A Tale Of Two Studies

Two studies describing the outcomes for gender dysphoric young people have emerged in the past year. They say completely different things. Why is that? A laywoman attempts to answer.

May 16, 2022

I want to tell you about two studies. One was done in 2021 - it is Kenneth Zucker, Susan J Bradley, and Devita Singh following up on 139 boys who turned up to a Toronto gender clinic over a period between 1975 and 2009, while the other is part of the TransYouth project, and done by Kristina R. Olson, Lily Durwood, Rachel Horton, Natalie M. Gallagher, and Aaron Devor, and is currently pre publication, intended for a 2022 publication date. The Olson study was released last week, and has been the subject of glowing media coverage that doesn’t look behind the curtain. The Zucker study? Uh, not so much.

These studies both focus on young people with gender dysphoria (or childhood Gender Identity Disorder, a DSM listed mental illness). The crucial difference? Whether these children underwent social transition or not. In the Zucker study, only one of the boys was socially transitioned, compared to the Olson study, where all 309 patients being tracked had socially transitioned, many of them having done so while under the age of six. Both studies warn against comparing them to others: however, I don’t care and for the purposes of this article, I will do it anyway, because there is no double blind study with a control group on this matter. Read at your own risk.

Olson’s study has been subject to glowing media treatments since the release of its prepublication last week. Here’s a sample:

Nicole Talbot was 13 when she faced her school assembly, her principal by her side, and told her classmates for the first time something she had always known: She was a girl.
Talbot said she is often asked when she knew she was trans, and that her answer is simple — she always knew who she was.
Her mom could see it early, too. Before she transitioned, she played with trains, but hers had tea parties. She traded her elephant Halloween costume with a friend to be Cinderella. And she loved Mulan, a girl who had to pretend to be a boy to fit in.
Some trans children want to begin a social transition at a young age, where social factors like their name, clothes and appearance match their gender identity. But some families hesitate to support the social transition, especially considering the possibility of retransition, when a child transitions to a nonbinary gender or the gender that aligns with the sex they were assigned at birth, said Kristina Olson, a professor of psychology at Princeton University.
“There’s a lot of discussion about early childhood social transitioning, whether it’s a good thing or a bad thing,” Olson said. “Despite there being a lot of talk about it, there is surprisingly little data.”
Olson and a team of researchers added to the data in a study published Wednesday in the journal Pediatrics. They found that of the more than 300 transgender kids who socially transitioned from 3 to 12 years old, only 7.3% retransitioned within the next five years.

Some more glowing media coverage in the New York Times:

The data come from the Trans Youth Project, a well-known effort following 317 children across the United States and Canada who underwent a so-called social transition between ages of 3 and 12. Participants transitioned, on average, at age 6.5.
The vast majority of the group still identified with their new gender five years later, according to the study, and many had begun hormonal medications in adolescence to prompt biological changes to align with their gender identities. The study found that 2.5 percent of the group had reverted to identifying as the gender they were assigned at birth.
As tension mounts in courtrooms and statehouses across the country about the appropriate health care for transgender children, there’s been little hard data to draw on about their long-term development. The new study provides one of the first large data sets on this group. The researchers plan to continue following this cohort for 20 years after their social transitions began.
“There’s this sort of idea that the kids are going to be starting those things and that they’re going to change their minds,” said Kristina Olson, a psychologist at Princeton University who led the study. “And at least in our sample, we’re not finding that.”
Dr. Olson and other researchers pointed out, however, that the study may not generalize to all transgender children. Two-thirds of the participants were white, for example, and the parents tended to have higher incomes and more education than the general population. All of the parents were supportive enough to facilitate full social transitions.

(An aside: The bolded section is because this is an absolute fucking lie. We already know about their long term development, or this article wouldn’t exist! Hell, older research is even referenced in Olson’s shambles of a publication! Shame on you, New York Times. Also, why isn’t ‘the paper of record’ questioning why a bunch of six year olds are transitioning sex?!)

Of course, this is my favourite part of this article:

“Correction: May 4, 2022
An earlier version of this article referred incorrectly to a psychological diagnosis. As the article noted, research from the 1990s and 2000s looked at children diagnosed with gender identity disorder — but not gender dysphoria, a diagnosis that came into use more recently. “

Alright folks, lets pack up. They changed the name of the disorder, which means we can’t talk about old studies anymore. We are all wrong about everything, let’s pack up and go home.

And of course, stuff like this, courtesy of Healthline and everyone’s favourite bullshit artist on this topic, Jack Turban:

Dr. Jack Turban, a fellow in child and adolescent psychiatry at Stanford University School of Medicine where he researches the mental health of transgender youth, said that a common refrain is that “prepubertal transgender children will grow up to identify as cisgender.” Studies like this, prove that isn’t the case.
“This is a misinterpretation of the literature. Past studies didn’t actually follow transgender kids over time, they followed kids referred to gender clinics, many of whom were never transgender to begin with,” said Turban, who is not affiliated with this research out of Princeton. This new study is important because it only included kids who identified as transgender and followed them over time. It found that for the vast majority, their gender identity was stable over a five-year follow up period.”

Any desisters weren’t really trans, apparently. It’s also proof that Turban didn’t read the Olson study, because many of these children did not meet diagnosis criteria (i.e they weren’t ‘truly trans’), but were treated anyway, which raises huge red flags:

This study did not assess whether participants met criteria for the DSM-5 diagnosis of Gender Dysphoria in Children. Many parents in this study did not believe that such diagnoses were either ethical or useful and some children did not experience the required distress criterion.

As for Turban’s claim? I will respond with a quote from the Zucker study, because he is the expert and I am some random woman with a laptop and a Substack:

In the Wallien and Cohen-Kettenis (52) study, the DSM-III-R criteria were used to diagnose GID. Of the 12 persisters, all met the criteria for GID at the time of the baseline assessment; in contrast, only 68% of the 47 desisters met the criteria for GID; the remainder were deemed subthreshold for the diagnosis. Thus, in their study, the threshold-subthreshold distinction appears to have been an important one in predicting outcome; nonetheless, it should be noted that 68% of the desisters had been threshold for the diagnosis in childhood—perhaps a strong rebuttal to the No True Scotsman argument. In Steensma et al. (51), the DSM-IV-TR criteria were used. Of the 23 persisters, 21 (91.3%) met the criteria for GID; in contrast, only 22 (39.3%) of the 56 desisters were threshold for the diagnosis, suggesting an even more substantial difference in the threshold-subthreshold distinction than was found in Wallien and Cohen-Kettenis. Although the latter percentage was lower than what was found in Wallien and Cohen-Kettenis, that almost 40% of the desisters met the criteria for GID in childhood still argues in favor that the children were desisting from something.6

But let us forget the media coverage for a moment, and really get into the meat of things.

Studies on young people at gender clinics are notorious for two things: small sample sizes, and not having control groups. This is the closest we’ll get at this point in time, in an awkward sort of manner, to compare the outcomes of the two sets of treatments with two relatively large sample sizes - where a child is left alone, or given therapy, and where a child is socially transitioned and put on a potentially lifelong medical pathway that will involve not sexually maturing and sterility.

Firstly, what is social transition? Olson defines it as this:

Increasing numbers of children are socially transitioning to live in line with their gender identity, rather than the gender assumed by their sex at birth—a process that typically involves changing a child’s pronouns, first name, hairstyle, and clothing. Some concerns about childhood social transitions have been raised , including that these children may not continue to identify as transgender, rather they might “retransition” (also called a “detransition” or “desistence”), which some suggest could be distressing for the youth. Research has suggested that ages 10-13 years may be particularly key times for retransition and that identity may be more stable after this period for youth who show early gender nonconformity.

Today I learned I have socially transitioned, as I am wearing a men’s 49ers jersey, recently gave myself a number five, and was mistaken for a man and went along with it when I went to put some gas in my car. I will update you on further developments in my gender trajectory1. I cannot wait for my period to stop arriving, personally, now that I am a man.

The Olson paper aims to:

In the present paper we aimed to compute an estimate of retransition amongst a cohort of more than 300 early-transitioning children. Here we report the retransition rate an average of 5 years post-initial (binary) social transition, as well as how many of these participants are living as binary transgender youth, nonbinary youth, and cisgender youth at the same timepoint.

The word ‘iatrogenic’ isn’t mentioned, nor does Olson set out to compare early-transitioning to older methods. Why would ‘iatrogenic’ be important? Iatrogenic means the creation or perpetuation of an illness from medical treatment. In this case, Olson fails to see whether socially transitioning a six year old might perpetuate a cross-sex identification and cause the persistence of gender dysphoria.

This is significant for Olson to ignore, because the study says things like this:

Past work has suggested that the ages 10 to 13 are an especially critical time for retransition. In our sample, many of the youth who retransitioned did so before that time frame, particularly the cisgender youth.

The bolded section ends with a reference to ‘Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study’ a 2013 study by Steensma et al. Olson disavows previous work while resting upon its laurels. which is kind of terrible because she cites a study that shows half of it’s small sample desisted. Olson has 2.5% of her sample desisting. Why the huge difference?

Olson doesn’t answer that question, she just says that ‘things are different’ now. Whether socially transitioning a child might make things worse or drive down desistance rates is just too transphobic a question to ask.

Olson has to know this. She has to know, on some basic level, that socially transitioning a six year old may cause persistence unless she is being willfully disingenuous and/or has an ideologically based set of conclusions already formed on the subject, rather the testing a hypothesis scientifically - which has to be the case, given how widely read she seems to be on this subject, given the citations in her paper.

Instead, we get cop-outs like this:

Importantly, our sample differed from the past work upon which this age range was determined in several key ways including that our participants socially transitioned at earlier ages (perhaps pushing retransitions earlier too), had undergone complete social transitions including pronouns and names (not just hairstyle and clothing changes as in most cases in previous studies3 ), and are living at a different historic time in a different country

2013 is now a ‘different historic time’. I feel old. It was less than a decade ago, come on!

Or:

Our observed low retransition rate is consistent with a study in which 4 youth who had “completely” socially transitioned had not retransitioned 7 years later10. That finding is in the same ballpark as our study’s estimate of approximately 2.5% if we examine the percentage living as cisgender at the end of the study (i.e., those “desisting” from gender diverse outcomes). Together these papers suggest this outcome is relatively rare in this group.

One study. Four people as a sample size. Okay, Olson and her co-writers are being willfully disingenuous at this point. They know this is a huge question and a huge issue with their research - they have a huge, massive outlier of persisters compared to previous studies, so instead they’ll simply refuse to answer it, and cherry pick pieces of studies while disavowing them as relevant to their sample.

Of course, there are other issues too. Zucker mentions that being subthreshold for a gender identity disorder diagnosis was a predictor of desistance from a cross-sex identification is his study - while Olson (quoted above) comments that many children in her sample could be described as ‘sub-threshold’ for a diagnosis, or weren’t diagnosed with gender dysphoria (the new term for gender identity disorder) at all. So if they are subthreshold for the diagnosis or not diagnosed at all, i.e. they don’t have the illness, why are they being treated with social transition? Are there cultural factors at play here? Who knows, because Olson doesn’t answer that question, even though many of the tools of social transition, such as clothes, names and hairstyles, are cultural objects by their very nature.

The two different attitudes and treatment modes of each study’s authors are exemplified in their use of language. Zucker talks of ‘desisters’ and ‘persisters’ to talk about gender dysphoria in children, while Olson uses (potentially loaded) terms like ‘retransition’ to describe ‘desisting’, perhaps wanting to avoid the connotations that ‘desist’ has in the trans community. Olson does concede that using the traditional term and meaning of ‘desisting’ in her study would mean that only 2.5% of her sample ‘desisted’, which is a result that is very much contrary to all the prior literature on the topic.

Critics might level the accusation at me that I shouldn’t compare these two studies, because the follow-up times are different. The mean age of follow-up in the Zucker study was twenty - he was following up with grown men. Olson followed up with young children five years after initial contact, and the mean age at the start of the five year follow up period was 8.1 years old - meaning many of these young children were barely teenagers when followed up with.

In contrast, in the Zucker study, only one boy was socially transitioned (who persisted in adulthood), 88% desisted, and 66% became gay or bisexual men in adulthood. Similar results can be seen in a smaller study done in Toronto by two of the same authors in 2008, following up on twenty-five girls. Olson doesn’t give any information about these children’s sexual orientation because they are too young to have such a thing. Which raises further questions that Olson doesn’t answer, like whether or not a child under the age of six understands what transition and its consequences are. Their parents must understand the consequences though, right?

Remarkably, the parental demographics of the children are similar across both studies. Zucker records a parental demographic that seems to be overwhelmingly white, with 84.4% of children being Caucasian, (in Toronto, which is only 50% white) and upper-middle class (with a Hollingshead mean score of 40). Olson’s sample shows something similar - 68% of children in her study were white (vs 57.8% in the general US), and that ‘transitioning your child’ is almost certainly an upper-middle class pursuit - while the median household income in the US is $67,521, 66% of participants in the Olson study had a household income over $75,000. 35% had a household income of over $125,000. Only 11.78% of Americans earn more than $125,000 in household income a year.

Canada has universal healthcare, but still showed that upper-middle class bias for children who showed up at a gender clinics ‘needing’ treatment - so that isn’t an artifact of the American ‘health system’, either. Maybe it is a product of people who have the time to bring their transgender child to studies or to gender clinics, but nevertheless, it raises more than a few questions about how supposedly liberal parents view children that don’t conform to sex stereotypes, and the fact that parentally, the demographics for those who bring their children to gender clinics have been consistent since the 1970s in two different Anglosphere countries.

Olson’s study concludes thus:

“As more youth are coming out and being supported in their transitions early in development, it is increasingly critical that clinicians understand the experiences of this cohort and not make assumptions about them as a function of older data from youth who lived under different circumstances. Though we can never predict the exact gender trajectory of any child, these data suggest that many youth who identify as transgender early, and are supported through a social transition, will continue to identify as transgender five years after initial social transition. These results also suggest that retransitions to one’s gender assumed at birth (cisgender) might be likely to occur before age 10 amongst those who socially transition at the earliest ages (before age 6), though retransitions are still unlikely in this group. These data suggest that parents and clinicians should be informed that not all youth will continue on the same trajectory over time. Further understanding of how to support youth’s initial and later transitions is needed.”

Once again, Olson has begged and pleaded for us to not compare her study to any other studies. This is because Olson must know at this point that her data shows nothing but a massive outlier compared to other studies, and that what is does show is that social transition perpetuates cross-sex identification in children who otherwise would have had their gender-identity disorder resolve at puberty, with two thirds going on to being gay adults.

Olson has to claim that because ‘circumstances are different now’ we shouldn’t compare the results of her study to any other studies done on the same clinical population that used different forms of treatment instead of social transition. Her study is now unique and different, because um, she’s using a totally different form of ‘treatment’ that manages to perpetuate a mental illness in children, and questioning that is uh, bad and might make Olson look like the trendy millennial, glasses wearing Seattle hipster version of the guy that tortured homosexuals in the 1950s and called it a scientific exploration of the ‘homosexual condition’, clearly.

I mean, she one of the authors that produced claptrap like this a few years ago:

“To measure participants’ gender expression in everyday life, without telling parents or children in advance, two experimenters independently rated the outﬁt worn by each participant at the testing session on a scale ranging from 1 to 5 (allowing for half-point ratings) with lower numbers representing more stereotypical boy outﬁts and higher numbers representing more stereotypical girl outﬁts (r = .94, p < .001). However, in some cases (n=13) only one experimenter was able to provide an outﬁt rating,”
[…]
“Experimenters were told that the most masculine outﬁts consisted of clothing items such as male-stereotypic sports attire, superhero costumes, and men’s formal wear, whereas the most feminine outﬁts consisted of frilly dresses or skirts, princess costumes, and sparkly accessories. Experimenters also considered the colors (e.g., pink) and style (e.g., ﬁtted vs. baggy shirt) when determining outﬁt ratings”

Sounds very scientific. Not sexist at all. Rightio. Bazinga.

Lest I remind you of the ‘signs of your child being trans’ these days:

Talbot said she is often asked when she knew she was trans, and that her answer is simple — she always knew who she was.
Her mom could see it early, too. Before she transitioned, she played with trains, but hers had tea parties. She traded her elephant Halloween costume with a friend to be Cinderella. And she loved Mulan, a girl who had to pretend to be a boy to fit in.

I would like to remind you at this time that a little boy playing tea party with his toy trains and who likes watching Mulan is now being taken to a gender clinic and told that makes him a girl who was ‘born in the wrong body’ by his white upper class parents. These are the children that make up Olson’s socially transitioned sample. This is what we’re dealing with.

What exactly changed between 2009 (the last follow up in Zucker’s study on the 139 boys), or even 2013 with the Steensma study, and 2022 to the point that could possibly justify Olson insisting that circumstances are different?

Firstly, the demographics have changed, though as Olson omits this as a justification for her ‘circumstances’ claims (and it isn’t reflected in her study). The vast majority of young people turning up at gender clinics across the West these days are born female. Secondly, social transition of young children at the gender clinic became the primary and preferred mode of treatment for childhood gender dysphoria for a particular internationally influential clique of doctors (most of whom are also participating in the TransYouth project)2, a clique of which Olson is a prominent member. Thirdly, after 2011, a huge influx of philanthropic money surged into LGB organizations and into astroturf transgender organizations, to the point many lesbian and gay organizations refocused onto trans politics, to the point of changing names and making acronyms meaningless (like GLAAD). A lot of this ‘new activism’ focused on promoting childhood gender transition, with vacuous and defectively slogans like ‘protect trans kids’ designed to shut down debate on what amounts to medical experiments on young, pre-gay youth.3

Even if the ‘circumstances’ have changed, Olson doesn’t have a control group. Where are the kids who weren’t socially transitioned? How do we know that social transition provides the best outcomes for these kids, when none of its biggest fans want to evaluate it next to the old approach of leaving these kids be? Many advocates of social transition throw around the threat of children killing themselves, despite the fact that in older studies where children were not socially transitioned, none of them appear to have killed themselves over not getting it. In fact, transitioning children might produce the opposite outcome than intended - British data appears to show that transitioning children may make the problem worse, with an increase in the numbers of children reporting self-harm or thoughts of self harm after being prescribed puberty blockers.

The closest we have to a comparison or a control group is Zucker’s study and others like it. We need to know why, with social transition, only 2.5% of kids desist in a cross-sex identification, as opposed to 88% desisting in the Zucker study.

Zucker’s study, and the dozens on the topic before that, tell us that children who presented for treatment, prior to the evidence-free institutionalization of ‘social transition’ - even if they do meet clinical criteria for childhood GID - desisted in cross-sex identification - something else that has been replicated in prior studies. Two thirds of those young men followed up were gay or bisexual.

All Olson’s study shows is that a particular mode of treatment creates a particular outcome - where the vast majority of young children continue having a mental illness.

Why then, would figures like Olson focus on social transition as a treatment, creating a perverse outcome where the majority persist in a cross-sex identification, putting them on a pathway to becoming lifelong medical patients, rather than trying to figure out why a small number of children persist in a cross-sex identification in adulthood, and attempting to resolve that persistence?

That’s the thing with these kids: childhood gender identity disorder is listed in the DSM for a reason. It’s a mental illness. Personally, I think it’s a culture-bound syndrome, a product of a deeply sexist and homophobic society - that the majority of cases either ‘resolve’ into accepting oneself as a homosexual adult or develop into homosexual transsexualism in adulthood (or ‘persisters’) tells me that we as a society still have a problem with the mere potential of one’s children turning out homosexual or where they don’t conform to sex stereotypes.

With all of this in mind, in what universe does social transition for children make sense as a treatment? Why on earth would medicine start focusing on perpetuating a mental illness in young children? Not only that, the social transition pathway in young people is ‘traditionally’ followed by medical treatment involving puberty blockers and cross-sex hormones, meaning young people who are socially transitioned are destined to iatrogenic sterility, among other health problems.

I mean… like, really? Come on. It’s like treating cancer by giving you more cancer or sticking your head in a microwave to give yourself a tan. It’s stupid.

That’s why the Olson study and the TransYouth project don’t have control groups. If they did have a control group, they know from prior literature, which Olson is aware of and cites repeatedly that leaving kids alone might prove to be the only sensible option. The fact that Olson’s study doesn’t account for the fact that only 2.5% of her cohort desisted beyond plaintively whining that ‘circumstances' are different’ speaks to the design of a study that wants to cheerlead a particular treatment methodology, rather than actually helping these kids. In fact half the short paper is devoted to insisting that the circumstances are different for these kids! I suppose they are, in that social transition was prescribed for them on an evidence-free basis! Like I’ve said before, there’s no answer to this bar the authors of this study being willfully disingenuous about their dataset.

What could possibly motivate such a bad study, designed to support a bad, evidence-free treatment at all costs, however? What demographic factor is present in a huge number of young gender dysphoric young people? What could it possibly be?

It’s the same thing I say every time I look at these studies: two-thirds of the young men followed up by Zucker were gay or bisexual in adulthood. Like desisting, I have to repeat once again that that’s replicated repeatedly in older follow-up studies and in studies done that included young women. The vast majority of children with gender dysphoria are going to be gay adults, not trans. I hate to keep repeating myself, but it’s true so I will keep saying it over and over again until people finally understand.

And I will keep saying this too: socially transitioning your ‘transgender child’ is conversion therapy for the white liberal with Black Lives Matter and Biden yard signs proudly displayed in their all-white gated community. I get it, gay people are fine when we emerge from the ether as fully-grown, freaky adults who have cool parties and star in RuPauls Drag Race, instead of being your children, or god forbid, mullet-wearing vegan lesbians in Tevas. But little Timmy playing tea parties with his trains? Timmy growing up to be the drag queen you gawk at on Drag Race? Well that’s just not good enough now, is it? Fuck you.

What conclusion can we draw from this? For two centuries, modern medicine has asked itself a question - ‘how do you make a gay person straight?’. It has sought many answers - aversion therapy, electroshock torture, the lobotomy, chemical castration, and proclaimed that they all work. Of course, until they realize that a fundamental aspect of one’s biological urges is rather difficult to do away with. By the 1980s, modern medicine had an answer to their question - you can’t make a gay person straight. No matter how hard you try, it turns out that love of the same sex is irresistible, natural, and normal for the homosexual.

Instead of facing defeat, modern medicine has decided that they should try the next best thing. If the homosexual cannot be straight, you can at least make them ‘look’ straight. The easiest way to do that is to tell them they’re really the opposite sex, but born in the wrong body, and you can ‘become’ the opposite sex through sterilizing hormones and surgery. At the end of it, those homosexuals, now broken in body and mind, will at least look straight, and that’s seemingly enough for the homophobic world we live in these days.

And that’s why Olson doesn’t want comparisons, let alone a control group. It might point out that what’s she’s doing is conversion therapy by another name.

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