Social transition evolves as trans young people refine their goals

A prospective observational study of 234 trans children and adolescents aged 8 to 17 in Victoria, Australia, found that social transition is an evolving process involving changes in names, pronouns and appearance. Participants were followed for up to two years, and more than half consistently achieved the social transition goals they set. Younger participants were more likely to add goals over time, trans boys were more likely than trans girls to meet their aspirations, and stronger family functioning was associated with greater goal attainment.

The results, published in The Lancet Regional Health – Western Pacific, describe substantial variation within the cohort rather than a single pathway shared by all trans young people. The MCRI-led study was described as the first prospective longitudinal investigation to examine how social transition changes over time. Researchers assessed how goals developed across home, school, online spaces, friendships and extended family relationships.

Social transition in the research included changes intended to align how a young person is known and presented with their gender identity, such as using a different name or pronouns and changing appearance. Because the study followed participants across multiple settings, it captured social transition as a process occurring within relationships and environments rather than as an isolated event. Its observational design documents patterns and associations but does not establish that any particular change or form of support caused an outcome.

The clearest age-related finding was that younger children were more likely to add to their social transition goals during follow-up. The supplied results do not indicate that goals remained fixed, nor do they show that every participant broadened them in the same way; they establish that additions to goals were more common among the younger group. MCRI researcher Will Conabere said the study showed social transition was often evolving as young people developed and better understood themselves.

He said families, schools and healthcare providers should respond to each young person’s individual needs rather than expect everyone to follow the same path, an interpretation consistent with the study’s descriptive finding that goals changed over time. Gender was also associated with goal attainment. Trans boys were more likely than trans girls to meet the social transition aspirations they set during the study, although the supplied findings do not identify a single reason for that difference.

The observational cohort cannot determine whether particular barriers caused the gap, and the result should not be interpreted as a universal rate for all trans boys or trans girls. MCRI researcher Dr Pip Buckingham said the lower rate among trans girls warranted greater attention to the reasons behind the gap. She said environments should be created in which trans girls and trans women are supported and safe to live as their true selves, while the study itself leaves the underlying causes of the observed difference unresolved.

Family functioning was linked to participants’ likelihood of making the changes they wanted. Young people whose families communicated well, provided support and demonstrated effective problem-solving were more likely to achieve their social transition goals. This was an association within the observed cohort, not proof that family functioning by itself produced the successful changes, and it does not imply that families outside the study provided inadequate support.

The finding nevertheless identifies communication, support and problem-solving as factors that varied alongside goal attainment. In a cohort in which social transition goals could evolve, the results also underline the need to accommodate changing individual preferences rather than treat an initial plan as fixed. A separate MCRI-led study published in JAMA Pediatrics examined the gender-related clinical presentation of non-binary children and adolescents attending a specialist gender service.

The proportion of non-binary young people among those attending the service increased from 14.2% in 2017 to 39% in 2023. This is a change in the composition of the specialist-service population; it does not show that the prevalence of non-binary identity among all young people increased by the same amount. The research also found that almost all non-binary participants reported high levels of gender dysphoria compared with their binary trans peers, while non-binary young people generally reported higher body satisfaction and a lower desire for some forms of medical affirmation.

Those findings did not amount to a uniform rejection of physical or medical affirmation. Almost all non-binary participants wanted to change at least one body part or feature, with breasts, the chest and the voice most commonly identified. Most also wanted social affirmation through changes in presentation, name or pronouns.

The results therefore describe a combination of generally higher body satisfaction, substantial gender dysphoria for many participants and specific goals for physical or social change. They do not establish that all non-binary young people have the same needs, nor do they show that lower interest in some forms of medical affirmation means an absence of interest in affirming care. The service figures also cannot identify what caused the change in attendance proportions.

A third study, led by MCRI with the University of Melbourne and Swinburne University of Technology and published in eClinical Medicine, examined gender euphoria among more than 700 trans and gender-diverse Australians aged 16 to 79. The researchers defined gender euphoria as the positive feelings associated with living in a way that aligns with a person’s gender identity. Most participants reported experiencing gender euphoria at least once a week, but the reported experiences varied according to age, gender identity and access to gender-affirming care.

Non-binary participants reported higher levels of euphoria associated with community connection but lower levels of self-affirmation euphoria than their binary trans peers. Access to gender-affirming care was associated with differences in the cohort’s reported experiences. Participants who had accessed gender-affirming hormones or undergone gender-affirming surgery reported more self-affirmation euphoria.

Because this was a cohort study, the finding describes an association and does not prove that hormones or surgery produced the reported feelings. The study also covered a broad age range and included trans and gender-diverse people with different identities and levels of care access, so its results should not be reduced to a single definition of affirmation. MCRI Dr Michelle Tollit said the three studies together show that gender affirmation is not one-size-fits-all, encompassing evolving social goals, differing clinical presentations and varied experiences of euphoria.

Taken together, the studies present gender affirmation as a diverse experience shaped by individual goals, relationships, identity and access to care. The research does not test a single clinical pathway or demonstrate that one form of support benefits every participant. Its practical implication, as described by the researchers, is that families, schools, health services and policymakers should create flexible environments in which young people can safely express what they want and revisit their goals as they grow.

Subject of Research: Longitudinal patterns of social transition and gender affirmation among trans and gender-diverse people

Article Title: Social transition for trans young people an evolving process

Article References: Social transition for trans young people an evolving process. Original publication (Bibliographic details unavailable.)

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DOI: Not provided

Keywords: social transition, trans youth, gender diversity, gender euphoria, gender dysphoria, non-binary identity, gender-affirming care, longitudinal study, family support, Australia, Social, transition