A remarkable omission in all of the studies mentioned, is the very high risk of self harm and suicide amongst the transgender community and in particular adolescents. These are very likely to constitute a subgroup of the sample population and in particular in the ‘non-responder’ group.
Recent data from The Williams Institute, suggests that 41% of trans or gender non-conforming people attempt suicide at some time in their life (cf 4.6% of normal population and 20% in the lesbian/gay/bisexual community). The incidence is higher in MtF population than the FtM (46% v 42%) and is particularly high in adolescents and young people (45%). If there are pre-existing significant mental health issues, then suicide attempts climb to over 60% and many trans people are under treatment at mental health units.
This has been particularly relevant in the USA following the suicide of Leelah Alcorn, whose suicide note highlighted the bullying and discrimination of transgender people.
Her death led to widespread calls in the social media for her parents to face criminal charges and the establishment of ‘Leelah’s law’ for the banning and criminalisation of conversion therapy in the USA (https://en.wikipedia.org/wiki/Death_of_Leelah_Alcorn). This was strongly supported by Barack Obama, who called for the banning of conversion therapy for minors. Following this, Washington D.C. and Cincinnati have both criminalised conversion therapy, citing Leelah’s case in particular. Other major cities are likely to follow.
It is remarkable therefore, that when these studies talk about ‘desistence’ and ‘non-responders’ that no suggestion is made that some of these children may have committed suicide or be under extensive psychiatric treatment.