1. Rates of early re-transition were low (7.3%) following early transition for youth aged 3-12 years old for approximately 5 years after initial social transition.
2. Serious limitations of the study include its high risk for selection bias, use of pronouns at a single visit to define gender, and a follow up period of only 5 years.
Evidence Rating Level: 4 (Below Average)
Study Rundown: The number of transgender children has increased significantly in the United States in recent years. Some feel that early transition for gender-diverse youth may minimize childhood distress, although concerns exist surrounding the possibility of retransition where youth may no longer identify as transgender or gender-diverse. This study examined the rate of early retransition (within 5 years of initial transition) among children who transitioned at a young age (mean 6.5 years). Subjects were part of The Trans Youth Project, which is a group of children between age 3 and 12 years who made a complete social transition to the opposite gender. Of the study cohort, 7.3% re-transitioned within 5 years of initial social transition. The study carries serious shortcomings that limit the results and their generalizability. The authors only investigated rates of re-transition for 5 years following initial transition and are therefore not helpful in discerning rates of re-transition past that timeframe. Furthermore, the children and parents who volunteer to be part of the Trans Youth Project may have important differences from other populations that affect rates of re-transition (selection bias). Finally, the study relied on the use of preferred pronouns at a single encounter to define a child’s gender. Overall, the study suggests that in young transgender children, the rate of re-transition is low for the first 5 years following initial transition, although more robust studies are required to confirm this finding.
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In Depth [Longitudinal Study]: A total of 317 socially transitioned transgender children were included in this study from the Trans Youth Project aged 3 to 12 years of age between July 2013 and December 2017. Of the included participants, 208 were initially transgender girls and 109 were initially transgender boys. Demographic information included 65.6% of participants assigned male sex at birth, mean age of 6.5 years for first transition, and average of 5.4 years since first transition at time of data collection. Of the youth in the study, 37 (11.7%) had initiated gender-affirming hormone therapy prior to enrolling in the study. The results suggested a rate of retransition of 7.3% on average of 5.37 (SD 1.74) years after initial social transition, with 94.0% living as binary transgender youth. Additionally, 1.3% re-transitioned twice, 3.5% were living as non-binary, and 2.5% were using pronouns associated with their sex at birth. The majority (69%) of children were white, non-Hispanic and 66% of participants had an annual household income greater than $75,000. Post hoc analysis suggests low rates of retransition in children who transitioned prior to age 6 were more likely to be currently living as cisgender than children who transitioned later, where the younger group had a higher rate of retransition (p=0.02 on Fisher exact test), although the rate was low in both groups (n=7 vs n=1; 5.6% vs 0.5%).
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