Effect of assigned sex on the age at which individuals seek specialist gender affirming care

Background: Citing fears of possible social contagion, opponents of medical care for transgender youth have raised concerns over recent observations that adolescents assigned female at birth are presenting to specialist gender clinics worldwide in higher proportions than adolescents assigned male at birth. As population surveys report roughly equal numbers of adults assigned male and female at birth among those confiding gender diversity, we hypothesized that gender diverse individuals assigned male at birth are less likely to be referred during their adolescent years and instead present later during adulthood. Methods: In this retrospective analysis, we collected data from the medical records of specialist pediatric and adult gender services in Australia and the Netherlands. 1903 patients consecutively referred in Melbourne, Australia from January 1, 2017, to December 31, 2019, and 2044 patients consecutively referred in Amsterdam, the Netherlands from January 1, 2016, to December 31, 2018 were included. The main measures were birth-assigned sex and age at time of referral. Results: In Melbourne and Amsterdam respectively, the proportions of individuals assigned male at birth were: 59.6% and 47.1% for children under 10 years; 31.3% and 30.5% among adolescents aged 10–19 years; 56.1% and 52.5% in adults aged 20–29 years; and 68.4% and 70.7% among those aged 30 years and over. Discussion: Assigned sex influences the age of referral to specialist gender services. Individuals assigned male at birth represent the majority of referrals during early childhood and adulthood but a minority in adolescence. In the context of community-based estimates consistently showing equal proportions of individuals assigned male and female at birth among gender diverse people, these insights suggest that transgender adolescents assigned male at birth may be subjected to higher levels of societal intolerance–such as trans misogyny–which delays their presentation to clinical services but which they eventually overcome in an effort to affirm their authentic selves.