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This briefing outlines what is known about the factors that shape gender incongruence and gender dysphoria. The impact on the NHS from increased referrals for gender identity care is discussed.
Factors shaping gender incongruence and gender dysphoria, and impact on health services (741 KB , PDF)
DOI: https://doi.org/10.58248/PB53
Warning: This briefing discusses issues around suicide which some readers may find distressing.
In the 2021 census for England and Wales 45.7 million people (94% of the population aged 16 or over) answered the question: “Is the gender you identify with the same as your sex registered at birth?”. Of the people who answered the question, 262,000 (0.54% of people aged 16 and over) said their gender identity and their sex registered at birth were different. However, the reliability of this data has been questioned and the Office for Statistics Regulation is undertaking a short statistical review.
The evidence about why some people develop distress associated with gender incongruence is generally limited and poor quality. Stakeholders with varied perspectives may interpret the same research in different ways. Distress can be described as occurring at distinct levels, including individual (distress associated with one’s body); interpersonal (distress associated with social interaction); or social (distress associated with living as a transgender or non-binary person in society). The presence and relative importance of each of these factors is unique to each individual.
The demand for gender identity services has increased for children and adults. Healthcare services in England do not have the current capacity to meet this significantly increased demand in a timely way. There are long waiting lists between approximately 40 and 60 months and there are concerns that waiting times are contributing to distress experienced by children and adults.
Specialist NHS services for children and adolescents are the subject of an independent review (the Cass Review). The review was commissioned by NHS England and NHS Improvement to explore how services could be improved, and to ensure that the NHS can commission safe and effective services. There were concerns that overall service design was not subjected to some of the normal quality controls that are typically applied.
The way the medical community defines gender incongruence is changing. The World Health Organisation moved “gender incongruence” from a mental health to a sexual health classification in the International Classification of Diseases and Related Health Problems (ICD) 11th edition. This may have potential future implications for the way gender is recognised in legislation.
POSTbriefs are based on literature reviews and interviews with a range of stakeholders and are externally peer reviewed. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:
* denotes people and organisations who acted as external reviewers of the briefing.
Factors shaping gender incongruence and gender dysphoria, and impact on health services (741 KB , PDF)
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