some cases, the expressed desire to be the othe r gender appears later, usually at entry into
elementary school. A small minority of childre n express discomfort wi th their sexual anat-
omy or will state the desire to have a sexual anatomy correspondin g to the experienced
gender (“anatomic dysphoria”). Expressions of anatomic dysphoria become more com-
mon as children with ge nder dysphoria approach and anticipate puberty. 
Rates of persistence of gender dysphoria fr om childhood into adolescence or adulthood
vary. In natal males, persistence has ranged fr om 2.2% to 30%. In natal females, persistence
has ranged from 12% to 50%. Persistence of gender dysphoria is mo destly correlated with
dimensional measures of severity ascertaine d 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 interventi on or receiving ther-
apeutic interventions of various types, ranging from ac tive 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 b een followed longitudinally in a systematic
manner. For both natal male and female ch ildren showing persistence, almost all are
sexually attracted to individuals of their na tal sex. For natal male  children whose gender