"Desistance": A multi-method review of the literature on gender identity variability in transgender and gender diverse youth

The rates of persistence and desistance in transgender identities (broadly defined) are among the most common rhetorical points in legal and ethical debates over transgender health. Originally popularized by a researcher’s blogpost, political and legal action restricting gender-affirming care (GAC) claim that 60-90% of youth presenting for care “desist” from a transgender identity on the basis of informally 11 reviewed datasets. Our multi-method synthesis of this literature, in contrast, uses and finds: (1) a series of meta-analytic estimates suggesting very heterogeneous and fickle estimates of desistance from both these studies alone, and when supplemented by more recent samples, (2) simulations suggesting that volunteer bias compromises how informative these estimates can be, and (3) a qualitative review revealing serious conceptual problems, outdated assumptions, and substantial methodological limitations. These analyses undermine the popularized “60-90%” desistance estimate that commonly underlies policy efforts intended to restrict access to gender affirming care for transgender youth. Attempts to justify such legislative and healthcare policy initiatives with this ostensible desistance rate reflect, at best, a misunderstanding of the nature of the scientific literature and, at worst, a motivated reading of the scientific literature.