Rates of persistence of gender dysphoria from childhood into adolescence or adulthood vary. In natal males, persistence has ranged from 2.2% to 30%. In natal females, persistence has ranged from 12% to 50%. Persistence of gender dysphoria is modestly correlated with dimensional measures of severity ascertained at the time of a childhood baseline assess- ment. In one sample of natal males, lower socioeconomic background was also modestly correlated with persistence. It is unclear if particular therapeutic approaches to gender dysphoria in children are related to rates of long-term persistence. Extant follow-up sam- ples consisted of children receiving no formal therapeutic intervention or receiving ther- apeutic interventions of various types, ranging from active efforts to reduce gender dysphoria to a more neutral, “watchful waiting” approach. It is unclear if children ”en- couraged" or supported to live socially in the desired gender will show higher rates of per- sistence, since such children have not yet been followed longitudinally in a systematic manner. For both natal male and female children showing persistence, almost all are sexually attracted to individuals of their natal sex. For natal male children whose gender dysphoria does not persist, the majority are androphilic (sexually attracted to males) and of- ten self—identify as gay or homosexual (ranging from 63% to 100%). In natal female chil- dren whose gender dysphoria does not persist, the percentage who are gynephilic (sexually attracted to females) and self—identify as lesbian is lower (ranging from 32% to 50%).
In both adolescent and adult natal males, there are two broad trajectories for develop- ment of gender dysphoria: early onset and late onset. EarIy-onset gender dysphoria starts in childhood and continues into adolescence and adulthood; or, there is an intermittent pe- riod in which the gender dysphoria desists and these individuals self-identify as gay or ho— mosexual, followed by recurrence of gender dysphoria. Lute—onset gender dysphoria occurs around puberty or much later in life. Some of these individuals report having had a desire to be of the other gender in childhood that was not expressed verbally to others. Others do not recall any signs of childhood gender dysphoria. For adolescent males with late-onset gender dysphoria, parents often report surprise because they did not see signs of gender dysphoria during childhood. Expressions of anatomic dysphoria are more common and salient in adolescents and adults once secondary sex characteristics have developed.
Adolescent and adult natal males with early-onset gender dysphoria are almost al- ways sexually attracted to men (androphilic). Adolescents and adults with late-onset gen- der dysphoria frequently engage in transvestic behavior with sexual excitement. The majority of these individuals are gynephilic or sexually attracted to other posttransition natal males with late-onset gender dysphoria. A substantial percentage of adult males with late-onset gender dysphoria cohabit with or are married to natal females. After gen- der transition, many self—identify as lesbian. Among adult natal males with gender dyspho- ria, the early-onset group seeks out clinical care for hormone treatment and reassignment surgery at an earlier age than does the late-onset group. The late-onset group may have more ﬂuctuations in the degree of gender dysphoria and be more ambivalent about and less likely satisfied after gender reassignment surgery.