Studies › Steensma 2013 · Last reviewed 2026-05-16

Steensma et al. (2013) — desistance

Factors associated with desistence and persistence of childhood gender dysphoria. J Am Acad Child Adolesc Psychiatry. 2013;52(6):582–90.

Summary

In a Dutch follow-up of 127 children with gender dysphoria, only a minority (about 27%) persisted in their cross-gender identification into adolescence; the majority desisted. The study identified the intensity of dysphoria, cognitive and affective cross-gender identification and social transition before puberty as factors associated with persistence.

1. Sample

n	127 children referred 1989–2005
Age at referral	5–12 years
Persistence	~27% remained gender-dysphoric in adolescence
Desistance	~73% later identified with birth sex

2. Associated factors

Intensity of dysphoria in childhood.
Cognitive and affective cross-gender identification (not just behavioural).
Social transition before puberty was associated with persistence.
Birth sex (FtM slightly higher persistence than MtF).

3. Importance for the protocol

The high desistance rate supports the choice of the Dutch Protocol not to apply interventions in prepubertal children and to consider puberty suppression only from Tanner stage 2 onwards. It has been one of the central empirical arguments for "watchful waiting" until the awakening of puberty.

4. Debate around desistance

The methodology and interpretation of desistance figures are debated. Critics (including Olson et al. 2022) point to definitional issues — what counts as "desisted" — and to potential distortion by changes in referral patterns. See /debate/desistance-research/.

Critical note

The finding that social transition before puberty is associated with persistence has policy implications interpreted differently by different authors (Cass 2024, Zucker, Singh 2021): either as evidence of "early diagnostic certainty", or as a signal of an iatrogenic effect — that social transition itself raises the probability of persistence. The study cannot establish causality. The high desistance rate (~73%) at the same time undercuts the case for early medical intervention.¹