Rise in gender dysphoria diagnoses in SG indicative of greater self-awareness

New diagnoses of gender dysphoria (GD) at younger ages are increasing in Singapore, suggesting greater self-awareness and willingness to seek help among younger individuals.

“Our findings emphasize the significant distress experienced by children and adolescents with GD, underscoring the need for tailored interventions and support,” according to researchers.

In this study, medical records were retrospectively reviewed for patients with GD diagnosis based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth and Fifth editions, between 1 January 2017 and 31 December 2021. Researchers collected and analysed demographic, medical, and GD-specific clinical variables.

A total of 107 participants (mean age 16.6 years) were included, consisting of 47 natal males and 60 natal females. GD prevalence stood at 1:5434 or 0.019 percent, and incidence rates rose from 2.17 to 5.85 per 100,000 population between 2017 and 2021. [Ann Acad Med Singap 2024;53:647-656]

The mean age of diagnosis was 15.6 years, with an average 5-year delay between experiencing gender identity-related concerns and seeking professional help. Nearly half of the participants (~45 percent) reported social and physical transitions. In addition, about one in five (20.6 percent) reported self-harm or suicidal thoughts.

These statistics support those reported in other Asian studies. [Arch Sex Behav 2022;51:1881-1889; Arch Sex Behav 2023;52:1009-1017; J Sex Med 2022;19:1185-1195]

Apart from greater self-awareness and willingness to seek help, the increase in new diagnoses over the 5-year study period could also reflect an increasingly supportive social environment for gender minorities, according to the researchers.

"Open discussions and psycho-education about GD could foster a more positive and collaborative approach to treatment, reduce unsafe practices, and decrease stigmatization,” they added.

Aetiology

The exact cause of GD remains unknown, but previous studies suggest genetic factors, mother–child relationship, higher level of depression, and staying in urban and populated areas as possible aetiologies. [J Pers 1999;67:127-155; J Adolesc Health 2015;57:374-380; Eur Psychiatry 2015;30:807-815]

A disparate sex ratio (more natal males than females) also indicates the impact of physical sexual differentiation in development, potentially involving biological, social, and cultural determinants, according to another study. [Sex Health 2017;14:404-411]

“The variability in persistence of GD further complicates the picture,” the researchers said. “[A]bout 80 percent of children reported GD desistance when they reached puberty.” Identification of GD at a higher age may indicate a greater likelihood of persistence. [Int Rev Psychiatry 2016;28:13-20; J Am Acad Child Adolesc Psychiatry 2013;52:582-590]

Intervention

When managing individuals with GD, the American Academy of Child and Adolescent Psychiatry pushes for evidence-based, individualized clinical care. [J Am Acad Child Adolesc Psychiatry 2013;52:582-590]

On the other hand, affirmative treatment, which highlights acceptance for diverse gender expressions and identities, is recommended by the Guidelines for Psychological Practice with Transgender and Gender Nonconforming People and the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. [Am Psychol 2015;70:832-864; Int J Transgend 2012;13:165-232; J Humanist Psychol 2022;62:104-122]

“Currently, there is no evidence-based intervention for changing gender identity,” the researchers said. “While affirmative treatment is supported, there is a recognized risk of iatrogenic harm, prompting the suggestion of exploratory psychotherapy (neither affirmative nor conversion) as a first-line treatment to provide psychological support.” [Arch Sex Behav 2021;50:7-16; https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx]