Behind Florida’s decision to block clinical services for transgender teens is an argument – repeated by the state’s governor and leading medical authorities – that most cases of gender incongruity fade away with time.
The Florida Board of Medicine voted Nov. 4 to approve a rule prohibiting doctors from performing surgeries on minors to alter “primary or secondary sex characteristics” and prescribing them drugs to suppress puberty and hormones. The rule provided an exception for patients who were already receiving these treatments.
Two days later, Republican Florida Governor Ron DeSantis said gender-affirming care is “an example of ideology moving beyond the practice of medicine,” saying he had worked with the council to take a stand against that.
“Over 80% of dysphoria in adolescents resolves on its own by the time they get older,” DeSantis said at a Nov. 6 campaign event. “Then why are you mutilating their body parts?”
Earlier in the year, the Florida Department of Health used the statistic as it advised against medical transition for minors. The department’s April memo stated that “80% of those who seek clinical care will lose their desire to identify with gender unrelated to birth.”
Dr. Hector Vila, a Tampa anesthesiologist and governor-appointed board member, said he supports the rule because a “significant percentage” of transgender children would revert to their assigned sex.
PolitiFact consulted experts and data to determine whether gender incongruity will “resolve itself” for a large cohort of teens.
These experts said Florida misinterpreted a statistic related to a 2016 academic journal. Additionally, one of the researchers whose work is cited as the source of the statistic said that the data he viewed did not were not “optimal” and could lead to “false deductions”.
The public comment period for the rule ended on December 5.
The 80% figure comes from a 2016 article published in the International Review of Psychiatry.
Dutch health psychologist Thomas Steensma and Italian psychologist Jiska Ristori reviewed previous studies on gender dysphoria, which describe the distress people may experience due to a discrepancy between their gender identity and the sex they was assigned at birth.
Not all transgender people suffer from or are diagnosed with gender dysphoria. Gender dysphoria diagnoses focus on psychological distress related to gender identity, not gender identity itself.
The researchers wanted to know if people who had suffered from gender dysphoria in childhood still suffered from it later in life. They looked at outcomes for children involved in 10 studies conducted from 1968 to 2012 in the United States, Canada and the Netherlands.
Their review of studies says they showed that feelings of gender dysphoria disappeared for 85% of children “around or after puberty” – while acknowledging several limitations.
“There may be a number of arguments to qualify this high percentage of withdrawals,” the review read. “Lower persistence rates in earlier studies, compared to more recent studies after 2000, may be a result of the inclusion of less extreme cases in earlier studies than in later studies.”
In other contexts, “desistance” may refer to an apparent end to gender variance and a return to an identity that aligns with sex assigned at birth. In the article, the researchers meant the lifting of dysphoric feelings.
Other experts have raised concerns about the methodology of the studies cited in the paper.
Dr Kristin Dayton, a pediatric endocrinologist, said the studies had a small proportion of children assigned to females at birth – and are therefore not representative samples of the population. Eight of the 10 studies examined only children designated male at birth.
At least six of the studies were conducted before the American Psychiatric Association developed a formal diagnosis of gender dysphoria in children. Some of the 10 studies did not include children who had been referred to the studies by healthcare professionals.
A 1987 study, for example, used advertisements to recruit children. Only 30% of the children examined had “frequently” expressed the desire to be a girl. Experts said most of the children in this study would not have met current criteria for gender dysphoria.
Diagnostic criteria for the condition include a “marked incongruence” between lived sex and sex assigned at birth lasting at least six months and a “strong desire to be of the opposite sex or an insistence on the fact that one is of the opposite sex”.
The Florida Department of Health and Board of Medicine misrepresented the review’s conclusion by stating that 80% of children will “lose the desire” to identify with a gender not assigned at birth.
The 80% figure in the review did not refer to the children’s gender identity; it focused on the persistence and disappearance of gender dysphoria in adulthood. Steensma later wrote that “the use of the term disclaimer in this way does not imply anything about the identity of the disclaimers”.
Although the review noted that studies have found that childhood gender dysphoria is “strongly associated” with a “lesbian, gay or bisexual outcome”, it did not specify what percentage of people studied quit. to identify as transgender.
“The 80% statistic, used by the Florida Department of Health and state leaders, is categorically false,” Dr. Meredithe McNamara, assistant professor of pediatrics at Yale School of Medicine, told PolitiFact. “After careful reading of the scholarship cited by the State, the State’s conclusion simply cannot be drawn in good faith.”
Steensma, who did not respond to interview requests from PolitiFact, responded to criticism from colleagues about how his research is used to discourage social and medical assertiveness among gender-diverse teens.
“We would like to emphasize that we do not consider the methodology used in our studies to be optimal … or that the terminology used in our communications is always ideal,” Steensma wrote in 2018. “As noted, this may lead to confusion and false conclusions.”
McNamara also said Florida’s reliance on a 2016 paper is a “glaring problem” because the state neglected to consider about six years of new research.
A study published in July, for example, sought to develop an estimate of transgender children who later stop identifying with a gender that does not align with their assigned sex. He assessed 300 transgender children over five years. To participate in the study, children must have already begun social transition, which often involves changing names, haircuts and pronouns.
Researchers from the TransYouth project at Princeton University followed the participants in person and online. At the end of the five years, 94% of participants still identified as transgender.
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