This post is part of Outward, Slate’s home for coverage of LGBTQ life, thought, and culture. Read more here.
What if there were a psychological test to tell if someone was transgender? Would the controversies over trans youth disappear if there was a clear way to sort out which children would grow up to be transgender adults and which ones would not?
In an upcoming paper for Psychological Science, as reported by the Atlantic, researcher Kristina Olson and her team found differences between children who would later go on to transition (by changing the pronouns that they used) and those who did not. Their longitudinal study found that the future transitioners were similar on measures of gender identity and gender-nonconforming behavior to trans children who had already changed their pronouns, and that both the future transitioners and the trans youth were similar to a control group of cisgender children of the opposite sex. Importantly, the gender-nonconforming kids who transitioned differed significantly from the ones who did not—think a boy who often wore dresses, but still felt himself to be a boy after the 12- to 18-month follow-up. The study also found that the behavior of these children did not change further after they transitioned; they did not become more masculine or feminine as a result of changing the pronouns that they used. (This runs contrary to the anti-trans hypothesis that imagines gender nonconformity as being like a progressive illness that starts small and ends in transitioning if parents fail to nip it in the bud.) The result builds on Olson’s previous research, which showed that transgender youth in an affirming environment have no more mental health issues than their cisgender peers, and that the gender identity and expression of trans youth is similar to that of cisgender peers of the opposite assigned sex.
As the paper itself cautions, this research deals with group differences only. There’s currently no way to tell whether a given individual will go on to transition or not. Still, the data suggests that even among gender-nonconforming children, kids who transition are different from those who don’t, and that these differences already exist before a child begins living as a different gender than they were assigned at birth.
So will there ever be a test that predicts whether a person will grow up to be trans? And, if there was, would it be a good thing or a bad thing for those of us who are trans?
The Olson team’s paper is careful not to say they have identified a test for transness, but it does hint at what such a test might look like. According to the data, gender-nonconforming children who eventually transitioned were more strongly gender-nonconforming than their nontransitioning peers: They liked more toys typically associated with the opposite sex, were more likely to say they were already part of the other sex or would grow up to be that sex, dressed in a way closer to that of the other sex, etc. It’s easy to imagine a codified version of these measures being used to help parents of gender-nonconforming children understand how strongly gender-nonconforming their children are compared with others, and therefore how likely those children are to transition later in life. Of course, such a test wouldn’t be perfect, but medicine doesn’t create perfect tests; every blood test has an error rate, to say nothing of psychiatric tests like this, which measure attitudes, behavior, or mood.
This could be good for some transgender youth whose parents were on the fence about whether to affirm them or try to discourage them from changing their name and pronouns to reflect their gender identity. But it could also make it more difficult for the outliers, the kids who don’t test as being extremely gender-nonconforming but are still, nevertheless, trans.
Another study that’s been on my mind since I read the Atlantic’s coverage of the Olson team’s work is Lisa Littman’s paper on so-called rapid-onset gender dysphoria. Littman’s study (whose many limitations have been covered extensively, including on Slate) posits that while some children with extreme gender nonconformity from earliest childhood might be trans, there’s another group of children with less extreme gender-nonconforming behavior who are lying or mistaken about being trans. (ROGD, which has not been demonstrated in any study of trans youth, is convenient for people who want to limit trans rights because it posits that visibility and acceptance for actual trans people should stop because it is causing a public health crisis in the form of falsely trans ROGD kids.) Although Littman’s methods don’t have the rigor that Olson’s work does, it’s easy to see how one could reconcile a belief that the most intensely gender-nonconforming kids are really trans while other young people that claim to be trans are lying or mistaken.
Littman’s ROGD paper has nagged at me since it was published because I see myself in its depiction of mistaken, falsely trans youth. Like most of the young people depicted in that paper, I was raised as a girl. I was mildly gender-nonconforming at most, and I did not insist that I was really a boy from a very young age. In fact, I didn’t know I was transgender until I was an adult; I didn’t have the words to describe what gender dysphoria felt like to me. Like many of the kids described in the anecdotes that Littman shares in her paper, I too struggled with depression and anxiety as a young teen. I didn’t tell my parents I wanted to transition, but I began wearing men’s clothing as a teenager around that time—which was perceived as a phase and a sign of depression or low self-esteem.
Put simply, any picture of gender dysphoria that rests on children knowing their gender identity from earliest childhood is a picture that doesn’t include me. And it’s not just me—it may leave out a lot of trans men in particular. The large majority of gender-nonconforming children in the Olson team’s starting sample were assigned male at birth, as were 83 percent of the “future transitioners” (i.e., those who identify as trans women). It may turn out that gender dysphoria develops differently in trans men than it does in trans women, and that a later onset is more common for trans men.
Further research could help to clarify the most common ways that gender dysphoria presents itself and whether that course differs between trans women and trans men. It can also strengthen the existing research that suggests medical transition is safe and effective as a treatment for trans people who wish to pursue it. But there are things that research can never do. It can’t say with certainty that medical transition will be right for a specific person or decide for them which medical interventions to try. There will always be people who successfully pursue transition that don’t look like the typical case, and there will always be people who start to transition and later change their minds, or who come to feel that a medical intervention like hormones wasn’t really the right choice for them.
So what if there is, eventually, a screening mechanism that can tell whether a child is likely to grow up to be transgender? It won’t change much. Parents will still feel frightened and unsure about the best way to help their gender-nonconforming child thrive. Adults will still have to make decisions about which treatments to pursue; often those decisions will be right, but sometimes they will be wrong. Acceptance of trans people who fit the established mold may improve, but at the same time a test would provide justification for treating those who don’t with suspicion. Scientific research can give us a framework for understanding, but in the end, it can’t tell us who we are or how to live our lives.