Is a Child’s Future Gender Identity Predictable?

06/06/2019

Over the past decade, public awareness and media visibility of gender nonconforming and transgender children has increased in the Global North. While a variety of terms with overlapping and shifting meanings are in use to describe these children, including gender nonconforming, transgender, gender dysphoric and gender creative, I use the term gender variant throughout this essay as an umbrella term for children whose behaviors and interests diverge from the cultural expectations of the gender assigned to them at birth. This shift in visibility has been accompanied by the proliferation of children’s gender clinics in the US and in several other countries.

One of the main questions that frames public and clinical debates around gender variant children is whether we can know if they will grow up to be transgender, and if it is appropriate to initiate a gender transition during childhood. Critics of early childhood gender transition point to studies showing that the majority of gender dysphoric children do not grow up to be transgender, or in their words “desist” rather than “persist.” They also invoke particular cases of people (adults or children) who change their mind about their transition and “detransition.”

In response, supporters of childhood gender transition question the validity of the studies on adult outcome and whether the children they followed had the same profiles as transgender children today. Those who believe gender identity is innate and immutable reject the possibility of change and attribute it to misdiagnosis in the first place. Some others emphasize how rare such cases of retransition1 are, and some question the underlying assumption in these debates that a cisgender outcome is more desirable than a transgender one. They largely maintain that transgender children will remain transgender into adulthood and, therefore, children’s social transition (for example, change of name and clothes) and medical treatments to prevent puberty are warranted.
   

A clinical preoccupation with the future gender and sexual identity of the gender variant child began in the 1960s in the US. As sociologist Karl Bryant has shown, the earliest rationale for treating feminine boys (the primary recipients of treatment) was to prevent adult homosexuality, transvestism and transsexuality. The treatment protocols attempted to eliminate feminine interests and behaviors of these children, such as playing with girls and their toys, wearing girls’ clothes and exhibiting “girly” bodily gestures.
 

By the late 1990s, the emergence of the “affirmative” approach to gender variant children began transforming this clinical field in the US. Positing that children’s gender variance is neither pathological nor inherently distressing, affirmative clinicians argue that this natural variation in the child’s developmental trajectory should be allowed to flourish without disparaging any potential adult outcome or pressuring the child toward conformity. The affirmative clinicians I interviewed and observed, offered supportive counseling mainly to parents—and sometimes to children—to cope with stigma and anxiety, encouraging parents to accept the uncertainty of the future and support the child regardless of the future.
 

But this era was brief. During my fieldwork in the early 2010s at children’s gender clinics in the US, concern for adult outcome resurfaced. The rise of the treatment of “puberty suppression” was crucial in this shift. Children diagnosed with gender dysphoria are offered drugs that block the secretion of hormones that initiate puberty, in order to prevent the development of secondary sexual characteristics and the distress associated with them. Halting puberty, a systemic growth phase beyond sexual maturation, has health consequences for other organs, as well. Children start on puberty blockers around ages 9-13, often followed by cross-sex steroid hormones to at ages 13-16 to transition to the other sex. A major goal of the treatment is achieving an adult gender-congruent body that would allow a life free of the suffering and social stigma that many people with visible transgender bodies endure. As a consequence, recognizing children’s trajectory early in order to know whether to start puberty blockers or not became important. The clinicians and parents were increasingly anxious to know if the child would be transgender as an adult.

This clinical return to a preoccupation with the adult outcome leads us to the question, Is the child’s future gender and sexual identity predictable? And, should that guide the decision about childhood gender transition and the related medical interventions?

To answer these questions, it would be helpful to consider that gender changes across life stages. A four-year old is not gendered the same way as a nine-year old. For example, the pink taboo that has ruled little boys’ lives in recent decades in parts of the world, loosens it grip to some extent as they age; wearing dresses, however, does not (yet). Breasts become salient sex/gender markers after puberty. A fifty-year-old experiences gender differently from a twenty-year-old or from herself thirty years earlier. Moreover, what constitutes gender even for the same age and cultural group shifts. Wearing pants is no longer a masculine identifier. Facial hair did not historically negate womanhood, as it does today. Gendered social roles in family and workplace change as well, historically, and across one’s lifespan. Whether people feel more comfortable with, or more enthusiasm for, living in one gender or another could vary in different stages of life based on these shifting components of gender. Not all transgender adult people were gender variant or dysphoric in their childhood.

Children are new to exploring and understanding gender, how it shapes their position in the world, how this position varies in different environments and cultures and subcultures they move through, and how it relates to their body. Their knowledge of the world is growing exponentially, and their body grows and develops with a velocity different from adults. Their gender interests, conformity or nonconformity might change. Not all gender conforming children will grow up to be heterosexual cisgender adults and not all gender nonconforming children will belong to gender and sexual minorities in the future, while many might. Moreover, categories of sexual and gender variance are in flux and how we understand the relation between gay and transgender these days was different twenty years ago, and may be different twenty years from now. Within the same category, transgender lives are diverse and not as uniform as often portrayed in the clinical debates. New identity categories emerge, as well. As an example, in recent years in the US, increasing numbers of young adults are identifying as non-binary. We do not know what possibilities for gender variant life await children and what categories will be available to them, and created by them, in the future.

Questioning a linear trajectory from childhood gender interests and desires to adult gender and sexual identities does not mean that gender among children is trivial and we should not take children’s gender troubles and cross-gender interests and identifications seriously. Gender is pervasive in children’s lives. Punishment for its transgression could range from physical violence that could drive the family of a transgender child from their town to milder but relentless forms, such as the four-year-old boy who was brought to the clinic and was teased by his six-year-old sister every night for his pink toothbrush. Allowing young children to explore gender, and those who strongly desire to live as the other gender to change their name, pronouns and clothes without body alteration, is not incompatible with leaving the door open for various trajectories that could emerge later. Accepting the unpredictability of the child’s future identity, would, however, invite clinicians to revisit medical interventions that are primarily geared toward preventing, or achieving, certain adult gender or sexual outcome.

1- I use the term “retransition” rather than the more commonly used “detransition” to account for time, and for the entanglement of age and gender. One does not go back in time to a previous gender. 

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