“…Our study found that the TGD reporting among adolescents differed by age. Similar to self-report of sexual attraction and orientation, younger adolescents may be less likely to report as TGD because they are exploring their gender identity, unwilling to answer, or simply do not understand the question [18,31]. Tailoring of questions about gender identity by age may be warranted, as well as exploring how best to ask the question about gender to ensure both comfort and gender affirmation (e.g., allowing a patient to identify as "male" or "female" while also indicating they are "transgender").…”