Indicators for continuance of childhood gender dysphoria into adulthood: A critical interpretive synthesis of literature (2000–2020)

Abstract

Introduction: Health professionals are unable to predict whether gender nonconforming distress or manifestations will continue after puberty. They also hold varied ideologies about gender. Information about these indicators lacks integration to benefit decision-making about how to intervene in childhood gender dysphoria. Aims: The aim of this review was to synthesize the literature on early indicators that anticipate the continuity of childhood gender dysphoria following puberty. A secondary aim, because of the ideological debates that underpin clinical decisions in transgender health care, was to critically interpret that literature. Methods: A critical interpretive synthesis was selected to integrate and offer a critical appraisal of literature (n=20). Results: A synthesizing argument was developed from four constructs: the intensity of gender dysphoric feelings, the child’s assertion of their gender identity, the stability of gender identity, and gender is a composite of multiple selves. Conclusions: The framing of experts’ arguments fed into presumed stability of gender identity. No single homogenous indicator can be postulated, but a compartmentalizing process is needed to understand the experiential world of a child’s gender nonconformity so that one concept (dysphoria about gender identity) can be teased apart from other investments of gender, body, and sexuality. Our constructs of the intensity of feelings and gender as a composite of multiple selves were found to challenge DSM-5 criteria. Understanding that multiple transitions may occur can help a child locate a gendered positioning in which they are comfortable. This could enable health practitioners offer affirmative care while remaining cautious about using medical treatments that cannot be reversed. The search for indicators itself, however, can be considered a historical moment, given the developments in the field in the 2 years after this review was conducted.