99% of trans teens persist with gender-affirming care

Just 1% of young people who commenced medical treatment in WA ended up reidentifying with their assigned gender at birth.

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The “spectre of reidentification” doesn’t need to overshadow clinical care frameworks for young transgender and gender diverse Australians, say researchers from Perth’s Telethon Kids Institute.

Published earlier this week in JAMA Pediatrics, the cohort study looked at around 550 patients who had been treated at the Perth Children’s Hospital gender diversity service between 2014 and 2020.

All patients included in the study had been discharged from the clinic.

Just 29 young people – representing roughly 5% of the total – had been discharged because they no longer identified as transgender.

In every case bar two, the patients were still in the assessment stage: i.e. had not received a medical intervention like puberty blockers, which are widely considered to be reversible, or treatment with more permanent cross-sex hormones.

Of the two people who received a medical intervention before reidentifying with their gender assigned at birth, one was on puberty suppression for nine months and the other was on puberty suppression for four months and testosterone treatment for one month.

Upon reidentifying and ceasing medical treatment, both patients continued to attend the gender clinic for mental health appointments over several months.

This puts the reidentification rate among the patients who have received medical interventions at the Perth children’s gender clinic at just 1%, consistent with results from international cohorts.

“Ultimately, the data really reassures [me] that this care is safe and that this care benefits the young people who access it,” said RACGP trans healthcare specific interest group chair Dr Michelle Dutton.

“It adds to the existing evidence … and continues to confirm what those of us who do this work see: that this care is incredibly beneficial.”

Dr Dutton, a GP in Melbourne, also told The Medical Republic that the fact that the vast majority of people who had reidentified with their birth gender had gone no further than the assessment stage was a sign that the gender affirming model used in Australia worked.

“The approach to care was about not validating one outcome over the other,” she said.

“[The research] emphasised that both outcomes – whether the young person continuing to identify as trans or re-identify with their birth sex – were equally valid.

“The process is about helping the young person, with the support of their family, to make the best possible decision for themselves.”

Dr Blake Cavve, the lead author on the paper and a researcher at Telethon Kids Institute, told TMR that it had been a key finding for the research team too.

“The important part, from our point of view, is supporting people regardless of the outcome and making sure that people who do reidentify with their birth sex are receiving good, high quality medical care,” he said.

The study did have its share of limitations, however, the biggest one being that it had no visibility of people who reidentify with their assigned birth gender after the age of 18.

It also could not account for people who may have dropped out of the clinic after reidentifying as their birth gender, only to identify as trans and seek gender affirming care as an adult.

The study design didn’t allow for the collection of information on regret or other personal reflections from the young people who desisted treatment.

JAMA Pediatrics, online 4 March 2024