The study of 317 transgender kids age 3-12 shows that their gender identity is just as strong as that of cisgender kids.

This week, we’re going to delve into an issue that is fraught with cultural, sociological and scientific controversy. It’s an area that has become something of a political football as well. So before we dig into this study, looking at gender development among transgender children, appearing in the Proceedings of the National Academy of Sciences, let’s acknowledge that emotions around this issue run hot, but that we’re not here to talk about emotions.

OK. The study centers around a cohort of 317 transgender children, all between the ages of 3 and 12. 208 of them, 65% were transgender girls. To define our terms, this means they were born with male genetics and genitalia, but, at some point prior to enrollment in the study, socially transitioned to living as a girl.

The central question examined was how strongly these kids experienced that gender identity.

They assessed this across a variety of domains including toy and clothing preferences, peer preferences – who they preferred to play with, and how similar they felt to other members of their lived gender.

Before I show you the results, I want to point out that we could hypothesize either direction here. One could imagine that transgender children who have transitioned, might demonstrate a particularly strong affinity for their current gender, perhaps in an effort to reclaim the experience denied them when they were younger. Alternatively, they might have a weaker affinity for their current gender due to the culturalization of the years living as the opposite gender.

What the authors found was fairly striking – transgender kids, across almost all domains, had basically the same affinity for their current gender as cisgender controls as well as their cisgender siblings.

Transgender girls liked playing with dolls, wearing dresses, and playing with other girls just as much as cisgender girls. Transgender boys felt they were as similar to other boys as cis-gender boys. 

I spoke with lead author Selin Gulgoz about the results. She was struck by the remarkable similarity in data between the transgender and cisgender kids.

“If I saw the data of any random participant I would not be able to tell if that child is transgender or cisgender and I think that’s really interesting”. 

-Selin Gulgoz, PhD

Lead Author

Of course it’s important to note that these families chose to participate in the study – it’s unlikely they reflect the experience of all transgender children out there.

OK, I think there’s a potential reaction to this study that we should address. It’s this idea that basically, how does a 3 year old have any idea what gender they are?

Well, prior research on cisgender children has shown that gender identity – the sense that “I’m a girl” or “I’m a boy” actually emerges quite early – around 2 years old.

But I think there is an intuition that this is socially-induced. In other words, my two year old thought she was a girl because I told her she was a girl, and dressed her like a girl. Are parents of transgender children affecting their gender identity, or is it more internal?

The study offers two ways to look at the question. First, they examined the cisgender siblings of the transgender kids. Those siblings had just as strong an affinity for their own gender, suggesting these aren’t families that are particularly different with regards to gender socialization.

Second, in a rather clever analysis, the researchers had blinded scorers look at photographs of the children from prior to transition, on “special” days where the children were unlikely to dress themselves – like early birthdays and Halloween.  Here’s Dr. Gulgoz again:

“What we found is that actually parents in those early years were very much treating their children or at least dressing them and decorating their nurseries and cribs aligned with their assigned sex.”

-Selin Gulgoz, PhD

Lead Author

This is evidence that these kids’ gender identity was not imposed upon them – it began internally. Transgender girls feel like girls and then adopt the socially-acquired signals of femininity – not the other way around.

Of course, we’re only beginning to understand the complex interplay of biology and gender. It will take more time, and probably more open minds, before a deep understanding emerges.

This commentary first appeared on medscape.com.