As the incidence of gender incongruence (GI)/gender dysphoria (GD) rises yearly, public understanding of transgender is also increasing, whereas this improvement cannot be achieved without extensive transgender-related surveys. However, most of the surveys were only issued to people who identify themselves as transgender with the absence of medical confirmations in most situations. These result in a gap between transgender survey and diagnosed GI/GD.

This study aims to discover the gap between self-reported and diagnostically confirmed transgender and GI/GD individuals among students in China.

We chose two middle schools and one college from Changsha (a city in China) at random with a total of 2047 students. Among them, 1661 students gave us certain gender identify responses in which we categorized them into two types (cisgender and gender minorities). Professional psychiatrists then used ICD-11 and DSM-5 criteria to confirm whether the self-reported gender minorities could be diagnosed with GI/GD via phone or in person.

In total, 7.5% of the college students and 5.8% of the middle school students reported themselves as gender minorities. Although 29% of college students and 43.8% of middle school students did not cooperate with the subsequent psychiatric interviews, none of the self-reported gender minority students meet the GI/GD criteria of ICD-11/DSM-5.

The epidemiological investigation of transgender is heavily affected by the definition and the data sources. There is a huge heterogeneity between self-reported transgender and diagnosed GI/GD. Future transgender studies should strictly control inclusion criteria.

No significant relationships.

Increasing numbers of adolescents seek help for gender-identity questions. Consequently, requests for medical treatments, such as puberty suppression, are growing. However, studies investigating the neurobiological substrate of gender incongruence (when birth-assigned sex and gender identity do not align) are scarce, and knowledge about the effects of puberty suppression on the developing brain of transgender youth is limited.

Here we cross-sectionally investigated sex and gender differences in regional fractional anisotropy (FA) as measured by diffusion MR imaging, and the impact of puberty on alterations in the white-matter organization of 35 treatment-naive prepubertal children and 41 adolescents with gender incongruence, receiving puberty suppression. The transgender groups were compared with 79 age-matched, treatment-naive cisgender (when sex and gender align) peers.

We found that transgender adolescents had lower FA in the bilateral inferior fronto-occipital fasciculus (IFOF), forceps major and corpus callosum than cisgender peers. In addition, average FA values of the right IFOF correlated negatively with adolescents' cumulative dosage of puberty suppressants received. Of note, prepubertal children also showed significant FA group differences in, again, the right IFOF and left cortico-spinal tract, but with the reverse pattern (transgender > cisgender) than was seen in adolescents.

Importantly, our results of lower FA (indexing less longitudinal organization, fiber coherence, and myelination) in the IFOF of gender-incongruent adolescents replicate prior findings in transgender adults, suggesting a salient neural correlate of gender incongruence. Findings highlight the complexity with which (pubertal) sex hormones impact white-matter development and add important insight into the neurobiological substrate associated with gender incongruence.

Gender identity is each person’s internal and individual experience of gender. Gender expression is how a person publicly expresses their gender. Gender incongruence (GI) is defined as a condition in which a person has a marked incongruence between the expressed or experienced gender and the biological sex at birth. Adolescence is a crucial period for the persistence or development of GI, due hormonal changes, peer relations and first romantic experiences.

To make a revision of the literature about GI along childhood throughout adolescence.

Research in the literature with the words “gender identity”, “gender incongruence”, “gender dysphoria”, “childhood” and “adolescence” in scientific databases.

GI is present in a small percentage of children, often provoking psychopathological distress. There is a high prevalence of autism spectrum disorders in these children, compared with the general population. In most cases the dysphoria does not persist until adolescence. There has been an increasing number of adolescents seeking for treatment at gender identity services. The studies show that after the onset of puberty, the probability of persistent GI is high and that adolescents submitted to hormonal suppression tend to continue the medical treatment.

Epidemiological formal studies about gender incongruence in children and adolescents are very few. Studies of prevalence in these populations are community studies and don’t reflect the true prevalence of GI, so it would be necessary to investigate its prevalence and persistence in different world populations. It’s also necessary to make more prospective studies about the long-term effects of the medical treatment of GI.

No significant relationships.