Sex Assigned at Birth Ratio Among Transgender and Gender Diverse Adolescents in the United States

Abstract

OBJECTIVE: Representatives of some pediatric gender clinics have reported an increase in transgender and gender diverse (TGD) adolescents presenting for care who were assigned female sex at birth (AFAB) relative to those assigned male sex at birth (AMAB). These data have been used to suggest that youth come to identify as TGD because of “social contagion,” with the underlying assumption that AFAB youth are uniquely vulnerable to this hypothesized phenomenon. Reported changes in the AMAB:AFAB ratio have been cited in recent legislative debates regarding the criminalization of gender-affirming medical care. Our objective was to examine the AMAB:AFAB ratio among United States TGD adolescents in a larger and more representative sample than past clinic-recruited samples. METHODS: Using the 2017 and 2019 Youth Risk Behavior Survey across 16 states that collected gender identity data, we calculated the AMAB:AFAB ratio for each year. We also examined the rates of bullying victimization and suicidality among TGD youth compared with their cisgender peers. RESULTS: The analysis included 91 937 adolescents in 2017 and 105 437 adolescents in 2019. In 2017, 2161 (2.4%) participants identified as TGD, with an AMAB:AFAB ratio of 1.5:1. In 2019, 1640 (1.6%) participants identified as TGD, with an AMAB:AFAB ratio of 1.2:1. Rates of bullying victimization and suicidality were higher among TGD youth when compared with their cisgender peers. CONCLUSION: The sex assigned at birth ratio of TGD adolescents in the United States does not appear to favor AFAB adolescents and should not be used to argue against the provision of gender-affirming medical care for TGD adolescents.

Assessment of Quality of Life of Transgender and Gender-Diverse Children and Adolescents in Melbourne, Australia, 2017-2020

“…In terms of the generalizability of our study findings, it is important to note that our study sample represented a gender clinic–referred cohort of TGD young people that represents only a small proportion of the entire TGD youth population; this is an important consideration given differences in nonclinical vs clinical samples. 49 , 50 …”

“…Given that the Trans20 study is now following up these same young people longitudinally, it will therefore be critical to continue to assess QOL over subsequent data waves; this should enable us to move beyond identifying associations and instead make causal inferences. In terms of the generalizability of our study findings, it is important to note that our study sample represented a gender clinic–referred cohort of TGD young people that represents only a small proportion of the entire TGD youth population; this is an important consideration given differences in nonclinical vs clinical samples …”

Exploring navigation of gender in a sample of clinically referred young people attending the Gender Identity Development Service

“…The sample consisted of a predominantly adolescent (pubertal) group and the majority were assigned female at birth, which limits study generalisability and comparison. However, the demographics of the sample does re ect the higher proportion of pubertal assigned female at birth young people referred to gender services, both in the GIDS [6, 19,32], and elsewhere [7,8,41], although more recent assessment of community samples indicate a more even ratio in the United States [42].…”

The mean age of gender dysphoria diagnosis is decreasing

“…GD has traditionally been introduced as a rare condition predominant in assigned males at birth (AMABs) 2. However, recent studies have shown an upward trend in assigned females at birth (AFABs) with a dramatic reversal of the AMAB:AFAB ratio 3–5. The actual AMAB:AFAB ratio varies by age group and study population 4–6.…”