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Thomas Steensma vs. transgender people

Thomas Steensma is a Dutch psychologist who researches gender diverse youth. Steensma’s research and clinical guidelines are frequently cited by anti-transgender extremists who reject affirmative models of care for young people seeking trans health services.

In 2022, Steensma attended a conference organized by anti-trans hate group Society for Evidence-Based Gender Medicine at Tampere University in Finland.

Steensma is also popular with anti-transgender activists for reporting high rates of “desistance” and “detransition.” Steensma co-authored a 2013 longitudinal study tracking 127 adolescents. approximately 37% continued with “gender dysphoria” (which they call “persisters”), while 63% did not (“desisters”) by age 15–16 .

Background

Thomas D. Steensma, works at the Department of Medical Psychology / Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands. Steensma’s research is focused on people of all ages with gender incongruence. Steensma’s primary projects focus on treatment evaluation, psychosexual development and (gender) identity development (including non-binary gender identities). Steensma studied social and clinical psychology, and is trained as a child and adolescent health psychologist.

“Desistance” research

In a 2013 paper, Steensma and co-authors stated that 63% of adolescents included in the study “desisted”:

Between 2000 and 2008, 225 children (144 boys, 81 girls) were consecutively referred to the clinic. From
this sample, 127 adolescents were selected who were 15 years of age or older during the 4-year period of follow-up between 2008 and 2012. Of these adolescents, 47 adolescents (37%, 23 boys, 24 girls) were identified as persisters.

Because this is one of the highest “desistance” rates reported, anti-trans activists frequently cite this study. Critics have discussed methodological issues, particularly how to count people lost to follow-up / non-responders.

Press coverage

In 2018 KQED reported:

In Amsterdam, clinicians at the Center of Expertise on Gender Dysphoria are much more cautious about recommending social transitions because of the statistics on desistance. Thomas Steensma, a researcher and clinician at the center, acknowledges  these studies probably included some kids who would not be diagnosed with gender dysphoria today. Nevertheless, despite the problems with the way they classified children, “the only evidence I have from studies and reports in the literature  … is that not all transgender children will persist in their transgender identity,” Steensma said. ‘Why are we asking a child to conform to something that is not them because society hasn’t done its learning yet?’

In 2013, Steensma co-authored an oft-cited study that examined 127 adolescents, all of whom had displayed various levels of gender dysphoria as children. The researchers found that 80 of the children had desisted by the ages of 15 and 16. That works out to 63 percent of kids who basically stopped being transgender — a lower rate than in previous studies, but still a majority.

Some clinicians criticize this study, however, on methodological grounds, because the researchers defined anyone who did not return to their clinic as desisting. Fifty-two of the children classified as desistors or their parents did send back questionnaires showing the subjects’ present lack of gender dysphoria. But 28 neither responded nor could be tracked down.

Brooks (2018)

Negative media coverage

In 2020, Steensma co-authored research and overviews on how negative media coverage affects transgender youth and their access to care.

Anti-trans activists who cite Steensma include:

References

Gorcenski, Emily (May 4, 2021). Jesse Singal Still Got More Wrong Than He Thinks. https://emilygorcenski.com/post/jesse-singal-still-got-more-wrong-than-he-thinks/

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

Selected coverage in anti-trans press

Klotz, Frieda (May 20, 2024). Pediatric Transgender Care and the Contentious Rise of SEGM. Undark https://undark.org/2024/05/20/pediatric-transgender-care-contentious-segm/

Ryan, Benjamin (September 18, 2024). New Evidence Challenges Institutionalized Belief That Transgender Teens Become Transgender Adults, Undermining Core Defense of Medical Gender Transitions for Minors. New York Sun https://www.nysun.com/article/new-evidence-challenges-institutionalized-belief-that-transgender-teens-become-transgender-adults-undermining-core-defense-of-medical-gender-transitions-for-minors

Singal, Jesse (April 4, 2021). A (Sorta) Quick Response To The Errors In Emily Gorcenski’s Article, “Jesse Singal Got More Wrong Than He Thinks” (Updated). Singal-Minded https://jessesingal.substack.com/p/a-sorta-quick-response-to-the-errors

Lane, Bernard (March 17, 2021). Dutch expert warns on ‘blind adoption’ of puberty blockers. The Australian https://www.theaustralian.com.au/nation/dutch-expert-warns-on-blind-adoption-of-puberty-blockers/news-story/d235ce6ebe409e8efde979f1ae0739cc

Singal, Jesse (July 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/

Navarro, Danielle (May 6, 2018). Nevertheless, she desisted: A brief review of Steensma et al (2013). https://djnavarro.net/desistance-essay/

Singal, Jesse (March 27, 2018). A Lot of People, Myself Included, Have Been Misreading the Single Biggest Published Study on Childhood Gender Dysphoria Desistance and Persistence — It Offers Stronger Evidence for Desistance Than We Thought. Medium https://medium.com/@jesse.singal/everyone-myself-included-has-been-misreading-the-single-biggest-study-on-childhood-gender-8b6b3d82dcf3

Selected publications by Steensma

van Dijken, J. B., Steensma, T. D., Wensing-Kruger, S. A., den Heijer, M., & Dreijerink, K. M. A. (2023). Tailored Gender-Affirming Hormone Treatment in Nonbinary Transgender Individuals: A Retrospective Study in a Referral Center Cohort. Transgender Health, 8(3), 220–225. https://doi.org/10.1089/trgh.2021.0032

van der Loos, M. A. T. C., Klink, D. T., Hannema, S. E., Bruinsma, S., Steensma, T. D., Kreukels, B. P. C., Cohen-Kettenis, P. T., de Vries, A. L. C., den Heijer, M., & Wiepjes, C. M. (2023). Children and adolescents in the Amsterdam Cohort of Gender Dysphoria: trends in diagnostic- and treatment trajectories during the first 20 years of the Dutch Protocol. The Journal of Sexual Medicine, 20(3), 398–409. https://doi.org/10.1093/jsxmed/qdac029

Pang, K. C., Hoq, M., & Steensma, T. D. (2022). Negative Media Coverage as a Barrier to Accessing Care for Transgender Children and Adolescents. JAMA Network Open, 5(2), e2138623. https://doi.org/10.1001/jamanetworkopen.2021.38623

  • Pang, K. C., de Graaf, N. M., Chew, D., Hoq, M., Keith, D. R., Carmichael, P., & Steensma, T. D. (2020). Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia. JAMA Network Open, 3(7), e2011161. https://doi.org/10.1001/jamanetworkopen.2020.11161
  • Indremo, M., Jodensvi, A. C., Arinell, H., Isaksson, J., & Papadopoulos, F. C. (2022). Association of Media Coverage on Transgender Health With Referrals to Child and Adolescent Gender Identity Clinics in Sweden. JAMA Network Open, 5(2), e2146531. https://doi.org/10.1001/jamanetworkopen.2021.46531
  • Chong, L. S. H., Kerklaan, J., Clarke, S., Kohn, M., Baumgart, A., Guha, C., Tunnicliffe, D. J., Hanson, C. S., Craig, J. C., & Tong, A. (2021). Experiences and Perspectives of Transgender Youths in Accessing Health Care. JAMA Pediatrics, 175(11), 1159. https://doi.org/10.1001/jamapediatrics.2021.2061
  • Pham, A., Morgan, A. R., Kerman, H., Albertson, K., Crouch, J. M., Inwards-Breland, D. J., Ahrens, K. R., & Salehi, P. (2020). How Are Transgender and Gender Nonconforming Youth Affected by the News? A Qualitative Study. Journal of Adolescent Health, 66(4), 478–483. https://doi.org/10.1016/j.jadohealth.2019.11.304
  • Hughto, J. M. W., Pletta, D., Gordon, L., Cahill, S., Mimiaga, M. J., & Reisner, S. L. (2021). Negative Transgender-Related Media Messages Are Associated with Adverse Mental Health Outcomes in a Multistate Study of Transgender Adults. LGBT Health, 8(1), 32–41. https://doi.org/10.1089/lgbt.2020.0279

Wensing-Kruger SA , Nes L, Steensma TD (2022). Genderdysforie. Het lichaam en psychisch functioneren, 261-277 2022 https://mijn.bsl.nl/genderdysforie/19783376

Bungener, S. L., Post, L., Berends, I., Steensma, T. D., de Vries ALC, & Popma, A. (2022). Talking About Sexuality with Youth: A Taboo in Psychiatry? The Journal of Sexual Medicine, 19(3), 421–429. https://doi.org/10.1016/j.jsxm.2022.01.001

Van Mello, N., De Nie, I., Asseler, J., Arnoldussen, M., Steensma, T., Den Heijer, M., de Vries ALC, & Huirne, J. (2022). P-506 Reflecting on the Importance of Family Building and Fertility Preservation: Transgender People’s Experiences with Starting Gender-affirming Treatment as Adolescent. Human Reproduction, 37(Supplement_1). https://doi.org/10.1093/humrep/deac107.469

Arnoldussen, M., van der Miesen, A. I. R., Elzinga, W. S., Alberse, A.-M. E., Popma, A., Steensma, T. D., de Vries ALC(2022). Self-Perception of Transgender Adolescents After Gender-Affirming Treatment: A Follow-Up Study into Young Adulthood. LGBT Health, 9(4), 238–246. https://doi.org/10.1089/lgbt.2020.0494

de Rooij, F. P. W., van der Sluis, W. B., Ronkes, B. L., Steensma, T. D., Al-Tamimi, M., van Moorselaar, R. J. A., Bouman, M.-B., & Pigot, G. L. S. (2022). MP20-09 Comparison of clinical outcomes after phalloplasty with versus without urethral lengthening in transgender men. Journal of Urology, 207(Supplement 5). https://doi.org/10.1097/ju.0000000000002553.09

van der Vaart, L. R., Verveen, A., Bos, H. M., van Rooij, F. B., & Steensma, T. D. (2022). Differences in self-perception and social gender status in children with gender incongruence. Clinical Child Psychology and Psychiatry, 27(4), 1077–1090. https://doi.org/10.1177/13591045221099394

de Rooij, F. P. W., van der Sluis, W. B., Ronkes, B. L., Steensma, T. D., Al-Tamimi, M., van Moorselaar, R. J. A., Bouman, M.-B., & Pigot, G. L. S. (2022). Comparison of surgical outcomes and urinary functioning after phalloplasty with versus without urethral lengthening in transgender men. International Journal of Transgender Health, 24(4), 487–498. https://doi.org/10.1080/26895269.2022.2110548

van der Sluis, W. B., Bruin, R. J. M. de, Steensma, T. D., & Bouman, M.-B. (2021). Gender-affirmation surgery and bariatric surgery in transgender individuals in The Netherlands: Considerations, surgical techniques and outcomes. International Journal of Transgender Health, 23(3), 355–361. https://doi.org/10.1080/26895269.2021.1890302

de Graaf, N. M., Huisman, B., Cohen-Kettenis, P. T., Twist, J., Hage, K., Carmichael, P., Kreukels, B. P. C., & Steensma, T. D. (2021). Psychological Functioning in Non-binary Identifying Adolescents and Adults. Journal of Sex & Marital Therapy, 47(8), 773–784. https://doi.org/10.1080/0092623x.2021.1950087

van der Sluis, W. B., de Nie, I., Steensma, T. D., van Mello, N. M., Lissenberg-Witte, B. I., & Bouman, M.-B. (2021). Surgical and demographic trends in genital gender-affirming surgery in transgender women: 40 years of experience in Amsterdam. British Journal of Surgery, 109(1), 8–11. https://doi.org/10.1093/bjs/znab213

Kennedy, E., Lane, C., Stynes, H., Ranieri, V., Spinner, L., Carmichael, P., Omar, R., Vickerstaff, V., Hunter, R., Senior, R., Butler, G., Baron-Cohen, S., de Graaf, N., Steensma, T. D., de Vries ALC, Young, B., & King, M. (2021). Longitudinal Outcomes of Gender Identity in Children (LOGIC): study protocol for a retrospective analysis of the characteristics and outcomes of children referred to specialist gender services in the UK and the Netherlands. BMJ Open, 11(11), e054895. https://doi.org/10.1136/bmjopen-2021-054895

Verveen, A., Kreukels, B. P., de Graaf, N. M., & Steensma, T. D. (2021). Body image in children with gender incongruence. Clinical Child Psychology and Psychiatry, 26(3), 839–854. https://doi.org/10.1177/13591045211000797

MJA Verbeek, MA Hommes, TD Steensma, AER Bos, J van Lankveld (2021). Transgender specific problem situations experienced during transition: Development of a Transgender Coping Questionnaire part 1. 4th EPATH Hybrid Conference: Reconnecting and Redefining Transgender Healthcare 2021 https://epath.eu/past-conferences/conference-2021/

Castellini G, Ristori J, Steensma T (2021). Psychopathology in adult transgender people. European Psychiatry. 2021;64(S1):S47-S47. https://doi.org/10.1192/j.eurpsy.2021.151

de Vries ALC, Beek, T. F., Dhondt, K., de Vet, H. C. W., Cohen-Kettenis, P. T., Steensma, T. D., & Kreukels, B. P. C. (2021). Reliability and Clinical Utility of Gender Identity-Related Diagnoses: Comparisons Between the ICD-11, ICD-10, DSM-IV, and DSM-5. LGBT Health, 8(2), 133–142. https://doi.org/10.1089/lgbt.2020.0272

Spizzirri, G., Eufrásio, R., Lima, M.C.P. et al. (2021). Proportion of people identified as transgender and non-binary gender in Brazil. Sci Rep 11, 2240 (2021). https://doi.org/10.1038/s41598-021-81411-4

Claahsen – van der Grinten, H., Verhaak, C., Steensma, T., Middelberg, T., Roeffen, J., & Klink, D. (2020). Gender incongruence and gender dysphoria in childhood and adolescence—current insights in diagnostics, management, and follow-up. European Journal of Pediatrics, 180(5), 1349–1357. https://doi.org/10.1007/s00431-020-03906-y

Bungener, Sara. L., de Vries ALC, Popma, A., & Steensma, T. D. (2020). Sexual Experiences of Young Transgender Persons During and After Gender-Affirmative Treatment. Pediatrics, 146(6), e20191411. https://doi.org/10.1542/peds.2019-1411

de Graaf, N. M., Steensma, T. D., Carmichael, P., VanderLaan, D. P., Aitken, M., Cohen-Kettenis, P. T., de Vries ALC, Kreukels, B. P. C., Wasserman, L., Wood, H., Zucker KJ (2020). Suicidality in clinic-referred transgender adolescents. European Child & Adolescent Psychiatry, 31(1), 67–83. https://doi.org/10.1007/s00787-020-01663-9

Steensma TD, Wensing-Kruger SA, Klink D (2017). How Should Physicians Help Gender-Transitioning Adolescents Consider Potential Iatrogenic Harms of Hormone Therapy? (2017). AMA Journal of Ethics, 19(8), 762–770. https://doi.org/10.1001/journalofethics.2017.19.8.ecas3-1708

Ristori, J., & Steensma, T. D. (2016). Gender dysphoria in childhood. International Review of Psychiatry, 28(1), 13–20. https://doi.org/10.3109/09540261.2015.1115754

de Vries ALC, Steensma, T.D., Cohen-Kettenis, P.T., VanderLaan DP, Zucker KJ (2016). Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: a cross-national, cross-clinic comparative analysis. Eur Child Adolesc Psychiatry 25, 579–588 (2016). https://doi.org/10.1007/s00787-015-0764-7

Steensma TD, McGuire JK, Kreukels BPC, Beekman AJ, Cohen-Kettenis P.T (2013). Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study. Journal of the American Academy of Child & Adolescent Psychiatry (Vol. 52, Issue 6, pp. 582–590). Elsevier BV. https://doi.org/10.1016/j.jaac.2013.03.016

  • Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M.-L., Jamieson, A., & Pickett, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children. International Journal of Transgenderism, 19(2), 212–224. https://doi.org/10.1080/15532739.2018.1456390
  • Zucker KJ (2018). The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018). International Journal of Transgenderism, 19(2), 231–245. https://doi.org/10.1080/15532739.2018.1468293

de Vries ALC., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., Cohen-Kettenis, P. T. (2014). Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment. Pediatrics, 134(4), 696–704. https://doi.org/10.1542/peds.2013-2958

Steensma TD, Kreukels BPC, de Vries ALC, Cohen-Kettenes PT (2013). Gender identity development in adolescence. Hormones and Behavior, July 2013, 64(2) pp. 288-297. https://doi.org/10.1016/j.yhbeh.2013.02.020

Steensma, T. D., Biemond, R., de Boer, F., Cohen-Kettenes PT (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology and Psychiatry, 16(4), 499–516. https://doi.org/10.1177/1359104510378303

Media

Gender: A Wider Lens with Stella O’Malley, Sasha Ayad, Annelou de Vries, and Thomas Steensma (March 11, 2022). EPISODE 66 – Pioneers Series – Where it All Started: The Dutch Researchers. https://www.youtube.com/watch?v=fISYeDL38tQ

Pedagogische en Onderwijswetenschappen (UvA) with Henny Bos and Thomas Steensma (Apr 14, 2021). Gender – Preventieve Jeugdhulp en Opvoeding. [Gender – Preventive Youth Care and Education] https://www.youtube.com/watch?v=jU5JweVHLeU

Resources

Amsterdam VUMC (research.vumc.nl/en)

ResearchGate (researchgate.net)

Google Scholar (scholar.google.com)

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