Sex Ratio in Children and Adolescents Referred to the Gender Identity Development Service in the UK (2009–2016)

Graaf, Nastasja M. de; Giovanardi, Guido; Zitz, Claudia; Carmichael, Polly

doi:10.1007/s10508-018-1204-9

Cited by 109 publications

(109 citation statements)

References 16 publications

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“…As demonstrated by this cross-sectional study as well as by previous studies, [1][2][3][4] there has been an increase in referrals for pediatric transgender health care over the past decade. Such a rapid increase in clinical demand is unusual within medicine, and the underlying reasons for this increase are of great interest.…”

Section: Discussionsupporting

confidence: 65%

“…Over the past decade, specialist gender identity clinics worldwide have witnessed a rapid increase in the number of transgender and gender diverse (TGD) young people being referred for clinical services. [1][2][3][4] The underlying reasons for this increase are of great interest, but there is a lack of evidence to explain it. A common theory is that the improved recognition and acceptance of TGD people in society-coupled with greater public awareness of specialist gender services and available clinical interventions-are important.…”

Section: Introductionmentioning

confidence: 99%

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Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia

et al. 2020

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IMPORTANCE Specialist gender clinics worldwide have witnessed an increase in referrals of transgender and gender diverse (TGD) children and adolescents, but the underlying factors associated with this increase are unknown. OBJECTIVE To determine whether increases in TGD young people presenting to specialist gender clinics are associated with related media coverage. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted at 2 publicly funded, pediatric specialist gender services, one located in the UK and the other in Australia. Participants were all children and adolescents aged 0 to 18 years, referred between January 1, 2009, and December 31, 2016, to their respective gender services in the UK and Australia. Data analysis was performed in April 2019. EXPOSURES Media coverage of TGD issues. MAIN OUTCOMES AND MEASURES Referral rates from each gender service were compared with local TGD-related media coverage during the study period. RESULTS Referral data for 5242 TGD young people were obtained (4684 in the UK, of whom 1847 [39.4%] were assigned male at birth and 2837 [60.6%] were assigned female at birth; 558 in Australia, of whom 250 [44.8%] were assigned male at birth and 308 [55.2%] were assigned female at birth), and a total of 2614 news items were identified (UK, 2194; Australia, 420). The annual number of TGD young people referred to both specialist gender clinics was positively correlated with the number of TGD-related local media stories appearing each year (Spearman r = 1.0; P < .001). Moreover, weekly referral rates in both the UK for week 1 (β = 0.16; 95% CI, 0.03-0.29; P = .01) and Australia for week 2 (β = 0.12; 95% CI, 0.04-0.20; P = .003) showed evidence of association with the number of TGD-related media items appearing within the local media. There was no evidence of association between referrals and media items appearing 3 weeks beforehand. Media predominantly focused on TGD issues showed some association with increased referral rates. Specifically, TGD-focused stories showed evidence of association with referral numbers at week 1 (β = 0.16; 95% CI, 0.04-0.28; P = .007) and week 2 (β = 0.23; 95% CI, 0.11-0.35; P < .001) in Australia and with referral numbers at week 1 (β = 0.22; 95% CI, 0.01-0.44; P = .04) in the UK. No evidence of association was found between media peripherally related to TGD issues and referral rates. CONCLUSIONS AND RELEVANCE This study found evidence of an association between increasing media coverage of TGD-related topics and increasing numbers of young people presenting to gender clinics. It is possible that media coverage acts as a precipitant for young people to seek treatment at (continued) Key Points Question Is media coverage of transgender issues associated with referrals of transgender and gender diverse (TGD) children and adolescents to specialist gender services? Findings In this serial cross-sectional study across an 8-year study period during which more than 5000 TGD young people were referred to 2 pediatric gender clinics in the UK and Austra...

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia

et al. 2020

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“…Next to our results regarding our hypotheses, in our demographic analyses, there was one changing trend. Although in early years, more assigned boys were referred to gender identity services [29], referred adolescents favour birth-assigned females since the mid-2000s [16,30]. Our study showed that this shift in sex ratio is further skewed.…”

Section: Discussionmentioning

confidence: 66%

Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals?

Arnoldussen

Steensma

Popma

et al. 2019

Eur Child Adolesc Psychiatry

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The background of this article is to examine whether consecutively transgender clinic-referred adolescents between 2000 and 2016 differ over time in demographic, psychological, diagnostic, and treatment characteristics. The sample under study consisted of 1072 adolescents (404 assigned males, 668 assigned females, mean age 14.6 years, and range 10.1-18.1 years). The data regarding the demographic, diagnostic, and treatment characteristics were collected from the adolescents' files. Psychological functioning was measured by the Child Behaviour Check List and the Youth Self-Report, intensity of gender dysphoria by the Utrecht Gender Dysphoria Scale. Time trend analyses were performed with 2016 as reference year. Apart from a shift in sex ratio in favour of assigned females, no time trends were observed in demographics and intensity of dysphoria. It was found, however, that the psychological functioning improved somewhat over time (CBCL β − 0.396, p < 0.001, 95% CI − 0.553 to − 0.240, YSR β − 0.278, p < 0.001, 95% CI − 0.434 to − 0.122). The percentage of referrals diagnosed with gender dysphoria (mean 84.6%, range 75-97.4%) remained the same. The percentage of diagnosed adolescents that started with affirmative medical treatment (puberty suppression and/or gender-affirming hormones) did not change over time (mean 77.7%; range 53.8-94.9%). These findings suggest that the recently observed exponential increase in referrals might reflect that seeking help for gender dysphoria has become more common rather than that adolescents are referred to gender identity services with lower intensities of gender dysphoria or more psychological difficulties.

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“…The sex ratio favoring natal females is consistent with recent changes in the population of individuals seeking care for gender dysphoria. Gender clinics have reported substantial increases in referrals for adolescents with a change in the sex ratio of patients moving from predominantly natal males seeking care for gender dysphoria to predominantly natal females [ 26 – 28 , 62 ]. Although increased visibility of transgender individuals in the media and availability of information online, with a partial reduction of stigma might explain some of the rise in the numbers of adolescents presenting for care [ 27 ], it would not directly explain why the inversion of the sex ratio has occurred for adolescents but not adults or why there is a new phenomenon of natal females experiencing late-onset and adolescent-onset gender dysphoria.…”

Section: Discussionmentioning

confidence: 99%

“…Although, by 2013, there was research documenting that a significant number of natal males experienced gender dysphoria that began during or after puberty, there was little information about this type of presentation for natal females [ 5 ]. Starting in the mid-2000s there has been a substantial change in demographics of patients presenting for care with most notably an increase in adolescent females and an inversion of the sex ratio from one favoring natal males to one favoring natal females [ 26 – 28 ]. And now, some clinicians have noted that they are seeing increasingly in their clinic, the phenomenon of natal females expressing a post-puberty rapid onset of gender dysphoria [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria

2018

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PurposeIn on-line forums, parents have been reporting that their children are experiencing what is described here as “rapid-onset gender dysphoria,” appearing for the first time during puberty or even after its completion. The onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity. The purpose of this study was to document and explore these observations and describe the resulting presentation of gender dysphoria, which is inconsistent with existing research literature.MethodsRecruitment information with a link to a 90-question survey, consisting of multiple-choice, Likert-type and open-ended questions, was placed on three websites where parents had reported rapid onsets of gender dysphoria. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques. Data were collected anonymously via SurveyMonkey. Quantitative findings are presented as frequencies, percentages, ranges, means and/or medians. Open-ended responses from two questions were targeted for qualitative analysis of themes.ResultsThere were 256 parent-completed surveys that met study criteria. The adolescent and young adult (AYA) children described were predominantly female sex at birth (82.8%) with a mean age of 16.4 years. Forty-one percent of the AYAs had expressed a non-heterosexual sexual orientation before identifying as transgender. Many (62.5%) of the AYAs had been diagnosed with at least one mental health disorder or neurodevelopmental disability prior to the onset of their gender dysphoria (range of the number of pre-existing diagnoses 0–7). In 36.8% of the friendship groups described, the majority of the members became transgender-identified. The most likely outcomes were that AYA mental well-being and parent-child relationships became worse since AYAs “came out”. AYAs expressed a range of behaviors that included: expressing distrust of non-transgender people (22.7%); stopping spending time with non-transgender friends (25.0%); trying to isolate themselves from their families (49.4%), and only trusting information about gender dysphoria from transgender sources (46.6%).ConclusionRapid-onset gender dysphoria (ROGD) describes a phenomenon where the development of gender dysphoria is observed to begin suddenly during or after puberty in an adolescent or young adult who would not have met criteria for gender dysphoria in childhood. ROGD appears to represent an entity that is distinct from the gender dysphoria observed in individuals who have previously been described as transgender. The worsening of mental well-being and parent-child re...

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Sex Ratio in Children and Adolescents Referred to the Gender Identity Development Service in the UK (2009–2016)

Cited by 109 publications

References 16 publications

Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia

Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia

Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals?

Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria

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