Journal Club: When Do People Know They Are Trans?
A 2021 study takes a look at the discovery of transgender identity in youth and the ways expressing that, or not expressing that, affects trans people as they age.
by Veronica Esposito
Right-wingers and reactionary centrists like to pose transgender people as akin to a contagion sweeping through society—just one wrong move and it could easily infect the children of unsuspecting parents. An associated talking point is that, because trans identities are seen by some as the product of fad, the surgeries and hormonal treatments needed by the community are at best bizarre cosmetic procedures—as such, they should not be considered essential medical care and should only be offered to those with a “fully developed brain.”
Such talking points necessarily infantilize trans people and imply that they are not capable of making decisions—even though 18-year-old Americans can vote and purchase a gun, and 21 year-olds can legally drink alcohol. Furthermore, research has demonstrated adolescents’ competence to make medical decisions, and cisgender adolescents are regularly granted autonomy to make decisions around various surgical and cosmetic procedures.
A 2021 research paper by Michael Zaliznyak and colleagues puts the lie to these myths. The researchers found that, regardless of current age, trans men and trans women tend to recall their first experience of gender dysphoria around age 6. For over 80 percent of the participants, the experience of gender dysphoria was among their earliest memories.
Importantly, the researchers also found that individuals tend to agonize over their transness for years before engaging in medical treatment—23 years for trans men, and 27 for trans women. (That gap of 4 years likely reflects the much greater stigma attached to transfeminine individuals.)
And putting the lie to another myth—that gender-affirming care is not dearly needed—18 percent of surveyed trans men had attempted suicide prior to beginning medical treatment, and 30 percent of the trans women. None of the participants reported an attempt after beginning gender-affirming treatment. This research also blatantly contradicts the frequent assertions that trans children are being rushed into irreversible medical procedures, and that trans identification is on the rise because it is fashionable. On the contrary, it shows that if anything, trans people are waiting much too long to access medical treatment for an extremely debilitating condition.
How did Zaliznyak and colleagues reach these conclusions? They recruited 210 participants from the ranks of trans people presenting to Cedars-Sinai Medical Center in pursuit of gender affirmation surgery. Researchers then subjected each participant to a series of questions regarding their history of gender dysphoria, as well as medical and mental health histories.
One interesting finding that this research unearthed through a variety of statistical analyses is that “there was no significant association between current age and age of earliest recollection of GD.” In other words, those who came out and pursued gender-affirming treatment later in life did not experience gender dysphoria at a correspondingly later age, they simply endured the pains of the malady for a longer period. These findings are summed up in the following graph.
These findings are consistent with other research into gender, which tells us that most children grasp the concept of gender between ages 5 and 7. Zaliznyak et al. also notes the astonishing fact that over 10 percent of their participants had endured untreated gender dysphoria for over 50 years.
The researchers’ findings speak to the importance of widespread education regarding gender dysphoria—those children who do not seek treatment during childhood are at greater risk of delaying any treatment for gender dysphoria until much later in life:
[for] children whose GD persists into adulthood, lack of awareness of the child’s experience and symptoms of GD increases the risk that GD will continue untreated throughout early childhood and early adulthood, increasing the risk to delay an adequate support and referral to specialized gender clinics. Given the well-defined morbidity of untreated GD, its cumulative morbidity can clearly be significant.
This research was further supported by a 2023 paper authored by Jack Turban and colleagues. This study of some 27,497 trans individuals pulled data from the 2015 U.S. Transgender Survey to determine that, among those who realized they were trans as a child, on average they waited 14 years before telling a single other person. As Turban et al. noted, their research undercuts the myth that transness is some sort of social contagion that threatens children:
The current study examined the notion that [transgender] TGD identities associated with “later realization” are transient and will not continue into adulthood. Though prevalence estimates from nonprobability samples should be taken with caution, in this study of 27,497 TGD adults, a substantial proportion of participants (40.8%) reported that they did not come to realize their TGD identities until adolescence or later, in contrast to the assumption of identity transience for this group that is an inherent component of the [rapid onset gender dysphoria] hypothesis. While prospective data would be needed to determine the precise percentage of continuation of TGD identities for those who come to understand their gender identity in adolescence or later, this study shows that adolescent or later realization of one’s TGD identity is not uncommon among TGD adults.
In the face of this scientific research, it should not be forgotten that no research has ever demonstrated that gender dysphoria is contagious, or that trans individuals are being rushed into treatment. On the contrary, there is a wealth of evidence that gender dysphoria is a very profound, lifelong malady, and that there are currently far too many barriers to its effective treatment in both children and adults.
At a time when lawmakers are hard at work taking away this medical care from as many trans people as possible, it is an absolute crime that such research is being ignored in favor of complete falsehoods.
Veronica Esposito (she/her) is a writer and therapist based in the Bay Area. She writes regularly for The Guardian, Xtra Magazine, and KQED, the NPR member station for Northern California, on the arts, mental health, and LGBTQ+ issues.