Key Findings

• A 50-fold increase in recorded diagnoses
• Between 2011 and 2021, the recorded prevalence of gender dysphoria/incongruence in English primary care rose from roughly 1 in 60,000 to about 1 in 1,200 among 17–18 year olds.
• The rise is driven mainly by recorded females
• After 2014, incidence increased far more rapidly in females than males; by 2021, prevalence was approximately twice as high in females, reversing historical patterns.
• Mental health co-conditions are very common
• Over half (52.7%) of affected children and young people had a record of anxiety, depression, or self-harm—substantially higher than matched youth with autism or eating disorders, especially for depression and self-harm.
• Medical hormone treatment remains rare in primary care records
• Only 4.7% received puberty-suppressing hormones and 8.0% received masculinising/feminising hormones, likely reflecting long specialist waiting times and under-recording of treatments initiated elsewhere.
• Strongly age-linked, but not deprivation-linked
• Cases were rarely recorded before age 11 and peaked at ages 17–18; there was no consistent association between prevalence and neighbourhood deprivation levels.

Abstract

Objective To examine trends in diagnosis of gender dysphoria and related conditions in children and young people attending primary care practices in England. Design Longitudinal analysis of electronic primary care records from the Clinical Practice Research Datalink (CPRD) Aurum database linked to hospital and Index of Multiple Deprivation data. Setting Primary care practices in England between 2011 and 2021. Participants 3782 patients aged 0–18 years with a recorded history of gender dysphoria/incongruence and matched comparators with autism spectrum conditions or eating disorder. Main outcome measures Incidence rates and prevalence of gender dysphoria/incongruence; prescribing rates for medical treatments; co-occurrence of anxiety, depression and self-harm. Results Between 2011 and 2021, incidence rates of recorded gender dysphoria/incongruence increased from 0.14 (95% CI 0.08 to 0.20) to 4.4 (95% CI 4.1 to 4.7) per 10 000 person years, and from 2014 the rate increased more rapidly in recorded females than males. There was no significant association between gender dysphoria/incongruence and area level deprivation. Of the 3782 children and young people with a record of gender dysphoria/incongruence, 176 (4.7%) were prescribed puberty suppressing hormones; 302 (8.0%) were prescribed masculinising/feminising hormones; and 1994 (52.7%) had a record of anxiety, depression or self-harm. Compared with matched comparators, those experiencing gender dysphoria/incongruence had similar recorded rates of anxiety and higher rates of depression and self-harm. Conclusions Recorded prevalence of gender dysphoria/incongruence increased substantially in children and young people between 2011 and 2021, particularly in recorded females. Levels of anxiety, depression and self-harm were high, indicating an urgent need for better prevention and treatment of mental health difficulties in these children.

Summary

This retrospective cohort study analysed electronic primary care records from 3,782 children and young people (aged 0–18) in England with a recorded diagnosis of gender dysphoria or gender incongruence between 2011 and 2021, using the CPRD Aurum database. The researchers compared them against matched groups with autism spectrum conditions or eating disorders to examine trends, treatments, and mental health co-occurrence. The study found a dramatic, roughly 50-fold increase in recorded prevalence over the decade, rising from 0.16 to 8.3 per 10,000. This surge was especially pronounced after 2014 and was driven primarily by those recorded as female, with prevalence becoming approximately twice as high in females as males by 2021. Cases were rare before age 11 and peaked among 17–18 year olds. Notably, there was no consistent link to area-level deprivation. Mental health conditions were highly prevalent: 52.7% of the gender dysphoria/incongruence group had a record of anxiety, depression, or self-harm. Rates of depression and self-harm were significantly higher than in matched comparators, particularly among recorded males. In contrast, medical hormone treatments were recorded relatively infrequently in primary care—4.7% received puberty-suppressing hormones and 8.0% received masculinising/feminising hormones—likely reflecting long waits for specialist services and incomplete recording of secondary care prescribing. The authors conclude that while gender dysphoria/incongruence remains uncommon in children and young people, its rapid increase and the high burden of co-occurring mental health difficulties highlight an urgent need for improved mental health support, better primary care guidance, and more effective coordination between primary, secondary, and specialist services.

Conclusion

The NHS in England is implementing a series of reforms in response to the Cass Review into gender identity services for children and young people, including introducing new service models and collaborative care arrangements. Our study provides information on trends in recording of gender dysphoria/incongruence and common co-occurring conditions in primary care, and can help to inform the development of local and national services. These developments should include appropriate support and guidance for primary care services, which will frequently be the first point of contact and will be responsible for coordinating care, often in the context of lengthy waits for specialist assessment. Local support networks will need to be robust as, despite the rapid increase in recorded prevalence over the last decade, gender dysphoria/incongruence remains uncommon under the age of 19 and direct clinical experience for most general practice staff is likely to remain limited. Levels of observed anxiety and depression have been increasing in children and young people in general over the last two decades for complex and contested reasons, challenging health, education and social services, and those experiencing gender dysphoria/incongruence are at particular risk. Future research should address the aetiology, pathways to diagnosis and interactions of these conditions, and explore other mental health issues and adverse social circumstances not examined in this study. Our findings highlight the need to provide comprehensive assessments, which should include screening for co-occurring conditions, of children and young people experiencing gender dysphoria/incongruence when they present to primary care, and where appropriate, for effective, coordinated interventions, supported by timely secondary and tertiary care, to address their wider mental health needs.