It is widely recognized that most children with gender dysphoria (GD) will come to terms with their sex and not live as transgender adults. Transition advocates contend, however, that administering irreversible endocrine and surgical interventions to adolescents is not a problem because, unlike childhood-onset GD, adolescent GD almost never remits.
This view is encapsulated in a quote from Stephen Rosenthal, a notable U.S. gender physician, in an article for Nature Reviews Endocrinology, one of the highest-ranked peer-reviewed medical journals: “Longitudinal studies have indicated that the emergence or worsening of gender dysphoria with pubertal onset is associated with a very high likelihood of being a transgender adult. This observation is central to the rationale for medical intervention in eligible transgender adolescents” (emphasis added).
Like many assertions in youth gender medicine, the claim about the near-permanence of adolescent gender dysphoria (GD) has never been properly tested. (How these studies are designed makes them incapable of answering this question, which is probably why Rosenthal uses the vague word “indicate[s].”) So we decided to test it ourselves. Our findings, from an ongoing Manhattan Institute analysis of an all-payer, all-claims national insurance database, challenge this “central” belief underpinning youth gender medicine. In fact, the rate of persistence of the gender dysphoria diagnosis for youth over seven years is 42.2 percent to 49.9 percent, with the trend line suggesting likely future declines.
Our findings are highly significant for the debate over youth gender medicine. Treatments with permanent effects, and that include negative impacts on health and functioning, should not be offered to patients—especially not minors—with a diagnosis likely to disappear after a few years.
Like our prior analysis of the number of mastectomies performed on minors, this analysis is based on a comprehensive database of insurance health claims in the United States containing health-care encounter data for about 85 percent of the insured U.S. population. Since American insurance rates are high (about 90 percent of the U.S. population overall, and 95 percent of children, are insured), this is probably one of the most comprehensive resources for health care-related inquires.
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So, what is the takeaway from this analysis? The single biggest observation is that, contrary to what has been asserted by advocates of youth transition, most adolescents with a GD diagnosis will not have this diagnosis within as few as seven years, during the period of rapid identity development. The single most important implication is that there is no empirical basis for assuming that most adolescents presenting with GD are destined to live as gender-transitioned adults. This further suggests that the GD diagnosis presents a dubious basis for offering teens life-altering interventions with permanent impacts on health and functioning.
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To summarize our key findings, the number of young people who have received a GD diagnosis in recent years is much higher than previously reported. By our conservative estimate, over 300,000 minors in the U.S. had a GD diagnosis between 2017 and 2023, which means that the condition is not rare. Even more important is that among adolescents with a GD diagnosis in 2017, over half lost their gender-related diagnoses by 2023, with future ongoing declines likely, as suggested by the trend. There is also some evidence of a sharper than usual 2023 decline, though future data would need to confirm this trend.
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In sum, while our analysis is the first comprehensive effort to track diagnostic persistence of GD in the U.S., our findings add to a growing international body of evidence that adolescent GD is not a permanent condition and that, given the stakes, it is irresponsible to view adolescents with GD as “transgender adolescents.”
Source: Adolescent Gender Dysphoria Is a Temporary Diagnosis for Most Teens | City Journal