Gay and Lesbian Young People in the Gender Debate: Space for Sexual Orientation and Careful Diagnosis
Young people who do not feel at home with traditional expectations of boys and girls deserve safety, calm and space to get to know themselves. This applies to transgender young people as well as gay and lesbian young people. In public debate, sexual orientation, gender expression and gender identity are regularly conflated. This can be confusing, particularly for young people who do not fit heteronormative or stereotypical images.
That is why an important starting point is simple: sexual orientation is about whom someone falls in love with or feels sexually attracted to; gender identity is about someone’s inner sense of being a woman, a man, both, neither or something else. A lesbian girl is therefore not “really a boy” because she is attracted to girls, and a gay boy is not transgender because he is not masculine. These things can coexist, but one does not automatically follow from the other.
Gender stereotypes are not a diagnosis
Children and young people often discover their personalities through clothing, hobbies, friendships, behavior and romantic feelings. A boy who enjoys dancing, is emotional or prefers spending time with girls, and a girl who wants short hair, is technically minded or does not conform to conventional ideas of femininity, may simply be boys and girls with their own style and character.
The problem arises when gender-nonconforming behavior is too quickly interpreted as evidence of a different gender identity. This can unintentionally reinforce old stereotypes: as if a girl can only be a girl if she is feminine, heterosexual and interested in boys. For gay and lesbian young people, who may already be struggling with discovering their sexual orientation, that message can be especially burdensome.
Careful support does not mean dismissing gender dysphoria. Some young people do experience a persistent and serious incongruence between their bodies, their sex assigned at birth and their gender identity. However, a professional assessment should make room for multiple possible explanations, including gender expression, sexual orientation, body image, social pressure, bullying, mental health difficulties and questions that arise during puberty.
What research on ‘desistance’ does and does not show
In older follow-up studies of children referred to a clinic because of gender dysphoria or gender nonconformity, a substantial proportion were no longer gender dysphoric in adolescence. A Dutch study by Wallien and Cohen-Kettenis followed children for an average of approximately ten years and reported that some no longer experienced gender dysphoria later on; same-sex or bisexual orientation was relatively common in this group. The authors concluded that homosexuality or bisexuality was a common outcome among children who had been referred at the time because of these concerns. Read the study by Wallien and Cohen-Kettenis.
A later Dutch follow-up study likewise found that the intensity of gender-dysphoric feelings in childhood was associated with the likelihood that these feelings would persist into adolescence. This underlines that not every child with gender-nonconforming behavior or gender-related uncertainty follows the same developmental path. Read the study by Steensma and colleagues.
The term desistance, often translated as the disappearance or discontinuation of gender dysphoria, does require caution. A systematic literature review from 2022 showed that researchers use varying definitions: sometimes it refers to reduced distress, sometimes to a changed identity and sometimes to not wanting medical treatment. Many classic studies also date from a period with different diagnostic categories and patient populations than today. The figures should therefore not be used to predict outcomes for individual young people or to deny transgender identities. Read the systematic review of the concept of desistance.
However, an important practical point does follow from this: because development does not proceed in the same way for every young person, time and open-ended exploration are valuable. Older follow-up studies do not show that a particular form of support automatically leads to a gay or lesbian outcome. They mainly show that gender-related concerns in childhood can follow different developmental paths, including a future as a gay or lesbian adult without medical transition.
Same-sex attraction in clinical populations
Several clinical studies have described a relatively large proportion of young people attracted to people of the same sex among referrals for gender-related concerns. A Canadian study of referrals to a gender identity service examined, among other things, age, sex and sexual orientation during the period from 1976 to 2011. Read the study on referral patterns. Dutch research also found an association between gender nonconformity in childhood and homosexuality later in life. Read the Dutch prospective study.
This does not mean that gay young people are “actually” transgender, or vice versa. Nor does it mean that every young person referred to a gender clinic will turn out to be gay or lesbian. It does indicate, however, that sexual orientation must not be treated as an afterthought in diagnosis. For a young person who fears rejection because of same-sex feelings, the question “am I transgender?” may sometimes overlap with broader questions about belonging, femininity, masculinity, desires and relationships.
Open-ended diagnosis prevents narrowing the focus
The Dutch quality standard for transgender care emphasizes that children and adolescents develop physically, psychologically, socially and sexually, and that this development can influence gender-dysphoric feelings. According to the standard, assessment should be carried out by professionals with expertise in developmental psychology, psychopathology, psychosocial circumstances and differential diagnosis, within a multidisciplinary team. Read the Dutch Quality Standard for Transgender Care.
The Cass Review, published on April 10, 2024 and summarized on this site in the Cass Review explained, also advocates a broad, individualized assessment of young people with gender-related concerns. Not one explanation, but the full developmental history, mental health, family situation, social environment and identity development should be taken into account. In its advice of June 2026, the Dutch Health Council likewise stated that Dutch transgender care includes an extensive exploratory phase, allowing room for information, reflection and voluntary informed consent. Read the advice of the Health Council.
What parents, schools and healthcare professionals can do
For parents, the most important attitude is to listen without prescribing an outcome. Take a young person’s feelings seriously, but make clear that there is no need to rush into giving every question a definitive label. Young people should be free to be transgender, but equally free to be gay, lesbian, bisexual, gender-nonconforming or still exploring their identity.
Schools can help by actively challenging gender stereotypes and normalizing homosexuality and lesbian visibility. Not every girl who differs from feminine expectations wants to be a boy; not every boy who differs from masculine expectations wants to be a girl. Safety requires protection from bullying, not the imposition of an identity. How a school can address bullying related to gender without taking sides in the debate is explained at genderopschool.nl.
Healthcare professionals have a responsibility to explore openly, without steering, and from a broad perspective. Asking about romantic feelings, sexual attraction, shame, social pressure and beliefs about masculinity and femininity does not deny gender dysphoria. On the contrary, it helps professionals understand a young person as a whole person. This is essential to prevent gay and lesbian young people from feeling unnecessarily medicalized, while transgender young people receive the serious and appropriate care they need.