A Melbourne Gender Study Scored 234 Children on Their Transition Goals and Left Wellbeing Out

At the Royal Children’s Hospital Gender Service in Melbourne, the paperwork reaches a family before any clinician does. In the four weeks or so before a first appointment, the young person and a parent each fill in a questionnaire, and the child’s version asks a run of plain questions about name, pronouns and appearance, setting by setting: home, school, friends, extended family and, for those 12 and older, online. Researchers have now used years of those answers to sort 234 children aged 8 to 17 by a single measure, the share of the changes they wanted that they had actually made. Whether making them left the children any better off was not part of the analysis.

The paper, by Will Conabere and colleagues at the Murdoch Children’s Research Institute, the research arm attached to the hospital, appeared in The Lancet Regional Health – Western Pacific, and the institute announced it this week as the first prospective longitudinal study of how social transition changes over time. It drew on data gathered between 2017 and 2024, with each child surveyed annually two or three times.

The results come as four trajectories. Some 56.4 percent of the children, 132 of them, met their goals at every survey wave; 22.2 percent, or 52, got there by the last one; 15.4 percent, or 36, never met them; and 6.0 percent, 14 children, met them at first and later fell short. Attainment tracked family functioning (p = 0.00075) and gender identity, with trans boys, patients born female, more likely than trans girls to reach their goals. Conabere’s summary in the release was that “social transition is often an evolving process,” and the paper calls it “a dynamic, non-linear process driven by evolving personal goals.”

The yardstick behind those trajectories got less attention in the release than it deserves. In the paper’s full text, attainment is the share of a child’s desired practices already enacted, with a practice counted as desired if the child marked it “Done” or “One day.” Answers of “I don’t want to” are excluded, so a change a child stops wanting leaves the calculation entirely, and a child who gives up a goal they hadn’t yet reached ends up with a higher score than before. “I don’t know” was treated as no desire to transition. The authors concede that measuring net change at each annual wave masks the order in which children added and dropped things.

Under that arithmetic, the movement the paper does report, which runs in both directions, is harder to read than four tidy trajectories suggest. Goals changed for 60.7 percent of the children, 142 of them. Within the cohort, 11.5 percent, or 27, decreased their goals, and 10.3 percent, or 24, removed a practice they had already adopted in at least one setting. Of the 14 who lost attainment, the authors write that none removed every step they had taken and none re-identified as cisgender. Those are useful facts, reported by a paper that was never built to say what any of them meant for the child.

The cohort behind it, called Trans20, enrolled 618 patients between February 2017 and February 2020 and was set up to follow long-term outcomes including mental health, schooling, family functioning and quality of life. To reach 234, the paper kept only children aged 8 or older who had answered the social-transition questions at baseline and at least once more; 137 were excluded for having a single wave, and 116 of those who remained contributed just two. Its authors say future research should examine how social transition relates to wellbeing and mental health. The cohort tracks the children’s mental health. This paper left it out of the analysis.

That leaves untouched the question a University of York team flagged when it reviewed the evidence for England’s Cass Review. It found 11 studies of social transition in under-18s, most of them low quality, mostly American and cross-sectional; children who had socially transitioned showed no difference in mental health outcomes, and the adolescent evidence was mixed. The reviewers concluded that “there are no prospective longitudinal studies with appropriate comparator groups.” The Melbourne paper is prospective and longitudinal, but it follows no comparable children who did not socially transition, and it does not even compare its own high- and low-attainment groups on how they were faring, so it cannot say whether social transition helps, harms or does neither.

The same group had already given its view of where that argument stands. In a 2025 paper on the cohort’s baseline data, published in the International Journal of Transgender Health, the authors wrote of “the present political climate, where misinformation about social transition is widespread,” and in the same sentence cited the Cass Review for claims that social transition sustains trans identity or does not benefit young people’s mental health. The second of those claims concerns an outcome their cohort collects, and their new paper had the longitudinal data to begin examining it.

That baseline paper is also candid about who is in the cohort. Of the 482 patients aged 8 to 17 it analyzed, 84.6 percent had already changed their name and 86.2 percent their pronouns in at least one setting before their first appointment, and 30.7 percent came from Australia’s most advantaged socioeconomic fifth. The measures were not co-designed, and examining their performance and validation was, in the authors’ words, “beyond scope.” Because social transition was long a condition of access to gender care, they added, “It is therefore possible that young people felt it necessary to overstate their social transition.” The longitudinal paper rests on the same kind of self-reported answers, collected around a service that decides on treatment, and nobody knows how large any such bias in it might be.

The family finding carries the same limit. Family functioning was measured with the General Functioning Scale of the McMaster Family Assessment Device, a general instrument rather than a test of whether parents back a transition, and better-functioning families went with higher attainment. The institute presents that as a lesson about support. What it shows is that children from cohesive families made more of the changes they wanted, which is a different thing from showing those children were better off, and the design can’t tell which way the influence ran.

The disclosures are in the paper, where disclosures usually sit. Ken C. Pang reports honoraria from WPATH, the international body that writes the standards of care for gender-affirming treatment, and an editorial board role at the journal Transgender Health; Michelle A. Tollit co-chairs the research committee of AusPATH, its Australian counterpart. Funding came from the Royal Children’s Hospital Foundation, the Hugh D. T. Williamson Foundation and the National Health and Medical Research Council, through grant GNT2006529.

That last funder has another job. On 31 January 2025, after Queensland halted publicly funded hormone treatment for under-18s, Health Minister Mark Butler asked the NHMRC for a comprehensive review of Australia’s standards of care for trans and gender-diverse children and adolescents, and for new national guidelines written to the international GRADE approach, which rates evidence by the outcomes that matter to patients. Which papers enter that review is the council’s call. The question its guidelines have to answer is whether social transition helps children, and the council has already paid for a cohort that follows these children’s mental health, and for a paper that scored their goals.

Sources

1. Conabere et al., “Trajectories of social transition among trans children and adolescents in Victoria, Australia: a longitudinal descriptive study,” The Lancet Regional Health – Western Pacific (2026)
2. Full text of the Conabere et al. study, PubMed Central
3. Buckingham et al., “Social transition in young trans people accessing gender-affirming care,” International Journal of Transgender Health (2025)
4. Hall et al., “Impact of social transition in relation to gender for children and adolescents: a systematic review,” Archives of Disease in Childhood (2024)
5. Murdoch Children’s Research Institute release, via News-Medical (October 20, 2026)
6. Trans20 cohort profile, Atlas of Longitudinal Datasets
7. The Medical Republic, “Butler orders NHMRC review of gender-affirming care for kids” (January 31, 2025)