The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018)

ABSTRACT

Temple Newhook et al. (2018) provide a critique of recent follow-up studies of children referred to specialized gender identity clinics, organized around rates of persistence and desistance. The critical gaze of Temple Newhook et al. examined three primary issues: (1) the terms persistence and desistance in their own right; (2) methodology of the follow-up studies and interpretation of the data; and (3) ethical matters. In this response, I interrogate the critique of Temple Newhook et al. (2018).

KEYWORDS:

• Desistance
• developmental psychiatry
• DSM-5
• gender dysphoria
• gender identity disorder
• persistence
• transgender

Notes

1 I wrote the first draft of this essay “masked” to the identity of the authors. In the interest of transparency, now that I know who the authors are, two points: The second author, Tosh, has been no fan of mine, as exemplified in the scholarly title of an essay penned for the Psychology of Women Section Review of The British Psychological Society entitled “‘Zuck off’! A commentary on the protest against Ken Zucker and his ‘treatment’ of childhood gender identity disorder” (Tosh, 2011). The fourth author, Pyne, has not exactly been a fan either. In March 2016, I filed a “statement of claim” (in plain English, a lawsuit) against Pyne and the Toronto Star Newspapers for a piece written by Pyne (2015). As noted in the Toronto Star on December 19, 2017, “This material was subject to legal complaint by Dr. Kenneth J. Zucker, which has been resolved” (https://www.thestar.com/opinion/commentary/2015/12/17/discredited-treatment-of-trans-kids-at-camh-shouldnt-shock-us.html).

2 Per Bouman et al. (2017), the term “birth assigned sex” was suggested as part of the language policy for the 2017 meeting of the European Professional Association for Transgender Health. It was recommended over the terms “natal male or natal female.” Natal is defined as in “relation to the...time of one's birth” (Soares, 2001). In the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013), terms such as “natal girls” and “natal boys” were used. It seems to me that all of these options are reasonable.

3 If one googles “Devita Singh doctoral dissertation,” the pdf of the dissertation is the first entry (see also https://search.library.utoronto.ca/details?9017513).

4 I use the diagnostic term “gender identity disorder,” along with the diagnostic term “gender dysphoria” because the former was the diagnostic label at the time of the follow-up studies that are reviewed.

5 The ethics protocol was such that parents were contacted first to let them know about the study and if they were willing to let us talk to the potential participants. In part, this was because we had no way or knowing if all of the adolescents or adults would have even remembered having been seen in the clinic as a child.

6 Late-onset birth-assigned females with gender dysphoria have, in recent years, become a very salient part of the clinical landscape, particularly among adolescents (see, e.g., Littman, 2017). They are not, however, exactly parallel with some aspects of the gender developmental histories of late-onset birth-assigned males.

7 It is true, however, that, several decades ago, we did a study in which 44 children referred to the clinic and their siblings were seen for psychological testing at a one-year follow-up (median interval, 371 days) that evaluated the evidence for stability and change in gender-typed behavior (Zucker, Bradley, Doering, & Lozinski, 1985). So what? It is common in specialized clinical programs at academic health science centers to conduct such types of follow-ups. Over the subsequent years, some children might have been seen for follow-up assessment, including psychological testing, on an as needed basis for clinical reasons. At times, such a re-assessment may have been for reasons completely unrelated to the child's gender identity (e.g., a learning disability, a psychopharmacology consult, etc.). So what? This is nothing more than being clinically responsible for the well-being of one's clients.