Studies and Reports: Transgender Children

This is a resource page for studies and reports relevant to the treatment of gender variant children. I especially recommend the second document– it is the future! 

There is no clinically reliable way to differentiate between a child’s future sexuality and her “gender identity.” Most children with gender “variance” in childhood will develop into homosexual, not transsexual, adults. Here is the research.


If the link is broken, leave a comment requesting a copy and I will email you a pdf of the relevant article or report.

31 MAY 2013



The World Health Organization (WHO), a specialized agency of the United Nations, is  responsible for developing and disseminating the International Classification of Diseases (ICD),  which is the standard set of definitions of diseases and health conditions used throughout most  of the world. The edition presently in use is ICD-101, which was completed in 1990. ICD-9 was  first published in 1975. The long intervals between editions may indicate the magnitude of the undertaking inherent in revising such an important and far-reaching international document. When a new edition is prepared, it must be ratified by representatives of 194 WHO Member States, comprising the World Health Assembly (WHA, the governing body of WHO), before it may be implemented globally.

PAGE 5, bold text not in original:

An added level of complexity is that children presenting as transgender raise an additional set of questions about what constitutes appropriate responses and treatment. For example, most cases of childhood gender dsyphoria do not persist into adulthood, while a minority of individuals do go on to seek gender transition in adolescence and adulthood. WHO is also attempting to examine the appropriate classification of gender dysphoric child populations, and whether or not such classification is necessary in order to facilitate appropriate treatment.

PAGE 9, bold text not in original:

a. For deletion of the diagnostic category

Gender variance in childhood is normal. Risks of a GI-Childhood diagnosis include: Stigmatizing children with a diagnostic label when there is no disorder45; diagnosis can become iatrogenic, instilling a sense in the child that “there is something wrong with me”; and a poor predictive value – 80% of children diagnosed with GID do not continue to have GID of adolescence or adulthood. One presenter suggested moving to a narrative approach for historical preservation and also emphasized the unethical position around reparative therapy. This presenter proposed using Z codes with a ‘g’ modifier for gender diversity, and advocated that we educate carriers to reimburse Z codes (Z codes are rarely reimbursed). Another presenter argued that childhood diagnoses should be removed because their existence undermines the removal of adult & adolescent diagnostic category from mental health chapter. This presenter gave many suggestions for Z codes.

b. For retention of the diagnostic category

Two presenters made a strong argument that without the diagnostic category there would be no justifiable basis for children with gender dysphoria to obtain medical or mental health services. A diagnosis may give the child a “protected status” (i.e., non-discrimination, accommodations in school). There is also a case for professional training (more competence is needed among providers) and research.



Report: Critique and Alternative Proposal to the “Gender Incongruence of Childhood” Category in ICD-11
GATE Civil Society Expert Working Group (
Buenos Aires, April 4-6, 2013



The group of experts convened by GATE considers “gender variance” to be an extremely problematic concept that is rooted in a binary and hierarchical understanding of gender. 

PDF PAGE 4/25, bold not in original:

First, there is no clear consensus among researchers and health care providers with regard to the need for or global applicability of such a diagnosis.11

Second, gender variance in childhood does not require any medical interventions such as hormone therapy or surgical procedures. Rather, children need information and support in exploring their gender identity and expression and dealing with sociocultural environments that are frequently hostile to gender variance.

Third, attaching a medical diagnosis to gender diversity in childhood contradicts WHO’s commitment to respecting rather than pathologizing sexual diversity. Specifically, research indicates it is impossible to reliably distinguish between a gender-variant child who will grow up to become trans and a gender-variant child who will grow up to be gay, lesbian, or bisexual, but not trans.12 As such, by conflating gender variance and sexual orientation, the proposed GIC category amounts to a re-pathologization of homosexuality.

PAGE 6, bold not in original:

• Children do not have medical needs related to gender diversity, such as hormone therapy or surgical procedures, that require a specific diagnosis.13 Instead, their primary needs are for information, counseling, and support, which the ICD can facilitate access
to via other means, such as Z codes. (Winter 2013).

• Children who experience clinically significant distress or impairment due to gender variance are able to access health care under the same diagnoses that are used for any child with clinical depression or anxiety. Attached to this document are numerous letters from WPATH members attesting to this point (“Letters of Support”)

• Children facing challenges such as family opposition, bullying at school, or social rejection due to gender variance should be able to access services through codes that address these hostile environments without pathologizing the child. Parents, other family members and other relevant individuals, such as teachers and social workers, should similarly be able to access information, counseling, and support through codes that target their specific needs, without projecting their own distress on the child. (Hill & Meinville 2009; Raj 2008; Riley, Sitharthan, Clemson & Diamond 2011; Winter 2013; Winters 2008).

PDF PAGE 7-8, bold not in original:

In addition to its manifest lack of medical necessity, evidence indicates that the proposed GIC diagnosis may in fact be potentially harmful. This evidence includes observations that diagnoses of gender variance or incongruence exacerbate stigma and discrimination for children and their families, as well as indications that such diagnoses have been used to justify the provision of harmful “reparative” therapies. (Langer & Martin 2004)21 Moreover, though the proposed GIC diagnosis will be regulated by definitions and diagnostic guidelines, the risk is unacceptably high that this diagnosis will be interpreted as pathologizing any form of gender variance in childhood.



Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation. APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation. (2009). Washington, DC: American Psychological Association

PAGE 4, bold text not in original:

The few studies of children with gender identity  disorder found no evidence that psychotherapy provided to those children had an impact on adult sexual  orientation. There is currently no evidence that teaching or reinforcing stereotyped gender-normative behavior in childhood or adolescence can alter sexual orientation.  We have concerns that such interventions may increase self-stigma and minority stress and ultimately increase the distress of children and adolescents.



link will DOWNLOAD the file to your computer Report of the APA Task Force on Treatment of Gender Identity Disorder
Approved by the Joint Reference Committee, July 2011
Approved by the Board of Trustees, September 2011


PAGE 4, bold text not in original:

An additional obstacle to consensus regarding treatment is the lack of
randomized controlled treatment outcome studies of children with GID or with any presentation of GV (2). In the absence of such studies, the highest level of evidence available for treatment recommendations for these children can best be characterized as expert opinion. Opinions vary widely among experts, and are influenced by theoretical orientation, as well as assumptions and beliefs (including religious) regarding the origins, meanings and perceived fixity or malleability of gender identity. Primary caregivers may, therefore, seek out providers for their children who mirror their own world views, believing that goals consistent with their views are in the best interest of their children.

The outcome of childhood GID without treatment is that only a minority will identify as transsexual or transgender in adulthood (a phenomenon termed persistence), while the majority will become comfortable with their natal gender over time (a phenomenon termed desistence) (3-6). GID that persists into adolescence is more likely to persist into adulthood (2). Compared to the general population, the rate of homosexual orientation is increased in adulthood whether or not GID was treated (2, 4). It is currently not possible to differentiate between preadolescent children in whom GID will persist and those in whom it will not. To date, no long-term follow-up data have demonstrated that any modality of treatment has a statistically significant effect on later gender identity.



Management of the transgender adolescent. Olson J, Forbes C, Belzer M.
Arch Pediatr Adolesc Med. 2011 Feb; 165(2):171-6.

PAGE 172, bold text not in original:

Most children aged 5 to 12 years diagnosed as having GID do not persist in having GID as adolescents; rather, most become homosexual or bisexual adolescents and adults.

PAGE 174, bold text not in original:

Because patients are potentially starting GnRH analogue therapy early in the pubertal process, the common adverse effects of these agents are generally not expected. The most common concern with the administration of GnRH analogues is the effect on height and bone density. In a study,26 of the Dutch protocol that calls for the administration of GnRH analogues starting at age 12 and moving to concomitant administration of cross-gender hormones at age 16, bone density was diminished at the time of GnRH analogue administration but was found to catch up when appropriate crossgender hormone therapy was started. Height was increased for female to male patients by delaying biologic female puberty and was decreased in male to female patients with the administration ofestrogen promoting closure of the growth plates. This effect is generally desirable to both populations. It is unlikely that GnRH analogue administration alone would affect fertility. However, initialing cross-gender hormones after the use ofGnRH analogues is likely to prevent the maturation of the gonads.


___________________________________________ Variance: An Ongoing Challenge to Medico-Psychiatric Nosology by Rosario, Vernon A. (2011) Journal of Gay & Lesbian Mental Health, 15: 1, 1 — 7

PAGE 3, bold text not in original:

Green’s prospective study of gender-variant boys (1987) followed into adolescence and young adulthood found that 75% of those who could be reassessed had developed a gay or bisexual orientation, and only one was primarily transsexual. Subsequent studies of girls and boys have continued to find that the majority of gender-variant children grow up to have a homosexual or bisexual orientation rather than identify as transsexual (Drummond et al., 2008; Wallien & Cohen-Kettenis, 2008).


___________________________________________ Outcome of Gender Dysphoric Children by MADELEINE S.C. WALLIEN AND PEGGY T. COHEN-KETTENIS

PAGE 1, bold not in original:

Conclusions: Most children with gender dysphoria will not remain gender dysphoric after puberty. Children with persistent GID are characterized by more extreme gender dysphoria in childhood than children with desisting gender dysphoria. With regard to sexual orientation, the most likely outcome of childhood GID is homosexuality or bisexuality.



The authors are very grateful to Ferring Pharmaceuticals for the financial support of studies on the treatment of adolescents with gender identity disorders.

“The authors are very grateful to Ferring Pharmaceuticals for the financial support of studies on the treatment of adolescents with gender identity disorders.”

Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects by Henriette A Delemarre-van de Waal and Peggy T Cohen-Kettenis.

European Journal of Endocrinology (2006) 155 S131–S137.

And THIS article has NO exerpts because it was funded by a major pharmaceutical company that has a financial interest in substantiating the safety and efficacy of puberty blockers. Because Ferring sells these outrageously expensive drugs to children and their families.


The authors are very grateful to Ferring Pharmaceuticals for the financial support of studies on the treatment of adolescents with gender identity disorders.


This paper was presented at the 4th Ferring Pharmaceuticals International Paediatric Endocrinology Symposium, Paris (2006). Ferring Pharmaceuticals has supported the publication of these proceedings.


  1. […] Studies and Reports: Transgender Children. […]

  2. […] A significant number of transmen are lesbians who report that they want to transition in an attempt to escape misogyny – their own internalized version as much as society’s. A significant percentage of transwomen are homosexual males, pressured into transitioning by conservative society that hates gender non-conforming gay men. And the majority of kids diagnosed with “gender dysphoria” will be or already are lesbian, gay, or b…. […]

  3. […] SEE ALSO: Bess Hungerford’s excellent page on studies & reports concerning “transgender”…. […]

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