New research finds that young transgender children who have "socially transitioned" -- living their lives under the gender they identify with -- had positive mental health outcomes.
Until now, studies had shown significantly higher rates for depression and anxiety in transgender children. Nearly half attempt suicide by age 24.
Researchers at the University of Washington looked at 73 children ages 3-12 living as their identified gender and compared those children against two control groups -- their own siblings and another group. They found average scores for depression and only slightly elevated anxiety rates.
"It puts out the possibility that being a transgender child doesn't have to be associated with negative mental health outcomes in the way that to date the research has suggested," said Kristina Olson, Ph.D., lead author of the study and director of the university's TransYouth Project. She hopes to follow these children for 20 years.
It is the first analysis of mental health outcomes in a group of socially transitioned transgender children. The study was published in the journal Pediatrics.
Parents who had suspected their children might be transgender and began research on their own would find depressing mental health outcomes, until now.
"Those felt like terrifying statistics to hold as a parent," said Alison Pennington, 42, of Oakland, one of the families in the study. She and her partner have two children, an older girl and a second child, now 6, born as a boy.
By age 3 and a half "it became increasingly clear," Pennington said, "that there was something going on ... that was pulling him into the realm of traditional girliness, and as it continued, it grew in intensity and grew in its consistency."
The intensity of gender identity was true of most kids in the study, "These are kids who are very persistent and insistent about their gender identity," said Olson, "and those are the only kids that experts working in this area have advised that these social transitions might be useful for."
Pennington and her partner began researching on their own and later with experts. While Pennington said she knew adults who had transitioned, "I had never heard of transgender children. I didn't know it had the capability of dating back to such early childhood."
Just before his 5th birthday her son asked to be called a girl. Pennington and her partner supported their child's choice to live as girl. She already had a gender neutral name (which Pennington declined to share, for her child's privacy) and began dressing as a girl.
"Now having a child who has lived in their identified gender for a year and a half, I have no doubt that we're making the right decision," Pennington said, adding that her daughter is well-adjusted at school and is accepted as a girl by her peers.
None of the children in the study had any medical or surgical treatments. "No one in the country does medical or surgical interventions with kids this young," said Olson. Estimates of the rate of transgender children range from 0.3 to 0.8 percent of the population.
The group of children Olson is studying, initially 73, has now grown to 153. None has transitioned back. She said her project welcomes additional participants.
In an accompanying editorial, Ilana Sherer a pediatrician and assistant medical director of UC San Francisco's Child and Adolescent Gender Center called the research "crucially important."
"Olson and her colleagues give supporters of social transition evidence of what we have suspected all along: that socially transitioned children are doing fine, or at least as well as their age-matched peers and siblings. This finding is truly stunning in light of the numerous studies that show depression and anxiety ... up to 3 times higher for non-socially transitioned children."
For the children in this study, family support appears to be key. But Olson pointed out that it's a big decision for a family to take the step of supporting a socially-transitioned child, and not all families today are likely to make this decision.
"Probably there are some attributes about the families who have done this that are unique to them," Olson said. She stressed the need for more research to illuminate whether it's those "other qualities" or the social transition itself that promotes the positive mental health outcomes seen in this analysis.