The full Cass Report into ‘gender affirming treatment’ for minors in England and Wales has released.
2.6 Several studies from that period (Green et al., 1987; Zucker, 1985) suggested that in a minority (approximately 15%) of pre-pubertal children presenting with gender incongruence, this persisted into adulthood. The majority of these children became same-sex attracted, cisgender adults. These early studies were criticised on the basis that not all the children had a formal diagnosis of gender incongruence or gender dysphoria, but a review of the literature (Ristori & Steensma, 2016) noted that later studies (Drummond et al., 2008; Steensma & Cohen-Kettenis, 2015; Wallien et al., 2008) also found persistence rates of 10-33% in cohorts who had met formal diagnostic criteria at initial assessment, and had longer follow-up periods. It was thought at that time that if gender dysphoria continued or intensified after puberty, it was likely that the young person would go on to have a transgender identity into adulthood (Steensma et al., 2011).
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8.16 Notwithstanding the problems in determining how ‘male’ or ‘female’ a brain is outside of extremely large group averages, some studies do suggest that the brains of male-attracted transgender females have changes in a female direction, whilst those who are female-attracted do not. So, if there are differences, they may be related to sexuality rather than gender identity (Steensma et al, 2013a).
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8.28 In the original Dutch study (de Vries et al., 2011b), 89% of the 70 patients were same-sex attracted to their birth-registered sex, with most of the others being bisexual. Only one patient was heterosexual.
8.29 In contrast, in a detailed study of young people with ASD[autism spectrum disorder] and gender dysphoria (de Vries et al., 2010), it was noted that ‘‘while almost all adolescents with GID [gender identity dysphoria] are sexually attracted to individuals of their birth sex, the majority of the gender dysphoric adolescents with ASD were sexually attracted to partners of the other sex”.
8.30 A paper from the GIDS service in 2016 (Holt et al., 2016) reported sexual orientation in 57% (97) of a clinic sample of patients over 12 years of age for whom this information was available. Of the birth-registered females, 68% were attracted to females, 21% were bisexual, 9% were attracted to males and 2% were asexual. Of the birth-registered males, 42% were attracted to males, 39% were bisexual and 19% were attracted to females
8.31 The Review has not been able to obtain recent data relating to the sexual orientation of the GIDS patient cohort. When asked, mixed responses were given by GIDS clinicians about the extent to which they explore sexuality with patients seen in the service, and this may reflect differences in practice. Understanding the patient cohort
8.32 In terms of narratives and case histories, the Review received several reports from parents of birth-registered females that their child had been through a period of trans identification before recognising that they were cisgender same-sex attracted. Similar narratives were heard from cisgender adults (some same sex-attracted and some heterosexual) regarding early experiences of gender-questioning.
8.33 Clinicians and parents reported that gay students are still being stigmatised and bullied in school and there is sometimes a perception that there is less validation for them than for trans pupils. However, the Review also heard multiple testimonies attesting that having a diverse gender identity is a difficult path with young people subjected to bullying and abuse.
8.34 It is widely accepted that exposure to sexuality is happening at a younger age. The impact of this on young people’s understanding of their sexuality and/or gender identity is unclear.
8.35 In some strictly religious cultures, being transgender is seen as preferable to being same-sex attracted as it is then perceived as a physical rather than a psychological issue.
8.36 It is common in adolescence to experience same-sex attraction and not to conform to gender stereotypes. In making sense of these feelings young people are now having to navigate an increasingly complex interplay between sex and gender.8.37 In reality, for any individual young person, there will be different socio-cultural influences that impact on their understanding of both their gender and sexual identity, and this is an area that warrants better exploration and understanding.
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8.60 A study followed 2,772 adolescents from age 11 to 26. Gender non-contentedness (as defined by the question “I wish to be of the opposite sex”) was high in early adolescence, reduced into early 20s, and was associated with a poorer self-concept and mental health throughout development. It was also more often associated with same-sex attraction when compared to those who did not have gender non-contentedness (Rawee et al., 2024).
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14.36 Adolescence is a time of overall identity development, sexual development, sexual fluidity and experimentation. 14.37 Blocking this experience means that young people have to understand their identity and sexuality based only on their discomfort about puberty and a sense of their gender identity developed at an early stage of the pubertal process. Therefore, there is no way of knowing whether the normal trajectory of the sexual and gender identity may be permanently altered.
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15.53 A self-identified sample of 100 detransitioners (Littman, 2021) completed an anonymous online questionnaire. Of these, 69% were birth-registered females and 31% were birth-registered males. A range of issues were reported prior to onset of gender dysphoria, including diagnosis of mental illness, neurodiversity, a history of trauma or selfinjury. Reasons for detransition were diverse and included individuals becoming more comfortable in their natal sex, being concerned about medical complications of transitioning, that mental health did not improve during transitioning, being dissatisfied with physical results, and discovering gender dysphoria was caused by something specific such as trauma or abuse. Homophobia or difficulty accepting themselves as lesbian, gay or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition
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In our sample of general practices, recorded prevalence of gender dysphoria in people aged 18 and under increased over a hundred-fold between 2009 and 2021. This increase occurred in two phases; a gradual increase between 2009 and 2014, followed by an acceleration from 2015 onwards. Increases in this second phase were more rapid for people registered as female, although clinical records do not indicate whether their recorded gender had been changed (see strengths and limitations). Throughout the study period, presentations predominantly occurred in the teenage years, and over half of people with a recorded history of gender dysphoria were in the 17-18 age group. A substantial minority of people with a history of gender dysphoria also had a recorded diagnosis of autism spectrum disorder, and the proportion of people with such a diagnosis increased over time. Depression and anxiety were also more frequently reported over time, approaching 15% of people with gender dysphoria by 2021. [Appendix 6]
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Where sexuality was discussed, most cases are of same sex, opposite-gender attracted children. An increasing number of young people described themselves as ‘straight’ or ‘not trans’, just a boy/girl. [Appendix 9]
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"8.34 It is widely accepted that exposure to sexuality (PORN) is happening at a younger age. The impact of this (PORN) on young people’s understanding of their sexuality and/or gender identity is unclear."
Teen girl googles "lesbian." Sees porn 'lesbians' fellating penises. Thinks, "I don't want to do that. I must be a man, then."
‘‘while almost all adolescents with GID [gender identity dysphoria] are sexually attracted to individuals of their birth sex, the majority of the gender dysphoric adolescents with ASD were sexually attracted to partners of the other sex”.
😂 talk about unsurprising