Growing numbers of young people are expressing a sense of a “mismatch” between the gender on their birth certificate and the one that they “feel” inside, particularly those assigned female at birth.
And the age when these people are seeking help and gender-affirming medical care is dropping, according to a new study of more than 66 million people. Those assigned female at birth seek such care at about age 11, on average, while those assigned male at birth reach out at around age 13, the study showed.
“Our study demonstrated a climbing prevalence of gender dysphoria especially in those assigned female at birth,” said study author Dr. Ching-Fang Sun, a resident at the Virginia Tech Carilion School of Medicine in Roanoke.
Gender dysphoria is the medical term for the conflict between the sex one is assigned at birth and the gender with which a person identifies.
“While further studies are warranted to determine the persistence of the diagnosis, we encourage youth to explore their gender identity with a non-biased stance, the public to be educated on gender diversity, and clinicians to provide timely assessment for children and youth with a concern of gender dysphoria,” Sun said.
Exactly why numbers are rising and people are seeking gender-affirming care at younger ages isn’t fully understood.
“The phenomenon might be related to increased accessibility of gender care as well as a gender-minority-friendly social context,” Sun said. “There is now acceptance of gender-neutral pronouns and gender non-congruent chosen names, and gender minority youth are no longer receiving consistent toxic feedback regarding their identity.”
The result? Less fear, fewer barriers of expression and more people seeking care, she said.
For the study, Sun’s team analyzed data for April 2017 through April 2022 from a network that includes 49 health care organizations. This database contains the medical records of around 66 million people, most (80%) in the United States.
Of 42 million people aged 4 to 65, 66,078 had received a diagnosis of gender dysphoria. The estimated prevalence of gender dysphoria rose significantly between 2017 and 2021, while the average age of those diagnosed with it fell.
Specifically, the estimated prevalence of gender dysphoria among those assigned female sex at birth rose at age 11, peaked between the ages of 17 and 19, and then dropped below that of those assigned male sex at birth, by age 22.
By contrast, the prevalence of gender dysphoria among those assigned male sex at birth started to increase at the age of 13, peaked at age 23, and then gradually declined.
These age differences may be due to the timing of puberty as girls generally enter puberty before boys, and young people tend to seek medical help for gender issues during puberty.
Children are typically diagnosed with gender dysphoria if they have experienced significant distress for at least six months. These kids may express a strong desire to be the other gender, a strong preference for wearing clothes typical of the opposite gender, a preference for toys and activities thought of as for the other gender, a strong dislike of their genitals, and other potential symptoms.
Gender-affirming care provides these kids a multidisciplinary approach to help them transition from their assigned gender to the gender that they want to be known. However, more than a dozen U.S. states have passed laws that ban gender-affirming care, and more are considering such laws.
“If your child is exploring their gender identity, it’s important that they are heard neutrally, neither encouraged nor discouraged toward a specific gender category,” Sun said. “Parents can facilitate the identity exploration by providing support and information with a non-judgmental stance.”
It’s always important for parents to seek additional assistance from mental health professionals or other local resources if they have questions or concerns, she said.
The study was published June 26 in the journal General Psychiatry.
The new findings reflect what Aaron Samuel Breslow sees in his practice as supervising psychologist at the Montefiore Transgender Health Program in New York City.
“There have been considerable strides in reaching out to and bolstering the mental health of transgender and nonbinary young individuals, particularly where I work in the Bronx, New York,” Breslow said.
“Instead of trans individuals resorting to extra-medical means for gender-affirming care, such as purchasing hormones from acquaintances or undergoing surgery in nonmedical environments, the data suggests that youth are now more likely to consult a doctor and gain access to gender-affirming care with support from an interdisciplinary team,” he said.
The importance and significance of this can’t be understated, Breslow said.
“We are living in a time when there is an organized, concerted effort to criminalize gender-affirming care, especially for young people, so I find these results to be very reassuring,” he said.
Individuals are receiving care for gender dysphoria at younger ages, and this is a marked success, Breslow said.
“The data don’t suggest people are identifying as trans at a younger age, but instead, that health care providers are meeting with patients and treating gender dysphoria at an earlier age,” he said. “This is a significant victory in early intervention.”
Breslow said the study adds considerably to existing literature given its large sample size and geographic range.
“Transgender health research often relies on smaller, convenience samples, limiting the extent to which findings can be generalized,” he said.
The study also reveals the ways society has improved in finding and supporting young people with gender dysphoria.
“This is critical given ongoing crises of mental health concerns and suicidality among trans and nonbinary young people, as well as systematic legislative attacks on access to health care for transgender people across the life span,” Breslow said.
He urged parents of kids expressing gender dysphoria to embrace their child’s unique expression of themselves.
“It’s crucial not to suppress or stigmatize creativity in gender expression,” Breslow said. “Should your child need support, I suggest finding local community groups that affirm trans identities.”
The most effective way to prevent suicide among trans kids is to make sure they are connected to other trans kids, he said.
The U.S. Department of Health and Human Services has more on gender-affirming care for young people.
SOURCES: Ching-Fang Sun, MD, psychiatry resident, Virginia Tech University, Carilion School of Medicine, Roanoke; Aaron Samuel Breslow, PhD, assistant professor, Psychiatry Research Institute, Montefiore Einstein, supervising psychologist, Montefiore Transgender Health Program, Bronx, N.Y.; General Psychiatry, June 26, 2023
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