Surge in Gender Identity Disorder Diagnoses Among German Youths, High Desistance Rates Highlighted
A ground-breaking German study looks at longitudinal data over five years which point to desistance rates from “gender identity disorder” above 50% ranging from 72.7% in 15- to 19-year-old females to 50.3% in 20- to 24-year-old males.
Bachmann, C J; Golub, Y; Holstiege, J; Hoffmann, F, Gender identity disorders among young people in Germany: prevalence and trends, 2013–2022. An analysis of nationwide routine insurance data Deutscher Ärzteblatt Int 2024; 121: 370-1. DOI: 10.3238/arztebl.m2024.0098
Original German language version: Störungen der Geschlechtsidentität bei jungen Menschen in Deutschland: Häufigkeit und Trends 2013–2022
Synopsis
In recent years, there has been a significant rise in the focus on gender identity disorders, particularly among adolescents. Despite this increased attention, quantitative data from Germany has been limited. This study aims to address this gap by analysing trends in the frequency of diagnosed gender identity disorders, the stability of these diagnoses over time, and associated psychiatric comorbidities.
Methodology
This study evaluated nationwide billing data from the associations of statutory health insurance physicians in Germany, focusing on insured individuals aged 5-24 years from 2013 to 2022. The Central Institute for Statutory Health Insurance in Germany assessed the prevalence of the ICD-10 diagnosis F64 “Gender Identity Disorder” and stratified it by age and gender. Additionally, “Mental and Behavioural Disorders Related to Sexual Development and Orientation” (F66) were considered in a sensitivity analysis.
For individuals with a confirmed F64 diagnosis in 2022, the study examined common psychiatric comorbidities and assessed the persistence of these diagnoses from 2017 to 2022 in a longitudinal cohort.
Results
From 2013 to 2022, the prevalence of confirmed F64 diagnoses increased significantly, from 22.5 per 100,000 insured persons to 175.7 per 100,000 (confirmed over a single quarter) and from 15.2 per 100,000 to 132.6 per 100,000 (when confirmed over two-quarters). The frequency of F64.0 diagnoses (transsexualism) remained relatively constant, ranging from 70.2% to 78.5% (we presume this to represent the frequency of diagnosis of those presenting).
Conversely, the prevalence of F66 diagnoses decreased from 216.7 per 100,000 to 73.7 per 100,000 (single quarter confirmation) and from 37 per 100,000 to 19.4 per 100,000 (two-quarter confirmation). When combining F64 and F66 diagnoses, a notable increase in prevalence was observed using the two-quarter criterion, rising from 51.9 per 100,000 to 149.8 per 100,000, while the single quarter criterion showed minimal changes.
The highest prevalence of F64 diagnoses in 2022 was among 15- to 19-year-old females, reaching 452.6 per 100,000. F66 diagnoses were also most prevalent in this group, at 191.5 per 100,000.
In 2022, 72.4% of individuals diagnosed with F64 had at least one other psychiatric diagnosis. The most common comorbidities were depressive disorders (49.3% in males and 57.5% in females), anxiety disorders, emotionally unstable personality disorders of the borderline type, ADHD, and PTSD.
In the longitudinal cohort, the study found a high rate of desistance, with 63.6% not maintaining a confirmed F64 diagnosis after five years. Desistance rates were above 50% across all age groups, ranging from 72.7% in 15- to 19-year-old females to 50.3% in 20- to 24-year-old males.
Discussion
The study highlights an eightfold increase in F64 diagnoses over a decade among German youths. Comparatively, a U.S. study reported a 2.8-fold increase in “gender dysphoria” diagnoses from 2017 to 2021, while an international registry showed an increase from 47 per 100,000 to 479 per 100,000 among 16-year-olds. The gender distribution and age peaks observed in this study align with international findings.
The decline in F66 diagnoses likely reflects a shift towards diagnosing F64 instead. The reasons for the increase in F64 diagnoses remain unclear and could be due to various factors such as increased awareness, decreased stigmatization, or overdiagnosis.
The study’s strengths include the comprehensive survey of outpatient billing data and a long observation period, with sensitivity analyses confirming the robustness of the F64 diagnosis trends. Limitations include minor imprecision in gender information and the inability to verify the clinical validity of coded diagnoses.
The high desistance rate observed, with 63.6% of individuals not maintaining their F64 diagnosis after five years, underscores the transient nature of transgender ideation during childhood and adolescence. With such high rates of desistance, the case against the medicalisation of gender incongruence just became even stronger than was made out in The Cass Review.
Media
This story was covered in the Frankfurter Allgemeine
Criticism
Our reporting of this story as being about desistance has attracted some criticism.
Specifically, that we cannot say that those who did not persist with medicalisation under code F64 (‘gender identity disorder’) were actually desisters in the commonly accepted sense. Technically, we are looking at ‘withdrawal’ or ‘cessation’ and not desistance.
In normal discourse around adolescent transgenderism we use the words desister and desistance to refer to those who suffer from transgender ideation but cease to desire medical intervention before they receive any. This study does not report on those people except by reference to those who were referred but were not medicalised:
The frequency of the F64.0 diagnosis was fairly constant between 70.2% and 78.5%.
This is the paragraph from the report that we took to change persistence to desistance:
In the longitudinal cohort (n = 7 885, 47.1% 20- to 24-year-olds, 37.7% male), only 36.4% had a confirmed F64 diagnosis after five years, and a diagnosis persistence of < 50% was seen in all age groups (27.3% [15- to 19-year-old women] to 49.7% [20- to 24-year-old men]).
It is normal to describe those who have been medicalised and then cease both medicalisation and claim to a transgender identity as detransitioners. We cannot claim that all those who have desisted from medicalisation in this study have detransitioned. At the same time, there are those who have ‘mentally detransitioned’ who continue with medicalisation because they see no alternative.
Our Duty is about support and advocacy – we’ll leave the dry science to SEGM and CAN-SG – the parents we support need hope, and the wider world needs to see the gender ideology undermined. There could be other explanations for non-persistence with medication, as reported in this study, other than desistance from transgender ideation. However, pure desistance occurs before medical appointments (which themselves have a 21.5% to 29.8% drop out rate in this study). We still do not know the true percentage of those who desist from transgender ideation, whether medicalised or not.
More research is desperately needed.
