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

• בין 2011 ל-2021 עלה שיעור בני 0 עד 18 ברשומות רופאי המשפחה באנגליה עם אבחנה של דיספוריה מגדרית מ-0.16 ל-8.3 לכל 10,000, יותר מפי 50.
• אבחנות חדשות בכל שנה עלו מ-0.14 ל-4.4 לכל 10,000 צעירים, ועלו בכל שנה מלבד 2020, השנה הראשונה של מגפת הקורונה.
• לבנים ולבנות היו שיעורים דומים עד בערך 2015; לאחר מכן השיעור עלה מהר יותר אצל בנות, ועד 2021 היה גבוה פי שניים בערך אצל בנות.
• אבחנות היו נדירות לפני גיל 11 והנפוצות ביותר בגילאי 17 ו-18, שם לכ-1 מכל 240 (42 לכל 10,000) היה רישום ב-2021.
• יותר ממחצית (52.7%) היו עם רישום של חרדה, דיכאון או פגיעה עצמית. חרדה הייתה שכיחה בערך כמו אצל צעירים עם אוטיזם או הפרעות אכילה, אבל דיכאון ופגיעה עצמית היו שכיחים יותר, במיוחד אצל בנים.
• רק ל-4.7% היה מרשם מרופא משפחה לחוסמי התבגרות (תרופות שעוצרות את ההתבגרות) ול-8.0% להורמונים של המין השני, ככל הנראה בגלל המתנות ארוכות לטיפול מומחה וטיפול שנרשם במקום אחר.
• השיעורים לא היו קשורים בבירור לכך שהאזור המקומי עני או אמיד.

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.