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Gender Dysphoria: What Do We Know For Sure?



In the public discussion and submitted resources regarding the proposed APS transgender and gender nonconforming student policy implementation procedure (J-2 PIP), various speakers and authors have cited studies to support their assertions, which are sometimes contradictory. This is not surprising; gender identity research is relatively new and evolving rapidly, and different studies have reached different conclusions on certain topics.


There is one area, however, where data have been consistent over time and continue to be so: The likelihood of persistence of gender dysphoria[1] beyond adolescence. In most children with gender dysphoria, the condition will not persist; that is, these children will eventually identify with their birth sex.


The American Psychiatric Association’s Diagnostic and Statistical Manual, 5th Edition (APA DSM-5) is the current standard for psychiatric diagnosis in North America. It states that gender dysphoria may be either transient or persistent.[2] In developing the current DSM-5, the APA’s task force considered many individual studies of persistence of childhood gender dysphoria into adolescence or adulthood. In those studies, persistence rates ranged from 2.2% to 30% for natal boys and 12% to 50% for natal girls.[3] Since publication of the DSM-5 in 2013, newer studies have continued to show that most cases of gender dysphoria in children are transient.[4,5]


In the real world of human variability, every study arrives at different numbers. The studies may use different methods, definitions, and diagnostic criteria. But the number of persisting children is never a majority. We simply cannot find any study in a peer-reviewed, academic publication that has found otherwise. If such a study exists, we welcome being directed to it.

As it stands, the preponderance of data is clear: gender dysphoria in children is usually temporary. If there is not scientific consensus on that point, then there is no scientific consensus on anything related to gender.

This does not mean that expectant management (“watchful waiting”) is the right approach for every child with gender dysphoria. A child’s distress may range from mild to severe, and some children will require more intensive evaluation and support.


What this does mean is that watchful waiting is the right approach for most children, and that these children should not be propositioned with the unlikely scenario of having an identity different from their birth sex. This would cause unnecessary anxiety and confusion in impressionable minds.


If staff training or classroom instruction about gender identity is to be science-based, then it will teach that most children who have gender dysphoria will eventually come to identify with their birth sex. We have yet to see this point acknowledged in any of the resources that presumably form the basis for the J-2 PIP.[6] This is an inexcusable omission that discredits the J-2 PIP’s entire development process.


It should also be noted that the APA’s current standards for diagnosing gender dysphoria include several alternative explanations not involving gender identity that must be considered,[7,8] including the following:

  • simple nonconformity to traditional gender roles

  • transvestic fetishism (cross-dressing, which is usually not accompanied by gender dysphoria)

  • body dysmorphic disorder (e.g. perceiving one’s genitalia to be malformed)

  • psychotic disorders. (Believing oneself to belong to the other sex can be a delusion).[7,8]

These are not topics for classroom or assembly discussion. Rather, such conversations and decisions should be between families and their chosen health care providers. And given the increased rates of depression, anxiety, and self-harm in children with gender dysphoria,[9] parents should be notified and involved at the first sign of gender dysphoric ideation or behaviors.


We hope Arlington Public Schools will continue to work with individual families when issues relating to gender dysphoria arise. We also urge APS to withdraw the J-2 PIP for redevelopment. The current proposal is based on insufficient research, and it does not adequately consider the emotional and developmental needs of all students.


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[1] In medical literature, “gender dysphoria” sometimes refers to the symptom itself, other times to the new diagnostic category of gender dysphoria, formerly “Gender Identity Disorder,” in the DSM-5.

[2] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Arlington, VA, 2013, p. 451

[3] Ibid., p. 455

[4] Steensma, TD and Cohen-Kettenis, PT, “More Than Two Developmental Pathways in Children with Gender Dysphoria,” Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 54, No. 2, February 2015, pp. 147-148. The persistence rate in this study was 27%. The authors’ survey of other studies suggested a persistence rate averaging about 16%.

[5] Steensma, TD, et al, “Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study.” Journal of the American Academy of Child and Adolescent Psychiatry, 2013, June 52(6) pp. 582-90. This persistence rate in this study was 37%. The authors’ survey of other studies showed persistence rates ranging from 2% to 27%.

[6] “Process and resource document,” attachment under “Meeting Materials” for February 26, 2019 work session, accessed on apsva.us/school-board-meetings.

[7] DSM-5, p. 458.

[8] Shafer, L. “Sexual Disorders and Sexual Dysfunction,” Massachusetts General Hospital Comprehensive Clinical Psychiatry, 2nd Edition. London, 2016, Elsevier, p. 406.

[9] Garcia-Vega, E., et al, “Suicidal ideation and suicide attempts in persons with gender dysphoria,” Psicothema, 2018, Vol. 30 No. 3, pp. 283-288.

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