Sex ratio in children and Adolescents Referred to the Gender Identity Development Service in the UK (2009-2016)

Over the last decade, several child and adolescent gender identity services have reported an increase in young people who seek help with incongruence between the experienced gender identity and the gender to which they were assigned at birth (Aitken et al., 2015; Wood et al., 2013). Many of those, but not all, would meet the diagnostic criteria for gender dysphoria (GD) (APA, 2013). It has been suggested that this increase is mostly due to an influx of birth-assigned females coming forward. Aitken et al. (2015) reported a significant temporal shift in the sex ratio of clinic-referred gender-diverse youth to Toronto and Amsterdam, from a ratio favoring males prior to 2006, to a ratio favoring assigned females from 2006 to 2013.

The national Gender Identity Development Service (GIDS) in the UK is the largest child and adolescent specialist gender service in the world, seeing young people up to the age of 18. Historically, more birth-assigned males were presenting to GIDS in childhood and adolescence (Di Ceglie, Freedman, McPherson, & Richardson, 2002). However, in a more recent study, adolescent referrals to GIDS favored birth-assigned females (de Graaf et al., 2017; Holt, Skagerberg, & Dunsford, 2016).

Gender-diverse young people often present with psychological difficulties. Compared to children, a greater percentage of gender-diverse adolescents have psychological difficulties in the clinical range (Steensma et al., 2014). The level of psychological well-being for birth-assigned males and females referred in childhood are often comparable (Steensma et al., 2014). In adolescents, however, gender differences in psychological functioning are noted more frequently. The literature suggests that birth-assigned males tend to show more internalizing difficulties in the clinical range than birth-assigned females (de Vries, Steensma, Cohen-Kettenis, VanderLaan, & Zucker, 2016). However, more recently, increased psychopathology was also reported for gender-diverse birth-assigned females (de Graaf et al., 2017; Kaltiala-Heino, Sumia, Työläjärvi, & Lindberg, 2015).

The current study aimed to examine the sex ratio in the number of children and adolescents referred to GIDS over the past 7 years and to investigate whether any gender differences can be found in terms of psychological functioning and age at referral.