Why are there more transmasculine youth in pediatric gender diversity clinics?

A recent study, co-authored by Claire Vandendriessche and David Cohen from TJT and published in European Child & Adolescent Psychiatry, examines the social and structural factors that explain the predominance of people assigned female at birth (AFAB) among transgender youth and cisgender LGB (lesbian, gay, bisexual) youth in Europe. Drawing on an analysis of data from the second wave (2019) of the EU LGBTI Survey conducted by the European Union Agency for Fundamental Rights, involving more than 137,000 participants across 30 countries, the study explores the controversial hypothesis of rapid-onset gender dysphoria (ROGD).
This hypothesis, which suggests that social media promote a form of “social contagion” leading to an increase in transmasculine youth and thereby explaining their overrepresentation in pediatric gender identity clinics, is confronted with a more nuanced exploration of social influences.

Differences in coming out ages between AFAB and AMAB people:

The results show that young people assigned male at birth (AMAB), whether cisgender or transgender, disclose their LGBT identity (coming out) later than those assigned female at birth, at the same age of LGBT self-recognition (coming in). This disparity is observed in each of the 30 European countries analyzed. The researchers explain this difference by social costs that disproportionately penalize AMAB youth who transgress cisheterosexist stereotypes associated with masculinity, compared with the transgression of stereotypes linked to femininity among AFAB youth. Thus, if most pediatric gender identity clinics report a higher proportion of transmasculine adolescents than transfeminine adolescents, this would be linked to transmisogyny, which reduces the ability of transfeminine youth to disclose their transgender identity before reaching adulthood, and therefore to access pediatric services. For example, among individuals who perceived themselves as transgender during childhood or adolescence, transfeminine people came out at an average age of 23.3 years, compared with 18.8 years for transmasculine people. More generally, AMAB LGBT individuals (cisgender gay or bisexual men and transfeminine people) would be less likely than AFAB LGBT individuals (cisgender lesbian or bisexual women and transmasculine people) to receive care in any service dedicated to LGBT minors.

By relying on the probability of coming out at a given age for a person who already perceives themselves as LGBT, the researchers were able to reconstruct expected sex ratios as a function of age. They found that even under the assumption of equal AFAB and AMAB population sizes across all age groups, the tendency for AMAB individuals to come out as LGBT later than AFAB individuals implies that, below a certain age, the sex ratios of people declaring an LGBT identity are dominated by AFAB individuals. For example, at age 17, 61.3 % of people who had come out as transgender were AFAB, while 59.7 % of cisgender people who had come out as LGB were AFAB. This minimal difference allowed the researchers to confirm that the higher frequency of transmasculine adolescents in pediatric gender identity clinics reflects a broader phenomenon affecting the entire LGBT community, and is therefore not a trans-specific phenomenon. At older ages, AMAB individuals increasingly come out as LGBT, which tends to rebalance sex ratios across the overall population. This is supported by population censuses in Canada (2021), as well as in England and Wales (2021) – the only countries to have enumerated their transgender populations – which show a balanced sex ratio within the transgender population across all age groups (53 % trans women and 47 % trans men in Canada; 50 % trans women and 50 % trans men in England and Wales).

The impact of national policies on LGBT identity affirmation

In each of the 30 European countries studied, LGBT people assigned male at birth (AMAB) come out later than LGBT people assigned female at birth (AFAB), at the same age of coming in. For example, in France, LGBT individuals assigned male at birth come out on average 1.73 years later. Portugal shows the smallest gap (1 year), while Bulgaria shows the largest (3.4 years).

The study highlights the influence of national laws and policies on the ability to disclose an LGBT identity to one’s social environment depending on sex assigned at birth. Countries with less favourable LGBT-rights policies, measured by ILGA-Europe’s Rainbow Index (2019), show larger age gaps between people with different sexes of assignment. This suggests that the social costs associated with the penalisation of gender-stereotype transgression are not only higher for people assigned to masculinity, but that these costs increase further in national contexts that are more repressive of LGBT identities.

Questioning key aspects of the ROGD hypothesis

Contrary to the assumptions of the ROGD hypothesis, transmasculine adolescents who affirm their identity rapidly (less than one year after self-awareness) and who frequently use social media do not exhibit poorer mental or physical health than others. This finding contradicts the idea that rapid affirmation of a trans identity during adolescence reflects an underlying psychopathology.

The study highlights that the ROGD hypothesis, often invoked to justify restrictions on healthcare for trans youth, lacks robust scientific foundations. In particular, the researchers criticise its instrumentalisation in political contexts, notably in the United States, where it has been used as a pretext for laws restricting access to care for transgender minors.

In conclusion, the authors call for further research into the social, legal and cultural influences shaping LGBT youths’ trajectories. They advocate for a more comprehensive approach, integrating factors such as minority stress, discrimination and societal norms. This work paves the way for public policies and clinical practices better adapted to the complex realities of LGBT youth.

Coverage in Le Monde

The study was covered by the newspaper Le Monde in its Wednesday, 19 March 2025 edition, available to subscribers here. The article situates the TYT study within the context of the anti-trans offensive in the United States, citing in particular an article published in the prestigious New England Journal of Medicine: “two physicians and a lawyer denounce the repressive and transphobic laws adopted in the United States since Donald Trump’s return to the White House, explaining that they ‘underscore a broader effort aimed at rolling back the rights of trans and non-binary people’. Yet, ‘research has consistently demonstrated the positive effects of access to gender-affirming care’ on health, and such care is far from being ‘experimental’ or akin to ‘mutilation’.”

Interviewed by Lilas Pepy, a journalist for Le Monde, the American child and adolescent psychiatrist Jack Turban warns of prospects increasingly marked by “stigmatisation, harassment and discrimination against transgender youth.” He recalls what he wrote in 2022 in the journal Pediatrics: “the ROGD theory has been used by legislators in the United States to ban gender-affirming care for transgender adolescents, despite the ‘unequivocal support’ of major medical organisations for such care.” The author of this theory, Lisa Littman, suggests that “social contagion” via social media would primarily affect AFAB youth: “the degraded image of women conveyed on social media would plunge them into profound distress, from which they would emerge by transitioning to the male gender.” In support of this belief, changes in sex ratios among young people over the past two decades show an increase in transmasculine youth.

It is this research question that motivated Claire Vandendriessche and David Cohen to study, using a very large dataset of LGBT individuals, differences in age at coming out between transfeminine and transmasculine people, at an equivalent age of coming in. Claire Vandendriessche summarises one of their main findings in the Le Monde article: “What we demonstrate is not so much the predominance of young transmasculine people in paediatric clinics or in the general population, but rather the absence of young transfeminine people who remain in the closet.” For Annelou de Vries, a Dutch child and adolescent psychiatrist interviewed by Le Monde, “these results provide an important ‘different perspective’ compared with the criticisms and doubts about trans youth that we often hear.”

Access the Le Monde article by clicking here (subscribers)
Access the full TYT study in open access here (in English)