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“Desistance”: a disputed concept

The idea that it is possible to prevent or cure transgender people is a foundational belief of the anti-trans conversion therapy movement and the ex-transgender movement. A key concept used in these movements is “desistance.”

Sometimes a gender diverse person will express their gender diversity differently over time. Trans-supportive people see these additional changes as part of a spectrum or a fluid way of existing.

Anti-trans activists and psychologists often think being transgender is a disease and frame gender identity and expression as a rigid all-or-nothing binary. Proponents of the “desistance” framing use the term in two ways:

  • “Prevention”: People (especially young people) who stop expressing gender diversity or stop identifying as transgender before taking medical transition steps
  • “Cure”: People who stop expressing gender diversity or stop identifying as transgender during or after taking medical transition steps (more commonly called “detransition”)

Background

The term desistance came from criminology, the study of criminals that emerged from the 20th century eugenics movement. Eugenics researchers were interested in why some criminals “desist” from committing crimes.

At the heart of the dispute is whether gender diversity is a disease. In the dozens of disease models created to describe gender identity and expression, people who support the “desistance” framing often believe in the psychopathology (mental illness) model. They see anti-trans conversion therapy (also called gender identity change efforts, or GICE) as a way to cure a mental illness. They consider gender transition a bad outcome. They have given this mental illness many names over the years, including:

  • gender identity disorder
  • gender dysphoria
  • gender incongruence

Claims about widespread transgender “desistance” often appear in debates about youth gender care. The term suggests that many children who show gender variance will later reject a transgender identity. At first glance this idea seems cautious. It sounds like a reason to delay support. Yet the concept rests on weak methods and narrow views of gender.

Claims about “desistance” tell us more about past research design than about the true paths of transgender youth. Good science requires clear terms, careful sampling, and respect for how identity develops over time. Better studies now track youth who clearly identify as transgender and receive support. Early evidence shows many continue that identity over time.

History of “desistance”

In 1971, the Archives of Sexual Behavior was founded by Richard Green with a stated goal: “the prevention of transsexualism.”

In 1990, Susan Bradley and Kenneth Zucker of the Clarke Institute (later renamed CAMH) discussed the clinical goals of their movement: “Two short term goals have been discussed in the literature: the reduction or elimination of social ostracism and conflict, and the alleviation of underlying or associated psychopathology. Longer term goals have focused on the prevention of transsexualism and/or homosexuality.” Bradley and Zucker reasoned that “a homosexual lifestyle in a basically unaccepting culture simply creates unnecessary social difficulties.”

Zucker began using the term after seeing “desistance” used to describe children who exhibited “oppositional defiant disorder.” Zucker suggested “remission” as an alternative, adding it “is a bit too medical for my taste, but it is not necessarily an incorrect term.”

The Gender Dysphoria Affirmative Working Group cites “the four publications central to the notion that 80% of gender dysphoric youth will ‘desist’:

In 2016, CAMH employee and anti-trans activist James Cantor posted a collection of “desistance” documents.

In 2016, Zucker’s most ardent media supporter, Jesse Singal, described desistance as “an absolutely vital concept,” adding:

“Desistance,” in this context, means the tendency for gender dysphoria to resolve itself as a child gets older and older. All else being equal, this research suggests that the most likely outcome for a child with gender dysphoria is that they will grow up to be cisgender and gay or bisexual. Researchers don’t know why that is, but it appears that in some kids, nascent homo- or bisexuality manifests itself as gender dysphoria. In others, gender dysphoria can arise as a result of some sort of trauma or other unresolved psychological issue, and goes away either with time or counseling. And in still others, of course, it is a sign that the child will identify as transgender for their whole adult life. While the actual percentages vary from study to study, overall, it appears that about 80 percent of kids with gender dysphoria end up feeling okay, in the long run, with the bodies they were born into.

[…] Again: Every study that has been conducted on this has found the same thing. At the moment there is strong evidence that even many children with rather severe gender dysphoria will, in the long run, shed it and come to feel comfortable with the bodies they were born with. The critiques of the desistance literature presented by Tannehill, Serano, Olson and Durwood, and others don’t come close to debunking what is a small but rather solid, strikingly consistent body of research.

Anti-trans activists were outraged when critics characterized frequently cited “desistance” rates as a myth, particularly a 2016 piece by Brynn Tannehill and a 2017 piece by Zack Ford. They took that to mean that critics were saying no one ever makes additional gender changes, which is not what was being argued.

In 2017, anti-trans activist Katie Herzog wrote a piece for The Stranger about the ex-trans movement, citing Cantor and Tannehill:

There have, however, been almost a dozen studies of looking at the rate of “desistance,” among trans-identified kids—which, in this context, refers to cases in which trans kids eventually identify as their sex at birth. Canadian sex researcher James Cantor summarized those studies’ findings in a blog post: “Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans-kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks.” The exact rate of desistance varied by study, but overall, they concluded that about 80 percent trans kids eventually identified as their sex at birth. Some trans activists and academics, however, argue that these studies are flawed, the patients surveyed weren’t really transgender, and that mass desistance doesn’t exist.

“The desistance myth was promoted by reparative therapists, concern trolls, and charlatans,” trans advocate Brynn Tannehill wrote on the Huffington Post. “It’s time for the 80 percent desistance figure to be relegated to the same junk science bin as the utterly discredited link between vaccines and autism.”

In 2018, Jesse Singal wrote “When a Child Says She’s Trans” for The Atlantic:

Within a subset of trans advocacy, however, desistance isn’t viewed as a phenomenon we’ve yet to fully understand and quantify but rather as a myth to be dispelled. Those who raise the subject of desistance are often believed to have nefarious motives—the liberal outlet ThinkProgress, for example, referred to desistance research as “the pernicious junk science stalking trans kids,” and a subgenre of articles and blog posts attempts to debunk “the desistance myth.” But the evidence that desistance occurs is overwhelming. The American Psychological Association, the Substance Abuse and Mental Health Services Administration, the Endocrine Society, and Wpath all recognize that desistance occurs. I didn’t speak with a single clinician who believes otherwise. “I’ve seen it clinically happen,” Nate Sharon said. “It’s not a myth.”

In 2018, Dutch psychologists Thomas D. Steensma and Peggy Cohen-Kettennis, both key proponents of the concept, described it as “the persistence and desistence of children’s distress caused by the gender incongruence they experience to the point that they seek clinical assistance.”

Critics

After CAMH shut down the infamous Gender Identity Clinic and fired Zucker in 2015, trans-supportive journalists and academics began working to reverse the harms caused by clinicians at CAMH, including their often-cited “desistance” rates of ~80%.

In 2018, Julia Temple Newhook and colleagues published a peer-reviewed commentary that sought to reframe the clinical question:

The tethering of childhood gender diversity to the framework of “desistance” or “persistence” has stifled advancements in our understanding of children’s gender in all its complexity. […] The affirmative model is presented as a way to move away from the question of, “How should children’s gender identities develop over time?” toward a more useful question: “How should children best be supported as their gender identity develops?”

In 2022, Florence Ashley published a paper on the clinical irrelevance of “desistance” research, putting forth three arguments undermining its relevance:

  • “desistance” does not provide reasons against prepubertal social transition or peripubertal medical transition
  • transition for “desisters” is not comparably harmful to delays for trans youth
  • the wait-and-see and corrective models of care are harmful to youth who will grow up cis

Because the 80% “desistance” rate is a myth that continues to be cited in anti-trans legislation, in 2023, Erin Reed published an article debunking the claim and tracing its origins.

References

Reed, Erin (March 17, 2023). Debunked: No, 80% Of Trans Youth Do Not Detransition. Erin In The Morning https://www.erininthemorning.com/p/debunked-no-80-of-trans-youth-do

Ashley, F. (2022). The clinical irrelevance of “desistance” research for transgender and gender creative youth. Psychology of Sexual Orientation and Gender Diversity, 9(4), 387–397. https://doi.org/10.1037/sgd0000504

Yong, Ed (January 15, 2019). Young Trans Children Know Who They Are. The Atlantic https://www.theatlantic.com/family/archive/2018/07/desistance/564560/

Meadow, Tey (2018). The Loaded Language Shaping the Trans Conversation. The Atlantic https://www.theatlantic.com/family/archive/2018/07/desistance/564560/

Winters, Kelly (July 26, 2018). Media Misinformation About Trans Youth: The Persistent 80% Desistance Myth. GID Reform https://gidreform.wordpress.com/2016/07/26/media-misinformation-about-trans-youth-the-persistent-80-desistance-myth/

Brooks, Jon (May 23, 2018). The Controversial Research on ‘Desistance’ in Transgender Youth. KQED https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth

Newhook JT, Pyne J, Winters K, Feder S, Holmes C, Tosh J (April 2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children. International Journal of Transgenderism Pages 212-224. https://doi.org/10.1080/15532739.2018.1456390

Newhook JT, Winters K, Pyne J, Jamieson A, Holmes C, Feder S, Pickett S, Mari-Lynne Sinnott M (May 2018). Teach your parents and providers well: Call for refocus on the health of trans and gender-diverse children. Can Fam Physician 2018;64:332-5 [PDF] https://www.cfp.ca/content/cfp/64/5/332.full.pdf

Ford, Zack (September 5, 2017). The pernicious junk science stalking trans kids. ThinkProgress https://archive.thinkprogress.org/transgender-children-desistance-a5caf61fc5c6/

Staff report (March 4, 2017). A plea for better transgender research on the perpetual myth of ‘desistance’ and the ‘harm’ of social transitioning. Growing Up Transgender https://growinguptransgender.com/2017/03/04/a-plea-for-better-transgender-research-on-the-perpetual-myth-of-desistance-and-the-harm-of-social-transitioning/

Tannehill, Brynn (January 1, 2017) The End of the Desistance Myth. Originally at Huffington Post. http://www.brynntannehill.com/the-end-of-the-desistance-myth/

Winters, Kelley (July 26, 2016). Media Misinformation About Trans Youth: The Persistent 80% Desistance Myth. GID Reform https://gidreform.wordpress.com/2016/07/26/media-misinformation-about-trans-youth-the-persistent-80-desistance-myth/

Olson, Kristina; Durwood, Lily (January 14, 2016). Are Parents Rushing to Turn Their Boys Into Girls? Slate https://slate.com/human-interest/2016/01/what-alarmist-articles-about-transgender-children-get-wrong.html

Serano, Julia (2016). Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates. Medium https://medium.com/@juliaserano/detransition-desistance-and-disinformation-a-guide-for-understanding-transgender-children-993b7342946e

Writing by “desistance” activists

Singh D, Bradley SJ, Zucker KJ (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychiatry, Volume 12 – 28 March 2021 https://doi.org/10.3389/fpsyt.2021.632784

Vigo, Julian (July 2, 2018). The ​Myth of the “Desistance Myth.” Public Discourse https://www.thepublicdiscourse.com/2018/07/21972/

Singal, Jesse (June 18, 2018). When a Child Says She’s Trans. The Atlantic https://www.theatlantic.com/magazine/archive/2018/07/when-a-child-says-shes-trans/561749/

Responses to Newhook et al (2018):

  • Zucker KJ (2018): The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender nonconforming children” by Temple Newhook et al. (2018), International Journal of Transgenderism https://doi.org/10.1080/15532739.2018.1468293
  • Steensma, T. D., & Cohen-Kettenis, P. T. (2018). A critical commentary on “A critical commentary on follow-up studies and ‘desistence’ theories about transgender and gender non-conforming children.” International Journal of Transgenderism, 19(2), 225–230. https://doi.org/10.1080/15532739.2018.1468292

Singal, Jesse (July 25, 2016). What’s Missing From the Conversation About Transgender Kids. The Cut https://www.thecut.com/2016/07/whats-missing-from-the-conversation-about-transgender-kids.html

Cantor, James (January 11, 2016). Do trans- kids stay trans- when they grow up? Sexology Today! http://www.sexologytoday.org/2016/01/do-trans-kids-stay-trans-when-they-grow_99.html

Singh, Devita (2012). A follow-up study of boys with gender identity disorder [doctoral thesis supevised by Kenneth Zucker]. https://tspace.library.utoronto.ca/bitstream/1807/34926/1/Singh_Devita_201211_PhD_Thesis.pdf

Bradley, S. J., & Zucker, K. J. (1990). Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. The Canadian Journal of Psychiatry, 35(6), 477–486. https://doi.org/10.1177/070674379003500603

Green, R. Diagnosis and treatment of gender identity disorders during childhood. Archives of Sexual Behavior 1, 167–173 (1971). https://doi.org/10.1007/BF01541061

Resources

Gender Dysphoria Affirmative Working Group (gdaworkinggroup.com)

Trans Policy Reform (transpolicyreform.wordpress.com)

GID Reform (gidreform.wordpress.com)