Kids who feel their true gender identity doesn't match the sex they were given at birth are sometimes given the chance to adopt the lifestyle and characteristics of the opposite gender, in a process known as "social transitioning."
It involves no treatments or surgery, yet some people question whether kids who socially transition at a very young age might end up regretting the decision, raising the risk for a traumatic re-transition. But new research finds that's rarely the case: Among children under age 12, investigators found that more than nine in 10 stuck with their initial transition decision as much as five years out. And the few who re-transitioned back did not typically find the process traumatic.
"Social transitioning refers to a change in pronouns, first name, hairstyles and clothing," explained study author Kristina Olson, a psychology professor at Princeton University, in New Jersey. It's "the 'social' part of gender."
Such transitions may be the first step families take in tackling the distress often experienced by children who feel that their gender identity doesn't match their assigned gender.
Social transitions are distinct from medical transitions "that can involve the use of gender-affirming hormones or surgeries," Olson explained.
Olson said only one other small study - involving just four children - had explored long-term re-transition risk. That study found none of the kids had returned to their birth-assigned gender.
But to dig deeper, Olson and her team focused on more than 300 children who had undergone a social transition.
About two-thirds were transgender boys, meaning boys who had been assigned a female gender at birth; about one-third were transgender girls.
All were enrolled in the TransYouth Project between 2013 and 2017. The project tracked transition experiences over a five-year period, with children being between the ages of 3 and 12 when first socially transitioning.
Though Olson's focus was on social transitioning, she noted that some of the children had embarked on a medical transition as well, though she emphasized that was only the case among the oldest kids, given that "youth are not eligible for medical transition until after the onset of puberty."
Specifically, nearly 12% had begun taking puberty blockers during the study period. (After the study period ended, however, 190 kids ultimately began taking blockers; nearly 100 of those children also started taking gender-affirming hormones, Olson noted.)
Solely on the social transition front, Olson noted that over five years only about 7% of the children transitioned back at least once.
By the end of the study period, 94% of the kids continued to identify as the gender they had embraced when first socially transitioning. (That figure includes the just over 1% who had at one point re-transitioned back to their birth gender, before then returning back again to the gender to which they had initially transitioned.)
Of the 6% who did not stick with their initial transition, a little more than 3% described themselves as non-binary by the end of the study period, while just under 3% said they identified with their birth gender. (Identifying with one's birth gender was notably more common among kids who had socially transitioned before the age of 6.)
"Interestingly, we are not finding that the youth who re-transitioned in our study are experiencing that as traumatic," Olson noted. "We've been finding that when youth are in supportive environments - supportive in the sense of being OK with the exploration of gender - both the initial transition and a later re-transition are fine."
The study findings were published online May 4 in the journal Pediatrics, but Olson said her team plans to keep tracking the study participants.
Meanwhile, a couple of experts not involved in the study hailed the effort to date.
The findings are already "important," said Dr. Jack Turban, chief fellow of child and adolescent psychiatry at Stanford University's School of Medicine, in Palo Alto, Calif.
"The main takeaway here is that gender identity, for binary transgender children, appears to be quite stable," he said.
And Turban - whose research focus is on the mental health of transgender youth - stressed that "social transition has value, regardless of the ultimate gender trajectory."
That, he said, is because "prohibiting a social transition can send the message to a child that their identity is wrong or invalid. And this can drive shame and damaged relationships within a family."
Indeed, "socially transitioning youth are [simply] making the same 'decisions' that cisgender children are making, in that they are seeking clothes, hairstyles, names, accessories, activities and playmates that reflect their gender identity and the resources in their community," said Matt Goldenberg, a psychologist in adolescent medicine with the Seattle Children's Gender Clinic.
And empowering children to explore their gender identity in an environment that "honors their authenticity and wisdom" is all a "healthy and normative aspect of human development," Goldenberg added.
There's more on the process of transitioning at Planned Parenthood.
SOURCES: Kristina Olson, PhD, professor, department of psychology, Princeton University, Princeton, N.J.; Matt Goldenberg, PsyD, psychologist, adolescent medicine, Seattle Children's Gender Clinic; Jack Turban, MD, MHS, chief fellow, child and adolescent psychiatry, and researcher, mental health of transgender youth, Stanford University School of Medicine, Palo Alto, Calif.; Pediatrics, May 4, 2022, online