Category: Comorbidity
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Rates of autism are much higher in trans-identified people.
In an analysis1 of five large datasets, “trangender and gender diverse” individuals were 3.03 to 6.36 times more likely to be autistic than those who do not claim an alternative gender identity.
- Warrier, V., Greenberg, D.M., Weir, E. et al. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature Communications 11, 3959 (2020). https://doi.org/10.1038/s41467-020-17794-1 ↩︎
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More than 80% of trans-identified young people experienced depressive mood, and more than half had considered suicide.
In a national quantitative cross-sectional survey1 of more than 25,000 “LGBQ” people, aged between 13 and 24 years, in the U.S., 82% reported experiencing depressive mood. 54% said they had seriously considered suicide, and 28% reported attempting suicide, in the last 12 months. Across all groups, females were more likely to experience depression, suicidality and attempted suicide than males. Participants with “trans” and “non-binary” identities were about twice as likely to report depressive mood and having considered suicide, and about one and a half times as likely to report a suicide attempt.
- Price-Feeney, Myeshia et al., Understanding the Mental Health of Transgender and Nonbinary Youth, Journal of Adolescent Health, Volume 66, Issue 6, 684 – 690 ↩︎
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“Gender questioning” adolescents may have very high rates of disordered eating.
In a cross-sectional study1 of 660 Australian adolescents described as “trans,” “non-binary” and “gender questioning,” adolescents who reported feeling unsure about their “gender identity” had the highest rates of nearly all symptoms of anorexia and bulimia.
- Kerr JA, Paine J, Thrower E, Hoq M, Mollica C, Sawyer SM, Azzopardi PS, Pang KC. Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care. Journal of Adolescent Health. 2024 Apr;74(4):850-853. doi: 10.1016/j.jadohealth.2023.11.396. Epub 2024 Jan 9. PMID: 38206224.
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- Kerr JA, Paine J, Thrower E, Hoq M, Mollica C, Sawyer SM, Azzopardi PS, Pang KC. Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care. Journal of Adolescent Health. 2024 Apr;74(4):850-853. doi: 10.1016/j.jadohealth.2023.11.396. Epub 2024 Jan 9. PMID: 38206224.
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Nearly a quarter of adolescents seeking “gender-affirming care” report symptoms of anorexia.
In a cross-sectional study1 of 660 Australian adolescents described as “trans,” “non-binary” and “gender questioning,” 23.9% reported symptoms of anorexia. Prevalence of disordered eating was more common in female patients than in male, regardless of whether they identified as trans or non-binary.
- Kerr JA, Paine J, Thrower E, Hoq M, Mollica C, Sawyer SM, Azzopardi PS, Pang KC. Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care. Journal of Adolescent Health. 2024 Apr;74(4):850-853. doi: 10.1016/j.jadohealth.2023.11.396. Epub 2024 Jan 9. PMID: 38206224. ↩︎
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Young people with “trans” identities are much more likely to have an eating disorder.
A study1 of data concerning 289,024 students from 223 U.S. universities found that students with a “trans” identity were almost four times more likely to have a self-reported eating disorder (OR: 4.62, 95% CI: 3.41-6.26) than their straight female peers. They were also about twice as likely to report past month use of diet pills (OR: 2.05, 95% CI: 1.48-2.83) and vomiting or laxatives (OR: 2.46, 95% CI: 1.83-3.30).
- Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE. Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. Journal of Adolescent Health. 2015 Aug;57(2):144-9. doi: 10.1016/j.jadohealth.2015.03.003. Epub 2015 Apr 28. PMID: 25937471; PMCID: PMC4545276. ↩︎
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Up to half of trans-identified children show disordered eating.
In an analysis1 of research conducted in 2022-23, 20-50% of children expressing a “trans” identity reported engaging in some form of disordered eating. More than 30% screened positive for eating disorder symptoms, and up to 12% had received an eating disorder diagnosis.
- Keski-Rahkonen A. Eating disorders in transgender and gender diverse people: characteristics, assessment, and management. Current Opinion in Psychiatry. 2023 Nov 1;36(6):412-418. doi: 10.1097/YCO.0000000000000902. Epub 2023 Aug 29. PMID: 37781981.
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- Keski-Rahkonen A. Eating disorders in transgender and gender diverse people: characteristics, assessment, and management. Current Opinion in Psychiatry. 2023 Nov 1;36(6):412-418. doi: 10.1097/YCO.0000000000000902. Epub 2023 Aug 29. PMID: 37781981.
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ADHD symptoms are more common in children with trans identities.
In an analysis of cross-sectional data from the Adolescent Brain Cognitive Development Study1, covering 10,227 children, children who answered “yes” or “maybe” to the question “are you transgender?” were more likely to show ADHD symptoms than those who answered “no.”
- Elizaveta Ignatova, Priyadharshini Balasubramanian, Julia H. Raney, Kyle T. Ganson, Alexander Testa, Jinbo He, Fiona C. Baker, Jason M. Nagata,
Transgender Identity and Attention Deficit Hyperactivity Disorder Symptoms: Findings From the Adolescent Brain Cognitive Development Study, Journal of Adolescent Health,
Volume 76, Issue 3, 2025. https://doi.org/10.1016/j.jadohealth.2024.10.015. ↩︎
- Elizaveta Ignatova, Priyadharshini Balasubramanian, Julia H. Raney, Kyle T. Ganson, Alexander Testa, Jinbo He, Fiona C. Baker, Jason M. Nagata,
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A Finnish study found detransitioners commonly had psychiatric comorbidities and childhood trauma, with most concluding their gender dysphoria arose from psychological distress rather than transgender identity.
A 2025 case series1 from Helsinki University Hospital reviewed nine adults who sought medical detransition after previously receiving “gender-affirming” treatments.
Seven were natal females and all expressed “major regret”; both natal males expressed “minor regret.” The average time from diagnosis to regret was 7 years. Patients had used hormones for an average of 7 years (median 4 years), with eight undergoing chest reconstruction/augmentation surgery and four females having reproductive organs surgically removed.
All nine had psychiatric comorbidities—mood disorders were most common (8 patients: 2 with bipolar II, 6 with depression), anxiety disorders (6 patients initially, 7 by detransition), personality disorders (3 patients, with borderline personality disorder increasing from 2 to 5 patients by detransition), and dissociative disorders (1 initially, 3 total). Childhood trauma was universal, with all having insecure attachment styles. Six reported sexual abuse/rape and six experienced school bullying. Eating disorders were diagnosed in 4 patients, with 78% having eating disorder symptoms.
Patients retrospectively believed their gender dysphoria stemmed from unresolved psychological stressors and developmental challenges rather than a stable transgender identity. The clinic has since revised its protocols to improve psychiatric screening, facilitate easier re-access for detransitioners without referrals, and emphasize clinical neutrality.
- Kettula, K., Puustinen, N., Tynkkynen, L., Lempinen, L., & Tuisku, K. (2025). Gender Dysphoria and Detransitioning in Adults: An Analysis of Nine Patients from a Gender Identity Clinic from Finland. Archives of Sexual Behavior, 54(5), 1981-1990. [Link] ↩︎
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Co-occurring mental health issues, rather than gender dysphoria, are the primary predictors of both all-cause and suicide-related mortality in adolescents seeking gender-related care
A 2024 study by Ruuska et al.1, which analyzed data from 2,083 adolescents referred to gender identity clinics and 16,643 matched controls, reported higher initial mortality rates among referred adolescents (0.81 per 1000 person-years) compared to controls (0.40 per 1000 person-years). The suicide rates were also higher among the referred group (0.51 per 1000 person-years versus 0.12 per 1000 person-years). However, after controlling for history of psychiatric treatment, these differences in mortality rates between the two groups were not statistically significant, with hazard ratios normalizing at 1.0 for all-cause mortality and 1.8 for suicide mortality.
- Ruuska, S. M., Tuisku, K., Holttinen, T., & Kaltiala, R. (2024). All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: a register study. BMJ Ment Health, 27(1). [Link] ↩︎
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Autism and gender dysphoria occur together at significantly high rates.
The connection between autism and gender dysphoria has emerged through increasingly robust research over the past decade. Early systematic reviews (Glidden et al., 2016)1 first identified unexpectedly high autism rates among youth with gender dysphoria diagnoses.
Clinical studies then provided stronger evidence. Hisle-Gorman et al. (2019)2 found children with autism diagnoses were over four times more likely to receive a gender dysphoria diagnosis. Warrier et al. (2020)3 confirmed elevated rates across five large independent datasets.
Kallitsounaki & Williams’ 2023 meta-analysis4 synthesized 47 studies – including the ones above – finding that 11% of individuals with gender dysphoria have autism diagnoses—compared to 1% in the general population. The analysis also showed statistically significant differences in autism traits between those with gender dysphoria and control groups (g=0.67), with the authors noting the rising number of publications on this overlap.
Kahn et al.’s 2023 study5 analyzed 919,898 youth across eight U.S. hospital systems, revealing that 0.05% had diagnoses of both autism and gender dysphoria. The probability of having a gender dysphoria diagnosis was 0.019 for those with autism, compared to 0.006 for those without—representing three times higher odds (aOR=3.00).
- Glidden, D., Bouman, W. P., Jones, B. A., & Arcelus, J. (2016). Gender dysphoria and autism spectrum disorder: A systematic review of the literature. Sexual Medicine Reviews, 4(1), 3–14. ↩︎
- Hisle-Gorman, E., Landis, C. A., Susi, A., Schvey, N. A., Gorman, G. H., Nylund, C. M., & Klein, D. A. (2019). Gender dysphoria in children with autism spectrum disorder. LGBT Health, 6(3), 95–100. ↩︎
- Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M. C., … & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature Communications, 11(1), 3959. ↩︎
- Kallitsounaki, A., & Williams, D. M. (2023). Autism spectrum disorder and gender dysphoria/incongruence: A systematic literature review and meta-analysis. Journal of Autism and Developmental Disorders, 53(8), 3103–3117. ↩︎
- Kahn, N. F., Sequeira, G. M., Garrison, M. M., Orlich, F., Christakis, D. A., Aye, T., … & Richardson, L. P. (2023). Co-occurring autism spectrum disorder and gender dysphoria in adolescents. Pediatrics, 152(2), e2023061363. ↩︎
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In one peer-reviewed study of 100 detransitioners, 76% did not inform their clinicians that they had detransitioned
The majority (55%) felt they did not receive an adequate evaluation from a doctor or mental health professional before starting their transition1.
38% believed that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition.
- Littman L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of sexual behavior, 50(8), 3353–3369. [Link] ↩︎
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Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors
A Swedish study1 points out that it is “difficult to distinguish one [gender dysphoria] from the other [mental health conditions] with regard to suicide risk.”
A 2019 study2 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.”
- Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link] ↩︎
- Zucker, K. J. (2019). Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues. Archives of Sexual Behavior 48 (5). [Link] ↩︎
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People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people
A Swedish study1 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 study2 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.”
- Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link] ↩︎
- Nordentoft, M., Madsen, T. & Fedyszyn, I. (2015). Suicidal behavior and mortality in first-episode psychosis. J Nerv Ment Dis. 203 (5): 387-92. [Link] ↩︎
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There seems to be a connection between disordered eating patterns and gender-related distress
In a review1 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.
- 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] ↩︎
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Transgender-identified youth are disproportionately likely to suffer from eating disorders
In a review1 of 20 publications, significantly higher rates of eating disorder symptoms were documented in transgender youth (aged between 8 and 25).
Another study2 corroborated this connection, noting that data, while scarce, suggest “an overrepresentation of eating pathology among adolescents with GD [gender dysphoria] or transgender identity.”
- 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] ↩︎
- 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] ↩︎
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Transgender-identified youth are prone to elevated rates of depression and/or anxiety
A study1 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 study2, 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 study3 – 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 found4 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 paper5 found somewhat lower figures, giving a prevalence of 42.1% for mood disorders and 26.8% for anxiety disorders.
- 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] ↩︎
- 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] ↩︎
- Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link] ↩︎
- Mazaheri Meybodi, A., Hajebi, A., & Ghanbari Jolfaei, A. (2014). Psychiatric Axis I: Comorbidities among Patients with Gender Dysphoria. Psychiatry journal 2014. [Link] ↩︎
- 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] ↩︎
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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 survey1, 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 article2 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 work3 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 review4 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 population5: a further paper6 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 study7 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.
- 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] ↩︎
- 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] ↩︎
- Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link] ↩︎
- 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] ↩︎
- Zucker, K.J., Lawrence, A.A., Kreukels, B.P. (2016). Gender Dysphoria in Adults. Annu Rev Clin Psychol. 12: 217-47. [Link] ↩︎
- 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] ↩︎
- 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] ↩︎
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Children with ADHD are far more likely than average to express gender variance
A study on children1 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.
- 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] ↩︎
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Roughly 15% of transmasculine and transfeminine youths in one study had attention deficit disorders
A study1 which used electronic medical records to identify transmasculine and transfeminine youths found attention deficit disorders in 15% of males and 16% of females.
- 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] ↩︎
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Obsessive-compulsive traits are more common in people with gender dysphoria
At least two studies1 2 have found a particular connection between intense interests or repetitive behaviors – associated with autism spectrum disorders – and gender dysphoria.
It has also been noted3 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).
- 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] ↩︎
- 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] ↩︎
- 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] ↩︎