Prepubertal social gender transitions: What we know; what we can learn—A view from a gender affirmative lens

ABSTRACT

  Background : This article provides a review and commentary on social transition of gender-expansive prepubertal youth, analyzing risks, and benefits based on a synthesis of research and clinical observation, highlighting controversies, and setting forth recommendations, including the importance of continued clinical research.

Methods : This article involved: (1) a review and critique of the WPATH Standards of Care 7th edition guidelines on social transition; (2) a review and synthesis of empirical research on social transition in prepubertal children; (3) a discussion of clinical practice observations; (4) a discussion of continuing controversies and complexities involving early social transition; (5) a discussion of risks and benefits of social transition; and (6) conclusions and recommendations based upon the above.

Results : Results suggest that at this point research is limited and that some of the earliest research on young gender-expansive youth is methodologically questionable and has not been replicated. Newer research suggests that socially transitioned prepubertal children are often well adjusted, a finding consistent with clinical practice observations. Analysis of both emerging research and clinical reports reveal evidence of a stable transgender identity surfacing in early childhood.

Discussion : The authors make recommendations to support social transitions in prepubertal gender-expansive children, when appropriate, as a facilitator of gender health, defined as a child's opportunity to live in the gender that feels most authentic, acknowledging that there are limitations to our knowledge, and ongoing research is essential.

KEYWORDS:

• Gender diversity
• gender expansive
• prepubertal
• social transition
• standards of care
• transgender children

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Note

Declaration of conflict of interest

The authors declare that they have no conflict of interest concerning this article.

Notes

1. It should be mentioned in this discussion that since Money's first publications his clinical practices, research projects, and published papers have been brought under scientific scrutiny, regarding both improper use of subjects without informed consent or ethical considerations, misrepresentation of data, and resulting false assertions that one's gender identity was predominantly shaped by sex labeling, social reinforcement, and messaging, an assertion most commonly disseminated in the story of John/Joan. In real life, John-David Reimer, was an infant twin who had his penis mutilated in a botched circumcision procedure, leading to Dr. Money taking the family on as patients and research subjects, advising the parents to do a genital reconstruction during infancy and raise David as a girl, a failed experiment which later led to deep psychological distress and David reclaiming life as a male in adolescence, which he was able to do for 20+ years until his death by suicide at age 38.