Higher prevalence of gender-diverse youth than previously reported

1. In a survey of 3168 high school students, 9.2% indicated incongruence between gender identity and sex assigned at birth, which is 5 times higher than current national estimates.

2. Gender identity among gender-diverse youth was equally split between masculine, feminine, and nonbinary identities.

Evidence Rating Level: 3 (Average)

Study Rundown: Gender-diverse youth (GDY) are individuals whose gender identity and sex assigned at birth are incongruent. Previous estimates of GDY are approximately 1.8%, and have focused mostly on clinical settings where there is a higher prevalence of white and masculine-identifying youth. GDY of color are more likely to experience systemic racism, socioeconomic disadvantage and violence, which contribute to inequities when seeking access to gender-affirming care. The goal of the current survey was to estimate the prevalence of GDY in a school-based sample, as well as evaluate the prevalence by race, ethnicity and gender identity. The survey was conducted in 2018 and included 3168 high school students located in a Northeastern midsized city school district. Youth completed a 2-step gender identity question as part of the modified Youth Risk Behavior Survey that inquired about assigned sex at birth and gender identity, where multiple options could be selected. In total, 291 participants (9.2%) reported incongruence between gender identity and sex assigned at birth. Prevalence was lowest among white youth (7.1%) and highest among Alaskan Native youth (14.4%). Gender identity was similar across masculine (29.9%), feminine (38.8%), and nonbinary identities (31.3%), and 13.1% selected multiple identities. Although this study is limited by its small sample size and may not be generalizable, findings indicate that GDY may be more prevalent than previously reported. It is additionally important to evaluate structures that perpetuate inequities in access to care for GDY of diverse races and ethnicities.

Click to read the study in PEDIATRICS

Relevant Reading: Non-binary youth: Access to gender-affirming primary health care

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