Article
Sex ratios in minor and adult transgender individuals seeking for medical treatment based on German health insurance data – the TRANSKIDS-CARE study
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Authors
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Katja Nettermann
- Universität Münster, Münster, Germany
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Alicia Basoglu
- Universität Münster, Münster, Germany
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Ursula Marschall
- BARMER Berlin, Berlin, Germany
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André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster, Münster, Germany
| Published: | September 6, 2024 |
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Outline
Text
Background: Increasing frequency rates of health service utilization for gender dysphoria and related medical support is under great discussion in the context of current guideline adjustments. In Germany, the latest numbers and the changes over the last years are scarcely examined, particularly the unequal sex ratios in different age groups.
Methods: As part of the research project TRANSKIDS-CARE we analyzed claims data of a major health insurance company (BARMER) to investigate the changes of health service utilization for gender dysphoria related ICD-10 codes. Trends regarding the sex ratio and the proportion of patients with hormonal treatment in 2010-2021 were examined. We compared the two age groups of minors (4-17 years) and young adults (18-30 years). Hormonal treatment included puberty blockers and gender affirming treatment with estrogen or testosterone.
Outcomes: The number of individuals with an incident gender dysphoria diagnosis considerably increased in a 12- year interval. For minors the incidence changed from 15 per 100,000 to 49 per 100,000 insured persons (IRR (incidence rate ratio) = 3.2, CI = 2.3 – 3.8). Among adults the incidence increased from 13 per 100,000 insured to 39 per 100,000 (IRR = 2.9, CI = 2.5 – 3.4). The proportion of newly diagnosed patients with assigned female sex at birth was higher in minors (70.0%) and adults (64.1%). The proportion of individuals that started hormonal treatment within 2 years after their first diagnosis differs between adults and minors. In the group of minor patients, 20% of trans males started hormonal treatment, whereas this proportion was 16% in trans female minors. In contrast, a higher proportion of adult trans women started hormonal treatment (trans men: 36% vs. trans women: 49%).
Discussion: An increasing number of transgender individuals receive medical treatment because of gender dysphoria. However, increase rates were similar in adults as compared to minors. Thus a discussed youth-specific increase of diagnoses could not be confirmed. Relative frequencies of hormonal treatment differ between trans males and trans females in both age groups.
Funding: The TRANSKIDS-CARE project is funded by the German Federal Joint Committee (G-BA, grant# 01VSF20033).
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
