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

• Published in: The International Journal of Transgenderism 2018-04, Vol.19 (2), p.251-268
• Main Authors: Ehrensaft, Diane, Giammattei, Shawn V, Storck, Kelly, Tishelman, Amy C, St. Amand, Colt
• Format: Article
• Language: English
• Subjects: Clinical medicine; Gender; Gender diversity; gender expansive; prepubertal; social transition; standards of care; transgender children
• ISSN: 1553-2739; 2689-5269; 1434-4599; 2689-5277
• DOI: 10.1080/15532739.2017.1414649

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.