Gender Dysphoria Surges 50-Fold In English Kids From 2011 to 2021
This surge parallels what has been documented among adolescents and young adults in the United States, in particular among natal females, over the past decade.
Diagnoses of gender dysphoria in English minors attending primary care practices increased by 50-fold from 2011 to 2021, according to a new study.
I tucked this finding into the report I published Thursday in The New York Sun about a new pair of systematic literature review and meta-analysis papers that found that prescribing puberty blockers and cross-sex hormones to treat gender dysphoria in young people is based on “very low certainty evidence.”
I wanted to go into greater detail about the dysphoria-diagnosis study in this Substack.
The recent surge in England of children and adolescents struggling with their gender, in particular adolescent natal girls, mirrors a similar recent phenomenon in the United States.
Let’s take a look at some relevant recent studies.
A 50-Fold Surge
British researchers analyzed data on primary care practices in England from the Clinical Practice Research Datalink (CPRD) Aurum database, covering patients from birth to 18 years old and from 2011 to 2021. They published their findings on Thursday in the Archives of Disease in Childhood. The database includes over 13 million active patients registered with general practices in the UK and covers about 20% of the British population.
The investigators identified 3,782 minors with gender dysphoria or gender incongruence. And as comparison groups, they identified 18,740 minors with autism spectrum conditions and 13,951 minors with eating disorders.
Anxiety and depression were very common in all three groups. Depression was especially high among those with gender dysphoria and eating disorders compared with those with autism spectrum disorders. Fifty-three percent of those with gender dysphoria had at least one diagnosis of anxiety, depression or self harm.
On average, gender dysphoria was diagnosed when the minors were age 16 and was much more common among natal girls than natal boys. There was no difference in the diagnosis rate based on the socioeconomic indicators of the postal code where the children lived (called the deprivation quintile).
Diagnoses of gender dysphoria were almost entirely among those age 11 and older and increased the most steeply among 17 and 18 year olds. By 2021, 0.42%, or about 1 in 240, of 17 to 18 year olds had such a diagnosis, a figure that was somewhat higher among natal girls and somewhat lower among natal boys. (By comparison, a recent analysis found that about 1 in 1,000 privately insured U.S. 17 year olds were receiving cross-sex hormones between 2017 and 2022; the figure was higher for girls and was probably higher overall in 2022 in particular.)
Between 2011 and 2015, the increase in gender dysphoria diagnoses in the English youth was comparable among natal boys and girls. But then natal girls peeled away from the boys and began to receive the diagnosis at much higher rates. By 2021, of all people age 18 and under, 0.083% had such a diagnosis—the equivalent of 10,291 young people. This compared with what would have been 192 youth with such a diagnosis in 2011—a more than 50-fold increase.
Low percentages of these youth were prescribed puberty blockers or cross-sex hormones, in keeping with recent reports from the United States. I spoke with a British researcher who is savvy about the type of data set on which this study was based. She said that it’s possible that because England centralized its prescribing of gender-transition medications out of a single hub, the Gender Identity Development Service, or GIDS, minors’ GPs might not have registered all such treatments with their medical chart such that it would show up on an analysis like this one.
That said, 176 (4.7%) of the youth with gender dysphoria were prescribed puberty blockers and 302 (8.0%) were prescribed cross-sex hormones. (Remember that the database covered only about 1 in 5 Britons.) Puberty blocker prescriptions as a percentage of the gender dysphoric population declined markedly after 2017. The study authors noted that this occurred as gender dysphoria diagnoses were increasing fastest for 17 and 18 year olds, who are more likely to have finished puberty and thus had no reason to block it. That is also when the GIDS waiting list started to increase dramatically. GIDS prescribing also pulled back in 2020 and 2021 due to the Bell v Tavistock case, which, per the new study “examined the competence of under-16s to consent to treatment” with puberty blockers.
All told, GIDS saw about 9,000 minors between 2011 and when it was shut down in the spring of 2024. An audit of discharge data pertaining to approximately one third of those youth that was published in the Cass Review in April indicated that 27% of them were referred to endocrinology, of whom 55% were treated with both puberty blockers and cross-sex hormones and 20% received just puberty blockers before they were discharged. (All youth were discharged at age 18; others may have been discharged at younger ages for reasons other than aging out.)
Here are some recent Substacks I wrote on how commonly U.S. minors receive gender-transition treatments and interventions:
U.S. Growth of Gender Dysphoria, Trans Identification
Recent studies regarding the U.S. population suggest that the surge in transgender identification and gender dysphoria diagnoses has been a phenomenon that is largely limited to adolescents and young adults. Some, but not all, analyses suggest that the growth has been especially strong among young natal females.
A study published in December 2023 analyzed such trends in a database concerning those with employer-based health insurance, only examining people age 18 and older and covering 2014 to 2021. It found that the overall rate per 100,000 of having a transgender-related diagnosis increased from 13.4 to 114 (0.1%) during that time—an 8.5-fold increase.
Broken down by age cohort, the increase was concentrated overwhelmingly in those younger than 35, and in particular those 18 to 24 years old. There was no significant change in those age 45 and older.
Overall, transgender women (TGW—natal males) remained more common in the medical database than transgender men (TGM—natal females).
Another study, published in July, looked at the rates of adults who reported identifying as transgender between 2014 and 2022 in the nationally representative Behavioral Risk Factor Surveillance Survey. It found that during that time trans identification:
Nearly quintupled in 18-24 year olds
Quadrupled in 25-34 year olds
Stayed flat or declined in those age 35 and older
Also:
By 2022, 2.8% of 18-24 year-old adults identified as trans, up from 0.6% in 2014.
In contrast to the previous study I just mentioned, this one found that the increase was driven by those identifying as trans men or gender non-conforming; identifying as a trans woman did not change significantly among young adults and declined significantly among all adults.
The increase in identifying as trans was larger among White individuals than among Black or Hispanic individuals.
This graph is particularly interesting, indicating exponential growth in trans identification in adulthood based on how recently someone was born. The numbers started to swoop up for those born in 1990 or later:
Another insurance database study, this one published in 2023, covered 2017 to 2021 and found that the average age of people when they were diagnosed with gender dysphoria decreased from age 31.5 in 2017 to 26.3 in 2021, even as diagnoses grew much more common. Similar to the UK data, diagnoses were very uncommon in those under age 11.
This chart demonstrates how much more common gender diagnoses during adolescence are among natal girls, while for older people, diagnoses are more common for natal males.
The New York Times quite famously reported in October reported that, whereas a 2022 report from UCLA’s Williams Institute found that 1.4% of teens identified as trans, a new Centers for Disease Control and Prevention survey conducted in 2023 found that 3.3% of high school students identify as trans and an additional 2.2% are questioning their identity. There may be differences in how the questions were asked in these respective surveys that may have skewed the results; it’s hard to know if this represents and actual doubling of youth trans identification in such a short time.
A Gallup Poll conducted in 2023 found that about 1 in 10 millennials and 1 in 5 Gen Zers identify as LGBTQ. Most of this is comprised of young people identifying as bisexual.
Women are especially likely to identify as bisexual:
Later in the week, I plan to take what we’ve learned here from these recent trends and apply it to a new study that found that the recent surge in suicidality in teen girls is concentrated in those who identify as LGBTQ in particular. So stay tuned!
I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News and The New York Sun. I have also written for theWashington Post, The Atlantic and The Nation. Follow me on Twitter: @benryanwriter and Bluesky: @benryanwriter.bsky.social. Visit my website: benryan.net
Thank you for this important information and analysis!
This was really good. Thank you. In the future, I hope there will be research looking at medical interventions on minors through age 25 broken down state by state to see if there seems to be a surge in medicalization at age 18 in states with bans, increases outside the norm in states without bans that neighbors states with bans, or a bubble of increased prescriptions or surgeries this year that may signal a rush into medicalization before Trump might ban them (either in reality or because of a fear it will happen). I feel like we need this data so we can know if bans actually help reduce medicalization of minors and young adults