50-dobling af kønsdysfori/inkongruens hos engelsk ungdom (2011-2021)

Epidemiologi af kønsdysfori og kønsinkongruens hos børn og unge, der besøger almen praksis i England: retrospektiv kohortestudie

Kohorte- & registerstudier Mentalt helbred & selvmord Stigende diagnoser & social indflydelse

Authors: Stuart William Jarvis, Lorna K. Fraser, Trilby Langton, Catherine Elizabeth Hewitt, Tim Doran
Journal: Archives of Disease in Childhood
Year: 2025
Source: pmc.ncbi.nlm.nih.gov/articles/PMC12320607/

Summary

Researchers paid by NHS England for the Cass Review (a review of youth gender services) studied anonymised GP records from 2011 to 2021. They found 3,782 under-19s with a recorded diagnosis of gender dysphoria (distress about a mismatch between body and felt gender), and compared them with young people with autism or eating disorders. Recorded cases rose about 50-fold over the decade, to 8.3 per 10,000 overall and 42 per 10,000 among 17 and 18 year olds. By 2021, about twice as many girls as boys had a record. Over half (52.7%) had a record of anxiety, depression or self-harm, and depression and self-harm were more common than in the comparison groups. Few hormone prescriptions showed up in GP records. The authors call for better mental health support and GP guidance. It only counts what GPs wrote down, so it cannot show true numbers or explain the rise.

Key findings

Mellem 2011 og 2021 steg andelen af 0-18-årige i engelske lægejournaler med en diagnose med kønsdysfori fra 0,16 til 8,3 pr. 10.000, mere end 50 gange højere.
Nye diagnoser pr. år steg fra 0,14 til 4,4 pr. 10.000 unge og gik op hvert år undtagen 2020, det første år af COVID-19-pandemien.
Drenge og piger havde omtrent samme rater indtil omkring 2015; derefter steg raten hurtigere hos piger, og i 2021 var den cirka dobbelt så høj hos piger.
Diagnoser var sjældne før 11-årsalderen og mest almindelige i alderen 17 og 18 år, hvor omkring 1 ud af 240 (42 pr. 10.000) havde en registrering i 2021.
Mere end halvdelen (52,7 %) havde en registrering af angst, depression eller selvskade. Angst var omtrent lige så almindelig som hos unge med autisme eller spiseforstyrrelser, men depression og selvskade var mere almindelige, især hos drenge.
Kun 4,7 % havde fået recept på pubertetsblokkere (medicin, der sætter puberteten på pause) fra egen læge og 8,0 % på krydskønshormoner, sandsynligvis på grund af lange ventetider på specialistbehandling og behandling registreret andre steder.
Raterne var ikke tydeligt forbundet med, hvor fattigt eller velstående et lokalområde var.

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.

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.

Methodological limitations

Records, not true numbers: The study counts diagnosis codes written by GPs. More public awareness, more doctors looking for it, and changes to how diagnoses are coded may explain part of the rise. The authors used a wide set of diagnosis terms to reduce this problem, but it is not removed.
Depends on GP record-keeping: The results are only as good as GP staff recording unfamiliar conditions and treatments correctly. Some young people may never tell their GP about symptoms or diagnoses they feel ashamed of.
Specialist and private treatment missing: Puberty blockers and hormones from specialist clinics, private clinics or online sources often do not appear in GP records. So the 4.7% and 8.0% treatment figures are likely too low.
Sex recording errors: Records keep only the most recent recorded gender, so some people's birth sex may be wrong in the data. People recorded as 'other' were left out of the boy/girl comparisons because there were so few.
Unclear reason for prescriptions: Some hormone prescriptions may have been for reasons unrelated to gender dysphoria. The treatment rates were also worked out across children both before and after puberty, some of whom could not have had certain treatments.
Comparison groups were other patients: Young people with gender dysphoria were compared with young people with autism or eating disorders, who already have high rates of mental health problems, not with young people in general. The eating disorder group was also smaller than planned (about 3.7 matches per person instead of 5).
Cannot show cause or order: The study shows anxiety, depression and self-harm often occurred alongside gender dysphoria. Even with extra checks on timing, it cannot tell whether these problems came before, came after, or were caused by gender distress. It also did not test why the rise happened (social, medical or other reasons).
Rough age measure: Age was worked out from year of birth only. Very few cases before 2011 meant the early-years results were too small to be reliable.
No later results: The study only records diagnoses and prescriptions. It has no information on social transition, specialist assessments, desistance (no longer having gender dysphoria) or how young people fared later.
Who paid for it: The study was commissioned and funded by NHS England to inform the Cass Review. The authors say the funder played no part in running or interpreting the study, and they declare no conflicts of interest.

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Summary

Key findings

Abstract

Conclusion