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The End of the Desistance Myth

People should start listening to the transgender community when we say something is going horribly, horribly wrong inside medical institutions with power over us. It's time for the 80 percent desistance figure to be relegated to the same junk science bin as the utterly discredited link between vaccines and autism.
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Over the past few years, an endless parade of "concerned" people (trolls) have trotted out the same statistic over and over again: 84 percent of transgender kids stop being transgender on their own. They have used this to justify everything from reparative therapy, to denying medical care to transgender teens, to suggesting that reparative therapy on adults will work.

The problem is that the desistance narrative is built upon bad statistics, bad science, homophobia and transphobia.

For starters, the most cited study (Steensma) which alleges a 84 percent desistance rate, did not actually differentiate between children with consistent, persistent and insistent gender dysphoria, kids who socially transitioned, and kids who just acted more masculine or feminine than their birth sex and culture allowed for. In other words, it treated gender non-conformance the same as gender dysphoria. Worse, the study could not locate 45.3 percent of the children for follow up, and made the assumption that all of them were desisters. Indeed, other studies used to support this also suffered from similar methodological flaws.

As a result, the 84 percent desistance figure is meaningless, since both the numerator and denominator are unknown, because you have no idea how many of the kids ended up transitioning (numerator), and no idea how many of them were actually gender dysphoric to begin with (denominator). When Dr. Steensma went back in 2013 and looked at the intensity of dysphoria these children felt as a factor in persistence, it turned out that it was actually a very good predictor of which children would transition.

In other words, the children who actually met the clinical guidelines for gender dysphoria as children generally ended up as transgender adults. Further research has shown that children who meet the clinical guidelines for gender dysphoria are as consistent in their gender identity as the general population.

For the past decade, the biggest promoter of the desistance myth was Dr. Kenneth Zucker at the Center for Addiction and Mental Health (CAMH) in Toronto. He never missed an opportunity to speak to anti-LGBT organizations and news outlets, or to tout himself as the world's top expert in transgender children. He denied practicing reparative therapy, despite a 2003 report in the Journal of the American Academy of Child and Adolescent Psychiatry which called his techniques "something disturbingly close to reparative therapy for homosexuals."

Twenty years ago, though, Zucker was also pushing hard for reparative therapy of potentially gay children who were too effeminate, in order to prevent them from growing up to be gay. In 1990, Zucker wrote:

Two short term goals have been discussed in the literature: the reduction or elimination of social ostracism and conflict, and the alleviation of underlying or associated psychopathology. Longer term goals have focused on the prevention of transsexualism and/or homosexuality.

He felt that this was for the best, because, "a homosexual lifestyle in a basically unaccepting culture simply creates unnecessary social difficulties." In other words, force children to change, rather than working to change a homophobic culture. Along the way, Dr. Zucker became the darling of hate groups and their media outlets, such as Focus on the Family, NARTH, CourageC, Alliance Defending Freedom, Life Site News, American Family Association, Liberty Counsel, Family Research Council, Americans for Truth About Homosexuality (AFTAH), and Parents and Friends of Ex-Gays and Gays (PFOX).

In effect, because of his position, Dr. Kenneth Zucker was the last "respectable" patron of reparative therapy. He took the model for "fixing" gay kids, slapped a new label on it, and sold it as a way to fix gender non-conforming children. When the transgender activists tried to bring attention to these abuses, Dr. Zucker attempted to silence them with threats of lawsuits.

That is, until December 2015, when an independent investigation led to Dr. Zucker's firing and his clinic being closed. The investigation results were highly damning, finding:

• The methods being used were 30 years out of date

• The clinic assumed that all gender variant children need to be clinically "fixed" (i.e. they used coercive behavior modification on queer kids to make them act straight)

• Children were pressured into being photographed without clothing

• The clinic emphasized tests, treatment, methods with no scientific basis in evidence based medicine

• CAMH staff asked pre-pubescent children questions that were highly sexual in nature

• Former patients, parents, and therapists of former patients described the treatment as "disturbing" and "harmful"

• CAMH hid affirming community and medical resources from patients

• Dr. Zucker regarded being cisgender, heterosexual, and gender conforming as the "best" outcome

• Dr. Zucker and his team could not conclusively demonstrate that what they were doing was not reparative therapy

In a 2014 German study, 13 experts in treatment for gender identity were asked if CAMH's methods were ethical. 11 said no. The two who said yes were Dr. Zucker and another CAMH staffer.

But, the most outrageous piece of information coming out of CAMH was Dr. Zucker's claims that gender dysphoria desisted in 80 percent of cases. However, when investigators reviewed the files of children admitted to CAHM, 42 percent of them never met the clinical criteria for juvenile gender dysphoria in the first place.

In short, half of the kids Dr. Zucker claimed to "cure" were never transgender in the first place. He built his reputation convincing homophobic and transphobic parents that he could fix their kids. When someone actually got around to listening to the transgender community and pulled back the curtain, they found that the 80 percent desistance narrative was a fabrication of an attention seeking, creepy, reparative therapy promoting, snake-oil salesman.

Despite this, anti-transgender concern trolls came out in force defending Dr. Zucker. They couldn't actually refute any of the findings of the investigation, so instead they played the concern troll card and falsely claimed that non-transgender children will be coerced into medically transitioning if therapists allow children to explore their gender expression and identity.

This is a complete misrepresentation of what affirming therapy actually is. Dr. Colt Keo-Meier, the lead author of Division 44 (LGBT issues) of the American Psychological Association's guidance for treating transgender children, refutes this fear-mongering claim:

The gender affirmative model supports identity exploration and development without an a priori goal of any particular gender identity or expression. Practitioners of the gender affirmative model do not push children in any direction, rather, they listen to children and, with the help of parents, translate what the child is communicating about their gender identity and expression. They work toward improving gender health, where a child is able to live in the gender that feels most authentic to the child and can express gender without fear of rejection.

Dr. Keo-Meier is supported by a wave of new research showing that affirming therapy does not result in the parade of horribles alleged by the concern trolls. Gender variant youth know who they are just as much as the general population. Transgender youth who are receive affirming care have better health outcomes. Transgender youth on puberty delaying medication showed no health effects, and mental health outcomes as good as their cisgender peers.

The desistance myth was promoted by reparative therapists, concern trolls and charlatans, while being no better than a percentage pulled out of a hat to begin with. It's time for the 80 percent desistance figure to be relegated to the same junk science bin as the utterly discredited link between vaccines and autism.

And maybe people should start listening to the transgender community when we say something is going horribly, horribly wrong inside medical institutions with power over us.

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