In 2009, the NHS’s Gender Identity Development Service (GIDS) saw fewer than 50 children a year. Since then, the demand has increased a hundredfold, with more than 5,000 seeking support in 2021-22.
In her assessment of female services, Dr. Hilary Cass said there had been a “dramatic boost” in presentations to female clinics in the last century, particularly by birth-registered females. In 2009, GIDS treated 15 females. By 2016, that number had risen to 1,071.
Over the past ten to fifteen years, the population of young people has changed significantly, Cass said on BBC Radio 4’s Now program on Wednesday.
“But about 15 years ago, the company was seeing probably 50 mainly birth-registered boys in childhood. And over the past ten years or so, it’s changed to over 3,000 young people, primarily birth-registered girls who are presenting in the early teens and frequently with pretty complex additional issues.
Her review came to the conclusion that there is no one explanation for the rise in gender incongruence or the certain rise in birth-registered females referred to as GIDS.
However, it claims that several factors may be to blame for the rise in predominantly birth-registered females requesting gender services in the first few years of adolescence:
Social media and the internet
Generation Z and Generation Alpha (those born since 2010) have grown up with “unprecedented” online lives, the report says. This has big advantages but also brings risks and challenges.
Children and young people have more access to learning sources thanks to the internet, but the review notes that it has also made them more vulnerable to new hazards.
“Biology hasn’t changed, and adult biology hasn’t changed in the last few years,” Cass told the Guardian this week. “So it’s not that that’s changed things.
“I don’t think that young people today are being exposed to more abuse or trauma or so on than previous generations. The effects of social media must be taken very seriously.
According to the report, women spend more time using social media than kids. In a study conducted by Cass, it was discovered that 43% of girls used social media for three or more hours per day, compared to 22% of boys.
According to a rigorous assessment that the Cass statement highlighted, using social media was linked to concerns about body image. Several other studies cited by the report link smartphone and cultural media use to suicidality and mental compulsion in young people, especially girls.
All showed a distinct dose-response marriage: the more hours spent electronically, the greater the result.
Peer and patterns-social influence
The document suggests that although the effects of cultural influences on a child’s sex appearance remain unclear, it’s obvious that the influences of a child’s peers are “quite strong during adolescence.”
Although the document does not specifically state that women are impacted by social and cultural effects, such as friend force, more than males, and so too their female appearance, other evidence has suggested this is the case.
According to a number of studies, girls are more susceptible to peer pressure than boys, and they are more likely to develop a bad body image in adolescence.
Information on gender dysmorphia and gender expression that the report mentions as possibly having an impact on a young person’s gender expression is another societal influence.
A review’s review included information from a focus group of gender-questioned young people and their parents, who stated that they frequently discovered online information that described typical adolescent discomfort as a potential sign of being trans and that particular influencers have had a significant influence on their child’s beliefs and understanding of their gender.
A young, gender-conscious young person is quoted in the report as supporting this assertion, saying that “many trans people make YouTube videos, which I believe are a major source of information for many people, and that’s primarily where I get my information, not so much professional services.”
Another focus group of gender-questioning young people reported that they frequently found it difficult to find “true sources of information, favoring lived experience social media accounts over mainstream news outlets.”
According to the review, greater societal acceptance of transgender identities has made it easier for young people to come out. It suggests that the increased numbers now reflect the reality of gender incongruence in society.
Dangerous online influencers
Cass said her review team had heard reports of children being asked to keep things a secret from their parents when they were being questioned about gender. Although we haven’t conducted a thorough search, “Cass told the Guardian,” was certain to follow some of those who were informed about specific influencers. Some of them give them very unbalanced information.
“And some]young people] were told that parents would not understand, so that they had to actively separate from their parents or distance their parents. All the evidence demonstrates that family support is fundamental to people’s well-being. So there was actually some risky influencing going on.
Cass says the influencers “are legion” but declined to identify any specially.
Mental health
The Cass report found that the rising rates of poor mental health and emotional distress among the broader adolescent population, particularly among girls, should be seen in light of the alarming rise in young people who are presenting with gender dysphoria.
According to UK national surveys conducted between 1999 and 2017, there has been a significant increase in rates of mental health issues in children and young people, with teenage girls experiencing the highest rates of anxiety and depression.
The Cass review found that there was a “marked increase” in young women aged between 16 and 24 presenting with anxiety, depression, and self-harm. Some conditions – for example, eating disorders – have increased more than others, particularly in girls and young women.
Studies of rates of self-harm have shown similar increases. For example, the report says there was an almost 70% increase in girls aged between 13 and 16 presenting with self-harm. This was not seen in boys, the review noted.
According to the report, “the increase in presentations to gender clinics has to some degree paralleled this deterioration in child and adolescent mental health.” “Mental health issues have increased in both boys and girls, but have been most concerning in girls and young women,” the statement reads.
Girls were also more likely to have low self-esteem (12.8% versus 8.9% of boys), according to a study cited by the Cass review. They were also more likely to be unhappy with their appearance (15.4% versus 11.8% of boys).
Changes in concepts of gender and sexuality
The report states that the relationship between sexuality and gender identity is “complex and contested,” and that it was “important to take into account the relationship between sexual identity and gender identity given that both may be fluid during adolescence.”
The report cites a 2016 GIDS study that examined the sexual orientation of 57% (97) of a clinic sample of patients over the age of 12 for whom this information was available.
Of the birth-registered females, 68% were attracted to females, 21% were bisexual, 9% were attracted to males, and 2% were asexual. Of the birth-registered males, 42% were attracted to males, 39% were bisexual, and 19% were attracted to females.
According to the report, same-sex attraction is “common in adolescence and not to conform to gender stereotypes.” Young people are now having to navigate an increasingly complex interplay between sex and gender in making sense of these feelings.
The review comes to the conclusion that the relationship between sexual orientation and gender identity “is an area that warrants better exploration and understanding.”
Additionally, according to the report, it had received numerous reports from birth-related parents that their child had gone through a transgender transition before being identified as cisgender same-sex attracted.
