The scale of the change

Over roughly fifteen years, the population seeking gender-related medical care changed more dramatically than in the entire preceding century. Two things happened at once: the total number of referrals exploded, and the sex and age of those referred inverted.

A large 2025 study of English primary care records (Jarvis et al. 2025) found a roughly 50-fold increase in recorded gender dysphoria or gender incongruence among children and young people between 2011 and 2021 — from 0.16 to 8.3 per 10,000. The rise was driven overwhelmingly by birth-registered females after 2014, and by 2021 prevalence in females was about twice that in males, reversing the historical pattern.

What the clinic data show

Referral numbers

A 2024 systematic review of 143 studies across 17 countries (published in Archives of Disease in Childhood) found a two- to threefold increase in referrals overall and a steady rise in birth-registered females being referred. The review noted the shift was clearest in adolescents — Dutch data (1972–2016) suggest the female-to-male ratio increase occurred almost entirely in the adolescent group, not in young children.

The sex ratio inversion

Historically, gender clinics saw far more males than females. In the UK, referrals to GIDS in 2009/10 were 40 boys to 32 girls. By 2011/12 the ratio had reversed, and the gap widened every year after. By 2018/19, referrals were 624 boys to 1,740 girls.

A key study by Aitken et al. 2015 documented this inversion directly. Analysing two independent clinic samples (Toronto and Amsterdam, 748 adolescents total), they found the sex ratio shifted from favouring males before 2006 to favouring females between 2006 and 2013. Crucially, the same shift did not occur in 6,592 adolescents referred for other clinical problems — suggesting something specific to gender dysphoria referrals, not a general change in who seeks mental health care.

Age of onset and clinical profile

The new cohort differs from the old one in several ways:

• Later onset. Most of the current cohort developed gender dysphoria at or after puberty, not in early childhood. In a 2023 survey of 78 young adults who desisted or detransitioned (Littman et al. 2024), fewer than 17% met DSM-5 criteria for childhood gender dysphoria.
• More complex needs. The English primary care study found 52.7% of affected young people had records of anxiety, depression or self-harm — higher than matched youth with autism or eating disorders. A Finnish register study (Ruuska et al.) found gender-referred adolescents were about three times more likely to have received specialist psychiatric treatment before referral than matched controls, and that those referred after 2010 had roughly double the pre-referral psychiatric morbidity of earlier cohorts.
• More neurodiversity. Multiple services report high rates of autism traits. GIDS statistics cited in submissions to the UK Parliament indicated around 35–48% of referrals had a diagnosis of or traits associated with autism.
• More non-binary identities. Spanish and German clinic data both report a growing presence of non-binary-identified patients alongside the sex ratio shift.

Competing explanations

There is no single agreed explanation. The Cass Review (2024), the independent review of NHS gender identity services for children and young people in England, concluded that rising acceptance of transgender identities alone is insufficient to explain the increase, and pointed to a mix of factors: social media and online influences, deteriorating adolescent mental health (especially in girls), peer influence, struggles with emerging sexual orientation, early exposure to pornography, and a lower threshold for medical treatment. Critics of the review argue it underweights the role of increased visibility and reduced stigma, and that its speculation about social contagion is not supported by strong evidence.

1. Increased recognition and reduced stigma

The most straightforward explanation is that people who would previously have stayed silent now come forward. Gender non-conformity is more socially accepted, information is easier to find, and referral pathways are more accessible. This is almost certainly part of the story. But it struggles to explain the speed of the change, the sex ratio inversion, and the shift in age of onset — biology and stigma reduction do not typically produce a 50-fold increase in a decade.

2. Social contagion and peer influence

The idea that gender dysphoria can spread through friend groups and online communities is the most contested explanation. It is associated with Lisa Littman's 2018 paper on rapid-onset gender dysphoria (ROGD) — a proposed (not clinically validated) pattern in which gender dysphoria emerges suddenly in adolescence, often in the context of peer group influence and heavy social media use.

Littman's study surveyed parents recruited from websites critical of youth transition. It was heavily criticised for this sampling method, for relying on parental report rather than the young people themselves, and for framing gender dysphoria as an infectious phenomenon. PLOS ONE issued a correction and republished it with clarified framing, noting ROGD "has not yet been clinically validated." A later paper by Diaz & Bailey reporting on 1,655 parent-reported cases (75% natal female) was retracted by Springer in 2025 over methodological and consent concerns, though its authors and supporters argue the retraction was ideologically motivated.

Detransitioners frequently describe exactly this pattern in their own lives — friend groups coming out together, online communities shaping their self-understanding, and a sense that transition offered an explanation for diffuse distress.

Just from my own personal observation, I have seen a group of six people in a friend group all come out as trans within 6 months of each other... The odds of 6 out of 6 people in a friend group, all in the same school all being trans, just seems really high to me. —ZombiesAtKendall, desisted male.

When I was a young teen, we were warned of anorexia. … They taught us about social contagion and to be careful about which websites we visited. … And then came the trans craze, and this was actually a very big part of what made me detransition - it wasn't just eerily similar; it was EXACTLY similar to the anorexia craze of my youth. —Star_Aries, desisted female.

3. Adolescent mental health crisis

The Cass Review placed the gender clinic surge in the context of a broader deterioration in adolescent mental health, particularly among girls. UK national surveys between 1999 and 2017 showed marked increases in anxiety, depression and self-harm in teenage girls — including an almost 70% increase in self-harm presentations among girls aged 13–16, not seen in boys. Eating disorder rates also rose sharply in girls and young women.

On this view, gender dysphoria is one of several ways adolescent distress is now expressed and labelled. A young person struggling with depression, body image, trauma or social isolation may find in gender identity a concrete explanation for why they feel bad — and an online community that offers belonging and a clear path forward.

Being trans is an easy answer to the pains of life, of teenagehood. —SmileRevolutionary82, desisted female.

4. Autism and neurodivergence

Autism is significantly overrepresented among both trans-identified and detransitioning populations. Several detransitioners note that undiagnosed autism in girls — historically under-recognised — may contribute to gender distress, particularly around the sensory and social upheaval of puberty.

In my 10 years in the trans community, nearly every other trans masculine person I met either had Autism or ADHD... If girls were diagnosed younger, and told that discomfort with puberty and growing up as your sex can be part of autism, I wonder how that would change things. —ButchPeace274, detrans female.

5. Escaping womanhood and misogyny

Many detransitioners describe transition as a way to escape the social realities of being female — sexualisation, objectification, misogyny, and the loss of physical parity with boys during puberty. This explanation is specific to the female cohort and does not apply to the historical male-dominated population.

Before you were able to keep up with the boys and even outrun them... Now you are not physically on par with boys, it's disheartening... And you also see that you're being judged for your body and the guys aren't... No wonder a lot of these teenagers don't want to identify as women. —ferone, desisted.

Identifying as trans solves multiple issues in these moments. It lets you escape the new expectations that you aren't ready for... it affords you a degree of social protection that you didn't have before and it promises you a community and a "tribe". —Hedera_Thorn, detrans male.

The male side of the shift

The historical transsexual population was mostly male — estimates often cited suggest males made up around 90% of adult transitioners in the mid-20th century. Detransitioners and clinicians describe two broad male patterns: younger, often same-sex attracted males with early gender non-conformity, and older males transitioning later in life, sometimes in the context of autogynephilia (male sexual arousal at the thought of being a woman; see: Blanchard's typology).

In the past, and generalising broadly, the middle-aged men were driven by a strong sexual and/or romantic yearning to feminise their bodies... The male children were little boys who passionately loved 'girl things' and whose families and psychologists could not envision a worthwhile life for them as feminine men who would most likely be gay. —A_D_Tennally, desisted female.

Male detransitioners on /r/detrans often note that older male transitioners are less likely to detransition — partly due to sunk cost, partly because their social lives may be entirely embedded in trans communities. This means the detransitioning population skews even more female than the transitioning population does.

Non-binary identities and the reinforcement of stereotypes

The rise of non-binary identification is closely tied to the demographic shift. Many detransitioners describe adopting a non-binary label as a way to reject gender stereotypes — without realising that the label itself depends on those stereotypes being real and binding.

For me, being non-binary was a way to escape gender stereotypes without doing anything about it... no matter what anyone tells you, 99% of the time someone is non-binary because of stereotypes. Why else would so many people opt for "they/them" pronouns? They think femininity and masculinity are what being a woman or a man is all about and don't want to be seen as either. —TheOldLazySoul, desisted female.

Most people who say they're nonbinary just don't want to be put in a traditional gender category based on their sex. People used to just call it being androgynous, but now they made it into a different gender. —butchpeace, detrans female.

Non-binary identity, in this analysis, does not escape the gender binary — it reifies it. If you must leave the category "woman" because you are not feminine, you have accepted that "woman" means "feminine." Gender non-conformity does not require a new label; it requires the freedom to be an unconventional woman or man.

What this means for detransition

The demographic shift directly predicts the detransition population. Because the surge was driven by teenage females, and because detransition typically happens years after transition, the detransitioning population is now also mostly young women.

The new wave of gender patients are overwhelmingly female... I'm guessing if there're more females transitioning now in the first place, there would consequently be more detransitioners too. —Icy_Owl7841, detrans.

Historically a majority of transitioners were always MtF, until a few years ago when something in society flipped and there was a new trend of young, teenage FtM tranisitioners, however as with all trends they eventually go out of fashion and a few years later a lot of teenage girls are coming to regret this decision, because they were never really trans, just sad, confused, and lied to. —CaffeineForCoding, desisted.

A clinician posting on /r/detrans described the change in their own practice:

It's between 2 and 3% of my practice... 10 years ago I was detransitioning maybe one person per year. Now I'm doing one to two per month. —Drwillpowers, verified professional.

Limitations of the evidence

• Clinic referral data measure help-seeking, not prevalence. Not everyone who identifies as trans attends a clinic, and referral patterns are shaped by service availability, waiting lists and policy changes.
• ROGD research is contested. Littman's work relies on parental report and convenience samples from critical websites; critics argue it cannot establish causation or representativeness. Supporters argue the same methods are used elsewhere in the field. The concept remains clinically unvalidated.
• Detransition studies are self-selected. Surveys of detransitioners (e.g. Littman 2021, Littman et al. 2024) recruit from online detransition communities and likely overrepresent those with negative experiences. They cannot tell us what proportion of all transitioners detransition.
• Loss to follow-up is severe. Most detransitioners do not inform their clinicians (Littman 2021 found only 24% did), so clinic-based detransition rates are almost certainly underestimates. Conversely, surveys that only reach currently trans-identified people (e.g. the U.S. Transgender Survey) systematically exclude detransitioners.
• Multiple factors are entangled. Social media, mental health, autism, misogyny, homophobia and clinical practice changes all moved at once. No study has cleanly isolated their individual contributions.

Related pages

• Echo chambers and moderated online communities — how online spaces shape gender beliefs
• Rapid-onset gender dysphoria — the contested concept and its evidence
• Blanchard's typology — the historical male transition patterns
• Detransition — what it means and why people do it
• Gender dysphoria — the diagnosis and its history

References

• Jarvis et al. (2025). Epidemiology of gender dysphoria and gender incongruence in children and young people attending primary care practices in England. study page, source.
• Aitken et al. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. source.
• Littman, O'Malley, Kerschner & Bailey (2024). Detransition and Desistance Among Previously Trans-Identified Young Adults. study page, source.
• Littman (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned. study page, source.
• Ruuska et al. (2026). Psychiatric Morbidity Among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019. study page.
• Butler & Hutchinson (2020). The pressing need for research and services for gender desisters/detransitioners. study page.
• Characteristics of children and adolescents referred to specialist gender services: a systematic review (2024). Archives of Disease in Childhood. source.
• Cass Review (2024). Independent review of gender identity services for children and young people. source.
• Block (2023). Gender dysphoria in young people is rising—and so is professional disagreement. The BMJ. study page.