Summary

Using German public health insurance billing records on about 14 million people aged 5 to 24, researchers tracked diagnoses of 'gender identity disorder' from 2013 to 2022. Confirmed diagnoses rose about eight-fold, from about 1 in 4,400 to about 1 in 570, with the steepest rise in teenage girls. In 2022, 72.4% of people with the diagnosis also had another mental health diagnosis, most often depression and anxiety. Of those diagnosed in 2017, only 36.4% still had the diagnosis five years later. The authors say the data cannot explain the rise. It could reflect a real increase, more awareness, less stigma, better services or over-diagnosis. They say how few kept the diagnosis, and how common other mental health problems were, should shape advice on starting medical transition. As a short look at billing codes, it shows population trends but little about individual people's histories.

Key findings

• 在有保险的5至24岁人群中，确诊的“性别认同障碍”从2013年到2022年由每10万人22.5例升至175.7例（约每4,400人中1人升至每570人中1人），增长八倍；使用更严格的统计方法（在至少两个三个月的账单周期内被诊断），则从每10万人15.2例升至132.6例。
• 几乎每年都是15至19岁女孩的比例最高，2022年达到每10万人452.6例（约每220人中1人）；青春期前男孩多于女孩，从青春期起女孩多于男孩，成年早期两性趋于持平。
• 一个较旧的相关诊断代码在同一时期从每10万人216.7例降至73.7例，作者主要归因于医生改用了不同的代码；即便如此，在更严格的统计下，两个代码合计仍在上升（每10万人从51.9例升至149.8例）。
• 2022年，24,624名被诊断者中有72.4%至少还有另一项心理健康诊断：男性中49.3%、女性中57.5%有抑郁，分别有23.5%和34.0%有焦虑，12.1%和17.6%有边缘型人格障碍。
• 在2017年被诊断的7,885人中，到2022年只有36.4%仍有该诊断；各年龄组均低于一半，15至19岁女孩中最低（27.3%）。
• 作者说，账单数据无法解释这一增长，并建议在对青少年开始医学过渡提出建议时，考虑该诊断有多常不会持续，以及有多常伴有其他心理健康问题。

Conclusion

Our data do not allow any conclusions to be drawn about possible causes (for example, actual prevalence increase, increased awareness, decreased stigmatization, improved health care services, overdiagnosis) for the increase in the prevalence of F64 diagnoses. ... The diagnostic persistence over the 5-year follow-up period of less than 50% in all age groups is in line with the literature and presumably reflects the fluidity of the concept of gender identity in childhood and adolescence; however, it could also be interpreted as an indication of the need for a comprehensive, standardized diagnostic procedure. ... There is a need for further research into what causes the low diagnostic persistence and the observed increase in prevalence. In the meantime, diagnostic stability and the high prevalence of concomitant mental disorders should be taken into account in the recommendations on the initiation of gender reassignment treatment in adolescence.