Social affirmation is the term often given to the acts of others in reinforcing a person’s transgender ideation. It can also be called social transitioning.
It is harmful. It is a profoundly powerful psychological intervention, one which can foreclose any exploration of identity, it must be avoided.
The Cass Report describes social transition as an active healthcare intervention “because it may have significant effects on the child or young person in terms of their psychological functioning and longer-term outcomes.”
Regrettably, much of society, including schools, has been convinced that affirming an incongruent gender identity is the right and kind thing to do. It is not.
Almost all the research with a sufficiently long timescale to evaluate desistance has been conducted on the cohort of prepubescent boys. It is important to caution against applying statistics drawn from this cohort to the adolescent cohort (majority girls).
Clinicians and parents should, where possible, delay social gender transition (Steensma et al., 2013). This is based on evidence that gender dysphoria (and cross-gender identities) frequently desist in prepubertal children (Drummond et al., 2008; Singh et al., 2021; Zucker, 2018) and that premature social gender transition may foreclose the child’s gender identity development, increasing the likelihood that gender dysphoria will persist (possibly necessitating medical transition in adolescence onward). This approach has been referred to as “watchful waiting” (de Vries & Cohen-Kettenis, 2012).
If an incongruent sexed identity is socially affirmed, there is a reduced chance of the affected person desisting from their transgender ideation. A 5 year study shows 94% persistence rate in socially transitioned children. This compares unfavourably with a 20% rate of persistence under a ‘watchful waiting’ approach.
“Though we can never predict the exact gender trajectory of any child, these data suggest that many youth who identify as transgender early, and are supported through a social transition, will continue to identify as transgender five years after initial social transition.”
“…transgender youth who socially transitioned at early ages continued to identify that way.”1
Children who begin identifying as transgender at a young age tend to retain that identity at least for several years, a study published Wednesday suggests.
The research involved 317 youngsters who were 3 to 12 years old when they were recruited to the study. Five years later, at the study’s end, 94% were living as transgender and almost two-thirds were using either puberty-blocking medication or sex hormones to medically transition.
Most children in the study were from white, high-income families who supported their transitions. On average, the kids began identifying as transgender at around age 6.
It’s unknown whether similar results would be found among youngsters from less advantaged backgrounds or those who begin identifying as transgender as teenagers. The study was published online in Pediatrics.
Early transgender identity tends to endure, study suggests
By LINDSEY TANNER
It is worth noting that these were generally prepubescent children whose parents supported the social affirmation of an incongruent sex identity. We know from other research that ‘watchful waiting’ in this cohort can lead to a 17.4% desistance rate2.
In 2019 Ken Zucker published a paper in the journal ‘Child and Adolescent Mental Health’3, the abstract of which states:
A gender social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender-affirming hormonal treatment and surgery). Gender social transition of prepubertal children will increase dramatically the rate of gender dysphoria persistence when compared to follow-up studies of children with gender dysphoria who did not receive this type of psychosocial intervention and, oddly enough, might be characterized as iatrogenic. Parents who bring their children for clinical care hold different philosophical views on what is the best way to help reduce the gender dysphoria, which require both respect and understanding.
Zucker, K.J. (2020), Debate: Different strokes for different folks. Child Adolesc Ment Health, 25: 36-37. https://doi.org/10.1111/camh.12330
Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008)4 found:
“Most children with gender dysphoria will not remain gender dysphoric after puberty. With regard to sexual orientation, the most likely outcome of childhood GID is homosexuality or bisexuality.”
It is clear that socially transitioning a child cements a cross-sex identity, forecloses other options, prevents other outcomes (gay/lesbian/resolution of gender dysphoria) and increases the likelihood of medical intervention.
This knowledge has serious implications for schools, many of which believe that they are to socially affirm transgender ideation.
The act of providing social affirmation may contribute to the solidification of a gender identity, subsequently elevating the likelihood of the individual seeking medical transition in the future. Substantial evidence indicates that 80% of children would desist from such feelings with the support of a “watchful waiting” approach. Engaging in physical transition involves irreversible experimental drugs and, later, invasive surgeries, both of which are detrimental to the child. This viewpoint aligns with the clear judgment delivered after Keira Bell’s case against the Tavistock Clinic.
The affirmative approach to gender lacks a long-term evidence base. In contrast, the “Supportive Waiting” approach, has demonstrated efficacy in managing gender dysphoria and emotional distress over the long term.
Recent studies, including those by Wong et al. (2019)5 and Sievert et al. (2020)6, have shown that socially transitioning a child does not yield psychological benefits. Wong et al. (2019) found “little evidence that psychosocial well-being varied in relation to gender transition status.” Similarly, Sievert et al. (2020) concluded that “the degree of social transition did not significantly predict the outcome,” and claims of its benefits could not be supported.
Moreover, trans-identified children often exhibit a higher likelihood of mental health conditions, autism, or a history of trauma or abuse. Affirmation and social transition might serve as temporary solutions, neglecting underlying issues. Numerous detransitioned individuals, especially women, attribute harm to the affirmation received in schools, as it diverted them from necessary counseling and psychological support, as highlighted on the Detrans Voices website.
Implementing social transitioning without parental or medical input could be viewed as an experimental treatment on a child. This approach, with potentially far-reaching consequences and little evidence of its efficacy, goes beyond a school’s legal responsibility for a child’s medical care and welfare. Social affirmation is not a benign and neutral act; teachers must exercise caution due to its potential consequences.
The argument that affirming trans children is crucial to prevent suicide or self-harm is flawed. Suicide is a complex issue, and attributing it solely to one factor is irresponsible. Fearing self-harm or suicide should not justify keeping a child’s distress secret from parents. Teachers should adhere to safeguarding policies, treating concerns about child suicide seriously and consistently, without diminishing the protection afforded to trans-identified children.
Contrary to some statistics, recent studies emphasize that social transitioning does not yield psychological benefits for children. Misleading statistics often derive from small sample sizes. The Gender Identity Development Service notes that the majority of children and young people they see do not self-harm or attempt suicide, and any concerns should be addressed within the framework of normal school safeguarding policies.
References
Kristina R. Olson, Lily Durwood, Rachel Horton, Natalie M. Gallagher, Aaron Devor; Gender Identity 5 Years After Social Transition. Pediatrics August 2022; 150 (2), DOI: e2021056082. 10.1542/peds.2021-056082
Singh D, Bradley SJ, Zucker KJ. A Follow-Up Study of Boys With Gender Identity Disorder. Front Psychiatry. 2021;12:632784. Published 2021 Mar 29. doi:10.3389/fpsyt.2021.632784
Zucker, K.J. (2020), Debate: Different strokes for different folks. Child Adolesc Ment Health, 25: 36-37. https://doi.org/10.1111/camh.12330
Wallien MS, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry. 2008 Dec;47(12):1413-23. doi: 10.1097/CHI.0b013e31818956b9. PMID: 18981931
Kenneth J. Zucker (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, DOI: 10.1080/15532739.2018.1468293
Wong, W. I., van der Miesen, A. I. R., Li, T. G. F., MacMullin, L. N., & VanderLaan, D. P. (2019). Childhood social gender transition and psychosocial well-being: A comparison to cisgender gender-variant children. Clinical Practice in Pediatric Psychology, 7(3), 241–253. https://doi.org/10.1037/cpp0000295
Sievert ED, Schweizer K, Barkmann C, Fahrenkrug S, Becker-Hebly I. Not social transition status, but peer relations and family functioning predict psychological functioning in a German clinical sample of children with Gender Dysphoria. Clin Child Psychol Psychiatry. 2021 Jan;26(1):79-95. doi: 10.1177/1359104520964530. Epub 2020 Oct 20. PMID: 33081539.
https://www.transgendertrend.com/teenager-says-theyre-transgender/
https://www.transgendertrend.com/childhood-social-transition/
https://www.researchgate.net/publication/333516085_Debate_Different_strokes_for_different_folks