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• Early social transition has not been found to reduce mental health difficulties
  James Thornhill
  Published on: 15 October 2021

• Published on: 15 October 2021

  Early social transition has not been found to reduce mental health difficulties

  • James Thornhill, painter Greenwich Naval Hospital

  The authors note that increasing numbers of children have already socially transitioned by the time they are referred to gender services, and add that "recent research has suggested that this early social transition can have desirable outcomes for CYP, particularly in relation to a reduction in mental health difficulties." They cite (at notes 16, 17) two papers from the University of Washington, Seattle, that used overlapping data from the TransYouth Project, based on samples recruited in 2015-16. [1, 2]

  However neither made any findings about a reduction in mental health difficulties resulting from the social transition, a limitation the authors themselves acknowledged. Both were cross-sectional studies whose transgender cohorts were all children who had already socially transitioned, that merely observed that the psychological functioning of the socially-transitioned children was broadly the same as non-transitioned children, apart from their elevated anxiety. When the data was re-analysed by another team in 2020, it "featured numerous statistical errors and omissions... Such issues highlight the need for careful examination of statistical research, even when published in highly regarded medical journals." [3]

  Nor is the research recent, and the two latest studies on early social transition depart from these earlier Seattle papers, by suggesting that not social transition but peer relationships are the key to these children's wellbe...

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  The authors note that increasing numbers of children have already socially transitioned by the time they are referred to gender services, and add that "recent research has suggested that this early social transition can have desirable outcomes for CYP, particularly in relation to a reduction in mental health difficulties." They cite (at notes 16, 17) two papers from the University of Washington, Seattle, that used overlapping data from the TransYouth Project, based on samples recruited in 2015-16. [1, 2]

  However neither made any findings about a reduction in mental health difficulties resulting from the social transition, a limitation the authors themselves acknowledged. Both were cross-sectional studies whose transgender cohorts were all children who had already socially transitioned, that merely observed that the psychological functioning of the socially-transitioned children was broadly the same as non-transitioned children, apart from their elevated anxiety. When the data was re-analysed by another team in 2020, it "featured numerous statistical errors and omissions... Such issues highlight the need for careful examination of statistical research, even when published in highly regarded medical journals." [3]

  Nor is the research recent, and the two latest studies on early social transition depart from these earlier Seattle papers, by suggesting that not social transition but peer relationships are the key to these children's wellbeing. Wong et al 2019, using data from Toronto, found that socially-transitioned children had elevated problems relative to the general population, but that "there was little evidence that psychosocial well-being varied in relation to gender transition status... only poor peer relations predicted lower psychological well-being among these children." [4] Sievert et al 2020 in Hamburg, Germany, concluded similarly that "claims that gender affirmation through transitioning socially is beneficial for children with GD could not be supported from the present results" [5] This was because "the social transition status... was not significantly associated with psychological functioning. ... our study found that, social support in general (from family and peers), but not necessarily in terms of affirming one's child gender status, plays a role for the psychological outcomes." [5] This finding is in line with a comparative analysis betwen the Toronto and Amsterdam clinics [6].

  [1] Olson KR, Durwood L, DeMeules M, McLaughlin KA. Mental Health of Transgender Children Who Are Supported in Their Identities [published correction appears in Pediatrics. 2018 Aug;142(2):]. Pediatrics. 2016;137(3):e20153223. doi:10.1542/peds.2015-3223
  [2] Durwood L, McLaughlin KA, Olson KR. Mental Health and Self-Worth in Socially Transitioned Transgender Youth [published correction appears in J Am Acad Child Adolesc Psychiatry. 2018 Nov;57(11):899]. J Am Acad Child Adolesc Psychiatry. 2017;56(2):116-123.e2. doi:10.1016/j.jaac.2016.10.016
  [3] Schumm WR, Crawford DW. Is Research on Transgender Children What It Seems? Comments on Recent Research on Transgender Children with High Levels of Parental Support. Linacre Q. 2020;87(1):9-24. doi:10.1177/0024363919884799
  [4] Wong WI, Li TGF, van der Miesen AIR, MacMullin LN, VanderLaan DP. Childhood Social Gender Transition and Psychosocial Well-Being: A Comparison to Cisgender Gender-Variant Children. Clinical Practice in Pediatric Psychology. 2019; 7(3):241-253. doi:10.1037/cpp0000295
  [5] 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;26(1):79-95. doi:10.1177/1359104520964530
  [6] de Vries AL, Steensma TD, Cohen-Kettenis PT, VanderLaan DP, Zucker KJ. Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: a cross-national, cross-clinic comparative analysis. Eur Child Adolesc Psychiatry. 2016;25(6):579-588. doi:10.1007/s00787-015-0764-7

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  Conflict of Interest:
  None declared.

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