Critics claim gender clinics are seeing an excess of trans boys. But new data suggest otherwise

Gender clinics provide multidisciplinary care that helps trans people to explore and affirm their gender identity.

The number of adolescents referred to gender clinics has increased worldwide in recent years, especially among those who were assigned female at birth.

This has prompted claims that “social contagion” is driving young people – and in particular, teenagers who were assigned female at birth – to identify as trans and seek medical care.

But this notion isn’t supported by robust evidence, and our latest research directly challenges this idea.

Backlash against gender care

Despite its lack of evidence, the social contagion theory has been used by critics to help fuel an international backlash against adolescent gender care.

In the United States, more than half of all states have enacted laws or policies limiting access to gender care for those under 18 years.

In the United Kingdom, laws now prohibit transgender young people under 18 from starting puberty blockers.

Evidence has now emerged of the adverse consequences of these laws in both the US and UK. This includes sharp declines in mental health and increased suicide attempts among transgender young people.

Despite this evidence, the Queensland government in Australia recently halted access to puberty blockers and gender-affirming hormones to new patients aged under 18.

This decision was made even though a 2024 independent evaluation found that gender care in Queensland is safe and evidence-based and recommended that service capacity be increased.

Trans people seek gender care at different stages of their lives

Our recently published study examined gender clinic referrals across the entire lifespan.

We used data from publicly funded gender clinics in Melbourne and Amsterdam across a three-year period between 2016 and 2019. The Amsterdam and Melbourne services received 2,044 and 1,903 referrals respectively.

We found remarkably similar results in both countries. The majority of adolescent referrals (around 70%) were for trans boys and non-binary people assigned female at birth. However, among adults, this observation was flipped, with the majority of adult referrals being for individuals assigned male at birth.

Specifically, 55% of referrals of those aged in their 20s were for individuals assigned male at birth. This grew every subsequent decade, reaching around 80% for those in their 50s and beyond.

What do these findings mean?

Previous surveys from Sweden, Belgium and the United States indicate the proportion of people assigned male and female at birth who are transgender is roughly equal.

Assuming these two groups share a similar desire to access gender clinics, you would expect the number of referrals to be around the same over the course of a lifetime.

Our new findings are consistent with this expectation but the likelihood of referral to gender clinics seems to be influenced by both the sex a person was assigned at birth, as well as their age. While those assigned female at birth are more likely seek referral as adolescents, those assigned male “catch up” in later years.

So rather than an over-representation of those assigned female at birth, adolescent referral patterns most likely reflect an under-representation of assigned males.

Why is this happening?

Trans misogyny is a unique type of discrimination trans girls and women face. It combines transphobia, the hatred for and discrimination against trans people, with misogyny, the prejudice and contempt towards women.

The impact of trans misogyny is far-reaching. During adolescence, trans girls experience higher rates of bullying and victimisation than trans boys and cisgender peers.

During adulthood, trans women remain at high risk of abuse and violence. They are also more likely to encounter housing discrimination, homelessness, unemployment and poverty than the general population.

Faced with such daunting prospects, it seems much harder for trans girls to reveal their gender identity as adolescents at an already uncertain time of their lives.

But as trans girls progress into adulthood, we suspect an intrinsic desire to express their gendered sense of self eventually tips the balance in favour of “coming out”. As a result, we see more trans women seeking gender care in their 20s, 30s and beyond.

These new findings suggest we need to do more to support trans adolescents. Rather than being driven by the fear of “social contagion”, we must instead recognise and address the challenges trans adolescents, and specifically trans girls and women, face.

This article was co-authored by Freya Kahn, a paediatrician working on research projects at the Royal Children’s Hospital.