differently: within the NHS, social transition should be regarded as an active intervention, because it may have significant effects on psychological functioning and on longer-term outcomes (para. 12.5; source).
What does social transition involve?
A social transition may include adopting a new name, asking people around them to use different pronouns, a different clothing and hairstyle, and systematically presenting as the opposite sex at school, work, in sports and in social circles. For adults, this is a personal choice that falls within the right to self-determination. For children and adolescents, the weakness of the research means that much is unknown about the consequences (para. 12.31; source). It often begins with a coming out.
Social transition is an active intervention
That social transition “can simply be reversed if it turns out not to be right” has not been shown. The Cass Review writes that, given the weakness of the research, much remains unknown about the impact of social transition: it is unclear whether it alters the trajectory of gender development and what short- and longer-term impact it may have on mental health (para. 12.31; source). There is no clear evidence that social transition in childhood has positive or negative mental health outcomes. Cass considers it possible that social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence, and therefore advises a more cautious approach for children than for adolescents (para. 12.36, same source).
Early studies found that gender incongruence persisted into adulthood in around 15% of prepubertal children. Later studies that did use formal diagnostic criteria found higher rates, including 37% (Steensma et al., 2013), at a time when a greater proportion of referred children had already socially transitioned before being seen in clinic (para. 12.32-12.33; source). See also desistance.
Social transition in children and adolescents
According to Cass, outcomes for children and adolescents are best if they are in a supportive relationship with their family, and parents should be actively involved in decision-making unless there are strong grounds to believe this would put the child or young person at risk (para. 12.36; source). Parents should play a central role in this process. For young children, Cass says advice on the risks and benefits of social transition requires clinical involvement; this is not a role for staff without appropriate clinical training (para. 12.36, same source). Cass also writes that schools struggle with how to respond when a pupil wants to socially transition at school (para. 12.6, same source). On 19 December 2023 the English Department for Education published draft guidance stating that schools do not have to accept all requests for social transition and must fully consult parents before any decision is taken (source). Information on how a school can act carefully can be found at genderopschool.nl. See also Social transition in children and Schools and transgender children.
Social transition in adults
Adults may socially transition on their own responsibility. This is a choice that falls within personal freedom. However, it is advisable to be realistic about what social transition can and cannot resolve. Good psychological guidance before taking steps is not “gatekeeping” but due diligence.
Reversibility in theory and practice
In theory, a social transition can be reversed. Cass writes that a child or young person who wants to reverse a transition may need help, because it can be a difficult step (summary of chapter 12; source). See also Detransition.