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

• 2013 至 2022 年間，受保的 5 至 24 歲者中確診的「性別認同障礙」每 10 萬人從 22.5 人升至 175.7 人（約每 4,400 人 1 人升至每 570 人 1 人），增加八倍；若採較嚴格的計算方式（至少在兩個三個月的計費期間內被診斷），則從每 10 萬人 15.2 人升至 132.6 人。
• 幾乎每一年都是 15 至 19 歲的女孩比率最高，2022 年達每 10 萬人 452.6 人（約每 220 人 1 人）；青春期前男孩多於女孩，青春期起女孩多於男孩，到成年初期兩性趨於持平。
• 同期間，一個較舊的相關診斷代碼從每 10 萬人 216.7 人降至 73.7 人，作者主要歸因於醫師改用其他代碼；即便如此，在較嚴格的計算下，兩種代碼合計仍在上升（每 10 萬人 51.9 人升至 149.8 人）。
• 2022 年，24,624 名有此診斷的人中，72.4% 至少有一項其他心理健康診斷：男性有 49.3%、女性有 57.5% 有憂鬱症，焦慮症分別為 23.5% 和 34.0%，邊緣型人格障礙分別為 12.1% 和 17.6%。
• 在 2017 年被診斷的 7,885 人中，2022 年只有 36.4% 仍有此診斷；每個年齡組都低於半數，15 至 19 歲的女孩最低（27.3%）。
• 作者表示，計費資料無法解釋這種上升，並建議在青少年開始醫療過渡的建議中，應考慮此診斷多常不持續，以及多常伴隨其他心理健康問題。

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.