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Distribution from 2010

From 2010, referrals to gender clinics rose sharply, mostly among adolescent girls. The reasons are not known: the Cass Review mentions, among others, the influence of peers and media, and calls that the most contested explanation (source). Clinics applied the Dutch protocol to a group for which it was not developed.

The figures: explosive growth, inverse sex ratio

In the UK the Tavistock GIDS saw fewer than 50 children a year before 2009; from 2014 referrals rose exponentially to about 5,000 in 2021/22, a figure that may include double counting according to the Cass Review (source). A study by Kaltiala and colleagues (2020) found a similar pattern of increase in Denmark, Finland, Norway, Sweden and the UK over 2011–2017; the authors write that the reasons are not known and mention awareness, availability of care, destigmatisation and social and media influences (source). The Cass Review describes a change from mostly prepubertal birth-registered males to mostly birth-registered females in or after puberty; of the GIDS patients discharged between April 2018 and the end of 2022, 73% were registered female at birth (source). See Rapid Onset Gender Dysphoria.

The Cass Review writes that there is no single explanation for the increase and that online experiences and peers can influence self-image (source). It considers that greater acceptance may explain part of the increase, but not the overall phenomenon, nor the switch from birth-registered males to birth-registered females (source).

Tumblr, Reddit, TikTok: peer contagion in practice

Lisa Littman (2018) described, in a survey of 256 parents recruited via three websites, a pattern she called rapid-onset gender dysphoria: 86.7% of the parents reported more social media or internet use, a friend group in which friends came out as transgender around the same time, or both (source). Littman presents social influence as a hypothesis, and rapid-onset gender dysphoria is not a recognised medical diagnosis (source). Journalist Abigail Shrier (Irreversible Damage, 2020) argues that social contagion through friend groups and social media plays a key role (source). See Lisa Littman.

In 36.8% of the friend groups described in Littman's survey, parents indicated that the majority of the members became transgender-identified (source). Marchiano (2017) herself writes that rapid-onset gender dysphoria is a new presentation that has not been well studied; she relies partly on online posts and blogs and on an online survey of detransitioned women (source).

Impact on the evidence base: protocol ignores its own scope

Medical care applied the Dutch Protocol to a group for which it was not developed (source). In the original Dutch study 89% of the 70 patients were same-sex attracted to their birth-registered sex and only one was exclusively heterosexual (source). See the Cass Review and the VUmc protocol.

Environmental Progress (2024) concluded from the WPATH Files that WPATH members know that children and young people cannot oversee the lifelong consequences of treatment, and that WPATH does not meet the standards of evidence-based medicine. That is the reading of Environmental Progress; of the members contacted, one person confirmed their own statements and another disputed the interpretation (source). See also the WPATH Files and the research on detransition, regret and desistance.

Clinical implications and international turnaround

NHS England closed the GIDS in 2024, after the interim report of the Cass Review (source). The Cass Review concluded that of the international guidelines only the Finnish (2020) and Swedish (2022) ones could be recommended (source). In December 2022 Sweden's Socialstyrelsen gave a weak negative recommendation for puberty blockers and cross-sex hormones in minors: treatment only in exceptional cases (source). The Swedish systematic review (Ludvigsson et al., 2023) found the evidence insufficient to assess the effects of hormone treatment (source), and NICE (2020) judged the certainty of the evidence on puberty blockers as very low (source). See SBU, NICE and the Tavistock closure.

In the Netherlands, the Gezondheidsraad (30 June 2026) found that the care for young people is carefully organised and fits within the legal framework; it rated the strength of the evidence for the effects found as low to very low and stresses the importance of research into long-term outcomes (source). See the Dutch rollout.

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