Homenews

Transgender children and the specter of ‘desistance’

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“I would be dead, to be totally honest.”

That’s how 12-year-old Conner McLaren responded to a ThinkProgress question about what her life would be like if she’d had parents who forced her to be raised as a boy. Conner socially transitioned to living as a girl at age 4.

“I felt so wrong when I wasn’t a girl. I felt like my connection with my family wasn’t right. They were holding onto a piece of myself that wasn’t myself. I was someone else. I probably would’ve committed suicide,” she explained. “I probably would’ve made a few attempts.”

Conner’s story isn’t unique, but it is relatively new. It’s only in the last decade or two that U.S. society has seen its first generation of transgender kids who are out and proud both at home and at school — who live completely as a gender different from the sex they were assigned at birth. And though these kids appear to be thriving, there is a significant backlash against them, one that seeks to demonize their parents, segregate them in schools, and deny the legitimacy of their identities — all based on research that can most generously be described as imprecise.

Because it’s so novel for kids to come out as transgender so young, there hasn’t been an opportunity to conduct much research about what they’ll experience when they do so. Those skeptical of affirming trans kids instead rely on a small collection of older studies to assert that some 80 percent of them will supposedly “desist” (i.e. not persist) in being transgender — that they won’t actually turn out to be transgender as adults. Many kids, they warn, are being harmed by “social experimentation” and “gender propaganda,” and the 80 percent desistance rate proves that their gender identities are illegitimate and that they’ll grow out of them. The underlying assumption is that they’ll be better off if they do grow up to be cisgender.

The desistance myth has been the underpinning for legislative efforts in states like North Carolina, Texas, and South Dakota to justify banning schools from respecting trans students’ identities, and groups like the anti-LGBTQ Alliance Defending Freedom use the argument to substantiate their many cases challenging schools’ inclusive policies. There were also two multi-state lawsuits filed last year seeking to overturn guidance issued by the Obama administration protecting transgender students —  guidance that has since been rescinded and replaced with a watered down substitute by the Trump administration. If that guidance hadn’t been rescinded, the Supreme Court might have already chimed in on the issue. Indeed, in the current political climate, courts are the only venue trans kids have to advocate for themselves when they are rejected by their schools, but despite some victories, there’s still no national legal precedent that will guarantee their protection from discrimination.

Despite skepticism from those who believe most trans kids will — and should — desist, therapists and families like Conner’s are moving forward with social transitions. In doing so, they are allowing for a new wave of research to be conducted that is already starkly contradicting the desistance research regarding who exactly transgender kids are and what they are actually experiencing.

Who exactly are transgender kids?

The rise of LGBTQ visibility over the past 100 years has forced society to reconcile the complexities of gender and sexuality, and this has been especially true for children, who are often unfairly considered too young to understand these aspects of their identity.

Diane Ehrensaft, who serves as director of mental health for the Child and Adolescent Gender Center at the University of California San Francisco, explained to ThinkProgress how slow society has been to sort out all these different aspects of gender. “There has been a conflation for many years between being gender nonconforming in one’s expressions and being either transgender or other in one’s gender identity,” she said. “People get all that mixed up with sexual orientation. All three get collapsed into one.”

Though she celebrates the fact that “gender limits are being blown out of the water,” she still sees a divide between how people understand children’s gender. The more conservative approach assumes a “specific pathway of gender development” that kids can be steered toward, with the idealized outcome that they will identify with the gender they were assigned at birth, perform that gender, and be heterosexual. The more progressive approach, on the other hand, appreciates that “gender comes in infinite varieties” and that all of those variations are healthy,  allowing for children to have the space to explore and grow into whoever they turn out to be, even if that changes over time.

Ehrensaft’s eagerness to celebrate the diversity of gender in kids was informed by the journey of her own son, Jeff. As a kid, Jeff was, as she described him, “gender creative,” and would wear dresses around the house, but he ultimately grew up to be a gay man. Identifying with feminine traits or preferences is quite different from actually identifying as a girl, but even the world of psychiatry hasn’t always appreciated that delineation. Indeed, it was less than five years ago that the American Psychiatric Association (APA) formally recognized such a distinction.

The APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM) contains a set of criteria specifically for “gender identity disorder in children” (GID), but that criteria was significantly changed when the APA published its newest edition (the DSM-5) in 2013.

In the DSM-IV, which was in use from 1994 to 2013, the diagnosis required children to meet four out of five listed criteria. The first of those was a “repeatedly stated desire to be, or insistence that he or she is, the other sex,” but the other four criteria reflected the kind of preferences Ehrensaft’s son expressed as a kid, like “cross-dressing,” a “preference for cross-sex roles in make-believe play,” preferring games and toys “of the other sex,” and preferring playmates “of the other sex.” Separate from the four-out-of-five criterion, they must have additionally expressed discomfort in either their body or their gender roles; for young children that could be something like a boy rejecting rough-and-tumble play or stereotypically masculine toys and games.

Under the DSM-IV, a pre-adolescent Jeff could have potentially been diagnosed as having GID. “I asked him in adulthood, whether he could imagine being a six-year-old and taking a different pathway and identifying as a transgender child,” Ehrensaft recalled. “He said, ‘Absolutely not. I knew my gender.’” That’s a lesson she applies when she works with kids and families as a private therapist. “If you want to know a child’s gender, ask them; don’t tell them.”

When the DSM-5 came out, it changed that diagnostic approach in a rather significant way. Under the new guidelines, to be diagnosed with what is now referred to as “gender dysphoria,” children must meet that first criterion of desiring or insisting that they are “the other sex.” If that doesn’t describe their experience, then it doesn’t matter how many of the other gender nonconforming criteria they meet; they can’t be diagnosed. In other words, there’s no way a kid like Jeff could now be classified as having gender dysphoria just because of his feminine characteristics.

CREDIT: ThinkProgress/Diana Ofosu

Therapists often now use the shorthand “insistent, persistent, and consistent” to describe children who meet this criterion. If a kid is adamant that they are a gender different from what they were assigned at birth, that feeling doesn’t go away, and it plays out across their entire life, it distinguishes what that child is experiencing from other kids who are gender nonconforming but not transgender. It also more closely mirrors how transgender adults are diagnosed. Research has found that children as young as 18 months can articulate these aspects of their gender.

Ehrensaft explained that one way to recognize insistence, persistence, and consistence is to distinguish between whether the kid is engaging in fantasy play or “serious work.” For example, “if a little boy is [persistently] saying they’re a girl, they don’t want the Elsa costume, they want the school [uniform] dress.” In her work, she has found that it’s not actually that difficult to glean from a child whether he simply has feminine traits or preferences or if she is insisting she is a girl. “If you sit down with them, you can actually sort out apples and oranges” and distinguish transgender kids like Conner from gender nonconforming kids like Jeff.

But essentially, until at least 2013, therapy protocols weren’t formally sorting out apples and oranges. And neither were researchers. While there were some kids expressing what would now be understood as a “transgender” identity and some who weren’t, they were all lumped together under the umbrella of being gender nonconforming.

And that’s one of the main reasons the “desistance” research just doesn’t hold up.

The shoddy roots of the desistance myth

Dating back decades, there are about a dozen studies that prop up the desistance myth. Each claims to have studied a cohort of kids with GID and found that a significant percentage (around 60 to 90 percent) of those kids ended up “desisting” in their gender dysphoria and embracing the gender that they were assigned at birth. Even the most recent of these studies, however, relied upon the older DSM-IV diagnostic criteria, and that’s just the beginning of their flaws.

In their 2016 book Raising the Transgender Child, Dr. Michele Angello and Alisa Bowman break down the main problems with the research into three main concerns. First, the studies included children who simply were not transgender. Several also concluded that participants desisted simply because they did not complete the study. Moreover — especially given these first two flaws — the sample sizes of actual transgender kids were incredibly small (with most including fewer than five).

Kristina Olson, an associate professor of psychology at the University of Washington, is pioneering a new wave of research about transgender kids that aims to avoid these pitfalls, and as such, she’s also been one of the most outspoken critics of the conclusions drawn from desistance studies. In a 2016 critique published in the Journal of the American Academy of Child & Adolescent Psychiatry, she explained succinctly, “[C]lose inspection of these studies suggests that most children in these studies were not transgender to begin with.”

For example, in two of the studies, “[w]hen directly asked what their gender is, more than 90%  of children with GID in these clinics reported an answer that aligned with their natal sex, the clearest evidence that most did not see themselves as transgender.” Essentially, a tomboyish girl would say she still identified as a girl, but would be counted as transgender in the study.

In an interview with ThinkProgress, Olson further expounded on how weak the standard was for assessing which children to include in many of these studies. “A very significant number of kids, 30 to 40 percent, didn’t even meet the criteria for GID,” she explained. “Even if you thought they met that criteria, which is already less strong than the current criteria, you’re still looking at kids that didn’t meet the criteria.”

Colt Keo-Meier, a clinical child psychologist based in Houston who specializes in gender identity issues, summed up the desistance research to ThinkProgress thusly: “When they were older, of course they didn’t transition because they weren’t transgender to start with.”

But Keo-Meier also takes great exception to the fact that some of the studies just assumed, without actual evidence, that the children who dropped out had all “desisted.” For example, in a 2011 study in the Netherlands led by Thomas Steensma, nearly half (24 out of 53) of the participants didn’t return to the clinic conducting the study during adolescence. Because it was the only gender identity clinic for children and adolescents in the country, the researchers assumed that if they didn’t come back, those children must no longer be experiencing gender dysphoria. A 2013 follow-up study led by Steensma, the most recent in the desistance pantheon, made the same assumption when 80 of its 127 participants did not return to the Amsterdam clinic.

“You don’t see that in any study,” Keo-Meier said of drawing conclusions about participants who don’t actually complete the study. “I don’t have any idea how that got published! You just drop those people from your total percentages.”

Angello and Bowman explain why this assumption is so misguided:

They might have switched doctors, moved, or worse, committed suicide. Also, it’s common for transgender people to express their true gender, face an abundance of ridicule and harassment, and then repress it.

It’s the equivalent of a dentist who assumes that if patients stop coming back, that means that they’re no longer getting cavities.

The drop-off in participation in these studies — and the unwarranted assumption about what that means  — undermines how much can be generalized from them. Their sample sizes were small to begin with, there was significant drop-off, and the number of actual trans participants was a fraction of what remained. Madeline Deutsch, clinical director at the University of California San Francisco’s Center of Excellence for Transgender Health, explained to ThinkProgress that she suspects this isn’t a coincidence given who was conducting these studies.

Deutsch believes that, in addition to their other flaws, the desistance studies suffer from a selection bias because many were conducted looking only at patients who came to academic referral centers instead of assessing a wider population of patients seeing different caregivers in different locations. Families might wind up at these clinics because they didn’t have an affirming local therapist, or conversely because the parents were hoping to correct their child’s gender. “When a child is taken by parents who are not super supportive to an academic medical center in a city 100 miles away; they’re sat down at a table with a bunch of people who aren’t trans and are wearing white coats; and they ask them a zillion questions and take a zillion tests, I’m not surprised that some of those kids are like, ‘Yeah, I’m not really trans,’” she explained.

Likewise, Deutsch finds it conspicuous how few transgender researchers were actually involved in the desistance studies. Skepticism about letting kids transition, she said, “is driven underlyingly by a field of predominantly non-transgender researchers who are trying to turn this into some kind of field that is of interest and that is curious so they can generate more research and publications. It is not something that is being driven by the community.”

It’s not that she thinks only trans people should do this kind of research, but she questions the motives of people who aren’t working with the trans community to study the trans community. “It’s really mind-boggling,” she said, pointing out that researchers studying another demographic like racial minorities, immigrants, or substance abusers would likewise be expected to seek investment from the groups they were studying.

A new approach to studying trans kids

Olson has designed a massive new study, the TransYouth Project, to compensate for the flaws of the desistance research. To make sure she’s capturing the experience of kids who are actually trans, she’s only including participants who have fully socially transitioned their gender in every aspect of their lives — at home, at school, and everywhere else.

Olson’s research is only possible because of the recent rapid growth in transgender acceptance in society. “This project couldn’t happen if it wasn’t the case that we had affirming families today,” she explained. “And certainly, I couldn’t have done this work even five years ago. To get enough families would have been impossible.” She’s still recruiting families through this year, but all told, the study will have over 300 participants, and as long as the funding holds out, she’ll follow them for 20 years — well into their adulthood.

Though the TransYouth project’s cohort is still growing, it has already produced some preliminary findings that directly challenge the desistance myth. For example, a 2015 study of 32 participants found that transgender kids identify as consistently and innately with their gender as their cisgender peers and siblings do. In 2016, Olson found that having supportive parents virtually eliminates most of the mental health concerns transgender children are known to experience. Kids who had socially transitioned demonstrated “developmentally normative levels of depression and anxiety.”

Most recently, Olson investigated whether her previous results were biased because they relied on parents to report on the health of their child. This latest study of 63 transgender kids confirmed their normative mental health rates, but also found that parents actually reported higher levels of anxiety in the kids than the kids reported in themselves. Essentially, parents weren’t playing up how well their kids were doing, but were, in fact, being overly cautious in their observations.

The TransYouth Project is only the first part of Olson’s grand vision for new research on the gender of kids. As recruitment comes to a close for kids who have socially transitioned, she and her colleagues are also recruiting a whole separate cohort of kids who are gender nonconforming but who have not socially transitioned — i.e., a group that more closely resembles the participants in the desistance studies. By intentionally distinguishing this group from the trans kids and then following them into adulthood, Olson will be better equipped to draw the kinds of predictive conclusions the desistance studies tried to draw about who will grow up to be trans and who won’t. “[W]e expect at least some of them will socially transition, so that will give us some data from before and after,” she explained. But for those who do not identify as trans, “we’ll also be able to see if there are patterns of response in early childhood that predict who ends up socially transitioning or who identifies as trans later in life based on their presentation when they were very young.”

The TransYouth Project is not the only new research underway. Robert Garofalo, a pediatrician who directs the Center for Gender, Sexuality & HIV Prevention at Ann & Robert H. Lurie Children’s Hospital of Chicago, is spearheading another massive study that will specifically investigate the medical impacts of puberty blockers and cross-sex hormones on transgender young people.

Additional smaller studies are also providing new insights into trans kids’ experiences. For example, a 2015 study at Rady Children’s Hospital in San Diego found that almost all of the 42 trans adolescents in the study benefited from the physical transition steps they took, including puberty blockers, cross-sex hormone therapy, and mastectomies. Almost all of the participants who had previously experienced depression, anxiety, and self-harm reported improvement, and none of them regretted the steps they took.

While the new research is being collected, families and therapists are continuing to support transgender children as they grow up in a society that hasn’t seen a group like them before. And they are doing so precisely because transitioning is having such a noticeable positive impact on these kids’ lives.

Trans kids and their families correct the record

Opponents of transgender equality peddle a number of myths about transgender kids that all depend to some degree on the desistance myth. They argue, for example, that parents are “complicit” in turning their kids trans by allowing them to explore gender nonconforming play. Being trans is a social trend or a mass hysteria, and kids are spontaneously self-diagnosing as transgender out of rebellion after reading about it on the internet. Children who are really struggling with their gender identity are just going through a phase, just need a stern talking to, or just need corrective therapy to convince them to embrace the gender they were assigned at birth.

These claims are designed to discourage parents from affirming their kids and they are all premised on the bias that being transgender is a bad outcome. What gender therapists actually see are families who are simply concerned about the well-being of their children.

The biggest concern Keo-Meier hears from parents is, “I want to make sure that nothing is going to hurt my child.” Parents might recognize that their kids’ lives will be harder because of discrimination, bullying, harassment, and violence. They might likewise worry about their kids’ wellness, knowing the high rates of depression, substance abuse, and suicidality that the trans community can experience as a result of that stigma and mistreatment. And they might worry whether somebody will ever be able to love their child. Generally, by the time a kid arrives in his office, the parents have already noticed gender-related concerns for some time, have weighed these questions, and now want to do what’s best for their child.

“I think that’s a common misconception that this all happens so fast,” he explained. “[T]hese are not decisions made in haste. This is not, ‘One day my kid randomly said [‘I’m a different gender’] and so therefore we’re transitioning them.’”

Ehrensaft similarly described her approach as a therapist as taking “baby steps” to “try out the waters.” Deutsch framed it as “setting up swim lanes” in which kids have room to explore their own identities. Helping kids socially transition is about trial and error and assessing the impact that each change is having on their mental health.

ThinkProgress spoke with four different families whose kids have socially transitioned. What they’ve experienced directly contradicts the desistance myth and the many scare tactics built upon its foundation.

The Tchoryks

CREDIT: Pete Tchoryk

Pete and Sarah Tchoryk of Michigan became very concerned about their two-year-old Jacq Kai a few years back. He was exhibiting a number of signs of psychological distress, including obsessive-compulsive behaviors and massive tantrums that disrupted the entire family’s schedules. Despite having been designated female at birth, he was also insisting that he was a boy.

“Right from the beginning, he started saying his body parts didn’t match and kept asking about that,” Pete recalled, inquiring specifically, “Well, when am I going to get a peanut?” — his pronunciation of  “penis” at the time. Jacq started to refuse to wear dresses or any clothes he perceived to be “girly,” throwing such radical tantrums that Pete and Sarah couldn’t get him out the door to daycare — becoming late for work themselves. He would show great distress when people referred to him as a girl, which was frequent because of how people perceived his long hair. Unsure of how to help him, they started taking him to see a therapist.

One day, as Pete was dropping Jacq off at daycare, Jacq looked in the car’s rearview mirror, started crying, and said, “I look like a girl! My hair’s too long; I’m not going inside.” When Pete took him to get a short haircut, at the therapist’s suggestion, it was “one of the happiest days of his life.” But still there were times when Jacq said he didn’t feel comfortable even in the “boy clothes” his parents had gotten him, and that’s when they figured out that it wasn’t just about the clothes.

Even just a few years ago, the desistance myth was one of the only answers available for parents concerned about their kids’ gender, so the Tchoryks were very familiar with it. Because the theory seeks to avoid letting kids transition, it instead suggests that psychological issues like Jacq’s be treated without affirming the gender identity he’s espousing. But Sarah and Pete found that the more they let Jacq be the boy he said he was, the less there were any psychological issues to address.

Recognizing that the small gradual changes they were making weren’t enough, they asked Jacq’s school to start referring to him by his “boy name” and with masculine pronouns, and according to Pete, “It was as simple as that. It truly was a lightswitch. He came home happy that day and the next morning just couldn’t wait to get out to go to school.” Jacq’s tantrums and obsessive-compulsive behaviors disappeared, and they no longer had problems getting him out the door in the morning.

Jacq is now eight and entering the fourth grade. He loves going to school and this year he’s hoping to explain his identity to his classmates all by himself. “I want my classmates to know I’m trans, but they shouldn’t be scared of me or think I’m weird,” he told ThinkProgress. “It’s just who I am.”

Pete and Sarah are questioned all the time about whether they did the right thing by fully supporting Jacq’s transition, but Pete simply responds, “We’re trying to help our kids survive now. That’s how all medical treatment really is done. We want kids to survive now and as situations may change, you can address it.” They’re just glad Jacq’s a happy kid. “What’s the downside of the child changing if it’s going to help them be happier and safer in life?”

And though Jacq doesn’t really remember the days of his tantrums and anguish, he does have a good sense of what his life would be like if he wasn’t allowed to be the boy that he is. “I think I would just be really miserable,” he said. “I probably would spend a lot of time in a dark room.”

The McLarens

CREDIT: Melissa McLaren

Proponents of the desistance myth often try to dismiss the legitimacy of kids’ trans identities by claiming they’re simply responding to trends or fads or some sort of “social contagion” they learn from others. But that reasoning doesn’t explain why Melissa and Mikael McLarens’ daughter Conner, at age 3, was distressed about her genitals, expressed a preference for girls’ clothes, and said almost daily that she wanted to grow up to be a mommy, not a daddy. And Conner’s distress was particularly noticeable because it was so distinct from her identical twin brother, Murphy. According to Melissa, “They were different in ways that weren’t typical.”

As parents, they really struggled with how to support Conner. Desistance-based suggestions like “downplay anything feminine” and promoting “the father figure” and gender norms in the household were “absolutely not okay with how we view our lives,” Mikael said. The opposite approach — letting Conner just set her own limits — didn’t jibe with how they wanted to parent such a young child. But as Conner’s anxiety increased, they knew they couldn’t do nothing.

They were living in Minneapolis at the time and traveled to Chicago to see a therapist, who encouraged them to be affirming of Conner’s gender. Desistance believers tell tall tales about kids who are “rushed” into transitioning or who are transitioning “instantly,”  but the McLarens’ therapist suggested they take the smallest steps possible when allowing Conner to transition and assess the impact each change has on her well-being.

“We went ahead and put both gender clothes in the chest of drawers and let Conner choose what she was going to wear for the day,” Melissa offered as an example, “and I can tell you at that point we never again wore any boys clothes’ ever.” They tried out gender-neutral pronouns, but that only worked for a day or two. Indeed, shortly after they began using female pronouns at home, Conner took it upon herself to tell her classmates to stop using boy pronouns at school.

Speaking from their home in Ohio, the McLarens told ThinkProgress that letting Conner be herself completely changed who she was in remarkable ways. “I joke that at that point the princess had been let out of the castle and she was never going back in. She just blossomed,” Melissa said, explaining that up until that point she thought Conner was more of a wallflower.

Mikael said the difference was stark. “She had never really had a voice, even when it came to business. She was always just ok with whatever you wanted,” he said. But after she fully transitioned, it was the first time they saw her “happy with her own skin.”

“That moment was the most magical time,” Conner, now 12, recalled. “I felt like nothing could go wrong. I felt like nothing was impossible. I could go to the moon if I wanted to. I had dreams of being such a strong woman when I grew up. As soon as I put on that dress and realized I’m a girl, this is who I am, and my family accepted me, I wanted to make the world a better place for other children like me.”

The McLarens simply can’t reconcile everything they’ve heard about desistance with Conner’s experiences. “When we saw that our child was happy and healthy and thriving,” Melissa said, “that’s how you determine that an intervention is working.” Mikael added, “You would rather have a happy, healthy, well-functioning daughter than an anxious son. It was a difficult decision, but it was an easy decision.”

Conner understands the desistance concerns too. “People might think, ‘Well, they’re just going to grow out of it because 80 percent grow out of it.’ That’s not true, because you know who you’re going to be when you transition,” she said. Because of the legacy of caution from the desistance myth, Conner’s still only taking hormone blockers, and she’s impatient to start undergoing the kinds of permanent changes other girls her age are already experiencing. “I know that right now I should be on girl hormones — I should! — because my heart and my brain tell me the same thing: I am a girl. I know I’m a girl and I’ve truly always been a girl.”

The Fords

CREDIT: Vanessa Ford

Families that have already been in the public eye about their trans kids know all too well how persistent proponents of the desistance myth can be. Vanessa Ford’s family, which lives in the Boston area, has been profiled in the Washington Post several times and they were featured in the recent Katie Couric documentary Gender Revolution. When her daughter Ellie, now six, first started transitioning at age four, Vanessa remembered the biggest question being, “What if she changes her mind?”

“At the time, I knew that we didn’t have any other option but to listen to her,” she told ThinkProgress. “I remember initially saying, ‘Well, if she does [change her mind], then we’ll listen to her then.’ Right? We’re listening to her now; we’ll listen to her then.”

It was her curiosity about the possibility of desistance that motivated the family to participate in Olson’s TransYouth Project. “The research coming out of this study has never been done before, and it’s something to grasp onto, because the only research that was out there has been debunked.” Proponents of the desistance myth have nevertheless tried to fill that gap with warnings that kids like Ellie will change their minds, speculating without any evidence that it could be traumatic to transition back to the sex they were assigned at birth.

But in the barrage of questions about how Ellie knows, whether she’s too young, and whether her family should wait, Vanessa says simply, “For us, waiting hurts our child.”

She says she’d be “thrilled” if she was never again asked about Ellie changing her mind. “That question keeps parents who are not in as supportive an environment from having what they need to transition with a younger child.”

The Jacksons

CREDIT: Debi Jackson

Because proponents of desistance doubt the legitimacy of kids’ transgender identities, they often find ways to blame parents for somehow forcing their kids to be trans or — borrowing directly from ex-gay therapy rhetoric — disturbing their development with physical or sexual abuse.

Debi and Tom Jackson of Kansas City, Missouri, had been used to speaking out about their transgender ten-year-old Avery, but they were not prepared for the tsunami of negative feedback they received after she graced the cover of National Geographic’s recent issue on gender.

Detractors assumed from the photo that Debi and Tom forced Avery to adopt a transgender identity because of what they perceived to be feminine preferences. Debi explained, “Because of National Geographic, one of the big things is: ‘Oh look, the kid who thinks that she has to be a girl because she likes the color pink. She wants pink hair, she has a pink shirt on, and she’s wearing pink pants, so if they would’ve just taught her that boys can like pink, she wouldn’t have had to take this on.’” In reality, most of Avery’s wardrobe isn’t even pink, and they didn’t even know she was going to be photographed that day.

If anything, Avery is “a tomboy,” Debi explained, “but she’s not a boy, and she’s clear about that with her friends.”

CREDIT: National Geographic/Debi Jackson

Tom recounted some of the “vile and disgusting” claims he’s heard since the magazine was published: “I must be a pedophile and I must be raping Avery because that’s the only way a boy would think that he’s a girl, or that my wife must have Munchausen’s [syndrome by proxy] because that’s the only way Avery would be transgender, or that Avery’s the anti-Christ because she’s going to bring about the end of days, that she’s the leader of the satanic Illuminati and that she’s in control of all the liberal conglomerates of the world.”

ThinkProgress confirmed there were multiple videos on YouTube making these outrageous claims specifically about the Jacksons.

“If people knew the stuff we had to deal with in our six years of parenting Avery,” Tom said, “why would someone choose to do that as a trendy or ‘fun’ experiment? You do it because it’s what’s in the best interest of your kid.”

Debi added that it makes just as little sense to be skeptical of transgender kids themselves, given they often experience bullying and bathroom segregation at school. “Why would they keep that up if it wasn’t such an integral part of who they are? People aren’t going to put themselves into a marginalized category to be bullied and harassed just for kicks.”

What could have been/what always was

Though the kids currently being studied will become the first generation of trans adults who grew up transitioned since childhood, the stories of people who transition later in life further undermine the desistance myth.

One of the challenges many families face is finding doctors who are prepared to work with transgender kids. There are therapists and endocrinologists with experience working with cisgender kids or with transgender adults, but fewer with experience working with transgender kids. That was the case for the gender therapist the Jacksons took Avery to, who had never worked with a patient so young.

As Debi recalls, the therapist was a bit taken aback when Avery, at age 4, described how she knew that she was a girl on the inside, in her heart and in her brain. It was the exact same sentiment her older patients had articulated, and it was as genuine an expression of her identity as it was for the adults.

The therapist’s adult patients, some of whom hadn’t even begun to transition, would occasionally get together for a “girls night out” where they could be themselves and support each other, and they invited Debi to join them. “I’d never met a trans adult that I was aware of,” she recalled, and she explained to them that she thought her child was trans and asked to hear about their experiences. “Every single one of them had said, ‘I don’t know why they don’t trust kids. I’ve been saying since I was 3,’ or, ‘I’ve been saying since I was 6,’ ‘I’ve known since I was a child, and if only people would have listened to us then, we wouldn’t have gone through the hell that we’ve gone through our whole lives.’”

Transgender activist and writer Julia Serano recently explained how experiences with transphobia can significantly delay when a person identifies themselves as transgender:

I experienced intense gender dysphoria as a child. But living in a transphobic world with no gender-affirming options whatsoever, I learned to deeply repress those feelings in order to survive. If some researcher were to have carried out a follow up exam on me when I was eighteen, or twenty-one, or twenty-four, I probably would have described myself as a “happy cisgender male” (except for the fact that nobody was using the word “cisgender” back then). But repression only holds for so long, and I eventually had to come to terms with my gender dysphoria. I transitioned in my early thirties. Other transsexuals do so in their forties, or fifties, or even later.

The stories of people who transitioned as adults reflect how times have changed and how much more accepting society has become of children who do not conform to the expectations of their assigned gender.

Olivia K. Maynard

CREDIT: Olivia K. Maynard

Olivia K. Maynard, a 42-year-old retail makeup saleswoman in Houston, only faintly remembers beginning to understand who she was at around age 4 when she was growing up in Defiance, Ohio. “I don’t remember saying I’m a girl; I only remember being me,” she told ThinkProgress. “Whatever it was was the very basis of my personality… my manner, my energy, my aura.” But as soon as that femininity was perceived by her family, it was interrupted. “I was not allowed to form an identity.” She met so much resistance so quickly that she never had the chance to express how persistent, consistent, and insistent her identity was.

Her family actually subjected her to violence and forced her to conform to being a boy. “I wasn’t allowed to show emotion, I had to play male-dominated sports, I was forced to get into fights and I had to accept violence for being a sissy,” she recalled. “Like random attacks. My family would just attack me.” Maynard wasn’t even allowed to have female friends. “I compartmentalized myself very rigidly,” she said, finding ways to express her identity only when she was away from her family.

When Maynard was 21, her mother committed suicide, calling her before her death to apologize and to encourage her “to try to be happy,” but she just couldn’t. “She encouraged me, but I was too repressed.” She buried her identity for another 18 years. By all appearances, she fit the desistance myth’s expectations perfectly — until she didn’t.

Three years ago, Maynard realized she just couldn’t repress being trans anymore and had to cope with the dysphoria she’d been experiencing. Transitioning has already made a big difference in her life, and she describes herself as being “in a very blessed situation as far as trans people go.” But she knows her entire life would be different if she could have experienced acceptance at a young age. “I can’t comprehend what I lost really. I’m glad sometimes that I don’t know.”

Gunner Scott

CREDIT: Gunner Scott

Gunner Scott, 47, came to understand his identity more gradually, first coming out as a “queer bisexual lesbian” when he was around 21, then changing the name and gender on his identity documents around age 31. He now identifies as transgender and genderqueer, but, he told ThinkProgress, he suspects he could have started that journey earlier if his family hadn’t tried to suppress his gender at a young age.

As a teen, he felt very uncomfortable “presenting as feminine,” but at a therapist’s recommendation, his family forced him “to be more feminine” anyway. “Clothing was a big point of contention at my house,” he said. He wasn’t even allowed to wear jeans to school because they were considered “too much like a boy.” In fact, his parents overcompensated, buying him clothes “that were for 30-year-old women. Not wanting to be so feminine, that made it really difficult.”

“The therapist encouraged my parents to continue to reward me for dressing appropriately,” he explained, giving him privileges like taking out the car. They wouldn’t ground him for wearing “more masculine clothing,” but they tried to monitor his dress and buy his clothes for him so they would be more feminine. He’d pack jeans, sneakers, and t-shirts to change into at school, but would change back before he got home so they wouldn’t know.

Scott, who now lives in Seattle and is well known for his trans advocacy, isn’t sure what his life would have been like if he’d been freer to express himself at a younger age, noting that there were many other factors that impacted his development, such as his biological father’s abuse of his mother and his own experiences with homelessness and poverty. “Being trans and coming out was a way for me to take control of my life and the situations around me. If I had done that [earlier],” he said, “I don’t know, it’s so hard to say.”

Amanda Hunter

CREDIT: Amanda Hunter

Amanda Hunter, a cabinet maker in Ontario, Canada, had a childhood that was a lot like how Jacq Tchoryk thinks his would be if he hadn’t been affirmed in his transition. “I stayed home, I stayed alone,” she told ThinkProgress. She knew she was trans around age 10, but at age 15, her parents sent her to the Clarke Institute to receive reparative therapy.

Toronto’s Clarke Institute of Psychiatry, later incorporated into the Centre for Addiction and Mental Health (CAMH), ran a Child Gender Identity Clinic that was so notorious for its regressive ex-trans practices that many trans activists nicknamed it “Jurassic Clarke.” It was there that researchers like Susan Bradley and Kenneth Zucker conducted their research that still contributes to the desistance myth. CAMH closed in 2015 after an investigation confirmed that reparative therapy — by then banned under Ontario law — was still being performed there.

Hunter has repressed many of the memories from her time at Clarke, though she’s been able to recover some medical records of her time there. “Shivering — I shivered a lot when I was there,” she recalled. “I wasn’t cold; I was terrified. The memories — I try not to think of those memories because they cause a lot of pain. It’s hard to explain.”

As a result of the therapy, she buried aspects of herself for decades and just tried to blend in. If she’d been part of a study at CAMH, she’d have surely been counted as a desister. But she had anger issues, including a rage that scared even her, and five years ago, “it all came back,” she said. “I got to the point in the road where I couldn’t go any farther.” A therapist started helping her cope and transition, and now, at age 49, she’s been “full-time myself” for two years.

“Life is so much better. Friends who’ve known me for a very long time say it’s like I’m a completely different person. I’m outgoing, I’m happy, I’m full of life. Compared to what I once was — I was so shy, quiet, insecure, just everything about me had been crushed during those years.” Her workplace respects her identity, she’s been in a relationship for over a year, and life is stable and happy. “I wish I could have had this 30 years ago.”

These stories demonstrate that kids are coming out as trans at a younger age because society increasingly allows them to, not because society is somehow changing them. And though many families are now affirming of their trans kids, stories of gender repression still play out in homes across the country just like they did decades ago for Maynard, Scott, and Hunter — in large part because of the desistance myth.

The persistence of desistance

Despite the prevalence of the desistance myth, there are actually only a few “experts” still promoting the debunked theory. These voices, however, are elevated by conservative echo chambers and are increasingly reaching mainstream audiences, propagating the rejection of transgender kids by distorting, ignoring, or hiding the research that supports affirmation.

Paul McHugh, a Johns Hopkins University professor, has long been the darling of anti-trans conservatives, who often rely on his opinion alone to contradict mainstream medicine’s affirming approach to transgender people. McHugh infamously shut down Johns Hopkins’ sex reassignment surgery clinic in 1979 because he believed then, as he does to this day, that being trans is a mental illness and trans people do not benefit from transition.

In 2014, McHugh sparked a new wave of interest in his perspective with a Wall Street Journal op-ed comparing being transgender to having bulimia and dismissing surgery as a helpful solution. Last year, he and another Johns Hopkins scholar, Lawrence Mayer, published a massive report that tried to undermine common understandings (and medical consensuses) about LGBTQ identities, claiming among other things that because of the desistance research, nothing supports affirming children as transgender. The New Atlantis, published by the anti-LGBTQ Ethics and Public Policy Center and the Center for the Study of Technology and Society, is not peer-reviewed and the report notably contained no original research, but conservatives heralded it as game-changing anyway.

The report’s flaws and biases were obvious. For example, despite its claim to be a “careful summary” of the relevant research, it conspicuously didn’t mention any of the contemporary research Olson or others have published on transgender children. Mayer was taken aback that ThinkProgress and other outlets critiqued the report as anti-LGBTQ bigotry, but in emails to ThinkProgress at the time, he revealed his own biases. He claimed that it’s “untrue” children have a sense of gender at ages as young as two, expressed concern that parents “push” their gender nonconforming children to believe they’re transgender, and insisted, “I truly believe we will regret, as a society, allowing children as young as two be characterized as transgendered [sic].”

In some ways, the report backfired, prompting many in the academic and medical communities to criticize the university for silently allowing McHugh and Mayer to use its reputation to prop up their unscientific claims. Eventually, Johns Hopkins distanced itself from the two professors and even announced it would be reopening the trans surgical clinic McHugh had closed decades ago.

Nevertheless, McHugh and Mayer, joined by Paul Hruz of Washington University in St. Louis, published another report in The New Atlantis earlier this year objecting specifically to prescribing puberty blockers to trans kids. In it, they claim that children “are not fully capable of understanding what it means to be a man or a woman” and that affirming their gender identity “may drive some children to persist in identifying as transgender when they might otherwise have, as they grow older, found their gender to be aligned with their sex.” Conservatives ate it up.

Another vocal proponent of the desistance myth is the American College of Pediatricians (ACPeds), a sham medical organization and anti-LGBTQ hate group designed to be confused with the legitimate American Academy of Pediatricians. In 2016, ACPeds published a “position statement” co-authored by McHugh rejecting transgender kids. A few months later, the group’s president, Michelle Cretella, published a more extensive manifesto — propped up primarily by the desistance myth — outlining their objections to affirming transgender kids.

More recently, Cretella, who also advocates for ex-gay therapy, claimed that the field of medicine has been infiltrated by the transgender movement, countering with her belief that affirming transgender kids is “child abuse.” Medical professionals, she wrote, are “engaging in massive, uncontrolled, and unconsented experimentation on children who have a psychological condition that would otherwise resolve after puberty in the vast majority of cases,” reiterating the myth that transition is somehow being pushed on children.

After the Heritage Foundation published her piece, Tucker Carlson lifted up her perspectives with an interview on his Fox News show, where she again rejected the legitimacy of transgender identities, called affirmation “child abuse,” and reiterated the desistance myth (bumping the usual statistic from 80 percent all the way up to 95 percent). She claimed that since young children engage in “magical thinking” and “don’t know the difference so easily between fantasy and reality,” parents and physicians must encourage them to accept their assigned gender.

Other supporters of the desistance myth with medical credentials pop up all over the place. Eric Vilain, a pediatrician and geneticist at UCLA, told the NBC Bay Area Investigative Unit recently that children are unfairly “pushed” to socially transition. Australian doctor Stephen Stathis recently claimed that teens are “trying out being transgender… [like] it’s the new black.” Kenneth Zucker, who has continued to operate a private psychiatric practice since CAMH closed, recently appeared in a BBC documentary on transgender kids to say, among other things, “A four-year-old might say that he’s a dog. Do you go out and buy dog food?” His desistance research colleague Susan Bradley claimed earlier this year in Canada’s National Post that the trans movement is trying to coopt autistic children into being trans.

The “ex-trans” activist Walt Heyer claims he was previously trans, even though he has also admitted that he was misdiagnosed, but he has nevertheless capitalized on the desistance myth as a facet of his anti-trans advocacy, implying that his own story reinforces it. Kids should not even be allowed to socially transition, he warned earlier this summer, because “it doesn’t change the empirical fact that no one is able to predict which gender dysphoric children will remain gender dysphoric as time goes on.” Heyer’s anti-trans narrative is often lauded by conservatives; in fact, the White House recently promoted Heyer’s defense of President Trump’s ban on trans military service.

There are even some in the mainstream media who’ve stridently promoted the desistance myth. New York Magazine’s Jesse Singal, for example, regularly defends those who are skeptical of letting kids transition. Last year, he published his own analysis of the desistance myth, in which he excused every one of the studies’ many flaws. “It’s hard to imagine a kid meeting all the necessary criteria in the DSM-IV and not ‘actually’ being gender dysphoric,” he claimed, ignoring that the antiquated diagnosis didn’t actually require “all” the criteria. He likewise shrugged off the fact that many of the participants didn’t even meet that criteria.

Many who advocate for trans equality have dubbed these pro-desistance preachers “concern trolls” for the way they claim to be concerned about what’s best for kids as a cover for the anti-transgender message they’re promoting. Julia Serano has pointed out that they’re promoting a double standard when it comes to what kind of puberty kids should go through. They are concerned that the kids they assume will desist will be pushed into the “wrong” puberty with hormone therapy and ultimately surgery, when in fact it’s trans kids that they actually want to force to go through the wrong puberty, which will only exacerbate their gender dysphoria. “If the former example concerns you, but the latter one doesn’t, then that’s a clear sign that you value cis bodies and lives over trans ones,” she wrote last year.

Indeed, that’s the prejudice inherent in desistance: that kids will be better off if they turn out not to be transgender. Full of speculation and hope about how these children should turn out in the future, proponents of the myth casually disregard what’s most important to these families: the health and well-being of their children in the present.

As Conner McLaren recalled, “When I was a boy, I was holding down this geyser or growing ocean of distress and sadness that took a lot out of me. I knew I just couldn’t do it… There’s an ocean growing inside in me that’s filled with my tears, filled with my sadness, and hate for what my body is.”

As political and legal battles continue to be waged over how our schools and our society should respond to these kids, opponents of transgender equality will no doubt continue to wield the desistance myth as their weapon. But it is just a myth, and one that offers nothing to account for how transgender children across this country are thriving when they’re affirmed in their gender identities.

“When I was allowed to be who I was, I blossomed,” Conner said. “I was a flower that started drinking up that water and creating an island of happiness in that ocean of sadness… Now I’m filled with happiness, life, energy, and so much hope for the future.”

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