Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria

J Sex Med. 2015 Mar;12(3):756-63. doi: 10.1111/jsm.12817. Epub 2015 Jan 22.


Introduction: 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.

Aim: 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.

Keywords: Adolescents; Gender Dysphoria; Gender Identity Disorder; Sex Ratio.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Body Image / psychology*
  • Canada / epidemiology
  • Female
  • Gender Identity
  • Gonadal Steroid Hormones / therapeutic use
  • Guideline Adherence* / trends
  • Humans
  • Male
  • Motivation
  • Netherlands / epidemiology
  • Referral and Consultation / statistics & numerical data*
  • Referral and Consultation / trends
  • Sex Ratio*
  • Sex Reassignment Procedures* / psychology
  • Sex Reassignment Procedures* / trends
  • Sexual Maturation
  • Surveys and Questionnaires
  • Transgender Persons / psychology*
  • Transgender Persons / statistics & numerical data
  • Transsexualism / psychology*


  • Gonadal Steroid Hormones