For decades, more young men than young women presented to doctors and psychiatrists with gender dysphoria. But that has all changed in recent years.
As reported in a 2015 article in the Journal of Sexual Medicine, researchers in Canada and the Netherlands examined data from 748 total clinic referrals in the two countries across several decades. The flip-flop in the boy-girl ratio is obvious, as seen in the below graph from this quantitative study. As always, a picture is worth at least 1000 words.
The dramatic uptick in girls and women presenting to gender clinics from 2006-13 is abundantly clear–and there seems to be no end in sight.
Starting in 2006, we noted that the number of referred female adolescents with GD was now exceeding the number of referred male adolescents with GD in the Toronto clinic. Thus, there appears to be an emerging inversion in the sex ratio of adolescents with GD which, to our knowledge, has not been documented formally in the empirical literature.
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.
This reversal of the boy-girl ratio seems to be the case in other Western countries as well. Two other studies, one from Germany, the other from Finland, corroborate the findings from the Toronto and Amsterdam clinics.
In the German study (2014)
Between 2006 and 2010, 45 gender variant children and adolescents were seen by clinicians; 88.9% (n = 40) of these were diagnosed with gender identity disorder (ICD-10). Within this group, the referral rates for girls were higher than for boys (1:1.5). Gender dysphoric girls were on average older than the boys and a higher percentage of girls was referred to the clinic at the beginning of adolescence (> 12 years of age). At the same time, more girls reported an early onset age. More girls made statements about their (same-sex) sexual orientation during adolescence and wishes for gender confirming medical interventions. More girls than boys revealed self-mutilation in the past or present as well as suicidal thoughts and/or attempts.
And in the Finnish study (2015), which looked at referrals from 2011-2013:
The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.
…The natal girl:boy ratio among the adolescent SR applicants was very high. In prepubertal children referred to gender identity services, boy:girl ratio is reportedly 3–6:1, with some variation across countries presumably due to cultural reasons [5,13]. Previously a more even boy:girl ratio has been suggested in adolescents seeking sex reassignment than among child samples …
What could be causing this undeniable increase in referrals of girls with gender dysphoria?
The German and Finnish studies offer no explanation, other than to say “cultural factors” likely play a part. In the larger Toronto-Amsterdam paper, Aitken et al posit
It is well-known that cross-gender behavior in children is subject to more social stigma (e.g., peer rejection and peer teasing) in males than in females, in both clinic-referred adolescents with GD and in the general population [26–30]. Thus, it could be argued that it is easier for adolescent females to “come out” as transgendered than it is for adolescent males to come out as transgendered because masculine behavior is subject to less social sanction than feminine behavior. … Given that a transgendered identity as an “identity option” has become much more visible over the past decade, it is conceivable, therefore, that such an identity option is easier for females to declare than it is for males because it does not elicit as much of a negative
response. .. there are greater costs for a male to adopt a female gender identity in adolescence than it is for a female to adopt a male gender identity.
I find the authors’ explanation lacking for several reasons. One, this is nothing new. Girls who are “tomboys” are more socially acceptable than “sissy” or effeminate boys. This didn’t start in 2006. But more to the point, I think the authors’ reasoning is exactly backwards. If it is more acceptable for girls to be tomboys, why would those tomboys think they need to change their gender? It would seem that boys who are effeminate would feel a much greater sense of urgency about changing their sex, because they would face constant disapproval about their behavior from parents, schoolmates, and anyone else they encountered, especially in more conservative families and regions. Girls, on the other hand, would presumably feel more comfortable continuing to present as “gender nonconforming” or “tomboyish.”
I am not the first blogger to contemplate this question. The Dirt from Dirt has been blogging for years about the phenomenon of young, primarily lesbian young women “transitioning.” Others have written in elegaic terms about the near eradication of less conventionally “feminine” lesbians, with so many now choosing “transition” instead of the fomerly proud and celebrated butch identity as in the bygone Second Wave era. The loss of womens’ bookstores, support groups, and other spaces, as well as role models (both in real life, and in movies, TV, and other media consumed so much by young people) is also key. Homophobia/lesbophobia is most certainly a factor. I have written several posts pointing out the influence of social media in glamorizing transition, with video logs and journals chronicling the FTM transition and the profound (and partially permanent) changes wrought by testosterone.
And what of the straight girls who transition to then become gay men? What motivates these young women to abandon the relatively easier path of heterosexuality? The current cultural expectation seems to be that girls look, act and dress like–to put it bluntly–porn stars, so a girl who eschews makeup and the other accoutrements of “femininity” could be drawn to the relative freedom of a man’s life.
None of this fully explains the inversion in the ratio of girls to boys. But whatever the reason (and please share your own thoughts and theories in the comments), the increasing number of girls dis-idenitifying with their own bodies is an undeniable and growing trend–and to observers like me, an emergency.
I am haunted by the the words of a detransitioned woman, who recently wrote that when she was active in transgender circles, the only voices to be heard amongst both MTFs and FTMs were testosterone-deepened. Women’s voices were gone.
The voices of too many young women are being lost. Figuratively, as these young women no longer identify with their natal gender and join the chorus of male opinion. And literally: their female voices silenced and transformed by testosterone.