How Early in Life do Transgender Adults Begin to Experience Gender Dysphoria? Why This Matters for Patients, Providers, and for Our Healthcare System

Abstract

Introduction The age at which transgender women (TW) and men (TM) first experience gender dysphoria (GD) has not been reported in a U.S. population of adults seeking genital gender-affirming surgery (gGAS). Because gender is an innate part of identity, we hypothesized that untreated GD would be a part of individuals’ earliest memories. Understanding GD onset can help guide providers with when and how to focus care to patients not yet identified as “transgender Aim (i) Determine the age at which transgender adults seeking gGAS first experience GD (ii) Determine the number of life-years that transgender adults spend living with untreated GD Methods During initial consultation for gGAS, we asked patients the earliest age at which they experienced GD and the age at which they had their earliest episodic memory. We also queried history of anxiety, depression, and suicide attempt. Main Outcome Measures Patients self-reported their earliest recollections of experiencing GD, earliest memories in general, and history of anxiety, depression, and suicide attempt. Results Data from 155 TW (mean age 41.3; SD 16.3) and 55 TM (mean age 35.4; SD 10.8) were collected. Most patients (TM: 78%; TW: 73%) reported experiencing GD for the first time between ages 3 and 7 years. For TM the mean age of onset was 6.17 years; for TW it was 6.71 years. A total of 81% of TW and 80% of TM described their first recollection of GD as one of their earliest memories. Mean years of persistent GD before the start of gender transition were 22.9 (TM) and 27.1 (TW). Rates of depression, anxiety, and suicide ideation decreased following gender transition. Conclusion Our findings suggest that GD typically manifests in early childhood and persists untreated for many years before individuals commence gender transition. Diagnosis and early management during childhood and adolescence can improve quality of life and survival.

Possible association of keratoconus progression with gender-affirming hormone therapy: A case report

“…Demographic studies have noted that gender dysphoria typically arises within the first decade of life, and gender affirming treatment is sought in the next 10–20 years. 28 Opposite estrogen's effect, increasing age stiffens the cornea. 29 , 30 Accordingly, corneal changes in KC have been shown to stabilize with age, in a similar manner to corneal crosslinking treatment.…”

Suicide-Related Outcomes Following Gender-Affirming Treatment: A Review

“…There was no consideration of the effect of confounding diagnoses on the suicidality measures. Nevertheless, the authors conclude: “Given the high prevalence of suicidality, depression, and anxiety among transgender communities, it follows that proper measures should be taken to address the underlying condition − untreated GD [gender dysphoria]” [ 6 ].…”

“…Gender-affirming treatment remains a topic of controversy, with many calling for greater access to genderaffirming treatments to foster psychological well-being for transgender, nonbinary, and intersex individuals [1][2][3][4][5][6]. There is accumulating literature that suggests transgender individuals suffer worse mental health outcomes than their cisgender peers; of particular concern is increased suicidality [4,[7][8][9][10][11][12][13].…”

Medical considerations in the care of transgender and gender diverse patients with eating disorders

“…While the research suggests TGD individuals are often aware of their gender identity prior to entering adolescence, many do not present for gender affirming care until later in adolescence or early adulthood [ 20 , 21 ]. As with eating disorders, family involvement can have a significant impact on when an individual presents for gender-affirming care, with those presenting at a later age often having less support around their gender identity [ 22 ].…”