Category: Teenagers • Page 2
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Trans identities are more strongly associated with perpetration of bullying than subjection to bullying.
In a large sample of Finnish adolescents (N = 130,372), Heino et al. (2021)1 found that trans identities were more strongly associated with perpetrating bullying than being bullied. Youth identifying as non-binary reported the highest rates of both bullying others and being bullied.
Experiences of bullying and bullying others according to gender identity,% (n).
Regression analysis of being bullied.
Regression analysis for perpetration of bullying.
- Heino, E., Ellonen, N., & Kaltiala, R. (2021). Transgender identity is associated with bullying involvement among Finnish adolescents. Frontiers in psychology, 11, 612424. [Link] ↩︎
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Trans-identified adolescents are prescribed psychotropic medications more than twice as often as their siblings, with rates increasing after medical transition.
A 2021 study in the Journal of Sexual Medicine1 found that trans-identified adolescents in the US military healthcare system were prescribed psychotropic medications (such as antidepressants, sleep aids, antipsychotics, and mood stabilizers) at more than double the rate of their siblings (IRR = 2.57), with prescriptions increasing after “gender-affirming pharmaceutical initiation” (IRR = 1.67). The study compared mental health diagnoses, service use, and medication patterns before and after this medical transition step.
- Hisle-Gorman, E., Schvey, N. A., Adirim, T. A., Rayne, A. K., Susi, A., Roberts, T. A., & Klein, D. A. (2021). Mental healthcare utilization of transgender youth before and after affirming treatment. The Journal of Sexual Medicine, 18(8), 1444-1454. [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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Trans-identified and gender-questioning adolescents engage in significantly more recreational screen time and exhibit higher rates of problematic screen use compared to their peers
Using data from the third year of the U.S. Adolescent Brain Cognitive Development Study, which included 9,859 participants mostly aged 12-13, Nagata et al. (2024)1 found that trans-identified youth report an average of 4.51 more hours of daily screen time, and gender-questioning youth report 3.41 more hours, compared to other youth. This screen time includes activities such as browsing the internet, playing video games, texting, using social media, and watching television and movies. Adjusting for various confounders, the study also indicated higher instances of problematic use of social media, video games, and mobile phones among these groups. Problematic use was defined as being “characterized by inability to control usage and detrimental consequences from excessive use including preoccupation, tolerance, relapse, withdrawal, and conflict.”
- Nagata, J. M., Balasubramanian, P., Iyra, P., Ganson, K. T., Testa, A., He, J., … & Baker, F. C. (2024). Screen use in transgender and gender-questioning adolescents: Findings from the Adolescent Brain Cognitive Development (ABCD) Study. Annals of Epidemiology, 95, 6-11. [Link] ↩︎
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In one survey of WPATH-affiliated surgeons, over half reported performing vaginoplasty on minors
A 2017 study by Milrod and Karasic1 surveyed 20 WPATH-affiliated surgeons in the United States about their experiences and attitudes toward vaginoplasty in minors. Of these surgeons, 11 (55%) reported having performed the procedure on minors, with patient ages ranging from 15 to “a day before 18”.
- Milrod, C., & Karasic, D. H. (2017). Age is just a number: WPATH-affiliated surgeons’ experiences and attitudes toward vaginoplasty in transgender females under 18 years of age in the United States. The Journal of Sexual Medicine, 14(4), 624-634. [Link] ↩︎
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Intestinal vaginoplasty in patients with stunted penile growth from puberty blockers can lead to bowel inflammation, excessive discharge, persistent foul odors, and fecal leakage
A 2017 survey by Milrod and Karasic1 found WPATH-affiliated surgeons in the United States considered sigmoid- or ileum-derived vaginoplasty (using sections of large or small intestine) an option for patients who had used puberty blockers. These patients, who had sometimes used blockers for up to 3 years, had severely underdeveloped genitals, described as “11-year-old genitalia” or a “micropenis,” which complicated standard surgical techniques. However, this intestinal approach was associated with serious complications, including diversion colitis (inflammation of the repurposed bowel tissue), excessive secretion, persistent foul odors, and potential leakage of stool into the peritoneum (the membrane lining the abdominal cavity).
- Milrod, C., & Karasic, D. H. (2017). Age is just a number: WPATH-affiliated surgeons’ experiences and attitudes toward vaginoplasty in transgender females under 18 years of age in the United States. The Journal of Sexual Medicine, 14(4), 624-634. [Link] ↩︎
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60% of males and 70% of females attending the world’s largest gender clinic (GIDS) are same-sex attracted
In the 2015 statistics from GIDS, approximately 60% of the youth seen there who were biological males and 70% who were biological females reported attraction to the same sex or to both sexes1.
The 2015 Gender Identity Development Service (GIDS) statistics revealed a notably high rate of same-sex attraction among the youth seen at their clinic. Over half of the biological females reported same-sex attraction, about 20% were attracted to both sexes, and a quarter to the opposite sex, with the remaining identifying as asexual. Among biological males, approximately 30% reported same-sex attraction, another 30% to both sexes, 30% to the opposite sex, with the last 10% identifying as asexual or reporting no sexual attraction.
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Social transition solidifies a transgender identity
A study1 of 317 trans-identifying youth found an average of five years after their initial social transition, 94% continued to identify as binary transgender, while 3.5% identified as non-binary.
In a 2022 longitudinal study by Olson et al., 317 trans-identifying youth were followed for an average of five years after their initial social transitions (mean age at start of study = 8.1 years). The findings showed that five years post-social transition, 94% of youth continued to identify as binary transgender, 3.5% identified as nonbinary, and 2.5% identified as cisgender. Avoiding the use of the DSM-5 criteria for gender dysphoria due to ethical concerns from parents, the study classified gender identities using initial visit data, which displayed signs of gender identification and preferences, along with parent-reported “cross-sex” preferences. The final identity was then established based on the most recent interaction with the youth or their parents before January 1, 2021.
- Olson, K. R., Durwood, L., Horton, R., Gallagher, N. M., & Devor, A. (2022). Gender identity five years after social transition. Pediatrics, 150(2). [Link] ↩︎
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Young people who desist from a trans identity are disproportionately likely to grow up to be non-heterosexual
A Dutch paper1 notes that, for gender dysphoric children, the more likely psychosexual outcome in adulthood is a homosexual sexual orientation without gender dysphoria.
Evidence2 suggests that many boys whose childhood gender dysphoria recedes with puberty will grow up to be bisexual or homosexual. Another study of males3 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.
- 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] ↩︎
- 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] ↩︎
- Singh, D. (2012). A follow-up study of boys with gender identity disorder. Doctoral thesis, University of Toronto. [Link] ↩︎
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Gender-related distress will alleviate for around 80% of pre-teen children once they become teenagers
Evidence from 10 available prospective follow-up studies1 from childhood to adolescence indicates that childhood gender dysphoria will recede with puberty in ~80% of cases. A Dutch paper2 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 study3 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 study4 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 found5. Thorough investigations of the claims and counter-claims appear in two 2018 studies67.
- 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] ↩︎
- Steensma, T.D. & Cohen-Kettenis, P.T. (2011). Gender Transitioning before Puberty? Archives of Sexual Behavior 40 (4): 649-50. [Link] ↩︎
- 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] ↩︎
- Singh, D., Bradley, S.J. & Zucker, K.J. (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychology 12. [Link] ↩︎
- 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] ↩︎
- 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] ↩︎
- Zucker, K. J. (2018). The myth of persistence. International Journal of Transgenderism 19 (2): 231-45. [Link] ↩︎
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Studies on gender dysphoric young people often suffer from high rates of loss to follow-up – which could skew transition satisfaction rates
In one study1 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 study2, as many as 75% of participants were lost to follow up.
An excellent précis of this problem can be found in a 2018 paper3, 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 paper4, 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.
- 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] ↩︎
- Rauchfleisch, U., Barth, D. & Battegay, R. (1998). Resultate einer Langzeitkatamnese von Transsexuellen. Der Nervenzart 69: 799-805. [Link] ↩︎
- D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry 26 (5): 460-463. [Link] ↩︎
- 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] ↩︎
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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 study1 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.
- Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link] ↩︎
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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 study1 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.
- Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link] ↩︎
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In one study, two thirds of trans-identifying young people had one or more friends who were also trans
Lisa Littman’s 2018 study1 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.
- Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link] ↩︎
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In one study, almost 9 in 10 young people questioning their gender seemed to be subject to social influence
86.7% of the young people in Lisa Littman’s 2018 study1 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 individuals2 – is a well-accepted phenomenon in psychological literature3. It is well-documented that adolescents — and females in particular — are prone to social contagion effects, from cutting4 to eating disorders5. Social network analyses suggest that peer contagion underlies the influence of friendship on obesity, unhealthy body images, and expectations6.
- Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link] ↩︎
- 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] ↩︎
- 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] ↩︎
- 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] ↩︎
- 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] ↩︎
- 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] ↩︎
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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 paper1 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.
- Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives 60 (3): 345-366. [Link] ↩︎
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The profile of people seeking transition has shifted drastically, from overwhelmingly middle-aged males to predominantly adolescent females
A 2017 paper1 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 male2.
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 people3, 82.8% were female.
The data for the UK’s Gender Identity Development Service4 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 Marchiano5 collated data from different clinics around the world and found international evidence for this shift in distribution.
- Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health 14 (5): 404-411. [Link] ↩︎
- Barrett, J. (2015). Written evidence submitted by British Association of Gender Identity Specialists to the Transgender Equality Inquiry. data.parliament.uk [Link] ↩︎
- Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link] ↩︎
- Gender Identity Development Service (2021). Referrals to GIDS, financial years 2010-11 to 2020-21. [Link] ↩︎
- Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives 60 (3): 345-366. [Link] ↩︎
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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 survey1 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.
- 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] ↩︎
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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 paper1 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.
- 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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There has been a roughly twenty-fold rise in the number of people seeking transition, with teenagers hugely over-represented
A 2017 paper1 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 reported2 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 reported3 a twenty-fold increase, albeit over a longer time span: from 34 in 1980 to 686 in 2015:
New Zealand4, Finland5 and Canada6 have recorded similar dramatic exponential increases.
- Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health 14 (5): 404-411. [Link] ↩︎
- Gender Identity Development Service (2021). Referrals to GIDS, financial years 2010-11 to 2020-21. [Link] ↩︎
- 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] ↩︎
- 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] ↩︎
- 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] ↩︎
- 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] ↩︎