Stability of Transgender Identity in Adolescents Seen in Multidisciplinary Specialized Gender Centers: A Multicenter Study in Canada

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PURPOSE: To determine the proportions of adolescents continuing with their gender identity after referral to specialized gender clinics, the proportion continuing with gender-affirming hormones, and the proportion who detransition. METHODS: A retrospective chart review was conducted for adolescents referred with gender dysphoria to four Canadian pediatric endocrinology gender clinics between 2012 and 2017. RESULTS: For the 445 adolescents, median gender clinic follow-up was 2.4 years (interquartile range: 1.1-7.2); 331 (74.4%) were assigned female sex at birth (AFAB) and 114 (25.6%) assigned male (AMAB). Mean (standard deviation) age of reported gender dysphoria onset was 9.5 (3.6) years. In total, 421 (94.6%) continued with their presenting gender identity or reidentified as non-binary, while 24 (5.4%) changed back to gender identity typically aligned with their birth sex. Among 317 AFAB identifying as male at referral, 15 (4.7%) changed gender identity: 10 to female and five to non-binary. Of the 109 AMAB youth identifying as female at referral, five (4.6%) changed gender identity: three to male and two to non-binary. Among the 19 adolescents identifying as non-binary at referral, four (21.0%) changed gender identity: three AMAB to female and one AFAB to male. Gender-affirming hormones were started by 353 (79.3%) and discontinued by only four (1.1%) of adolescents. DISCUSSION: The majority (97.1%) of adolescents continued to identify with a gender not typically aligned with their birth sex. Only 2.9% reverted to a gender identity aligned with their birth sex. None who initially identified as non-binary returned to binary gender aligned with birth sex. Discontinuation of gender-affirming hormones was rare.

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