title: Gender variance in childhood and sexual orientation in adulthood: a prospective study.
abstract: BACKGROUND
  Several retrospective and prospective studies have reported on the association between childhood gender variance and sexual orientation and gender discomfort in adulthood. In most of the retrospective studies, samples were drawn from the general population. The samples in the prospective studies consisted of clinically referred children. In understanding the extent to which the association applies for the general population, prospective studies using random samples are needed.
  
  
  OBJECTIVE
  This prospective study examined the association between childhood gender variance, and sexual orientation and gender discomfort in adulthood in the general population.
  
  
  METHODS
  In 1983, we measured childhood gender variance, in 406 boys and 473 girls. In 2007, sexual orientation and gender discomfort were assessed.
  
  
  METHODS
  Childhood gender variance was measured with two items from the Child Behavior Checklist/4-18. Sexual orientation was measured for four parameters of sexual orientation (attraction, fantasy, behavior, and identity). Gender discomfort was assessed by four questions (unhappiness and/or uncertainty about one's gender, wish or desire to be of the other gender, and consideration of living in the role of the other gender).
  
  
  RESULTS
  For both men and women, the presence of childhood gender variance was associated with homosexuality for all four parameters of sexual orientation, but not with bisexuality. The report of adulthood homosexuality was 8 to 15 times higher for participants with a history of gender variance (10.2% to 12.2%), compared to participants without a history of gender variance (1.2% to 1.7%). The presence of childhood gender variance was not significantly associated with gender discomfort in adulthood.
  
  
  CONCLUSIONS
  This study clearly showed a significant association between childhood gender variance and a homosexual sexual orientation in adulthood in the general population. In contrast to the findings in clinically referred gender-variant children, the presence of a homosexual sexual orientation in adulthood was substantially lower.
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Steensma
authors.forename: Jan
authors.initials: J
authors.lastname: van der Ende
authors.forename: Frank C
authors.initials: FC
authors.lastname: Verhulst
authors.forename: Peggy T
authors.initials: PT
authors.lastname: Cohen-Kettenis
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012725:Sexual Behavior; D055815:Young Adult