New study says nothing about gender dysphoria

A recent study published in Archives of Sexual Behavior is starting to get some attention in the political blogosphere. The authors used data from a large longitudinal survey of 2229 adolescents from North of the Netherlands over the course of 15 years (ages 10-25), looking specifically at how they answered the question “I wish to be the opposite sex [never, sometimes, often]” over time. They found that 78% of participants answered never throughout the study, 19% answered sometimes or often when they were younger but switched to never as they aged, and a small cohort of about 2% answered never when younger but switched when they got older. (There was an even smaller cohort that answered sometimes or often throughout the study, but it was too small to track reliably.)

The authors make it clear in the very first paragraph that they are studying gender non-contentedness (the desire to be the opposite sex, for whatever reason) and not gender dysphoria (incongruence between one’s experienced/expressed gender and assigned gender):

To illustrate the relation between these concepts; a young adolescent girl who mostly likes things seen as typical for boys and who dislikes the changes she goes through during puberty, might (temporarily) experience gender non-contentedness, although she might not experience gender dysphoria or wish to transition from female to male.

There’s obviously a world of difference between “I wish I had been born a boy” and “I am a boy, my body got it wrong.” Unfortunately this distinction seems to be getting lost in translation. Kevin Drum (who is usually more careful) seemed to miss the distinction completely, summarizing the paper in a blog post titled Raw data: Gender dysphoria in teens, with similarly mislabeled graphs. I expect Drum’s misunderstanding is accidental, but it’s unfortunate because such a misunderstanding can be used to further the argument that teens should be denied gender-affirming hormones and/or hormone blockers.

And right on cue, within hours Wesley Smith at the National Review writes Study: Most Gender-Confused Children become Gender-Conforming Adults. He uses the term “gender confused“, a non-clinical term that is usually synonymous with gender dysphoria but also used by assholes people skeptical of transgenderism to refer to general issues around trans identity. Regardless of Smith’s intended meaning he quickly gets to his main point:

It is becoming increasingly difficult for “the science is settled” crowd to claim that enthusiastic “gender-affirming care” is medically necessary treatment for children experiencing gender confusion. The time has come for the medical establishment, politicians, the media, and gender ideologues generally to cease pushing puberty blocking and surgeries and focus more on long-term mental-health interventions to help these confused kids grow into adulthood with their bodies intact and fully functioning.

Smith’s argument against puberty blockers would be non-sensical even if they were being prescribed for gender non-contentedness. After all, the whole point of blockers is to delay puberty (and the permanent physical changes that come with it) to give a child, parents and care team time to decide the best course of action — which is exactly what you want if there’s a chance you might “grow out of it.” But puberty blockers aren’t recommended after the age of 14 or so (the body needs puberty to promote bone density), so at that point there needs to be a decision: stop blockers and let the body’s natural hormones start to surge or start taking hormones of the appropriate sex (testosterone for trans-male, estrogen for trans-female). Either decision leads to permanent body changes so it’s not like doing nothing is the “safe” choice, and in the end the child, parents and care team will need to make a decision.

The fact that a lot of children grow out of gender non-contentedness certainly weighs against deciding to take permanent action for children who aren’t suffering from gender dysphoria — which is presumably why doctors don’t do it. As described in this 2022 paper on gender affirming care:

Not all transgender patients actively experience gender dysphoria, and not all patients with gender dysphoria identify as transgender. Unfortunately, however, many treatment options, such as gender-affirming surgery and hormone therapy, are sometimes only accessible for patients if they have this DSM-5 diagnosis.

Hopefully this study won’t become the latest cause célèbre of folks who want to discredit gender-affirming care, but if it does then you heard it here first: it doesn’t say what they say it says.