© 2020 The Kelsey Coalition

Summary of Concerns

We are witnessing an unprecedented number of young people who see themselves -- and want others to see and treat them-- as if they were the opposite sex, or no sex at all. They may be young boys who prefer feminine clothing and toys, teenage girls who suddenly declare they are transgender soon after adolescence begins, or young adults who announce they are nonbinary.


Gender identities are assumed by people across all ages, appear in a variety of contexts, and emerge for many complicated and poorly understood reasons. They all deserve compassionate and evidence-based care. Instead, they may be ridiculed and shamed; or on the other extreme, have their gender identities quickly affirmed by their parents, teachers, and therapists without consideration of underlying issues. Most alarmingly, physicians are treating these young people with invasive and poorly-researched medical interventions.

Research focused on investigating underlying causal factors and developing non-medical therapeutic protocols is desperately needed, but prevented by ideologically-based activism. Instead, nearly all research is limited solely to hormonal and surgical interventions at increasingly younger ages. As a result, underlying issues are often ignored while identities are medicalized before non-invasive options are explored.


Nowhere is the medicalization of identities more concerning than in the United States where children as young as eight years old receive hormonal treatments, and those as young as 13, irreversible surgeries.

It is unconscionable that harmful hormonal treatments, and risky irreversible surgical interventions, have been deemed the standard of care when psychological approaches have never been studied for their efficacy.

It is essential for physicians, therapists, school personnel, parents, and patients to understand the different demographics and what currently available sound research reveals. People of all ages should carefully consider all potential underlying factors and non-invasive therapeutic options before consenting to untested interventions.

Gender Identity Demographics



The four main demographics are summarized below. For links to supporting evidence, research, and helpful articles, click on the "Learn More" buttons at the end of each column.

Young Children

More commonly affects boys than girls


Extreme gender nonconformity begins very early (although most gender nonconforming children do not have gender dysphoria)


Until recently, most early-onset gender dysphoric cases have desisted (become comfortable with their biological sex after passing naturally through puberty) rather than transitioned


Preliminary data suggests that children of parents who let them socially transition (allow change of name and pronouns; treat them like opposite sex) are especially likely to medically transition 

Longstanding research shows very likely to identify as gay, bisexual or lesbian adults if not medicalized.

Adolescents / Teens

Research has identified potential underlying social and psychological factors


Research has found an overrepresentation of autism and ADHD 

Rapid onset gender dysphoria (ROGD) is a term often used to describe this new demographic of teens based on a recent descriptive study

Social influences, in real life and online, have been noted

International data shows exponential increase in recent years and over-representation of females

Hormonal treatments offered to young adolescents


Surgeries performed as young as 13.

College Students

No research on this cohort

Thorough mental/physical assessments not required before medicalization

Health history often not considered before hormonal treatments initiated

College counselors refer students to “informed consent” clinics for cross-sex hormones prescribed in 1-3 visits

Many college health plans cover both hormonal and surgical treatments 


Extensive longstanding research shows over-representation of males; pathway for females not as well understood

Spontaneous remission is known to occur in some cases. Psychotherapy could potentially facilitate remission or reduction of symptoms, but has not been studied

Medical interventions often recommended without offering non-medical treatments


Complete information about health risks is not always provided 

Underlying Considerations

Psychological Factors


Identity Crisis

Erik Erikson's theory of identity formation is essential to consider when examining causal factors of incongruent gender identities in young people. Adolescents may feel uncomfortable and confused with their physically changing bodies and emerging sexuality. Teens are tasked with making sense of these changes and forming their identity as they integrate their own ideas of themselves with what they perceive others think of them. Failure to establish a sense of identity can lead to an “identity crisis.” It is normal for teens to experiment with different roles and behaviors during this stage of development. Sometimes an alternative identity may be adopted out of rebellion or seen as a solution to adolescent angst. There is evidence that some teens adopt alternative gender identities out of conflicted feelings over being same-sex attracted.


Maladaptive Coping Strategy


Dr. Lisa Littman hypothesized that the drive to transition may represent “a maladaptive coping mechanism to avoid feeling strong or negative emotions similar to how the drive to extreme weight loss can serve as an ego-syntonic, but maladaptive coping mechanism in anorexia nervosa.” Some of the parent participants of Dr. Littman’s study reported that their transgender-identifying children were overwhelmed by strong emotions, go to great lengths to avoid experiencing them, and are convinced that transition will solve their problems. Adolescents do not have the insight to realize that they should work on their basic mental health issues before seeking drastic medical treatments. The sample that Dr. Littman described in her study was “predominantly female, experienced the onset of symptoms during adolescence and contained an over-representation of academically gifted students which bears a strong resemblance to populations of individuals diagnosed with anorexia nervosa as they are predominantly female, typically have the onset of symptoms in adolescence and are likely to have high IQ.” Dr. Littman stated: “The risk factors, mechanisms and meanings of anorexia nervosa may ultimately prove to be a valuable template to understand the risk factors, mechanisms, and meanings of rapid-onset gender dysphoria.” In this preliminary observational study, Dr. Littman coined the phrase "rapid onset gender dysphoria" to describe this new and unstudied phenomenon. Lisa Littman, Parent Reports of Adolescents and Young Adults Perceived to Show Signs of a Rapid Onset of Gender Dysphoria


Autism Spectrum Disorder (ASD)


There is replicated evidence of an over-representation of autism among youth with incongruent gender identities compared to what would be expected by chance. In 2018, the CDC reported that autism occurs in 1 out of 59 births (1.7% of births).  In contrast, around 20% of gender identity clinic-assessed individuals reported clinical range features of Autism Spectrum Disorder. By this measure, researchers have cautiously concluded that co-occurring gender dysphoria and autism is frequent. Anna I.R. Van Der Miesen, Hannah Hurley & Annelou L.C. De Vries, Gender Dysphoria and Autism Spectrum Disorder: A Narrative Review


A clinical review of the literature referenced the increasing amount of evidence that suggests a co-occurrence between gender dysphoria and Autism Spectrum Disorder and concluded that there is a need for further research for educational and clinical purposes. D. Glidden et al, Gender Dysphoria and Autism Spectrum Disorder: A Clinical Review of the Literature.


Autism expert Dr. Tony Attwood's clinical observation is that this is often a 3-5 year obsessive interest. Dr. Attwood explained that in the teen years, autistic teens base their self-concept on criticism and weaknesses, rather than compliments or strengths. As many autistic teens have a fractured sense of self, they "begin to collect data about this difference." They may reason that their differences are because they are transgender. Attwood stated


What I want to explore compassionately with them is where did this belief first begin?  How did you come to believe this about yourself? Where do you place your feelings of acceptance? Do they see gender change as a solution to their social problems or challenges? I bypass the gender belief and go to the core questions of self- concept and how this was formed.”


Attention Deficit Hyperactivity Disorder (ADHD)

Studies suggest that children with ADHD are 6-7 times more likely to present with gender dysphoria than children without ADHD. Researchers have concluded that children with gender dysphoria will benefit from an approach where all possible contributing factors are considered. Therefore, in addition to psychosocial and psychodynamic evaluation, assessment and interventions regarding ADHD will help to improve [their] well-being and quality of life. Gender Dysphoria and Attention Problems: Possible Clue for Biological Underpinnings.

Mental Illness

Transgender-identifying youth have elevated rates of coincident mental illness as compared to the general population. This study found nearly half had at least one untreated mental health condition and 20% had two or more. Transgender-identifying adults also have higher rates of co-morbid mental illnesses as compared to the general population. One report found that nearly 63% of patients with gender dysphoria had at least one psychiatric disorder, the most common three being major depressive disorder (33.7%), specific phobia (20.5%), and adjustment disorder (15.7%). 




Attachment disorders and traumatic events, including sexual abuse, are overrepresented among the childhood histories of transgender identified individuals and may be precipitating factors. More research is needed to define the relationship between trauma and gender dysphoria.


Social Influences

Social Contagion

Recent research suggests that social and peer contagion may play a role in transgender identification for some individuals. One of the most compelling findings of this research is the reporting of cluster outbreaks. The expected prevalence of young adults who identify as transgender is 0.7%. Yet, more than a third of the friendship groups described in her study had 50% or more who identified as transgender within the same time frame (more than 70 times the expected prevalence rate). Dr. Littman noted how social contagion is known to foster depressive symptoms, disordered eating, aggression, bullying, and drug use. She concluded: "This is an observation that demands urgent further investigation." 

As Erica Weir explained in Mass Sociogenic Illness:


The confluence of eight symptoms or conditions typically indicates mass sociogenic illness and permits a presumptive diagnosis while investigations are underway. These include symptoms with no plausible organic basis; symptoms that are transient and benign; symptoms with rapid onset and recovery; occurrence in a segregated group; the presence of extraordinary anxiety; symptoms that are spread via sight, sound or oral communication; a spread that moves down the age scale, beginning with older or higher-status people; and a preponderance of female participants.

Social Media

It is plausible that online content may encourage vulnerable individuals to believe that nonspecific symptoms and vague feelings should be interpreted as gender dysphoria stemming from a transgender condition. Dr. Lisa Littman noted that increased exposure to social media and the Internet preceded many children’s announcement of a transgender identity.



Tumblr is one of the main sites that detransitioners reference as a place where young people gather online to encourage each other to medically transition. There are discussions on the site on how to use threats of suicide to ensure parental compliance, how to get breast binders and hormones for free, and the easiest places to get quick surgeries. It is important for parents to be aware of the power these online discussions have to greatly distort children’s thinking and views of themselves. Tumblr is designed in a way that fundamentally enables extreme groupthink, manipulation of information, destructive interactions, and distorted ways of thinking.




Instagram is filled with pictures of young people posting selfies in various stages of transition. Especially popular are post-surgical pictures of mastectomies that are glamorized and encouraged. For example, Dr. Sidhbh Gallagher posts pictures of her post-surgical patients on her own Instagram account, which further glamorizes and downplays the seriousness of these procedures (not to mention that this is ethically questionable behavior for a physician). Dr Christopher John Salgado, another plastic surgeon, was fired in March 2019 for sharing photos of his patients’ genitalia on Instagram.


Aydian Dowling is a prominent FTM influencer on Instagram with 190K followers. Chase Ross is one of the biggest influencers of transgender-identifying young people on Instagram with 61K followers. Chase actively reaches out to young people and sends cards to trans-identifying kids as young as 11 years old.




YouTube is filled with countless videos made by many transgender-identifying teens and young adults. Many have acquired large followings, have achieved celebrity status, and encourage medically transitioning. One of countless examples is the video series produced by FTM Chase Ross. There are also many “trans-hypnotic” videos that purport to use subliminal messages to feminize males.




Transgender identities appear to be common in online art communities. One teen explains how she got the idea she was transgender on DeviantArt:


First, it was on DeviantArt. It’s an art-sharing website...Some of the people I was watching, whose art I admired, came out as trans. Some people posted about how much they hated themselves and how badly they wanted to transition. Some started to transition and talked about how amazing they felt. Suddenly, a lot of the people I knew on DA were making transgender artwork…And it’s also a place for kids to post about all their self-diagnoses and identity issues. I know lots of kids who post about their self-diagnosed schizophrenia and other mental illnesses.


School Programming and Policies


Schools Have Led Young Children to Believe They are Actually the Opposite Sex

Some schools teach children that they may be born into the wrong body, that their sex was “assigned to them” by a doctor when they were born, and that it is up to them to decide their gender identity. As a result, very young children are confused and may believe they are the opposite sex, or any one of the 112 and growing “genders”discoverable online. At a school in California, this lesson was taught to kindergartners. One parent described the effect this lesson had on her young daughter: after bathing, she saw herself in the mirror with her wet hair slicked back and started shaking and crying because she thought she had turned into a boy. 


Books About Children Who Identify as the Opposite Sex are Read to Young Students


In many schools, books about being transgender are read to young children, purportedly to promote diversity and acceptance of differences. These readings are promoted to elementary schools by the National Education Association.


I Am Jazz (about a young boy identified as transgender at a very young age and who had transition surgery as a 17-year old in 2018) is commonly read to young children.


From the time she was two years old, Jazz knew that she had a girl's brain in a boy's body. She loved pink and dressing up as a mermaid and didn't feel like herself in boys' clothing. This confused her family, until they took her to a doctor who said that Jazz was transgender and that she was born that way.


Another book commonly read to young school children is They She He Me: Free to Be!


They She He Me: Free to Be! shows many gender presentations under each pronoun and invites even more. A go-to place to help keep the conversations alive, break down assumptions of who is “she” or “he” and expand beyond the binary to include “they” and more. The book offers a playful narrative about pronouns, inviting kids to know themselves inside and out, claim the pronouns that express the spirit of who they are and respect that in others.


Schools Invite Activists to Speak to Young Students


Some school districts invite activists to read books about children who identify as transgender to kindergartners. As one 5-year-old concluded after an activist's presentation: “Anyone can be anything.”


Schools Instructed Not to Inform Parents of Name/Pronoun Changes


According to this Position Statement by the National Association of Secondary School Principals:  


While it would be ideal for the parents or guardian to be supported and included in the transition process, school leaders must be mindful of protecting the student’s privacy and not creating an unsafe home climate for the student


The National Education Association has partnered with the Human Rights Campaign to produce and promote materials that promote automatic affirmation of identities, name changes, and pronouns regardless of parents’ concerns.

The American Civil Liberties Union has written to the principals and superintendents of secondary schools to inform them that it is against the law to disclose a student's gender identity to their parents without the student's full and voluntary consent. The letter states that disclosing a student's gender identity to their parents could have "dramatic and unforeseen consequences" and "could also lead to physical abuse or homelessness." 

Schools Encouraged to Report Parents 


Some organizations and state polices encourage schools to report parents who do not agree with their children’s social transition to appear and be treated as the opposite sex. One example is the New Jersey Department of Education’s Transgender Student Guidance for School Districts.


Community Programs: Drag Queen Story Hour for Children


Drag Queen Story Hour is a program that features drag queens who read stories to children in libraries, schools, or bookstores.” The program began in San Francisco in 2015 and has spread quickly across the country.  These events are promoted by the American Library Association.


In April 2019, it was revealed that two drag queens who participated in these readings in a Houston public library are convicted child sex offenders.  One drag queen admitted that he is “grooming children” at these events.  Drag Queen Story Hours have been held for preschoolers.


Semantic Contagion and Culture


In the 1990s, Ian Hacking described a phenomenon called the "looping effect": When people are classified, they respond  by actually altering not only their behavior, but their sense of self. Hacking used the term "semantic contagion" to explain how publicly describing a condition often creates the means by which the condition spreads, which also encourages people to reinterpret their past experiences and feelings in light of this newly described condition. Dr. Carl Elliott referred to Hacking’s work writing in 2000:


Once transsexual and gender-identity disorder and sex reassignment surgery became common linguistic currency, more people began conceptualizing and interpreting their experience in these terms. They began to make sense of their lives in a way that hadn’t been available to them before, and to some degree they actually became the kinds of people described by these terms.


This suggests that the sudden increase in young people identifying as transgender is not a reflection of societal acceptance that has led them to feel more comfortable in revealing their “true identities.” Rather, these identities are likely created: the result of widespread school programming, media coverage, and promotion by activist organizations, as well as many mental health and medical associations. Semantic contagion has likely fueled the idea among vulnerable young people that they were born into the wrong bodies.


Examples of semantic contagion in other contexts are explained in Ethan Watters’  Crazy Like Us: The Globalization of the American Psyche and in Lee Daniel Kravetz' Strange Contagion: Inside the Surprising Science of Infectious Behaviors and Viral Emotions and What They Tell Us About Ourselves (see Chapter 6: How to Start a Contagion)

Medical/Neurological Evidence

There is no evidence that gender identities are innate or fixed. Even if a brain-based difference were established, this brain difference would most likely be due to the behavior, thinking and relationships of the trans-identified individuals, not the other way around. The process whereby relationships, thinking and behavior alter the physical appearance and functional pathways of the brain is called neuroplasticity. At most, there may be a predisposition to identifying as trans but nothing more. Evidence shows that social and psychological factors are significant drivers in developing a transgender identity.


The hypothesis that gender identity is an innate, fixed property of human beings that is independent of biological sex — that a person might be “a man trapped in a woman’s body” or “a woman trapped in a man’s body” — is not supported by scientific evidence. Studies comparing the brain structures of transgender and non-transgender individuals have demonstrated weak correlations between brain structure and cross-gender identification. These correlations do not provide any evidence for a neurobiological basis for cross-gender identification. Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences

Considerations When Seeking Help

Proceed cautiously with gender clinicians and clinics. There are many reasons why people might identify as transgender. Complex psychological factors and social influences -- as well as age/sex differences -- must be considered to understand the basis for the identity and recommended treatment. The overwhelming majority of those who specialize in “gender” issues recommend immediate social transition without a thorough assessment of psycho-social factors, and portray these transitions as harmless and necessary. Many also recommend quick medical transition for young children -- as young as eight years old.


Supporting a child’s social transition is not harmlessChildren should be supported and encouraged to express their preferences for clothing, hair, and toys, regardless of whether they adhere to society’s stereotypes as to what boys and girls “should” look like and how they “should” play. Social transition, however, is not simply allowing them to be non-conforming in a developmentally appropriate manner. It requires treating children as if they are the opposite sex (such as by using opposite sex pronouns and bathrooms), which solidifies their belief. Moreover, the majority of children who socially transition go on to medically transition, which may begin as young as eight years old.


Not one long-term study supports medicalizing a child’s incongruent gender identity. Identity-based hormonal treatments on children are experimental. The medical literature on the health effects of hormonal interventions “in the pediatric/adolescent population is completely lacking.” The drugs used are based on low-quality evidence, or no evidence at all. Surgical interventions, sometimes performed as young as 13 years old, are irreversible and without long-term evidence to support their practice.


Suicide statistics used to promote the need for children to medically transition are verifiably falseMultiple studies are cited to promote the belief that transgender-identifying children are at seriously high risk of suicide and that the only way to prevent suicide is medical transition. This is a psychologically coercive technique that encourages parents to consent to their child’s risky hormonal treatment. When presented with the choice between a “dead daughter or a live son,” many parents will consent to this treatment, no matter their fears or doubts. These studies are fundamentally flawed.


A 2018 study has been widely promoted as evidence that over half of all girls who identify as transgender will attempt suicide. Oxford University professor Dr. Michael Biggs and pediatrician Dr. Michelle Cretella refute the study’s findings and explain its methodological flaws. In this article, Dr. Michael Briggs explains that the risk of suicide among trans-identifying youth is on par with that of youth carrying other mental health diagnoses such as anorexia nervosa. Endocrinologist Dr. Quentin Van Meter has stated his belief that the current practice of  “pro-affirming physicians who ‘blindly’ prescribe puberty blockers and sex-reassignment surgery to children” will lead to a wave of these children’s future suicides. 


Most physicians, psychologists, and therapists are unaware of and/or misinformed about gender identities and identity medicine. Finding proper help is extraordinarily difficult. Most professionals are trained to affirm their clients’ identities.


Many therapists are legally prohibited from questioning the gender identity of their clients. Conversion therapy bans across the United States legally prevent therapists from questioning the gender identity of their clients, including children, despite the fact that questioning means exploration, not "conversion." The erroneous conflation of gender identity with sexual orientation has contributed to the spread of these bans throughout the US. Without the ability to explore patients’ thinking, perceptions, experiences, and emotions through questions, psychology as a field would cease to exist.


Medical decisions must be considered carefully. Any decision to medically transition -- no matter how young or old -- should not be made quickly nor without a thorough understanding of risks and consideration of non-medical treatments.


Guidelines promoted by medical and psychological associations do not always reflect evidence-based treatment. It is important to know that guidelines promoted by medical and psychological associations do not necessarily reflect evidence-based treatment, especially when concerning an emerging phenomenon that has not yet been studied.


Many medical and psychological associations endorse the “affirmative care” model. Essentially, this means that “gender identities” are treated at face value and medicalized as “life-saving” treatment measures. This recommendation is not based on rigorous research. In fact, "affirmative care" guidelines are not evidence- or consensus-based, but instead reflect the goals and biases of select task forces whose recommendations are rubber-stamped by Board members on behalf of the associations. 


Most guidelines committees use a system that ranks evidence in a nonsensical manner.  According to the current approach, a meta-analysis of two small poorly done trials is deemed to provide a higher level of evidence than a single large-scale definitive trial. And a single large-scale definitive trial is assigned the same rank as non-randomized observational studies. It is a silly approach to the ranking of evidence. Better approaches exist, but they are used by very few. Many aspects of the guidelines simply reflect the fashion of the times. When Did Guidelines Become Holy Writ? Milton Packers Wonders Whether Our Opinions Should Be Worshipped 


In some cases, guidelines are produced in partnerships with activist organizations who do not have medical or psychological expertise, such as the Human Rights Campaign (HRC). For example, the 2016 American Academy of Pediatrics (AAP) guide, Supporting and Caring for Transgender Children, was co-produced with the HRC. Its lead author was a young HRC employee; its contributing authors were gender clinicians. Although almost all clinics and professional associations in the world use a "watchful waiting" approach, the AAP statement rejected that consensus as it misrepresented the medical literature in its pro-pediatric-transition statement released October 2018.

AAP’s statement is a systematic exclusion and misrepresentation of entire literatures. Not only did AAP fail to provide extraordinary evidence, it failed to provide the evidence at all. American Academy of Pediatrics and Trans- Kids: Fact-Checking, Rafferty (2018)


Contrast the AAP’s stance on tattoos with drastic hormonal and surgical interventions based on identities:

Adolescents and their families should be informed that tattoos are permanent and that removal is difficult, expensive, and only partially effective; Pediatricians should advise adolescents with a history of keloid formation to avoid body modifications that puncture the skin. The outcome is uncertain whenever there is trauma to the skin resulting in scar. Adolescent and Young Adult Tattooing, Piercing, and Scarification


Consider the source when researching for information on this topic. Activist organizations and research sponsored by pharmaceutical companies and conducted by gender clinicians must be examined carefully and critically. Guidelines produced by medical, mental health, and school associations are also subject to ideological and financial influences.

You are not alone. If you are a parent or caregiver of a loved one who identifies as transgender and you are having difficulty finding others who can understand and offer you support, consider joining a support group.


Learn More

Young Children


Medical Pathway

There are no biomarkers/medical tests for gender identity, which is in the mind, not the body. “Diagnosis” is based on children’s feelings, discomfort with their bodies, sex-stereotypical interests/clothing, and/or their steadfast “insistent, persistent, consistent” belief that they are something other than their biological sex. Some therapists will “rubberstamp” their approval for medical transition. Some clinicians will actually lead children to the belief that they are the opposite sex in their therapy sessions.



This demographic consists of more boys than girls. If supported through natural puberty, the vast majority will grow to accept their biological sex, and roughly ⅔ would come to identify as LGB adults, as referenced on page 455 of the 5th edition of the American Psychiatric Associations Diagnostic and Statistical Manual (DSM-5). 


The citations of the most important studies (1972-2013) on young children are available here. An excellent PowerPoint summary of studies, Gender Dysphoria Presentation, was created by Paul Dirks, Director of Research at Parents United Canada.  A similar summary presentation is available for physicians and health professionals.

Concerns and Considerations

Rather than simply encouraging these non-conforming children to express their clothing, toy, and friend preferences regardless of societal norms, gender clinicians encourage them to socially transition to be treated as if they were the opposite sex. Hormone medicalization begins as young as age eight. Preliminary data suggests that children of parents who let them socially transition (allow change of name and pronouns; treat them as the opposite sex) are especially likely to medically transition.


Many parents may support their children’s transition without adequate and reliable information.The most common reason that parents affirm their children's transition is because they are told by professionals that their children’s non-conformity is a sign they were born into the wrong body. Some clinicians believe that babies send pre-verbal gender messages.  This is illustrated in this interview of parents who affirmed their young child as transgender. 

Some parents may be uncomfortable considering that their children may be gay, such as this parent who affirmed her young gender nonconforming son as her daughter. Similarly, in countries like Iran, homosexual acts are punishable by death while surgeries to transition  are accepted, common, and are pursued by high percentages of Iranians who are same-sex attracted. Some parents who support their children's transition show signs of Munchausen by Proxy


The Unchartered Territories of Medically Transitioning Children

What's Missing From the Conversation About Transgender Kids

The Trans Child As Experimental Guinea Pig

Gender Dysphoria is Not One Thing

It Feels Like Conversion Therapy for Gay Children, Say Clinicians




Research shows that there are many psychological and social factors that influence the rapid development of transgender identities during adolescence. There are no biomarkers or medical tests for gender identity, which is in the mind, not the body.  While some physicians may require more thorough assessments, some clinicians will offer medical treatment at the first visit with no medical or mental health assessment.The medical interventions offered to young people are risky and cause serious, and sometimes irreversible changes to young developing bodies. Data from the UK, Canada, and Australia reveals an exponential increase of transgender identities among young people, with a disproportionately high ratio of girls.

Sex Ratio in Children and Adolescents Referred to the Gender Identity Service in the UK (2009-2016)


The steep increase in birth-assigned females seeking help from gender services across the age range highlights an emerging phenomenon. It is important to follow birth-assigned females’ trajectories, to better understand the changing clinical presentations in gender-diverse children and adolescents and to monitor the influence of social and cultural factors that impact on their psychological well-being.

Young People With Features of Gender Dysphoria: Demographics and Associated Difficulties


In conclusion, young people with gender dysphoria often present with a wide range of associated difficulties which clinicians need to take into account, and our article highlights the often complex presentations of these young people.


Two Years of Gender Identity Service for Minors: Overrepresentation of Natal Girls With Severe Problems in Adolescent Development


The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.


Parent Reports of Adolescents and Young Adults Perceived to Show Signs of a Rapid Onset of Gender Dysphoria

Emerging hypotheses include the possibility of a potential new subcategory of gender dysphoria (referred to as rapid-onset gender dysphoria) that has not yet been clinically validated and the possibility of social influences and maladaptive coping mechanisms. Parent-child conflict may also explain some of the findings. More research that includes data collection from adolescents, young adults, parents, clinicians, and third-party informants is needed to further explore the roles of social influence, maladaptive coping mechanisms, parental approaches, and family dynamics in the development and duration of gender dysphoria in adolescents and young adults.




Rather than explore reasons behind teens’ sudden identification as transgender, the current “affirmative care” model encourages parents, teachers, and therapists to accept these identities without question. Most critically, young people are offered medical treatment at very young ages. Hormonal treatments are offered as early as eight years old. Surgical treatments are offered as young as 13. Parents may consent to these treatments without being fully informed.


Many clinicians tell parents their children are likely to attempt suicide if they do not "affirm" them. Dr. Michael Briggs refutes studies that purport to support this. Parents are not informed that puberty-blocking drugs pose serious health risks. Many clinicians describe this as a safe way to "buy time" or avoid the "wrong puberty." 


Parents are typically not informed that this medical protocol is experimental and not evidence-based, that identities may change over time, and their children may grow up to regret medical interventions. Parents are not adequately informed about the complete health risks and impact of cross-sex hormones on sexual function and fertility. Medical associations endorse the medical treatment of children, which creates the false perception of evidence-based medical consensus.


It Feels Like Conversion Therapy for Gay Children, Say Clinicians

The Unchartered Territories of Medically Transitioning Children

Minister Orders Inquiry Into 4,000 Percent Rise in Children Wanting to Change Sex

Why Are So Many Teenage Girls Appearing in Gender Clinics?

Gender Dysphoria is Not One Thing

Autogynephilic Gender Dysphoria (Adolescent Boys and Men)

The Trans Child As Experimental Guinea Pig

College Students



There is no research about this unique demographic. Observational reports suggest there are perhaps as many males as females expressing alternative gender identities.



The social milieu at many colleges includes active trans-affirming programming and policies, as well as easy access to medical transition services. Students who seek mental health counseling are quickly affirmed in their identities. Cross-sex hormones are easily obtained at many colleges through campus health services and affiliated off-campus clinics. The"informed consent” model is commonly used, which allows students to access cross-sex hormones without a thorough medical or mental health assessment in only 1-3 visits. Letters for surgeries may be obtained easily from  therapists who do not believe in “gatekeeping” and provide letters for surgery after only one “therapy” session; some therapists offer this one-day service via Skype.

Many college health plans cover these medical treatments, including both hormones and surgeries. Colleges have been misinformed that they must cover students’ medical transition or face lawsuits. M. Dru Levasseur, senior attorney and transgender rights project director for Lambda Legal, has warned: "Any college or university that receives federal funding and is denying HRT, or not insuring it, is breaking the law. They can wait to be sued or change practices to be in line with the law.”​ Parents who attempt to communicate concerns or underlying issues are told by college employees that they cannot speak with them due to privacy laws. Although legal adults at the age of 18, brain development is not complete until well into the mid-20s; for those with developmental delays, not until 30. 


There’s a Sudden Surge of Trans Students Coming Out at My College … and I’m Scared to Talk About It

When Your Daughter Defies Biology

Over 100 Schools Now Offering Transgender Medical Coverage for Students

Gender Dysphoria is Not One Thing

Autogynephilic Gender Dysphoria (Adolescent Boys and Men)

Absolutist Dogma is Chilling Transgender Research


Adults 18+



Traditionally, this demographic was overwhelmingly male and well-documented by research. Today, because of complex social influences, the etiology of transgender identities that are now emerging with greater frequency in young adulthood is not well understood and it is too early to make conclusions. Some adults do experience a profound gender dysphoria and may experience relief from medical treatment. However, research shows that gender dysphoria can remit in some of these cases and that psychotherapy could theoretically facilitate such remission – or a reduction in symptoms of gender dysphoria in some subset of the diverse group of adults who meet the diagnosis. Unfortunately, these possibilities have not yet been investigated, and such investigations are strongly discouraged. For an excellent summary of the research, read What Many Transgender Activists Don’t What You to Know and Why You Should Know it Anyway



Though legal adults, the development of the frontal lobes of the brain responsible for risk assessment does not complete until at least 25 years of age. For young adults with developmental delays, full brain development may not be reached until age 30. It is concerning that young adults may be making rash medical decisions with significant adverse effects-- that are irreversible and may one day be regretted -- without proper evaluation, guidance, or full knowledge. While medical protocol accounts for developmental differences for drastic procedures such as tubal ligations and vasectomies, this is not the case for identity-based medical practices.


Although many young and older adults appear to be in extreme distress and psychic pain, there has been a rush in recent years to offer medical interventions without careful consideration of risks and whether relief might be provided by specialized therapeutic counseling. Non-medical alternatives are rarely discussed, let alone provided. 

The "informed consent” model is often used by clinics, including Planned Parenthood, to provide hormonal treatments, which are often offered in only 1-3 visits without a thorough medical or mental health assessment, or diagnosis. Letters for surgeries may be obtained easily by therapists who do not believe in “gatekeeping” and advertise that they will provide letters in only one “therapy” session on Skype. 



Gender Dysphoria is Not One Thing

Autogynephilic Gender Dysphoria (Adolescent Boys and Men)

Absolutist Dogma is Chilling Transgender Research