Gender at your fingertips.

The sources we use are selected for their reliability. We mostly use peer-reviewed papers; however, we occasionally refer to government-commissioned studies, authoritative bodies’ submissions to governmental commissions, published books, or doctoral theses. In a few cases, we provide references for the purpose of debunking unreliable data.

As this is an emerging field of research, the information on this page may develop over time. Statistics for the transgender population are often difficult to quantify as different definitions are used to describe the term ”transgender”. Our focus is to underpin the statements we provide with sound research. We know that these statements cannot comprehensively cover every topic; however, this initiative is intended to bring some much-needed clarity to this area of study.

Stats For Gender is powered by Genspect, an organization which supports parents with gender-questioning kids. If you would like to help us lift parents’ voices, please consider donating to our fundraiser, or visit Genspect for more information.

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  • There has been a roughly twenty-fold rise in the number of people seeking transition, with teenagers hugely over-represented. Expand
    There has been a roughly twenty-fold rise in the number of people seeking transition, with teenagers hugely over-represented.

    A 2017 paper [1] reports that “the prevalence of a self-reported transgender identity in children, adolescents and adults ranges from 0.5 to 1.3%, markedly higher than prevalence rates based on clinic-referred samples of adults.”

    This is reflected in data from gender clinics. The UK’s Gender Identity Development Service reported [2] a twenty-fold increase in referrals over the course of the last decade:

    This surge was primarily driven by adolescents, with 15 being the most common age of referral:

    Similarly, a Dutch gender identity clinic reported [3] a twenty-fold increase, albeit over a longer time span: from 34 in 1980 to 686 in 2015:

    New Zealand [4], Finland [5] and Canada [6] have recorded similar dramatic exponential increases.

    REFERENCES

    [1] Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health 14 (5): 404-411. [Link]

    [2] Gender Identity Development Service (2021). Referrals to GIDS, financial years 2010-11 to 2020-21. [Link]

    [3] Wiepjes, C.M., Nota, N.M., de Blok, C.J.M., Klaver, M., de Vries, A.L.C., Wensing-Kruger, S.A., de Jongh, R.T., Bouman, M.B., Steensma, T.D., Cohen-Kettenis, P., Gooren, L.J.G., Kreukels, B.P.C. & den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. Journal of Sexual Medicine 15 (4). [Link]

    [4] Delahunt, J.W., Denison, H.J., Sim, D.A., Bullock, J.J. & Krebs, J.D. (2018). Increasing rates of people identifying as transgender presenting to Endocrine Services in the Wellington region. N Z Med J 131: 33-42. [Link]

    [5] Kaltiala-Heino, R., Sumia, M., Työläjärvi, M. & Lindberg, N. (2015). Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health 9 (1). [Link]

    [6] Aitken, M., Steensma, T.D., Blanchard, R., VanderLaan, D.P., Wood, H., Fuentes, A., Spegg, C., Wasserman, L., Ames, M., Fitzsimmons, C.L., Leef, J.H., Lishak, V., Reim, E., Takagi, A., Vinik, J., Wreford, J., Cohen-Kettenis, P.T., de Vries, A.L., Kreukels, B.P. & Zucker, K.J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J Sex Med 12 (3): 756-63. [Link]

  • In 2018, one study noted that the estimated number of young people who identified as transgender ranged between 0.17% and 1.3%. Expand
    In 2018, one study noted that the estimated number of young people who identified as transgender ranged between 0.17% and 1.3%.

    A 2018 paper [1] presented the results of North American studies using short (one to three item) self-reports of gender identity and its variance. The studies suggested that 0.17%–1.3% of adolescents and young adults identified as transgender.

    Statistics for the transgender population are almost impossible to quantify as different definitions are used to describe the term ”transgender”. We have chosen this study for its reliability and its reasonable understanding of the term “transgender” in the twenty-first century.

    REFERENCES

    [1] Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link]

  • The District of Columbia has three and a half times more people who identify as trans than any State in the US, per head of the population. Expand
    The District of Columbia has three and a half times more people who identify as trans than any State in the US, per head of the population.

    A Williams Institute survey [1] found that 2.77% of the population of DC identified as trans – more than three and a half times as many as Hawaii, which (at 0.78%) had the highest proportion of trans people of all fifty States.

    REFERENCES

    [1] Flores, A.R., Herman, J. L.; Gates, G. J. & Brown, T.N.T. (2016). How many people are lesbian, gay, bisexual, and transgender? Los Angeles, CA: The Williams Institute. [Link]

  • The profile of people seeking transition has shifted drastically, from overwhelmingly middle-aged males to predominantly adolescent females. Expand
    The profile of people seeking transition has shifted drastically, from overwhelmingly middle-aged males to predominantly adolescent females.

    A 2017 paper [1] notes that “in adolescents, there has been a recent inversion in the sex ratio from one favouring birth-assigned males to one favouring birth-assigned females.” By contrast, over 90% of transsexual adults in the 1960s were male [2].

    In fact, there was hardly any scientific literature before 2012 on girls ages 11 to 21 ever having developed gender dysphoria at all. Yet of the young people described in Lisa Littman’s 2018 seminal paper on young people [3], 82.8% were female.

    The data for the UK’s Gender Identity Development Service [4] show that 138 children were referred in 2011, and most of those children were boys. By 2021, however, a complete sex ratio reversal had occurred, and the clinic saw 2383 children that year, with almost 70% being female.

    A 2017 article by Lisa Marchiano [5] collated data from different clinics around the world and found international evidence for this shift in distribution.

    REFERENCES

    [1] Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health 14 (5): 404-411. [Link]

    [2] Barrett, J. (2015). Written evidence submitted by British Association of Gender Identity Specialists to the Transgender Equality Inquiry. data.parliament.uk [Link]

    [3] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

    [4] Gender Identity Development Service (2021). Referrals to GIDS, financial years 2010-11 to 2020-21. [Link]

    [5] Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives 60 (3): 345-366. [Link]

  • Between 2007 and 2017, the number of transgender youth clinics in the US went from 1 to at least 41 – and the number continues to increase. Expand
    Between 2007 and 2017, the number of transgender youth clinics in the US went from 1 to at least 41 – and the number continues to increase.

    A 2017 paper [1] notes that

    The first transgender youth clinic in the United States opened in Boston in 2007. Since then, 40 other clinics have opened that cater exclusively to children, with new clinic openings being announced frequently.

    REFERENCES

    [1] Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives 60 (3): 345-366. [Link]

  • According to a long-range study, around 6% of children in the population are gender variant. Expand
    According to a long-range study, around 6% of children in the population are gender variant.

    Epidemiological study [1] based on data from 1983-2007 shows that 6% of children in the population are gender variant.

    REFERENCES

    [1] Steensma, T.D., van der Ende, J., Verhulst, F.C. & Cohen‐Kettenis, P.T. (2013). Gender Variance in Childhood and Sexual Orientation in Adulthood: A Prospective Study. J Sex Med 10 (11): 2723-2733. [Link]

  • One study found that adulthood homosexuality was 8 to 15 times higher for participants with a history of gender variance. Expand
    One study found that adulthood homosexuality was 8 to 15 times higher for participants with a history of gender variance.

    In a 20-year follow-up [1] of children, it was found that adulthood homosexuality was 8 to 15 times higher for participants with a history of gender variance.

    REFERENCES

    [1] Steensma, T.D., van der Ende, J., Verhulst, F.C. & Cohen‐Kettenis, P.T. (2013). Gender Variance in Childhood and Sexual Orientation in Adulthood: A Prospective Study. J Sex Med 10 (11): 2723-2733. [Link]

  • In one study, almost 9 in 10 young people questioning their gender seemed to be subject to social influence. Expand
    In one study, almost 9 in 10 young people questioning their gender appear seemed to be subject to social influence.

    86.7% of the young people in Lisa Littman’s 2018 study [1] belonged to a friend group where one or more friends came out as trans at the same time, and/or had an increase in their use of social media.

    Social contagion – the involuntary “catching” of behaviors and attitudes across connected individuals [2] – is a well-accepted phenomenon in psychological literature [3]. It is well-documented that adolescents — and females in particular — are prone to social contagion effects, from cutting [4] to eating disorders [5]. Social network analyses suggest that peer contagion underlies the influence of friendship on obesity, unhealthy body images, and expectations [6].

    REFERENCES

    [1] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

    [2] Levy, D. A., & Nail, P. R. (1993). Contagion: A theoretical and empirical review and reconceptualization. Genetic, Social, and General Psychology Monographs 119 (2): 233-284. [Link]

    [3] Burgess, L.G., Riddell, P.M., Fancourt, A. & Murayama, K. (2018). The Influence of Social Contagion Within Education: A Motivational Perspective. Mind, Brain, and Education 12: 164-174. [Link]

    [4] Hermansson-Webb, E. B. (2014). ‘With Friends Like These…’: The Social Contagion of Non-Suicidal Self-Injury Amongst Adolescent Females. Thesis, Doctor of Philosophy: University of Otago. [Link]

    [5] Allison, S., Warin, M. & Bastiampillai, T. (2013). Anorexia nervosa and social contagion: Clinical implications. Australian and New Zealand Journal of Psychiatry 48 (2): 116-120. [Link]

    [6] Dishion, T. J., & Tipsord, J. M. (2011). Peer contagion in child and adolescent social and emotional development. Annual review of psychology 62: 189–214. [Link]

  • In one study, two thirds of trans-identifying young people had one or more friends who were also trans. Expand
    In one study, two thirds of trans-identifying young people had one or more friends who were also trans.

    Lisa Littman’s 2018 study [1] found that 66.8% of adolescents and young adults who identified as trans belonged to a friend group where at least one other person became gender dysphoric and came out as transgender.

    REFERENCES

    [1] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

  • One study showed that, in 36.8% of trans-identifying young people’s friendship groups, the majority of members identified as trans. Expand
    One study showed that, in 36.8% of trans-identifying young people’s friendship groups, the majority of members identified as trans.

    Lisa Littman’s 2018 study [1] investigated the role of friendship groups in transgender identification, and found that the majority of the members in the friendship group became transgender-identified in 36.8% of cases – almost 2 in 5.

    REFERENCES

    [1] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

  • One study found that, in almost two-thirds of cases, internet and social media usage seemed to go up just before a young person came out as trans. Expand
    One study found that, in almost two-thirds of cases, internet and social media usage seemed to go up just before a young person came out as trans.

    Lisa Littman’s 2018 study [1] found that 63.5% of adolescents and young adults who came out as trans seemed to exhibit an increase in their internet and social media usage before coming out.

    REFERENCES

    [1] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

  • Children referred to the UK’s largest gender clinic were vastly more likely than average to present with autistic traits. Expand
    Children referred to the UK’s largest gender clinic were vastly more likely than average to present with autistic traits.

    One study [1] noted that:

    48% of children and young people who were seen in GIDS and whose parents completed the social responsiveness scale (SRS), a quantitative measure of autistic behaviours in children and young people, scored in the mild to severe range.

    A BMJ paper [2] reported:

    Around 35% of referred young people [i.e. referred to the GIDS] present with moderate to severe autistic traits.

    REFERENCES

    [1] Churcher Clarke, A. & Spiliadis, A. (2019). ‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties. Clin Child Psychol Psychiatry 24 (2): 338-352. [Link]

    [2] Butler, G., De Graaf, N., Wren, B. & Carmichael, P. (2018) Assessment and support of children and adolescents with gender dysphoria. Archives of Disease in Childhood103:631-636. [Link]

  • Obsessive-compulsive traits are more common in people with gender dysphoria. Expand
    Obsessive-compulsive traits are more common in people with gender dysphoria.

    At least two studies [1, 2] have found a particular connection between intense interests or repetitive behaviors – associated with autism spectrum disorders – and gender dysphoria.

    It has also been noted [3] that

    With the intensified public awareness and media coverage of issues concerning gender identity and gender incongruence, distinguishing true gender dysphoria or incongruence from the sexual obsessions of obsessive-compulsive disorder (OCD) is especially important. Although intrusive sexual obsessions are not uncommon in OCD, obsessions concerning sexual content are more difficult for clinicians to identify as OCD than other types of obsessions (e.g., obsessions concerning contamination). 

    REFERENCES

    [1] Zucker, K.J., Nabbijohn, A.N., Santarossa, A., Wood, H., Bradley, S.J., Matthews, J., & VanderLaan, D.P. (2017). Intense/obsessional interests in children with gender dysphoria: a cross-validation study using the Teacher’s Report Form. Child and adolescent psychiatry and mental health 11, 51. [Link]

    [2] VanderLaan, D.P., Postema, L., Wood, H., Singh, D., Fantus, S., Hyun, J., Leef, J., Bradley, S.J. & Zucker, K.J.. (2015). Do children with gender dysphoria have intense/obsessional interests? J Sex Res. 52 (2): 213-9. [Link]

    [3] Safer, D., Bullock, K. & Safer, J. (2016). Obsessive-Compulsive Disorder Presenting as Gender Dysphoria/Gender Incongruence: A Case Report and Literature Review. AACE Clinical Case Reports 2. [Link]

  • Roughly 15% of transmasculine and transfeminine youths in one study had attention deficit disorders. Expand
    Roughly 15% of transmasculine and transfeminine youths in one study had attention deficit disorders.

    A study [1] which used electronic medical records to identify transmasculine and transfeminine youths found attention deficit disorders in 15% of males and 16% of females.

    REFERENCES

    [1] Becerra-Culqui, T.A. Liu, Y., Nash, R., Cromwell, L., Flanders, W.D., Getahun, D. Giammattei, S.V., Hunkeler, E.M., Lash, T.L., Millman, A., Quinn, V.P., Robinson, B., Roblin, D., Sandberg, D.E., Silverberg, M.J., Tangpricha, V. & Goodman, M. (2018). ‘Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics 141(5). [Link]

  • Children with ADHD are far more likely than average to express gender variance. Expand
    Children with ADHD are far more likely than average to express gender variance.

    A study on children [1] found that, as compared to non-referred comparisons, participants with ADHD were 6.64 times more likely to express gender variance than participants without ADHD. The study also found that, in cases of ADHD, this gender variance was related to elevated emotional symptoms.

    REFERENCES

    [1] Strang, J.F., Kenworthy, L., Dominska, A., Sokoloff, J., Kenealy, L.E., Berl, M., Walsh, K., Menvielle, E., Slesaransky-Poe, G., Kim, K.E., Luong-Tran, C., Meagher, H. & Wallace, G.L. (2014) Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. Arch Sex Behav 43 (8): 1525-33. [Link]

  • People with an incongruent gender identity are much more likely than the general population to suffer from mental health problems. Expand
    People with an incongruent gender identity are over four times more likely than the general population to suffer from mental health problems.

    This finding, from an American campus survey [1], found that gender minority status was associated with “4.3 times higher odds of having at least 1 mental health problem.” Similarly, a Journal of Sex and Marital Therapy article [2] notes that “a large percentage of adolescents referred for gender dysphoria have a substantial co-occurring history of psychosocial and psychological vulnerability.”

    In Lisa Littman’s seminal work [3] on rapid onset gender dysphoria, 62.5% of the young people whose parents were surveyed had at least one mental health or neurodevelopmental issue. 58.0% had a poor or extremely poor ability to handle negative emotions productively; 61.4% were overwhelmed by strong emotions and tried to avoid (or went to great lengths to avoid) experiencing them.

    In a systematic review [4] of individuals diagnosed with gender dysphoria, 53.2% had at least one mental disorder in their lifetime. Such figures substantially exceed prevalence rates of comorbid psychopathology in the general population [5]: a further paper [6] studying hospital encounters found that the prevalence of mental disorder diagnoses was higher in transgender encounters (77%) than in the general population (37.8%).

    A Swedish study [7] found that sex-reassigned persons had a higher risk of inpatient care for a psychiatric disorder (other than gender identity disorder) than the control population. Inpatient care for psychiatric disorders was also significantly more common among sex-reassigned persons than among controls, both before and after sex reassignment.

    REFERENCES

    [1] Lipson, S. K., Raifman, J., Abelson, S. & Reisner, S. L. (2019). Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses. American Journal of Preventive Medicine 57 (3): 293-301. [Link]

    [2] Bechard, M., VanderLaan, D. P., Wood, H., Wasserman, L. & Zucker, K. (2017). Psychosocial and Psychological Vulnerability in Adolescents with Gender Dysphoria: A “Proof of Principle” Study. Journal of Sex & Marital Therapy 43 (7). [Link]

    [3] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

    [4] de Freitas, L. D., Léda-Rêgo, G., Bezerra-Filho, S., & Miranda-Scippa, Â. (2020). Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry and Clinical Neurosciences, 74 (2), 99–104. [Link]

    [5] Zucker, K.J., Lawrence, A.A., Kreukels, B.P. (2016). Gender Dysphoria in Adults. Annu Rev Clin Psychol. 12: 217-47. [Link]

    [6] Bishoy, H., Repack, D., Tarang, P., Guirguis, E., Kumar, G. & Sachdeva, R. (2019). Psychiatric disorders in the U.S. transgender population. Annals of Epidemiology 39: 1-7. [Link]

    [7] Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLoS ONE, 6(2). [Link]

  • Trans-identified young people are prone to elevated rates of depression and/or anxiety. Expand
    Transgender-identified youth are prone to elevated rates of depression and/or anxiety.

    A study [1] which compared the medical records of 1333 trans-identified children and adolescents between the ages of 3 and 17 years old with a similar cohort of non-trans-identified children and adolescents showed that 49% of males and 62% of females had depressive disorders.

    An Australian study [2], with a smaller sample of gender dysphoric children and adolescents, found depression and anxiety rates of 62.0% and 63.3% respectively.

    The majority of parent respondents in Littman’s 2018 study [3] – 69.4% – answered that their child had social anxiety during adolescence; 44.3% said that their child had difficulty interacting with their peers, and 43.1% that their child had a history of being isolated (not associating with their peers outside of school activities).

    Similar conclusions have been found [4] for adults with gender dysphoria, who suffer from elevated rates of mood disorders (48.9% among natal males, 36.1% among natal females) and anxiety (38.8% among natal males, 33.3% among natal females). A further paper [5] found somewhat lower figures, giving a prevalence of 42.1% for mood disorders and 26.8% for anxiety disorders.

    REFERENCES

    [1] Becerra-Culqui, T.A. Liu, Y., Nash, R., Cromwell, L., Flanders, W.D., Getahun, D. Giammattei, S.V., Hunkeler, E.M., Lash, T.L., Millman, A., Quinn, V.P., Robinson, B., Roblin, D., Sandberg, D.E., Silverberg, M.J., Tangpricha, V. & Goodman, M. (2018). ‘Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics 141(5). [Link]

    [2] Kozlowska, K., McClure, G., Chudleigh, C., Maguire, A.M., Gessler, D., Scher, S. & Ambler, G.R. (2021). ‘Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service’. Human Systems, 1(1), 70–95. [Link]

    [3] Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link]

    [4] Mazaheri Meybodi, A., Hajebi, A., & Ghanbari Jolfaei, A. (2014). Psychiatric Axis I: Comorbidities among Patients with Gender Dysphoria. Psychiatry journal 2014. [Link]

    [5] de Freitas, L. D., Léda-Rêgo, G., Bezerra-Filho, S., & Miranda-Scippa, Â. (2020). Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry and Clinical Neurosciences, 74 (2), 99–104. [Link]

  • Transgender-identified youth are disproportionately likely to suffer from eating disorders. Expand
    Transgender-identified youth are disproportionately likely to suffer from eating disorders.

    In a review [1] of 20 publications, significantly higher rates of eating disorder symptoms were documented in transgender youth (aged between 8 and 25).

    Another study [2] corroborated this connection, noting that data, while scarce, suggest “an overrepresentation of eating pathology among adolescents with GD [gender dysphoria] or transgender identity.”

    REFERENCES

    [1] Coelho, J., Suen, J., Clark, B., Marshall, S., Geller, J. & Lam, P.-Y. (2019). Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Current Psychiatry Reports 21. [Link]

    [2] Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link]

  • There seems to be a connection between disordered eating patterns and gender-related distress. Expand
    There seems to be a connection between disordered eating patterns and gender-related distress.

    In a review [1] of 20 publications, a consistent theme emerged: transgender youth (aged 8 to 25) engaged in food restriction and/or compensatory eating behaviors to prevent puberty onset or progression.

    The review suggested that, for some transgender youth, these behaviors may be understood as a means of coping with gender-related distress. However, the exact nature of this observed connection is uncertain.

    REFERENCES

    [1] Coelho, J., Suen, J., Clark, B., Marshall, S., Geller, J. & Lam, P.-Y. (2019). Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Current Psychiatry Reports 21. [Link]

  • Social transition – changing names, pronouns, clothing and bathroom use – correlates with the persistence of transgender identity. Expand
    Social transition – changing names, pronouns, clothing and bathroom use – correlates with the persistence of transgender identity.

    Pediatric transition doctors in the Netherlands who first pioneered the use of puberty blockers in dysphoric children observe that social transition correlates with an increase in young people’s persistence when it comes to gender identity [1]. This led them to caution against social transition before puberty.

    Another paper [2] notes that gender dysphoria is more persistent into adolescence where social transition has occurred, and as such asserts that social transition is a “psychosocial intervention [which] might be characterized as iatrogenic” – a medical problem caused by the treatment itself.

    There is evidence [3] that social transition by the child was found to be strongly correlated with persistence for natal boys, more so than for girls.

    REFERENCES

    [1] de Vries, A. L., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality 59 (3): 301–320. [Link]

    [2] Zucker, K. J. (2019). Debate: Different strokes for different folks. Child and Adolescent Mental Health 25(1): 36-37. [Link]

    [3] Steensma, T.D., McGuire, J.K., Kreukels, B.P., Beekman, A.J. & Cohen-Kettenis, P.T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. J Am Acad Child Adolesc Psychiatry. 52 (6): 582-90. [Link]

  • More and more children have already socially transitioned – often including pronoun changes – by the time they present to gender clinics. Expand
    More and more children have already socially transitioned – often including pronoun changes – by the time they present to gender clinics.

    Dutch data [1] indicate that, between 2000 and 2004, 3.3% of children had completely socially transitioned (clothing, hairstyle, change of name, and use of pronouns) when they were referred to gender clinics, with 19% already living in the preferred gender role in clothing style and hairstyle, but not announcing that they wanted a name and pronoun change. 

    However, between 2005 and 2009, these percentages increased to 8.9% and 33.3% respectively, demonstrating that social transition is becoming more common before medical transition is investigated.

    REFERENCES

    [1] Steensma, T.D. & Cohen-Kettenis, P.T. (2011). Gender Transitioning before Puberty? Archives of Sexual Behavior 40 (4): 649-50. [Link]

  • There is no evidence that English historically used ‘they’ to refer to a named and known individual. Expand
    There is no evidence that English historically used ‘they’ to refer to a named and known individual.

    For centuries, the English language has used ‘they’ as an epicene pronoun (i.e. to mean ‘he or she’). This epicene use is shared by authors from Shakespeare to Austen and Shelley [1].

    However, epicene use of ‘they’ rules out knowledge of the identity — and thus the sex — of the person in question. In other words, this historical use of singular ‘they’ is restricted to contexts where ‘they’ refers to an unknown party, rather than to a particular named and known individual.

    There is no literature on the use of definite singular ‘they’ (i.e. to refer to a named and known person) before 2017 [2].

    Furthermore, the research undertaken in 2017 [3] indicates that many English speakers who naturally use epicene ‘they’ find it difficult to parse uses of ‘they’ to refer to a named and known singular individual.

    REFERENCES

    [1] Grubber, B. (2017). Singular They: The Best Epicene Pronoun. Student Research Conference Select Presentations: Paper 45. [Link]

    [2] Konnelly, L. & Cowper, E. (2020). Gender diversity and morphosyntax: An account of singular they. Glossa: a journal of general linguistics 5 (1): 1–19. [Link]

    [3] Bjorkman, B.M. (2017). Singular they and the syntactic representation of gender in English. Glossa: a journal of general linguistics 2 (1): 1-13. [Link]

  • There is limited evidence that medical transition leads to positive outcomes. Expand
    There is limited evidence that medical transition leads to positive outcomes.

    A number of different studies have noted the paucity of good quality evidence for transition.

    An Australian paper [1] states that most available evidence indicating positive outcomes for gender reassignment is of poor quality.

    A German study [2] “found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition”, adding that “[t]his lack of studies shows a gap between current clinical practice and clinical research.”

    A British review [3] conducted by the National Institute for Health and Care Excellence (NICE) graded certainty of evidence for puberty blocker use as “very low” in every category, including impact on gender dysphoria, mental health, body image, global functioning, psychosocial functioning, cognitive functioning, bone density and adverse effects.

    A chapter [4] in an edited volume details the low evidence base for treatment pathways employed at the UK’s Gender Identity Development Service, demonstrating how negative evidence was “ignored or suppressed”.

    Finally, a systematic review [5] commissioned by the World Professional Association for Transgender Health (WPATH) to “systematically review the effect of gender-affirming hormone therapy on psychological outcomes among transgender people” noted that, in some areas, there was low quality or insufficient evidence.

    REFERENCES

    [1] D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry 26 (5): 460-463. [Link]

    [2] Haupt, C., Henke, M., Kutschmar, A., Hauser, B., Baldinger, S., Saenz, S.R. & Schreiber, G. (2020). Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women. Cochrane Database of Systematic Reviews 11. [Link]

    [3] National Institute for Health and Care Excellence (2021). Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria. National Institute for Health and Care Excellence (NICE); NHS England; NHS Improvement. [Link]

    [4] Biggs, M. (2019). The Tavistock’s Experiment with Puberty Blockers. In: Moore, M. & Brunskell-Evans, H. (eds.). Inventing Transgender Children and Young People. Cambridge Scholars Publishing. [Link]

    [5] Baker, K.E., Wilson, L.M., Sharma, R., Dukhanin, V., McArthur, K. & Robinson, K.A. (2021) Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review. Journal of the Endocrine Society 5 (4). [Link]

  • Studies on gender dysphoric young people often suffer from high rates of loss to follow-up – which could skew transition satisfaction rates. Expand
    Studies on gender dysphoric young people often suffer from high rates of loss to follow-up – which could skew transition satisfaction rates.

    In one study [1] of 77 pre-teen participants, 30% were lost to follow up by their teenage years: either they did not respond to the recruiting letter, or were not traceable. In another study [2], as many as 75% of participants were lost to follow up.

    An excellent précis of this problem can be found in a 2018 paper [3], which gives further detail:

    Smith et al. report that sex reassignment is effective, based on a study of 162 adults who had undergone SRS. They were able to obtain follow-up data from only 126 (78%) of subjects because a significant number were “untraceable” or had moved abroad.

    De Cuypere et al. report that sex reassignment surgery is an effective treatment for transsexuals. Of 107 patients who had undergone SRS between 1986 and 2001, 30 (28%) could not be contacted and 15 (14%) refused to participate.

    Johannson et al. reported good outcomes for SRS. Of 60 patients who had undergone SRS, 42 (70%) agreed to participate in the follow up research. Of the non-participants, 1 had died of complications of SRS, 8 could not be contacted and 9 refused to participate.

    Salvador et al. reported that SRS has a positive effect on psychosocial functioning. Only 55 of the 69 patients (80%) could be contacted as 17 were lost to follow-up

    Van de Grift et al. reported 94–96% of patients are satisfied with SRS and have good quality of life. A total of 546 patients with Gender Dysphoria who had applied for SRS at clinics in Amsterdam, Hamburg and Ghent were contacted to complete an online survey. Only 201 (37%) responded and completed the survey. 

    A good example of how this phenomenon can affect satisfaction and regret statistics comes from a 2018 paper [4], which is often cited as proof of low regret rates. The loss to follow up rate in this paper is 36%. The authors also state:

    In addition, in our population the average time to regret was 130 months, so it might be too early to examine regret rates in people who started with HT [hormonal treatment] in the past 10 years.

    REFERENCES

    [1] Wallien, M.S. & Cohen-Kettenis P.T. (2008) Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47 (12): 1413-23. [Link]

    [2] Rauchfleisch, U., Barth, D. & Battegay, R. (1998). Resultate einer Langzeitkatamnese von Transsexuellen. Der Nervenzart 69: 799-805. [Link]

    [3] D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry 26 (5): 460-463. [Link]

    [4] Wiepjes, C.M., Nota, N.M., de Blok, C.J.M., Klaver, M., de Vries, A.L.C., Wensing-Kruger, S.A., de Jongh, R.T., Bouman, M.B., Steensma, T.D., Cohen-Kettenis, P., Gooren, L.J.G., Kreukels, B.P.C. & den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. Journal of Sexual Medicine 15 (4). [Link]

  • One study showed that, without social transition, nearly two-thirds of pre-teen gender-dysphoric males grow up to be gay or bisexual. Expand
    One study showed that, without social transition, nearly two-thirds of pre-teen gender-dysphoric males grow up to be gay or bisexual.

    A University of Toronto study [1] found that 63.6% of boys with early onset gender dysphoria, who received ‘watchful waiting’ treatment and no pre-pubertal social transition, grew up to be gay or bisexual. 

    Only 12% of the study participants continued to identify as transfeminine. 

    REFERENCES

    [1] Singh, D., Bradley, S.J. & Zucker, K.J. (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychology 12. [Link]

  • Gender-related distress will alleviate for around 80% of pre-teen children once they become teenagers. Expand
    Gender-related distress will alleviate for around 80% of pre-teen children once they become teenagers.

    Evidence from 10 available prospective follow-up studies [1] from childhood to adolescence indicates that childhood gender dysphoria will recede with puberty in ~80% of cases. A Dutch paper [2] notes that follow-up studies show the persistence rate of gender identity disorder to be about 15.8%, or 39 out of the 246 children who were reported on in the literature.

    In one study [3] of 54 children referred to a clinic in childhood because of gender dysphoria and then later investigated by a follow-up study, only 21 (39%) still had gender dysphoria.

    A different study [4] of Canadian boys with gender identity disorder showed that 87.8% desisted, with only 12.2% — fewer than 1 in 8 — persisting in their transgender identity.

    An ~80% desistance is not universally found [5]. Thorough investigations of the claims and counter-claims appear in two 2018 studies [6, 7].

    REFERENCES

    [1] Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link]

    [2] Steensma, T.D. & Cohen-Kettenis, P.T. (2011). Gender Transitioning before Puberty? Archives of Sexual Behavior 40 (4): 649-50. [Link]

    [3] Wallien, M.S. & Cohen-Kettenis P.T. (2008) Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47 (12): 1413-23. [Link]

    [4] Singh, D., Bradley, S.J. & Zucker, K.J. (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychology 12. [Link]

    [5] Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M., Jamieson, A., & Picket, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender non-conforming children. International Journal of Transgenderism 19 (2). [Link]

    [6] Steensma, T.D. & Cohen-Kettenis, P.T. (2018). A critical commentary on “A critical commentary on follow-up studies and “desistence” theories about transgender and gender non-conforming children”. International Journal of Transgenderism. [Link]

    [7] Zucker, K. J. (2018). The myth of persistence. International Journal of Transgenderism 19 (2): 231-45. [Link]

  • Young people who desist from a trans identity are disproportionately likely to grow up to be non-heterosexual. Expand
    Young people who desist from a trans identity are disproportionately likely to grow up to be non-heterosexual.

    A Dutch paper [1] notes that, for gender dysphoric children, the more likely psychosexual outcome in adulthood is a homosexual sexual orientation without gender dysphoria.

    Evidence [2] suggests that many boys whose childhood gender dysphoria recedes with puberty will grow up to be bisexual or homosexual. Another study of males [3] indicates that bisexual/homosexual orientation is far greater than base rates in the general male population, with 63.6% of boys with gender identity disorder being same-sex attracted.

    This suggests that a non-heterosexual orientation is particularly likely among gender dysphoric boys.

    REFERENCES

    [1] Wallien, M.S. & Cohen-Kettenis P.T. (2008) Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47 (12): 1413-23. [Link]

    [2] Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link]

    [3] Singh, D. (2012). A follow-up study of boys with gender identity disorder. Doctoral thesis, University of Toronto. [Link]

  • All-cause mortality is higher among trans people than among the general population. Expand
    There is evidence that all-cause mortality is higher among trans people than among the general population.

    A Swedish study [1] found that sex-reassigned transsexual persons – both male and female – had approximately a three times higher risk of all-cause mortality than non-transsexuals. Elevated causes of mortality included cancer, cardiovascular disease, and violent crime:

    This finding was backed up by a Dutch study [2], which stated:

    This observational study showed an increased mortality risk in transgender people using hormone treatment, regardless of treatment type. This increased mortality risk did not decrease over time.

    REFERENCES

    [1] Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLoS ONE, 6(2). [Link]

    [2] de Blok, C.J.M., Wiepjes, C.M., van Velzen, D.M., Staphorsius, A.S., Nota, N.M., Gooren, L.J.G., Kreukels, B.P.C. & den Heijer, M. (2021). Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria. The Lancet Diabetes & Endocrinology 9. [Link]

  • One long-ranging study estimated a suicide rate for gender dysphoric people of 0.6%. Expand
    One long-ranging study estimated a suicide rate for gender dysphoric people of 0.6%.

    Every suicide is a tragedy, and one suicide is a suicide too many. With such a serious issue, accuracy is critical.

    A Swedish government-commissioned study [1] found that 39 of 6334 gender dysphoric individuals — 0.6% — died by suicide.

    The UK’s largest gender clinic, the Gender Identity Development Service, states that [2]

    Suicide is extremely rare.

    Similarly, the Chair of the Child and Adolescent Committee for the World Professional Association for Transgender Health (WPATH), Dr Laura Edwards-Leeper, remarks [3]:

    As far as I know there are no studies that say that if we don’t start these kids immediately on hormones when they say they want them that they are going to commit suicide. So that is misguided…in terms of needing to intervene medically to prevent suicide and doing it quickly, I know of no studies that have shown that.

    This reinforces the point that talking about suicide is not the same as dying by suicide. While there is evidence [4] that suicidal ideation is higher among gender-dysphoric youth than in the general population, an increase in suicidal ideation rates is not proof of an equal increase in suicide rates themselves.

    However, the way suicidality is reported can affect numbers of suicides. A significant body of academic research from across the world, known as the Werther Effect, has found links between certain types of reporting of suicides and increased suicide rates [5].

    REFERENCES

    [1] Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link]

    [2] Gender Identity Development Service (2021). Evidence base. [Link]

    [3] Daum, Meghan (2021). “We Feel Like We’re In The Wild West:” Parents of Gender-Questioning Kids Ask Their Own Questions. The Unspeakable Podcast, October 4, 2021. [Link]

    [4] Aitken, M., Vanderlaan, D., Wasserman, L., Stojanovski, S. & Zucker, K. (2016). Self-Harm and Suicidality in Children Referred for Gender Dysphoria. Journal of the American Academy of Child & Adolescent Psychiatry 55. [Link]

    [5] Acosta, F. J., Rodríguez, C. J., Cejas, M. R., Ramallo-Fariña, Y. & Fernandez-Garcimartin, H. (2020) Suicide Coverage in the Digital Press Media: Adherence to World Health Organization Guidelines and Effectiveness of Different Interventions Aimed at Media Professionals. Health Communication 35 (13). [Link]

  • There is no high quality evidence to suggest that the overall attempted suicide rate of transgender youth is 41%. Expand
    There is no high quality evidence to suggest that the overall attempted suicide rate of transgender youth is 41%.

    The frequently repeated claim that 41% of 6,450 transgender respondents said they had attempted suicide at some point in their lives [1] is taken from the National Transgender Discrimination Survey [2].

    However, a 2021 paper [3] notes that the participants were recruited through transgender advocacy organizations and subjects were asked to “pledge” to promote the survey among friends and family. This recruiting method yielded a large but highly skewed sample. By targeting transgender advocacy groups, the survey underrepresented the experiences of transgender individuals who are not politically engaged. Also, a very high number of the survey participants (nearly 40%) had not transitioned medically or socially at the time of the survey, and a significant number reported no intention to transition in the future.

    A 2016 article [4] analyzes the power of this 41% statistic, investigating how it has affected conversations about the injustices transgender people face and the importance of family and societal acceptance.

    REFERENCES

    [1] Turban, J. L., Beckwith, N., Reisner, S. L., & Keuroghlian, A. S. (2020). Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry 77 (1): 68-76. [Link]

    [2] Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. National Gay and Lesbian Task Force; National Center for Transgender Equality. [Link]

    [3] D’Angelo, R., Syrulnik, E., Ayad, S., Marchiano, L., Kenny, D.T. & Clarke, P. (2021). One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria. Arch Sex Behav 50: 7-16. [Link]

    [4] Tanis, J. (2016). The power of 41%: A glimpse into the life of a statistic. Am J Orthopsychiatry, 86 (4): 373-7. [Link]

  • People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people. Expand
    People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people.

    A Swedish study [1] found that suicide rates for personality disorder, schizophrenia, substance addiction, bipolar and (among males) depression and autism were all higher than suicide rates for gender dysphoric people:

    These high suicide rates for schizophrenia are confirmed by another study [2] which puts the lifetime risk of suicide death for schizophrenics at 5.6%. This study also finds “the absolute risk of suicide in different psychiatric disorders to vary from 2% to 8%, higher for men than for women and highest for men and women with bipolar disorder, unipolar affective disorder, schizophrenia, and schizophrenialike disorder.”

    REFERENCES

    [1] Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link]

    [2] Nordentoft, M., Madsen, T. & Fedyszyn, I. (2015). Suicidal behavior and mortality in first-episode psychosis. J Nerv Ment Dis. 203 (5): 387-92. [Link]

  • Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors. Expand
    Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors.

    A Swedish study [1] points out that it is “difficult to distinguish one [gender dysphoria] from the other [mental health conditions] with regard to suicide risk.”

    A 2019 study [2] finds that “adolescents referred for gender dysphoria show higher rates of suicidality when compared to non-referred adolescents, but are much more similar to referred adolescents (presumably, the vast majority were cisgender) in general.”

    REFERENCES

    [1] Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link]

    [2] Zucker, K. J. (2019). Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues. Archives of Sexual Behavior 48 (5). [Link]

  • There is little evidence that medical transition decreases suicidality. Expand
    There is little evidence that medical transition decreases suicidality.

    When it comes to gender dysphoric children, there is little evidence that medical transition decreases suicide rates. There is little evidence to assert that puberty blockers are necessary to prevent suicide [1].

    After sex reassignment surgery, one study showed that adult transsexual clients were 4.9 times more likely to have made a suicide attempt and 19.1 times more likely to have died from suicide, after adjusting for prior psychiatric comorbidity [2]. Similarly, an Australian paper [3] notes that many patients have poor outcomes which put them at risk of suicide.

    A prominent study [4] claiming that medical transition alleviated suicidality had to be corrected [5], to clarify that it proved “no advantage of surgery” in this regard.

    A long-term Swedish study [6] finds that post-operative transgender people have “considerably higher risks” for suicidal behavior.

    Similarly, a study in the European Journal of Endocrinology [7] demonstrates that suicide rates among transgender male-to-females were 51% higher than the general population.

    REFERENCES

    [1] Biggs, M. (2020). Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria. Archives of Sexual Behavior (49): 2227–2229. [Link]

    [2] Zucker, K.J., Lawrence, A.A., Kreukels, B.P. (2016). Gender Dysphoria in Adults. Annu Rev Clin Psychol. 12: 217-47. [Link]

    [3] D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry 26 (5): 460-463. [Link]

    [4] Bränström, R. & Pachankis, J. E. (2019). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. American Journal of Psychiatry 177 (8): 727-734. [Link]

    [5] American Journal of Psychiatry (2020). Correction to Bränström and Pachankis. Published online: 1 August 2020. [Link]

    [6] Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., & Landén, M. (2011). ‘Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden’. PLoS ONE, 6(2). [Link]

    [7] Asscheman, H., Giltay, E. J., Megens, J. A. J., de Ronde, W., van Trotsenburg, M. A. A. & Gooren, L. J. G. (2011). A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. European Journal of Endocrinology 164 (4). [Link]

  • Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health. Expand
    Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health.

    The results of a 2021 international survey [1] of 129 female-to-male patients who underwent genital reconstruction surgery support anecdotal reports that complication rates following genital reconstruction are higher than are commonly reported in the surgical literature. 

    Complication rates, including urethral compromise, and worsened mental health outcomes remain high for gender affirming penile reconstruction. In total, the 129 patients reported 281 complications requiring 142 revisions.

    Another paper [2] found a 70% complication rate in one type of female-to-male genital reconstruction surgery.

    Even with the “radial forearm free flap” method of creating a synthetic penis — “considered by many as the gold standard for phalloplasty” [3] — there are high rates of complications, with up to 64% urethroplasty related complications [4].

    REFERENCES

    [1] Robinson, I.S., Blasdel, G., Cohen, O., Zhao, L.C. & Bluebond-Langner, R. (2021). Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients. J Sex Med 18 (4): 800-811. [Link]

    [2] Bettocchi, C., Ralph, D.J. & Pryor, J.P. (2005). Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 95:120–4. [Link]

    [3] Rashid, M. & Tamimy, M. S. (2013). Phalloplasty: The dream and the reality. Indian J Plast Surg 46 (2): 283-293. [Link]

    [4] Fang, R.H., Lin, J.T. & Ma S. (1994). Phalloplasty for female transsexuals with sensate free forearm flap. Microsurgery 15: 349–52. [Link]

  • Puberty blockers are more than a ‘pause button’: roughly 98% of children who take them go on to take cross-sex hormones. Expand
    Puberty blockers are more than a ‘pause button’: roughly 98% of children who take them go on to take cross-sex hormones.

    A 2021 study from the UK [1] found that only 1 out of 44 children placed on puberty blockers did not continue to take cross-sex hormones.

    Similarly, a Dutch study [2] reported that only 1.9% of adolescents who started puberty suppression treatment abandoned this course and did not take cross-sex hormones.

    In fact, in a different Dutch study [3], “[n]o adolescent withdrew from puberty suppression, and all started cross‐sex hormone treatment, the first step of actual gender reassignment.”

    Puberty blockers are drugs which change young bodies in ways we have yet to understand, and may be permanent. This is an experimental treatment program: puberty blockers have never been licensed to treat children with gender dysphoria, in any country.

    REFERENCES

    [1] Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., Skageberg, E. M., Khadr, S., & Viner, R. M. (2021). Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLOS ONE 16 (2). [Link]

    [2] Wiepjes, C.M., Nota, N.M., de Blok, C.J.M., Klaver, M., de Vries, A.L.C., Wensing-Kruger, S.A., de Jongh, R.T., Bouman, M.B., Steensma, T.D., Cohen-Kettenis, P., Gooren, L.J.G., Kreukels, B.P.C. & den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. Journal of Sexual Medicine 15 (4). [Link]

    [3] de Vries, A.L.C., Steensma, T.D., Doreleijers, T.A. & Cohen-Kettenis, P.T. (2011). Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 8 (8): 2276-83. [Link]

  • The chances of developing osteoporosis and cardiovascular problems increase with feminizing hormones. Expand
    The chances of developing osteoporosis and cardiovascular problems increase with feminizing hormones.

    A 2012 paper [1] found that a quarter of the male-to-female transsexuals it studied had osteoporosis at the lumbar spine and radius.

    In the same study, 6% of male-to-female transsexuals experienced a thromboembolic event (a blood clot causing obstruction), and another 6% experienced other cardiovascular problems. These effects were observed after only 11.3 years of hormone treatment on average.

    A further study [2] found that long-term bone mineral density decreases in transwomen who take cross-sex hormones in the long term.

    REFERENCES

    [1] Wierckx, K., Mueller, S., Weyers, S., Van Caenegem, E., Roef, G., Heylens, G. & T’Sjoen, G. (2012). Long-Term Evaluation of Cross-Sex Hormone Treatment in Transsexual Persons. The Journal of Sexual Medicine 9 (10): 2641-2651. [Link]

    [2] Delgado-Ruiz, R., Swanson, P., & Romanos, G. (2019). Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy. Journal of clinical medicine 8 (6): 784. [Link]

  • Puberty blockers and cross-sex hormones negatively impact bone health in a significant number of cases. Expand
    Puberty blockers and cross-sex hormones negatively impact bone health in a significant number of cases.

    There is little long-term evidence on bone mass density in relation to puberty blockers. However, in a significant minority of cases of long-term puberty suppression related to gender identity, bone mass density scores qualify as “low for age” [1]. Low bone mass density increases risk of osteoporosis and fractures.

    Adolescents who enter puberty at an older age have persistently lower bone mass density than their peers [2]: in one case study [3], an adolescent had a bone mass density -2 standard deviations below the mean after three years of blocking puberty.

    It has also been noted [4] that:

    In early-pubertal transgender youth, BMD [bone mass density] was lower than reference standards for sex designated at birth. This lower BMD may be explained, in part, by suboptimal calcium intake and decreased physical activity–potential targets for intervention.

    Bone metabolism is also decreased as a result of taking cross-sex hormones, for both males and (in later life) females [5].

    REFERENCES

    [1] Biggs, M. (2021). Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria. Journal of Pediatric Endocrinology and Metabolism 34 (7): 937-939. [Link]

    [2] Elhakeem, A., Frysz, M., Tilling, K., Tobias, J.H. & Lawlor, D.A. (2019). Association Between Age at Puberty and Bone Accrual From 10 to 25 Years of Age. JAMA Netw Open; 2(8). [Link]

    [3] Pang, K.C., Notini, L., McDougall, R., Gillam, L., Savulescu, J., Wilkinson, D., Clark, B.A., Olson-Kennedy, J., Telfer, M.M. & Lantos, J.D. (2020). Long-term Puberty Suppression for a Nonbinary Teenager. Pediatrics 145 (2). [Link]

    [4] Lee, J. Y., Finlayson, C., Olson-Kennedy, J., Garofalo, R., Chan, Y. M., Glidden, D. V., & Rosenthal, S. M. (2020). Low Bone Mineral Density in Early Pubertal Transgender/Gender Diverse Youth: Findings From the Trans Youth Care Study. Journal of the Endocrine Society 4 (9). [Link]

    [5] Vlot, M.C., Wiepjes, C.M., de Jongh, R.T., T’Sjoen, G., Heijboer, A.C. & den Heijer, M. (2019). Gender-Affirming Hormone Treatment Decreases Bone Turnover in Transwomen and Older Transmen. J Bone Miner Res, 34: 1862-1872. [Link]

  • One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria. Expand
    One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria.

    A British study [1] found that puberty blockers used to treat children aged 12 to 15 who have severe and persistent gender dysphoria had no significant effect on their psychological function, thoughts of self-harm, or body image.

    However, as expected, the children experienced reduced growth in height and bone strength by the time they finished their treatment at age 16.

    REFERENCES

    [1] Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., Skageberg, E. M., Khadr, S., & Viner, R. M. (2021). Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLOS ONE 16 (2). [Link]

  • Medical transition puts both males and females at risk of infertility. Expand
    Medical transition puts both males and females at risk of infertility.

    A wide-ranging study [1] found that gender-related drug regimens place patients at risk of infertility:

    Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear.

    On surgeries, the study noted that cross-sex surgery

    that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility.

    REFERENCES

    [1] Cheng, P.J., Pastuszak, A.W., Myers, J.B., Goodwin, I.A. & Hotaling, J.M. (2019). Fertility concerns of the transgender patient. Transl Androl Urol. 8 (3): 209-218. [Link]

  • There is an array of negative health effects associate with chest binding. Expand
    There is an array of negative health effects associate with chest binding.

    There is a range of negative effects which chest binding can cause [1].

    A survey [2] of transmen who engaged in breast binding found that 68% were concerned about the health effects. The most common symptoms associated with binding were back pain (65%), shortness of breath (48.6%), bad posture (32%), chest pain (30%), and light-headedness (30%).

    REFERENCES

    [1] Peitzmeier, S., Gardner, I., Weinand, J., Corbet A. & Acevedo, K. (2017). Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality 19 (1): 64-75. [Link]

    [2] Poteat, T., Malik, M., & Cooney, E. (2018). Understanding the health effects of binding and tucking for gender affirmation. Journal of Clinical and Translational Science 2 (Suppl 1), 76. [Link]

  • There is evidence that chest binding has a statistically significant impact on lung function. Expand
    There is evidence that chest binding has a statistically significant impact on lung function.

    A study [1] found that:

    Transgender individuals using chest binders have abnormal lung function. The acute effect of wearing the binder appears to be an overall volume reduction with little other change.

    REFERENCES

    [1] Cumming, R., Sylvester, K. & Fuld, J.P. (2016). Understanding the effects on lung function of chest binder use in the transgender population. Thorax 71. [Link]

  • A study which looked at 27 different negative health effects of binding found that some do not show for years. Expand
    A study which looked at 27 different negative health effects of binding found that some do not show for years.

    A survey [1] of 1800 females who used breast binders reported a number of negative health effects which develop over time. Some of these effects are felt immediately. However, in other cases, it can take years for the negative health effects to be fully seen:

    REFERENCES

    [1] Peitzmeier, S.M., Silberholz, J., Gardner, I.H., Weinand, J. & Acevedo, K. (2021). Time to First Onset of Chest Binding-Related Symptoms in Transgender Youth. Pediatrics 147 (3). [Link]

  • While long-term study is lacking, one case study suggests that tucking can affect fertility. Expand
    While long-term study is lacking, one case study suggests that tucking can affect fertility.

    In a case study [1] of one transwoman, tucking resulted in oligospermia – an abnormally low sperm count – affecting fertility. Elevation of the testes because of tucking may contribute to heat stress and consequent impairment of spermatogenesis.

    After cessation of tucking and the provision of a new sperm sample, the sperm count in the patient was improved, and the semen had increased opacification.

    A further study [2] found that tucking could create a suboptimal environment for spermatogenesis.

    REFERENCES

    [1] Trussler, J. T., & Carrasquillo, R. J. (2020). Cryptozoospermia Associated With Genital Tucking Behavior in a Transwoman. Reviews in urology, 22 (4), 170–173. [Link]

    [2] Debarbo, C.J.M. (2020). Rare cause of testicular torsion in a transwoman: A case report. Urology Case Reports 33. [Link]

  • One case study suggests that tucking can cause testicular torsion. Expand
    One case study suggests that tucking can cause testicular torsion.

    A case study [1] found that one transwoman had testicular torsion as a result of tucking.

    Testicular torsion – the rotation of the testes and subsequent arterial constriction – can present as severe acute unilateral scrotal pain, nausea, and vomiting. If permanent ischemic damage results, delay in treatment may be associated with decreased fertility, or may necessitate orchiectomy [2].

    REFERENCES

    [1] Debarbo, C.J.M. (2020). Rare cause of testicular torsion in a transwoman: A case report. Urology Case Reports 33. [Link]

    [2] Sharp, V. J., Kieran, K. & Arlen, A. M. (2013). Testicular Torsion: Diagnosis, Evaluation, and Management. Am Fam Physician 88 (12): 835-840. [Link]

  • In one survey, 50% of transwomen who tucked were concerned about negative health effects. Expand
    In one survey, 50% of transwomen who tucked were concerned about negative health effects.

    A survey [1] of transwomen who tucked (the process of reducing the visible male crotch bulge) reported that half were concerned about the health effects of tucking. 

    Their reported symptoms included itching (28%), rash (21%), testicular pain (17%), penile pain (14%), and skin infections (12%).

    In addition, patients may be reluctant to seek medical care for testicular complaints and when they do, it may be already late to salvage the testis. [2]

    REFERENCES

    [1] Poteat, T., Malik, M., & Cooney, E. (2018). Understanding the health effects of binding and tucking for gender affirmation. Journal of Clinical and Translational Science 2 (Suppl 1), 76. [Link]

    [2] Debarbo, C.J.M. (2020). Rare cause of testicular torsion in a transwoman: A case report. Urology Case Reports 33. [Link]

  • Long-term testosterone use in natal females can cause vaginal atrophy, which makes sex painful. Expand
    Long-term testosterone use in natal females can cause vaginal atrophy, which makes sex painful.

    A study [1] of 16 female-to-male transgender individuals concluded that long-term testosterone administration leads to vaginal atrophy (Baldassarre et al., 2013). The study noted that:

    Vaginal samples from FtM showed a loss of normal architecture of the epithelium, intermediate and superficial layers were completely lost, and glycogen content was depleted.

    Vaginal atrophy, characterized by thinning of vaginal walls and poor lubrication of vaginal tissues, leads to tearing, micro abrasions, bleeding, and painful intercourse.

    REFERENCES

    [1] Baldassarre, M., Giannone, F., Foschini, M., Battaglia, C., Busacchi, P., Venturoli, S., & Meriggiola, M. (2013). Effects of long-term high dose testosterone administration on vaginal epithelium structure and estrogen receptor-α and -β expression of young women. International Journal Of Impotence Research, 25 (5): 172-177. [Link]

  • In one study, 11% of transmen who took testosterone developed a condition called erythrocytosis, which impacts red blood cells and slows the blood flow. Expand
    In one study, 11% of transmen who took testosterone developed a condition called erythrocytosis, which impacts red blood cells and slows the blood flow.

    A study [1] of 776 transmen who took testosterone demonstrated that 11% of them developed erythrocytosis, a condition which slows the blood flow, and can lead to headaches, confusion, high blood pressure, nosebleeds, blurred vision, itching and fatigue.

    REFERENCES

    [1] Madsen, M.C., van Dijk, D. Wiepjes, C.M., Conemans, E.B., Thijs, A. & den Heijer, M. (2021). Erythrocytosis in a Large Cohort of Trans Men Using Testosterone: A Long-Term Follow-Up Study on Prevalence, Determinants, and Exposure Years. The Journal of Clinical Endocrinology & Metabolism 106 (6): 1710–1717. [Link]

  • Genital surgeries tend to reduce the capacity for orgasm in males, and may do so in females. Expand
    Genital surgeries tend to reduce the capacity for orgasm in males, and may do so in females.

    One study showed that around 30% of male-to-female genital surgeries result in the inability to orgasm [1].

    Figures on female-to-male transitioners are less clear. However, a clinical follow-up study [2] of 38 transmen – 29 of whom had received phalloplasty, and 9 metoidioplasty – found that reported loss of orgasmic capacity was more marginally common than reported gain of orgasmic capacity.

    The negative intrapsychic and interpersonal consequences of anorgasmia (the inability to climax) is well-documented, and applies equally to transgender individuals [3].

    REFERENCES

    [1] Manrique, O., Adabi, K., Martinez-Jorge, J., Ciudad, P., Nicoli, F. and Kiranantawat, K. (2018). Complications and Patient-Reported Outcomes in Male-to-Female Vaginoplasty—Where We Are Today. Annals of Plastic Surgery 80 (6): 684-691. [Link]

    [2] van de Grift, T., Pigot, G., Kreukels, B., Bouman, M., & Mullender, M. (2019). Transmen’s Experienced Sexuality and Genital Gender-Affirming Surgery: Findings From a Clinical Follow-Up Study. Journal Of Sex & Marital Therapy 45 (3): 201-205. [Link]

    [3] Levine, S. (2018). Informed Consent for Transgendered Patients. Journal Of Sex & Marital Therapy, 45(3), 218-229. [Link]

  • Feminizing hormones reduce sexual function in males. Expand
    Feminizing hormones reduce sexual function in males.

    Feminizing hormonal treatments lead to a lessening drive, erectile dysfunction, and shrinking of testes and penis [1], significantly compromising sexual function.

    A Belgian doctoral thesis study [2] found that 69.7% of transwomen reported a decrease in sexual desire — while the opposite effect is found in transmen.

    REFERENCES

    [1] Levine, S. (2018). Informed Consent for Transgendered Patients. Journal Of Sex & Marital Therapy, 45(3), 218-229. [Link]

    [2] Elaut, E. (2014). Biopsychosocial factors in the sexual desire of contraception‐using couples and trans persons. Doctoral thesis, University of Ghent. [Link]

  • Vaginoplasty can result in fistula, stenosis, necrosis, prolapse and even death. Expand
    Vaginoplasty can result in fistula, stenosis, necrosis, prolapse and even death.

    Male-to-female genital surgery (vaginoplasty) is associated with significant long-term complications: there is a 2% risk of fistula, 14% risk of stenosis (abnormal narrowing), 1% risk of necrosis (tissue death) and 4% risk of prolapse [1].

    One systematic review [2] found an overall complication rate of 32.5%.

    A Dutch study [3] of 55 (out of an original 70) adolescents treated with puberty blockers, cross sex hormones, and genital surgery, showed that among 22 male-to-female patients who underwent vaginoplasty, one adolescent died as a result of necrotizing fasciitis after the surgery.

    REFERENCES

    [1] Manrique, O., Adabi, K., Martinez-Jorge, J., Ciudad, P., Nicoli, F. and Kiranantawat, K. (2018). Complications and Patient-Reported Outcomes in Male-to-Female Vaginoplasty—Where We Are Today. Annals of Plastic Surgery 80 (6): 684-691. [Link]

    [2] Dreher, P.C., Edwards, D., Hager, S., Dennis, M., Belkoff, A., Mora, J., Tarry, S. & Rumer, K.L. (2018). Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clin Anat. 31 (2):191-199. [Link]

    [3] de Vries, A., McGuire, T., Steensma, E., Wagenaar, T., Doreleijers, P. & Cohen-Kettenis, P. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. [Link]

  • Around 1 in 5 vaginoplasty surgeries lead to corrective surgery. Expand
    Around 1 in 5 vaginoplasty surgeries lead to corrective surgery.

    A systematic review [1] of neo-vagina surgeries found a re-operation rate of 21.7% for non-esthetic reasons.

    A Brazilian paper [2] found a somewhat lower, but similar, reoperation rate of 16.8%.

    REFERENCES

    [1] Dreher, P.C., Edwards, D., Hager, S., Dennis, M., Belkoff, A., Mora, J., Tarry, S. & Rumer, K.L. (2018). Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clin Anat. 31 (2):191-199. [Link]

    [2] Moisés da Silva, G.V., Lobato, M.I.R., Silva, D.C., Schwarz, K., Fontanari, A.M.V., Costa, A.B., Tavares, P.M., Gorgen, A.R.H., Cabral, R.D. & Rosito, T.E. (2021). Male-to-Female Gender-Affirming Surgery: 20-Year Review of Technique and Surgical Results. Frontiers in Surgery 8. [Link]

  • There is evidence that up to a quarter of transgender genital surgeries result in incontinence. Expand
    There is evidence that up to a quarter of transgender genital surgeries result in incontinence.

    A systematic literature review [1] found that 21% of male-to-female patients and 25% of female-to-male patients suffered from incontinence as a result of transgender genital surgery.

    One recent study [2] estimates the number of post-operative transsexuals suffering stress incontinence to be 23%. This study was not a literature review, and almost all of the participants were male-to-female.

    REFERENCES

    [1] Nassiri, N., Maas, M., Basin, M., Cacciamani, G.E. & Doumanian, L.R. (2020). Urethral complications after gender reassignment surgery: a systematic review. Int J Impot Res. [Link]

    [2] Kuhn, A., Santi, A. & Birkhäuser, M. (2011). Vaginal prolapse, pelvic floor function, and related symptoms 16 years after sex reassignment surgery in transsexuals. Fertil Steril. 95: 2379-82. [Link]

  • Medical transition reduces dating pool size and likelihood of marriage. Expand
    Medical transition reduces dating pool size and likelihood of marriage.

    Individuals undergoing biomedical interventions to address their gender dysphoria are at risk for having a greatly diminished pool of individuals who are willing to sustain an intimate physical and loving relationship [1].

    This is evidenced in the much lower marriage rates of transgender adults [2].

    REFERENCES

    [1] Levine, S. (2018). Informed Consent for Transgendered Patients. Journal Of Sex & Marital Therapy, 45(3), 218-229. [Link]

    [2] Yarbrough, E. (2018). Transgender mental health. Washington, DC: American Psychiatric Association Publishing. [Link]

  • There is evidence that it is harder to sustain meaningful sexual relationships after medical transition. Expand
    There is evidence that it is harder to sustain meaningful sexual relationships after medical transition.

    A study [1] on informed consent found that male-to-female transitioners who are attracted to men may discover that men who are sexually interested in them are specifically interested in their trans status, and have no interest in serious long-term relationships. 

    The same study noted that male-to-female transitioners who are attracted to women may find that lesbians are unwilling to engage in a sexual relationship with a male.

    Because most female-to-male transitioners do not undergo phalloplasty, their ability to attract desirable sexual partners, and sustain relationships with them, could be compromised.

    Only a single case [2] of a female-to-male transitioner treated with puberty blockers followed by cross-sex hormones and surgeries has feen followed long-term.

    The individual, who was in his thirties during the follow up, reported an inability to have a satisfying sexual life due to “shame about his genital appearance and his feelings of inadequacy in sexual matters”. The researchers concluded, that despite the gender reassignment, “in the area of intimate relationships, it may remain difficult to find a suitable partner”.

    REFERENCES

    [1] Levine, S. (2018). Informed Consent for Transgendered Patients. Journal Of Sex & Marital Therapy, 45(3), 218-229. [Link]

    [2] Cohen-Kettenis, P., Schagen, S., Steensma, T., de Vries, A., & Delemarre-van de Waal, H. (2011). Puberty Suppression in a Gender-Dysphoric Adolescent: A 22-Year Follow-Up. Archives Of Sexual Behavior 40 (4): 843-847. [Link]

  • Young transgender people are at elevated risk of contracting HIV and other STDs. Expand
    Young transgender people are at elevated risk of contracting HIV and other STDs.

    Transgender adolescents and young adults, particularly trans females, are at a disproportionately high risk of contracting human immunodeficiency virus [1] and other sexually transmitted diseases [2].

    REFERENCES

    [1] Poteat, T., Scheim, A., Xavier, J., Reisner, S. & Baral, S. (2016). Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People. Journal of Acquired Immune Deficiency Syndromes 72 (Suppl 3). [Link]

    [2] Reisner, S.L., Vetters, R., Leclerc, M., Zaslow, S., Wolfrum, S., Shumer, D. & Mimiaga, M.J. (2015). Mental Health of Transgender Youth in Care at an Adolescent Urban Community Health Center: A Matched Retrospective Cohort Study. Journal of Adolescent Health 56 (3): 274-279. [Link]

  • Transmen are four or five times as likely as females in general to suffer a heart attack. Expand
    Transmen are four or five times as likely as females in general to suffer a heart attack.

    A 2019 study [1] found that post-operative female-to-male transgender people were 4.9 times as likely to suffer a myocardial infarction (heart attack) than women in general.

    Another study [2] also found a somewhat smaller yet still large discrepancy, concluding that transmen were 3.69 more likely to suffer a heart attack than women in general.

    REFERENCES

    [1] Alzahrani, T. Nguyen, T., Ryan, A., Dwairy, A. McCaffrey, J., Yunus, R., Forgione, J., Krepp, J., Nagy, C., Mazhari, R. & Reiner, J. (2019). Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population. Circulation: Cardiovascular Quality and Outcomes 12 (4). [Link]

    [2] Nota, N.M., Wiepjes, C.M., de Blok, C.J.M., Gooren, L.J.G., Kreukels, B.P.D. & den Heijer, M. (2019). Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy: Results From a Large Cohort Study. Circulation 139: 1461-1462. [Link]

  • There is very little evidence on the number of people who have detransitioned. Expand
    There is very little evidence on the number of people who have detransitioned.

    In a study [1] of 100 detransitioners, only 24% of respondents informed their clinicians that they had detransitioned. The vast majority made no attempt to contact their clinics.

    Not only does this mean that we have no way of ascertaining how many people detransition, it also potentially impact clinics’ assessments of patient satisfaction.

    One paper [2] claimed that the detransition rate was 13.1%. However, this research relies on data from the U.S. Transgender Survey, which was conducted via community outreach organizations, and may therefore have excluded detransitioners who were no longer in touch with any such organizations. Only people who still identified as members of the trans community were included:

    The 2015 U.S. Transgender Survey (USTS) was conducted by the National Center for Transgender Equality (NCTE) to examine the experiences of transgender adults in the United States.

    By contrast, the study by Lisa Littman [1] sought respondents from a political and ideological variety of sources.

    In a recent retrospective case-note review [3], performed as a service evaluation over twelve months, 6.9% of participants met the case definition of detransitioning, yet 21.7% disengaged from the study.

    In general, detransitioners remain an underserved population in healthcare, with far more research required to understand their needs [4].

    REFERENCES

    [1] Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Arch Sex Behav. [Link]

    [2] Turban, J.L., Loo, S.S., Almazan, A.N., & Keuroghlian, A.S. (2021). Factors Leading to “Detransition” Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT health 8(4): 273-280. [Link]

    [3] Hall, R., Mitchell, L., & Sachdeva, J. (2021). Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: Retrospective case-note review. BJPsych Open 7(6): E184. [Link]

    [4] Expósito-Campos, P. (2021). A Typology of Gender Detransition and Its Implications for Healthcare Providers. Journal of Sex & Marital Therapy 47 (3): 270-280. [Link]

  • In one study of detransitioners, around half originally believed that transition would mean they were better treated. Expand
    In one study of detransitioners, around half originally believed that transition would mean they were better treated.

    In a study [1] of 100 detransitioners, 50.7% of females and 45.2% of males identified with the comment “I felt I would be treated better if I was perceived as the target gender”.

    REFERENCES

    [1] Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Arch Sex Behav. [Link]

  • In one study of detransitioners, around half were worried about the medical complications of transitioning. Expand
    In one study of detransitioners, around half were worried about the medical complications of transitioning.

    A study [1] of 100 detransitioners showed that 49% had concerns about potential medical complications from transitioning. 

    A second study [2] of detransitioners and desisters – most of whom were detransitioners who had undergone medical transition – arrived at a higher figure, with 62% citing health concerns as a motivating factor for detransition.

    REFERENCES

    [1] Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Arch Sex Behav. [Link]

    [2] Vandenbussche, E. (2021). Detransition-Related Needs and Support: A Cross-Sectional Online Survey. Journal of Homosexuality. [Link]

  • In one study of detransitioners, around half believed that they received inadequate care. Expand
    In one study of detransitioners, around half believed that they received inadequate care.

    The majority (55.0%) of detransitioners in a 100-participant study [1] felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition.

    A second study [2] of detransitioners and desisters – most of whom were detransitioners who had undergone medical transition – arrived at a similar, although slightly lower, figure, with 45% of detransitioners not feeling properly informed about the health implications of the accessed treatments and interventions before undergoing them.

    REFERENCES

    [1] Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Arch Sex Behav. [Link]

    [2] Vandenbussche, E. (2021). Detransition-Related Needs and Support: A Cross-Sectional Online Survey. Journal of Homosexuality. [Link]

  • One study of detransitioners found that a large proportion of them believed, in hindsight, that they were suffering from internalized homophobia. Expand
    One study of detransitioners found that a large proportion of them believed, in hindsight, that they were suffering from internalized homophobia.

    A study of 100 detransitioners [1] found that homophobia or difficulty accepting themselves as lesbian, gay, or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition.

    In another study of detransitioners and desisters [2] – most of whom were detransitioners who had undergone medical transition – 52% expressed a psychological need for learning to cope with internalized homophobia.

    REFERENCES

    [1] Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Arch Sex Behav. [Link]

    [2] Vandenbussche, E. (2021). Detransition-Related Needs and Support: A Cross-Sectional Online Survey. Journal of Homosexuality. [Link]

  • In one study, female detransitioners were three times more likely to be lesbians than to be straight. Expand
    In one study, female detransitioners were three times more likely to be lesbians than to be straight.

    A study [1] of 100 detransitioners, the majority of whom were female, showed that 26.1% of the females were homosexual before they transitioned.

    Only 8.7% considered themselves heterosexual.

    REFERENCES

    [1] Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Arch Sex Behav. [Link]

  • In one study of detransitioners, males were three times more likely than females to have transitioned for erotic reasons. Expand
    In one study of detransitioners, males were three times more likely than females to have transitioned for erotic reasons.

    In a study [1] of 100 detransitioners, 38.7% of males identified with the comment “I had erotic reasons for wanting to transition”.

    The figure for females was a third of this, at 13%.

    REFERENCES

    [1] Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Arch Sex Behav. [Link]

  • There are 2 sexes: males and female. Biological sex is not a spectrum. Expand
    There are 2 sexes: male and female. Biological sex is not a spectrum.

    According to an Endocrine Society Scientific Statement [1],

    Sex is dichotomous, with sex determination in the fertilized zygote stemming from unequal expression of sex chromosomal genes.

    Sex differences in baseline physiology and associated mechanisms form the foundation for understanding sex differences in diseases pathology, treatments, and outcomes. 

    The erroneous claim that biological sex is a spectrum, or non-dichotomous, is often used to justify the ideological assertion that all humans are ‘assigned sex at birth’. In fact, biological sex is encoded in every cell of the body [2].

    REFERENCES

    [1] Bhargava, A., Arnold, A.P., Bangasser, D.A., Denton, K.M., Gupta, A., Hilliard Krause, L.M., Mayer, E.A., McCarthy, M., Miller, W.L., Raznahan, A. & Verma, R. (2021). Considering Sex as a Biological Variable in Basic and Clinical Studies: An Endocrine Society Scientific Statement. Endocrine Reviews 42 (3): 219-258. [Link]

    [2] Shah, K. McCormack, C. & Bradbury, N. (2014). Do you know the sex of your cells?’ American Journal of Physiology – Cell Physiology, C3-C18, 306, 1. [Link]

  • It is not true that 1.7% of the population is ‘born between the sexes’. The proportion of people with DSDs (‘intersex’ conditions) is 0.018%. Expand
    It is not true that 1.7% of the population is ‘born between the sexes’. The proportion of people with DSDs (‘intersex’ conditions) is 0.018%.

    Conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female, occur in 0.018% of the population [1].

    The claim that 1.7% of the population is ‘intersex’ [2] includes conditions which most clinicians do not recognize as intersex [1], and is often wrongly used to back up the ideological assertion that ‘sex is a spectrum’, or that biological sex is not dimorphic.

    The philosopher Kathleen Stock points out that she would be considered as “intersex” under Fausto-Sterling’s “preposterously over-demanding conditions on sex category membership”, as she lost an ovary in early adulthood [3], which would count as “intersex” according to Fausto-Sterling.

    REFERENCES

    [1] Sax, L. (2002). How common is intersex? a response to Anne Fausto-Sterling. J Sex Res. 39 (3): 174-8. [Link]

    [2] Fausto-Sterling, A. (2000). Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books. [Link]

    [3] Stock, K. (2021). Material Girls. Little, Brown Book Group: p.56 [Link]

  • The term ‘Two-Spirit’ was invented in 1990. Expand
    The term ‘Two-Spirit’ was invented in 1990.

    The term ‘Two-Spirit’ – often abbreviated to ‘2S’, and particularly common in Canada – is a modern invention. It was first coined at the Indigenous Lesbian and Gay International Gathering in Winnipeg, Manitoba, in 1990 [1].

    REFERENCES

    [1] de Vries, K. M. (2009). Berdache (Two-Spirit). In O’Brien, J. (ed.): Encyclopedia of gender and society. Los Angeles: SAGE. [Link]