New Study: Most German Youth Outgrow Gender Identity Diagnoses
A groundbreaking new study on insurance data suggests that the majority of German youth do not persist in their transgender identity after five years.
Update 6/15/24: In response to questions about their recent study on whether young people in Germany maintain their gender-related diagnoses throughout the transitioning process, the study authors were contacted for more information.
They confirmed that in Germany, individuals typically keep their medical diagnosis for an extended period as they navigate transitioning. This may include lifelong hormone treatments and other ongoing healthcare services such as speech therapy. They also shared new insights, noting that while changing one's gender marker on identification documents is a common step during transitioning, the study found that less than 0.5% of those diagnosed with gender identity disorders actually changed their marker during the time they were studied.
Additionally, the authors mentioned that surgeries for children and teenagers, tracked by a specific German coding system (OPS code), are quite rare. They observed that the stability of these diagnoses varies by age and sex, with older individuals generally having more stable diagnoses compared to adolescent girls.
The authors were confident in their interpretation of the data, emphasizing that their study findings align with past desistance research: “The proportion of unstable diagnoses is within the range of previously published international figures, which makes our results plausible.”
The results of this study are a significant finding—there is very little desistance data on the newer cohort of young people under the gender-affirming model of care, and this study adds to growing evidence that for many young people, a trans-identity can be a temporary phase.
A new long-term study from Germany suggests that the majority of young people diagnosed with gender identity disorders do not continue to identify as such over time. The study examined insurance data over five years, revealing that more than half of young people aged 5-24 across every age subgroup diagnosed with "gender identity disorder" no longer had the diagnosis after five years. Specifically, the desistance rate was 72.7% in 15- to 19-year-old females and 50.3% in 20- to 24-year-old males. Among the whole group of 5- to 24-year-olds, only about 36.4% of those diagnosed in 2017 still had the diagnosis five years later, indicating that more than 63% desisted.
One of the strengths of this study is its comprehensive collection of outpatient billing data for all legally insured persons in Germany, providing a large and representative sample. Additionally, the long observation period from 2013 to 2022 offers valuable insights into long-term trends and changes in diagnosis rates.
The research also noted a dramatic rise in the number of young people being diagnosed with gender identity disorders. In 2013, there were 22.5 cases per 100,000 insured young people, but by 2022, this had increased to 175.7 cases per 100,000, representing an increase of nearly 681%. The study highlighted that, in almost all years, the highest prevalence of gender identity disorder diagnoses was found in 15- to 19-year-old females. In 2022, this age group had a prevalence rate of 452.6 cases per 100,000.
The study also found that a large majority of those diagnosed with gender identity disorders had other mental health conditions. In 2022, 72.4% of individuals with a gender identity disorder diagnosis had at least one other psychiatric diagnosis. The most common co-occurring mental health issues included depressive disorders (affecting about 57.5% of females and 49.3% of males), anxiety disorders (34% of females and 23.5% of males), and borderline personality disorders (17.6% of females and 12.1% of males). Other frequent conditions were attention deficit/hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD).
The researchers highlighted the "fluid" nature of gender identity during childhood and adolescence as a likely reason for the high desistance rates. Citing the U.K.’s Cass Review, the authors suggested the need for a comprehensive, standardized diagnostic procedure for youth experiencing gender-related distress.
The study suggests that many young people might resolve their gender incongruence without needing long-term medical treatment. The authors recommend that diagnostic stability and the high prevalence of concurrent mental disorders be considered when starting “gender-adjusting therapy” in adolescence.
They call for more research into cases of "low persistent diagnosis," confirming that “the diagnostic persistence of less than 50% in all age groups in the 5-year follow-up corresponds to the literature.” This supports a growing body of research showing that gender dissatisfaction during adolescence is often temporary and tends to decline with age. This study aligns with recent findings from a long-term Dutch study, which found that most adolescents who expressed a desire to be the opposite sex no longer felt that way in adulthood.
h/t: OurDuty Group
It seems this is confirming what is known, which is not unimportant. But, more importantly it begs the question of the degree to which who desists or not is predictable. If it isn't, as the testimony of formerly dysphoric grownups who are very glad that gender affirmers weren't around in their youth confirms, it is malpractice to medicalize transition or even to encourage social transition because it's a path to irreversible medicalization.
I suspect Hilary Cass's advice to youth to "Keep your options open" will soon be a catch-phrase.
Thank you for this hope! We have a 21 year old son, who quite suddenly decided he was transgender in the last year during a relationship with a girl who we feel led him down the garden path - and he has recently started estrogen therapy. Our son is on the autism spectrum (mild and high-functioning, more Asperger now as he’s gotten older), is being treated for bipolar, ADHD, and unspecified tic disorder/possible Tourette’s - which is in line with the research we have been reading. Of course, with him now being an adult, we no longer have any say in his medical care, and anything we do or say will cause him to further dig his heels in and go in the opposite direction. It has been exceedingly difficult and heartbreaking to see your child suddenly change course and go down this path and feel helpless as our child seems hell-bent on this, and is disregarding the health risks, as well as further mental health risks, knowing that in the long run, taking estrogen or transitioning in any way is going to “fix” the problem, and we are just praying that the transgender illusions come to an end - because the mental and medical health professionals don’t dare not “affirm” his care due to this madness. Why is gender dysphoria the only mental illness in the DSM-5 where the only treatment is “affirmation”?