Summary

Researchers from gender clinics in Toronto and Amsterdam checked whether the mix of boys and girls referred for gender dysphoria in their teens had changed. Across 748 referrals, both clinics showed the same pattern. Before about 2006 more teens born male were referred. From 2006 to 2013 teens born female clearly outnumbered them. Among Toronto teens referred for other mental health problems, the balance of boys and girls hardly moved, suggesting something specific to gender referrals. Referral numbers also rose steadily. This was one of the first published reports of the shift later seen around the world. It reliably shows a change in who was referred to two clinics, but cannot say why. The authors suggested social and cultural reasons, but did not test them.

Key findings

• نظرت الدراسة في 748 مراهقاً أُحيلوا بسبب عدم الارتياح الجندري إلى عيادات في تورنتو (328 مراهقاً، 1976–2013) وأمستردام (420 مراهقاً، 1989–2013).
• في تورنتو، شهدت 1999–2005 إحالة نحو ولدين لكل بنت (36 ولداً و17 بنتاً). وفي 2006–2013 انقلب هذا إلى نحو 1.8 بنت لكل ولد (73 ولداً و129 بنتاً).
• في أمستردام، شهدت 1989–2005 إحالة 1.4 ولد لكل بنت (109 أولاد و77 بنتاً). وفي 2006–2013 انقلبت إلى 1.7 بنت لكل ولد (86 ولداً و148 بنتاً).
• بين مراهقي تورنتو المحالين لمشكلات أخرى، بالكاد تغير التوازن (نحو 2.2 ولد لكل بنت، ثم ولدان لكل بنت)، لذا فالتحول كان خاصاً بالإحالات الجندرية.
• ارتفعت أعداد الإحالات في تورنتو بقوة عاماً بعد عام بين 1976 و2013.
• في تورنتو، ارتفعت نسبة المراهقين الذين وُلدوا إناثاً وليسوا منجذبين إلى الإناث فقط من 11.4% قبل 2006 إلى 36.0% في 2006–2013.
• اقترح المؤلفون أسباباً اجتماعية وثقافية للانقلاب، لكنهم لم يختبروها.

Abstract

INTRODUCTION: The number of adolescents referred to specialized gender identity clinics for gender dysphoria appears to be increasing and there also appears to be a corresponding shift in the sex ratio, from one favoring natal males to one favoring natal females. AIM: We conducted two quantitative studies to ascertain whether there has been a recent inversion of the sex ratio of adolescents referred for gender dysphoria. METHODS: The sex ratio of adolescents from two specialized gender identity clinics was examined as a function of two cohort periods (2006-2013 vs. prior years). Study 1 was conducted on patients from a clinic in Toronto, and Study 2 was conducted on patients from a clinic in Amsterdam. RESULTS: Across both clinics, the total sample size was 748. In both clinics, there was a significant change in the sex ratio of referred adolescents between the two cohort periods: between 2006 and 2013, the sex ratio favored natal females, but in the prior years, the sex ratio favored natal males. In Study 1 from Toronto, there was no corresponding change in the sex ratio of 6,592 adolescents referred for other clinical problems. CONCLUSIONS: Sociological and sociocultural explanations are offered to account for this recent inversion in the sex ratio of adolescents with gender dysphoria.

Conclusion

In both the Toronto and Amsterdam clinics the sex ratio of adolescents referred for gender dysphoria inverted from favouring natal males before 2006 to favouring natal females in 2006–2013, with no matching change among adolescents referred to the Toronto service for other clinical problems. The authors offer sociological and sociocultural explanations for this recent inversion.