Fifteen-Year Referral Trends and the Gender-Affirming Care Pathway in a Predominantly Adult Gender Dysphoria Cohort: A Retrospective Cohort Study from a University-Based Center in Türkiye

Background/Objectives: Most long-term cohort data on gender-affirming care come from adolescent and young adult populations in Western Europe and North America. In a Muslim-majority setting where legal gender recognition is contingent on a court ruling, presentation trends and the care pathway of an adult-service gender dysphoria cohort remain unknown. This single-center, retrospective study describes 15-year presentation trends and the gender-affirming care pathway at a university-based center in Türkiye. Methods: Clinical records of 199 individuals presenting to a university gender identity clinic (2010–2024) were retrospectively reviewed, under routine institutional research consent obtained in writing from patients at intake; nine presented before age 18, and an adult-only sensitivity analysis was performed. Annual presentation counts were modeled with negative-binomial regression (accounting for overdispersion), with separate sub-period slopes estimated from 2015 and from 2017. Care-pathway stages (hormone board, surgical board, legal name change) were defined by board decision dates and cross-tabulated to show their overlap. Time-to-stage was analyzed with Kaplan–Meier estimation (with numbers at risk); predictors of reaching the hormone and surgical boards were assessed with Cox proportional-hazards models, censoring at the database closing date (25 November 2024). Results: The cohort comprised 67.3% trans men (AFAB) and 32.7% trans women (AMAB), approximately 2:1. Median age at presentation was 23.3 years (IQR 20.0–27.6). Annual presentations increased overall (negative-binomial IRR 1.21/year, 95% CI 1.06–1.37, p = 0.003), but the slope weakened from 2015 (IRR 1.07, 95% CI 0.86–1.34) and was flat from 2017 (IRR 0.96, 95% CI 0.70–1.31); neither age at presentation nor the proportion of trans men changed over time. Overall, 51% reached the hormone board, 41% the surgical board, and 31% a legal name change; stages were not strictly nested (12 individuals obtained a legal name change without surgical-board evaluation). In Cox models, endocrine pathology was associated with faster progression to the hormone board but not the surgical board; residence outside the center’s province was associated with lower odds of surgical-board attainment in logistic but not in time-to-event analysis. No prespecified between-group differences by sex assigned at birth were detected. Conclusions: This predominantly adult Turkish cohort shows an overall long-term increase in referrals—concentrated in the earlier years—with age at presentation and the recorded AFAB/AMAB distribution statistically stable across 15 years. Residence relative to the center was associated with surgical-board attainment in exploratory analysis only.