TRANS IDENTITY: FIXED OR TRANSIENT?
Longitudinal studies are conclusive: childhood wishes to be the opposite sex usually fade with time and rarely persist into adulthood.
All studies conducted to date agree on one point: if children are simply left alone —that is, if they are not socially transitioned, if their unrealistic desires to “change sex” (which, as we know, is impossible) are not affirmed— the vast majority will move through puberty, leave those fantasies behind, and grow up to be gay or lesbian adults.
Although the results of these studies are quite consistent, it is important to note that their findings may have been influenced —at least to some extent— by external factors that encouraged some participants to persist in their wish to “change sex” or undergo transition.
This is particularly evident in Green, R. (1987). The “Sissy Boy Syndrome” and the Development of Homosexuality. New Haven, CT: Yale University Press.
Green followed 44 boys for over fifteen years. Only one of them persisted in his desire to transition.
In his book, Green includes transcripts of interviews with several participants. In his conversations with Todd —the only persistent case— we can clearly see the pressures Todd faced to continue desiring transition: not only the influence of media representations, but also the direct encouragement of Dr. Green himself, who repeatedly presented “sex change” as a real and even desirable option, without adequately warning about the medical or psychological risks of hormonal and surgical interventions.
Below are some excerpts that illustrate this dynamic.
Todd at Eighteen
Evolution of Transsexualism
GREEN: How do you feel about yourself?
TODD: The same.
GREEN: Last year you said you were feeling more and more like a woman and that you were fairly willing to undergo medical, surgical, and hormonal treatments to become one.
TODD: Mmm, because I just read this book. I read this book — The Story of Christine Jorgensen.
GREEN: Did you identify strongly with Christine, as she described her life?
TODD: Mmm.
GREEN: In what way?
TODD: Well, in every way except she said she didn’t have sexual feelings toward men.
GREEN: You do?
TODD: Yes, but apart from that everything was the same. It was really strange. My mother also bought that book for me. She brought home three books and that was one of them.
GREEN: One of them was The Story of Christine Jorgensen? What do you think of that?
TODD: I don’t know. I didn’t know what it was until I read it. I read it, and she said, “Oh, I wish I’d never given it to you.”
GREEN: Do you think she was suggesting something to you by bringing you that book?
TODD: I guess so. I don’t know.
Obstacles to Sex Change
TODD: I don’t want to have a sex change because there are too many problems.
GREEN: What kind of problems?
TODD: Money, the time it takes, and… I don’t know, I just want to be normal. I just don’t want to do it.
GREEN: What do you mean by “normal”?
TODD: I want to be… I don’t know, it would be different.
GREEN: Different from other women?
TODD: Yes… I don’t know… I’d probably be really ugly too.
GREEN: That book by Christine Jorgensen was written many years ago, and her surgery took place about thirty years ago.
TODD: Oh.
GREEN: Suppose surgical techniques have improved a lot since then, so that with good doctors and a good surgeon today, you would actually look almost like a normal woman. Not exactly, but quite similar. How would you feel about the surgery then?
TODD: I think I’d want it. But I wouldn’t consider it until after college. Then I wouldn’t want it. I want it now.
Preparation for Change
GREEN: Before surgery, the surgeon will want you to live as a woman and take female hormones for about two years.
TODD: I don’t want to live as a woman for two years.
GREEN: Why not?
TODD: Because it seems like a waste of time, and… I don’t know… deceiving people; it’s too weird.
GREEN: Can you imagine yourself with female genitals?
TODD: I guess so.
GREEN: How does that make you feel?
TODD: I guess like a woman.
GREEN: And when you think about your penis and testicles no longer being there, how does that make you feel?
TODD: Like a woman.
GREEN: Does that scare you?
TODD: No.
GREEN: Does it make you feel like a woman?
TODD: Yes, but I don’t know if I’d feel normal. That’s what I keep thinking. I’d always know I used to be a man.
GREEN: Well, that’s true. You’d always have that history — that at one time in your life you were, in fact, a man…
These exchanges reveal several sources of influence: The Story of Christine Jorgensen (introduced by Todd’s mother), media portrayals of “sex change” as attainable, and Green’s own suggestive framing throughout their sessions. When Todd expressed hesitation —“I don’t want a sex change; there are too many problems”— Green reassured him that modern surgical techniques would make him “look almost like a normal woman.”
He then told Todd that a surgeon “would want you to take female hormones for about two years so you can have a realistic experience of living as a woman before surgery,” without mentioning any physical or psychological risks. He even proposed visualization exercises: “Can you imagine yourself with female genitals?”
At every step, Green presented medical transformation as a valid, possible, even desirable option.
It seems reasonable to conclude that, had the professional approach been more neutral —or simply more realistic— instead of subtly affirmative, the outcome of Green’s longitudinal study might have been quite different.
The fantasy that one can “change sex,” reinforced by media narratives and by many health professionals, inevitably influences vulnerable individuals who wish they had been born the opposite sex.
Appendix: All Longitudinal Studies on Gender-Dysphoric Children and Their Outcomes
(List preserved from the original sources for reference.)
Lebovitz, P. S. (1972). Feminine behavior in boys: Aspects of its outcome. American Journal of Psychiatry, 128, 1283–1289. [2/16 Gay, 4/16 Trans, 10/16 Straight/uncertain].
Zuger, B. (1978). Effeminate behavior present in boys from childhood: Ten additional years of follow-up. Comprehensive Psychiatry, 19, 363–369. [2/16 Trans, 2/16 Uncertain, 12/16 Gay].
Money, J., & Russo, A. J. (1979). Homosexual outcome of discordant gender identity/role: Longitudinal follow-up. Journal of Pediatric Psychology, 4, 29–41. [0/9 Trans, 9/9 Gay].
Zuger, B. (1984). Early effeminate behavior in boys: Outcome and significance for homosexuality. Journal of Nervous and Mental Disease, 172, 90–97. [2/45 Trans, 10/45 Uncertain, 33/45 Gay].
Davenport, C. W. (1986). A follow-up study of 10 feminine boys. Archives of Sexual Behavior, 15, 511–517. [1/10 Trans, 2/10 Gay, 3/10 Uncertain, 4/10 Straight].
Green, R. (1987). The “Sissy Boy Syndrome” and the Development of Homosexuality. New Haven, CT: Yale University Press. [1/44 Trans, 43/44 Cis].
Kosky, R. J. (1987). Gender-disordered children: Does inpatient treatment help? Medical Journal of Australia, 146, 565–569. [0/8 Trans, 8/8 Cis].
Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413–1423. [21/54 Trans, 33/54 Cis].
Drummond, K. D., Bradley, S. J., Badali-Peterson, M., & Zucker, K. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34–45. [3/25 Trans, 6/25 Lesbian/Bi, 16/25 Straight].
Singh, D. (2012). A follow-up study of boys with gender identity disorder. Doctoral dissertation, University of Toronto. [17/139 Trans, 122/139 Cis].
Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). 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, 52, 582–590. [47/127 Trans, 80/127 Cis].
Commentary on Study Outcomes
The striking difference between the earlier studies (1972–1987) and the more recent ones (2008–2013) is evident. In the older cohort, persistence rates were minimal (e.g., 1/44, 0/8), while in the newer cohort they rise sharply (e.g., 47/127).
This shift can reasonably be attributed to the growing availability and normalization of so-called gender-affirmative medicine. As this approach spread, the social and institutional pressure on gender-nonconforming children increased, and many of those included in later studies may have been socially transitioned or explicitly encouraged to view medical transition as their path forward.
A New Cohort, A New Context
An additional point deserves attention: the contemporary wave of gender dysphoria differs markedly from the clinical profiles documented in the classic literature. The new cohort is composed predominantly of adolescent girls with no early childhood history of gender incongruence. Their sudden onset of dysphoria often coincides with psychological distress, social isolation, or exposure to online communities where identity experimentation is valorized and “transition” is framed as a path to self-realization or relief.
This phenomenon, described by researchers such as Littman (2018) as rapid-onset gender dysphoria (ROGD), suggests that social contagion and psychological vulnerability now play a significant role in the surge of adolescent gender distress.
Unlike the small number of effeminate boys once studied by Green or Zucker, today’s cases reflect a broader cultural dynamic —one that merges adolescent identity struggles, digital influence, and institutional affirmation into a powerful feedback loop.
If the longitudinal lessons of the past still hold true, only an environment that allows psychological exploration without premature medicalization —and that resists the ideological certainty of “affirmation-only” models— will enable these young people to mature into stable, self-accepting adults.
When comparing the results of these 11 studies, a very clear difference emerges between those conducted before the year 2000 and those conducted afterward: in the 7 pre-2000 studies, among 148 participants, 8 persisted; in the 4 post-2000 studies, among 345 participants, 88 persisted. In other words, it went from 1 in 19 to 1 in 4. It is very reasonable to deduce that as “gender medicine” expanded, its negative impact grew, capturing more and more patients with gender dysphoria in the illusion of an —impossible— “sex change” as a solution to their distress.
Puberty blockers not only block puberty but also block the resolution of gender dysphoria. This is why they inevitably lead to hormones and surgeries, and afterward the percentage of those who die by suicide increases, and the more years that pass after medicalization, the higher the rate of patients who detransition.