Within ten years, the number of children, adolescents and young adults diagnosed with “gender identity disorder” has increased at least eightfold. This is shown by health insurance data on 5- to 24-year-olds receiving outpatient treatment in Germany.

German doctors bill quarterly through the compulsory basic insurance. In 2013, 23 out of 100,000 adolescents and young adults in Germany were diagnosed with a “gender identity disorder” (in at least one quarter per calendar year). In 2022, the figure was 176 out of 100,000. Female 15- to 19-year-olds were most affected.

Prevalence of gender identity disorder in Germany
Number of diagnoses of “gender identity disorder” among young people in Germany in at least one quarter per calendar year from 2013 to 2022 (M = male, F = female, J = age in years).

Social contagion is well known in other diseases

The reasons for this increase are unclear. The authors of the analysis cite possible causes as being, in addition to a real increase in the disorder, increased awareness, decreasing stigmatization, better medical care, social contagion and overdiagnosis, meaning that children without a “gender identity disorder” are wrongly given this diagnosis.

The phenomenon of “social contagion” is well known among adolescents. A well-known example was the YouTube channel “Gewitter im Kopf”. There, a person suffering from Tourette syndrome put himself on display for years – whereupon dozens of young people showed very similar symptoms – and were sometimes treated incorrectly for months. They had all become “infected” by watching the videos and believed that they also suffered from Tourette syndrome. Social contagion among young people also plays a major role in “cutting”.

Media reports on much more common diseases significantly less

In the past, there have also been strong increases in the incidence of other mental illnesses, such as autism. This has been due in part to better care options, but also to a more positive image of the illness and the media attention that has been paid to “gender identity disorder” in recent years. This is discussed much more often in the media than other, much more common illnesses among adolescents.

Since 2017, the diagnosis of “gender identity disorder” has been made particularly frequently, including in Switzerland (Infosperber reported). This sharp increase coincides with a ruling by the German Federal Constitutional Court. In November 2017, it decided that in addition to the entry “female” or “male”, a third option for civil status must be created for people who “permanently identify as neither male nor female”.

For the vast majority, the disruption was temporary

The scientists who evaluated the German health insurance data not only looked at whether a “gender identity disorder” was diagnosed, but also how long it was treated for. They wanted to know whether it was a temporary disorder or whether it lasted longer.

More than half of adolescents in all age groups were only given a temporary diagnosis of “gender identity disorder”: five years after the initial diagnosis, an average of 36 percent of those affected were still receiving outpatient treatment. Among 15- to 19-year-old women, the figure was 27 percent. This should be taken into account before those affected begin gender reassignment treatment, advise the authors of the analysis in the “Deutsches Ärzteblatt”.

Treatment can have irreversible consequences

Treatment with “puberty blockers” or hormones for gender reassignment can have irreversible consequences, including infertility. In view of the high rate of those affected in Germany who no longer had a “gender identity disorder” five years later, the study authors warn against hasty treatment.

The World Professional Association for Transgender Health (WPATH), on the other hand, advocated, for example, that affected girls should be able to have their breasts removed at the age of 15 and that boys should be able to have their testicles removed at the age of 17 (Infosperber reported).

Other mental illnesses often existed

According to the authors in the “Deutsches Ärzteblatt”, it should also be noted that the treating doctors diagnosed another psychiatric illness in addition to the “gender identity disorder” in almost three quarters of the young people. The most common were depressive and anxiety disorders, followed by borderline personality disorders, ADHD and post-traumatic disorders. The “gender identity disorder” was therefore possibly the expression of another problem.

The topic is “very politically charged,” said one of the study authors to the “Frankfurter Allgemeine Zeitung.” “For example, during our study, a health insurance company refused to provide access to data for research purposes because the board of directors considered the topic ‘too hot’.”

Planned guideline could endanger minors

The German Society for Child and Adolescent Psychiatry is in a state of disarray. The reason for this is the guideline “Gender incongruence and gender dysphoria in childhood and adolescence”, which will soon be completed and will then also apply to Austria and Switzerland.

The process for new medical guidelines usually works like this: Experts summarize the current knowledge about a disease. To do this, they systematically evaluate the available studies. Depending on how well the benefits of a treatment have been proven, they derive weak or strong treatment recommendations.

In the next step, the draft guideline is put up for discussion. Interested experts comment on it within a set period of time and suggest improvements before the final version of the guideline is finally adopted.

However, the planned guideline “Gender incongruence and gender dysphoria in childhood and adolescence” was different.

The Science Media Centre selected the experts unilaterally

The board of the leading German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy informed the child and adolescent psychiatrists in advance that during the consultation phase only editorial Improvements to the draft, not about content discussions.

Contrary to usual practice, the Science Media Centre informed media representatives about the planned guideline two days after the consultation phase began. It invited four authors of the draft (including Dagmar Pauli from the Psychiatric University Hospital of Zurich) and a specialist from Sweden, who praised the draft, as experts. The Science Media Centre, on the other hand, did not invite critics of the draft guideline – even though the criticism is fierce and comes from experts.

Strong criticism from experts

In a joint statement of over 100 pages, 14 professors, including several university clinic directors for child and adolescent psychiatry, sharply criticize the draft guidelines: The recommendations there are “in many critical points […] not evidence-based” or they would “significantly contradict the current evidence”. This means, for example, the premature use of puberty blockers.

The way the draft guidelines now appear, it could lead to a sometimes regular use of measures […] which have significant, permanent or even irreversible negative consequences, although their effectiveness and sustainability have not yet been sufficiently scientifically proven. […] If the recommendations were published, they would endanger vulnerable minors, as these measures have not yet been sufficiently tested. The risk that physically healthy minors would be treated with potentially irreversible measures without a clear scientific basis is “too great.” The signatories also include two authors of the study on health insurance data mentioned in the above article.

«Slower pace appropriate»

From the critics’ point of view, “it is urgently necessary to make the debate more objective and perhaps wait and see or slow down before […] a guideline is published which may need to be revised again in a few months.»

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Opinions in articles on Infosperber reflect the personal assessments of the author.

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