Social transitioning, which involves changing one's pronouns, name, clothing, or hairstyle to align with one's gender identity, is increasingly common among transgender children. While concern persists that children who socially transition may later identify differently-and thus undergo a potentially distressing "retransition"-a recent longitudinal study published online May 4 in Pediatrics indicates that retransitions in this population are rare.

Figure. Kai Shappley, an 11-year-old transgender girl, speaks at a rally at the capitol in Austin, Texas, against a bill that would ban transgender girls from participating in girls' school sports. Photo by Jay Janner / Austin American-Statesman / USA Today Network.

To estimate rates of retransitioning, Olson and colleagues analyzed data from 317 participants ages three to 12 years who were enrolled in the national TransYouth Project and who completed a binary social transition before age 12. Five years after their initial transition, 94% of study participants continued to identify as binary transgender, 3.5% had retransitioned to live as nonbinary, and 2.5% had retransitioned to live as cisgender (in alignment with their sex assigned at birth). Most of the retransitions to cisgender identity occurred before age 10, and they were more likely among participants who initially transitioned before age six (5.6%) than at age six or older (0.5%).

"As more youth are coming out and being supported in their transitions early in development, it is increasingly critical that clinicians understand the experiences of this cohort," the study's authors write. They note that further research on the study population is anticipated, as the TransYouth Project plans to follow the participants for 20 years. The project is the first-ever national longitudinal study of transgender children who have socially transitioned.

The new evidence comes as many U.S. states seek to restrict or ban gender-affirming care for transgender youth. Most states' efforts thus far have targeted the provision of medical interventions, such as hormone therapy. In April, however, the Florida Department of Health released brief guidelines for health care workers stating that social transitioning "should not be a treatment option for children or adolescents." The guidelines, which also advise against other forms of gender-affirming care for transgender youth, contradict support for such care voiced by major medical organizations, including the American Medical Association, the American Academy of Pediatrics, the American Psychiatric Association, and the American Academy of Child and Adolescent Psychiatry, as well as the U.S. Department of Health and Human Services.-Diane Szulecki, editor