Trajectories of social transition among trans children and adolescents in Victoria, Australia: a longitudinal descriptive study.

Background: The process of social transition, defined as outward changes in gender expression to align with and affirm one's gender identity, has been richly described in qualitative studies, but quantitative research often lacks the detail required to capture its full complexity. This study aimed to quantitatively examine how this process varies in transgender and gender diverse (trans) young people over time. Methods: Prospective longitudinal data (across 2-3 annual waves from 2017 to 2024) were obtained from 234 trans young people (aged 8-17 years) attending a specialist paediatric gender service in Australia. Social transition was operationalised using practices (name, pronouns, and appearance) across five contexts (home, school, online, with friends, and extended family). For each practice, we captured at each wave whether a change had been enacted or was desired in the future to determine longitudinal trajectories of social transition goal attainment. Findings: Four distinct trajectories were observed. The most common patterns were consistent goal attainment (meeting goals at every wave; 56.4%, n = 132) and progressive goal attainment (meeting goals by the final wave; 22.2%, n = 52). A small group of participants were initially meeting their goals at baseline, but not at the final wave (6.0%, n = 14). Even among participants consistently not meeting their goals (15.4%, n = 36), the majority were still actively progressing toward them. Additionally, most participants adjusted their goals over the study period (60.7%, n = 142). Goal attainment was associated with higher family functioning (p = 0.00075) and gender identity (p = 0.0034); specifically, trans boys were significantly more likely than trans girls to have met their social transition goals. Interpretation: Social transition is a dynamic, non-linear process driven by evolving personal goals rather than a uniform "all or nothing" milestone. These findings suggest that clinical, policy, and research frameworks should move away from rigid definitions of social transition to adequately reflect experiences of enactment and evolving goals. Funding: NHMRC GNT2006529 and GNT2006529, Hugh D. T. Williamson Foundation, and Royal Children's Hospital Foundation 2020-1314.