title: Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria.
abstract: BACKGROUND
  The number of adolescents referred to specialized gender identity clinics for gender dysphoria appears to be increasing and there also appears to be a corresponding shift in the sex ratio, from one favoring natal males to one favoring natal females.
  
  
  OBJECTIVE
  We conducted two quantitative studies to ascertain whether there has been a recent inversion of the sex ratio of adolescents referred for gender dysphoria.
  
  
  METHODS
  The sex ratio of adolescents from two specialized gender identity clinics was examined as a function of two cohort periods (2006-2013 vs. prior years). Study 1 was conducted on patients from a clinic in Toronto, and Study 2 was conducted on patients from a clinic in Amsterdam.
  
  
  RESULTS
  Across both clinics, the total sample size was 748. In both clinics, there was a significant change in the sex ratio of referred adolescents between the two cohort periods: between 2006 and 2013, the sex ratio favored natal females, but in the prior years, the sex ratio favored natal males. In Study 1 from Toronto, there was no corresponding change in the sex ratio of 6,592 adolescents referred for other clinical problems.
  
  
  CONCLUSIONS
  Sociological and sociocultural explanations are offered to account for this recent inversion in the sex ratio of adolescents with gender dysphoria.
authors.affiliation: Gender Identity Service, Child, Youth and Family Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Madison
authors.initials: M
authors.lastname: Aitken
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Steensma
authors.forename: Ray
authors.initials: R
authors.lastname: Blanchard
authors.forename: Doug P
authors.initials: DP
authors.lastname: VanderLaan
authors.forename: Hayley
authors.initials: H
authors.lastname: Wood
authors.forename: Amanda
authors.initials: A
authors.lastname: Fuentes
authors.forename: Cathy
authors.initials: C
authors.lastname: Spegg
authors.forename: Lori
authors.initials: L
authors.lastname: Wasserman
authors.forename: Megan
authors.initials: M
authors.lastname: Ames
authors.forename: C Lindsay
authors.initials: CL
authors.lastname: Fitzsimmons
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Leef
authors.forename: Victoria
authors.initials: V
authors.lastname: Lishak
authors.forename: Elyse
authors.initials: E
authors.lastname: Reim
authors.forename: Anna
authors.initials: A
authors.lastname: Takagi
authors.forename: Julia
authors.initials: J
authors.lastname: Vinik
authors.forename: Julia
authors.initials: J
authors.lastname: Wreford
authors.forename: Peggy T
authors.initials: PT
authors.lastname: Cohen-Kettenis
authors.forename: Annelou L C
authors.initials: AL
authors.lastname: de Vries
authors.forename: Baudewijntje P C
authors.initials: BP
authors.lastname: Kreukels
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Zucker
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001828:Body Image / Q000523:psychology*; D002170:Canada / Q000453:epidemiology; D005260:Female; D005783:Gender Identity; D012739:Gonadal Steroid Hormones / Q000627:therapeutic use; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D008297:Male; D009042:Motivation; D009426:Netherlands / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D012744:Sex Ratio; D057829:Gender-Affirming Procedures / Q000523:psychology / Q000639:trends; D012741:Sexual Maturation; D011795:Surveys and Questionnaires; D063106:Transgender Persons / Q000523:psychology* / Q000706:statistics & numerical data; D014189:Transsexualism / Q000523:psychology*
chemical_list: D012739:Gonadal Steroid Hormones
keywords: Adolescents; Gender Dysphoria; Gender Identity Disorder; Sex Ratio