The number of children and young people in England with a diagnosis of gender dysphoria recorded by a GP has risen fiftyfold over 10 years, researchers have found, though numbers are still relatively small.
The growing number of birth-registered females seeking referrals to gender clinics has raised concerns in recent years, with tensions over how best to tackle gender dysphoria in children resulting in the Cass review last year.
However, much of the previous work was based on referrals to specialist services rather than capturing the situation in primary care – the first port of call for many seeking help.
Now a study by a team that carried out research informing the Cass review has looked at GP records to shed light on trends in the community.
“What we have is the number of children who’ve ever had a diagnosis of something related to gender dysphoria,” said Prof Tim Doran, co-author of the work from the University of York.
Writing in the journal Archives of Disease in Childhood, Doran and colleagues describe how they examined data relating to children and young people aged 18 and under attending GP practices in England between 2011 and 2021, encompassing 3,782 individuals with gender dysphoria or similar diagnoses.
The results, based on data from about 20% of GP practices, show both the rates of incidence – the number of new cases each year – and the prevalence of such diagnoses rose over the decade.
The prevalence increased from about one in 60,000 in 2011 (equating to 192 children and young people nationally) to about one in 1,200 in 2021 (equating to 10,291 nationally) – more than a fiftyfold increase.
The team said that from 2015, prevalence rose more quickly among children recorded as female on their health records, ending up about twice as high as for recorded males by 2021.
Doran said among 17- and 18-year-olds, the prevalence of gender dysphoria was about one in 238 in 2021.
“[It’s] still really uncommon, but obviously much, much, much more common than it used to be 10 years ago,” he said.
The researchers found both incidence and prevalence rose with children’s age, but there was no link to the level of deprivation in their area.
That, said Doran, was a surprise. “If you look at adults with gender dysphoria, or who have transitioned, there’s a steep social gradient,” he said, adding more deprived populations tended to be overrepresented.
The team also looked at the prevalence of anxiety, depression and self-harm in children and young people with gender dysphoria, finding they were on a par with, or even exceeded, levels for children and young people diagnosed with autism or eating disorders – populations known to have high levels of these problems.
Doran said the latest figures – if scaled to a national level – suggested most children and young people diagnosed in the community were referred on to the now-closed Gender Identity Development Service (Gids).
“Even though we’ve seen this very rapid increase, most practices will have zero, one or two children, with gender dysphoria on their books. They’re not seeing this very often,” he said. He said many GPs might feel uncomfortable making a diagnosis, let alone providing off-label treatments.
The study showed that over the entire 10-year period, under 5% of children and young people with gender dysphoria also had a record of a prescription for puberty suppressing hormones while 8% had a record of a prescription for masculinising or feminising hormones.
The research comes as further work, published in the same journal by a different team, concluded it was impossible to determine conclusively from available evidence whether puberty blockers and gender hormone therapy helped or harmed children and young people – a position previously taken by the Cass review.
While the study by Doran and colleagues has limitations, including that some people with a diagnosis related to gender dysphoria may have requested their gender be changed on their health record, the team say it provides new insights.
Among them, Doran said it was previously unclear if a drop-off in referrals to Gids in 2020 was a result of the Covid pandemic or reflected a plateau in cases. However, the new work pushes back against the latter interpretation, revealing incidence rates in the community dropped in 2020 but increased the following year.
The team stressed more support was needed, including around mental health, for children with gender dysphoria, while Doran said those working in primary care also needed guidance and support.
“GPs are responsible for coordinating care for these children and young people with high levels of distress and complex needs, often in the context of long waits for specialist assessment,” he said.
