How many trans kids should there be?
Of course, the straightforward answer is, “as many as want to be trans”. However I’m going to delve into how many we would expect if we were trying to guess based on what we know.
There’s an often quoted statistic that there was a “4000% increase” in patient referrals to the Tavistock GIDS child and adolescent gender service in the decade from 2009 to 2019. This service consists of a network of clinics which serves the trans youth population in England and Wales. The statistic is often given itself (leaning heavily on innuendo) as reason enough to suspect that there are problems with social contagion causing kids to transition who are likely to later regret it.
Of course a 4000% increase for a service where previous iterations of the service were not nearly as available or widely known to the public (or to doctors who might provide referrals to the service), and which had radically increased capacity starting at the time when this increase is measured from does not tell us much . It’s hard to tell whether it would be possible to distinguish between the purported “social contagion” happening spreading through schools and Tumblr on the one hand, or if this is just what an improvement in access to an obscure and particularly underfunded corner of the NHS looks like. After all, if you start off dealing with a handful of patients with an experimental service and then roll it out nationwide, you would absolutely reasonably expect the number of patients to double, quadruple and more after your first handful until your service either reaches its own limits in terms of capacity or demand in terms of the number of patients in need of the service. This period of growth in the service corresponds directly with a period of the NHS commissioning information resources to inform and educate GPs, videos with young trans people talking about their experiences with the service and other awareness raising activities. So there’s plenty of historical reasons to expect more patients to successfully be accessing the service. The question is really whether the amount of demand we are seeing seems reasonable.
One rough way we can estimate this is by asking whether there is any way to estimate the number of new trans children we can expect to be brought into the world each year. And the answer is, “yes”. We have multiple estimates of the population of self identified trans adults over the last few years and these have oscillated between 0.2% and 1% at the most generous estimate. A recent census outcome in Canada gives us our best data yet:
0.33% of the population there identifies as trans or non-binary. Of these, 59% identify as transgender, and the other 41% identify as non binary, or as percentages of the whole population, 0.19% identify as transgender, and 0.14% as non-binary.
Now, while we cannot account for when young trans people are likely to discover they are trans, all trans people were born at some point and it seems reasonable to assume that the proportion of these births per year at least sets a reasonable “cap” to our expectation values for new trans youth discovering they need support from gender identity services. The majority of young people accessing GIDS do not get prescribed any sort of medical intervention and this service exists to offer access to therapeutic support as well as referral for medical transition support.
In England and Wales, the live birth rate for 2020 was 613,936. This was a particularly low year, and fell for the 5th year running. In 2010 the number of live births was 807,271.
So the proportion of young people who are likely to be reached within that, if the rates are similar to other developed countries like Canada, would be
0.33% × 613936 = 2026 children and adolescents (low estimate)
0.33% × 807271 = 2688 children and adolescents(higher estimate based on young people who would now be 12 years old)
Coincidentally, the current rate of referrals to GIDS, roughly stable for the last 4 years, is between 2000–2600. The vaunted “4000% increase” is the referral caseload reaching and stabilising at the number of trans children we would roughly expect to see. Certainly at least in the same order of magnitude.
Issues to be aware of
Only about 6% of young people referred to GIDS even get referred on for any degree of medically supported transition each year, let alone other forms of medical support. Rather unlike the media driven stereotype of young people being rushed onto drugs, GIDS appears to be cherry picking a very narrow sample of what they consider to be lowest risk patients, in part driven by risk aversion due to high profile legal cases featuring detransitioners. Anti trans activists are so insistent on the dangers of regret that young people who might want to be on and benefit from medication to delay puberty and give them time to improve their certainty about transition are very likely being withheld that treatment. This is not an unreasonable thing to surmise from the numbers of patients being prescribed being so much lower than the expectation rate for adolescent trans people predicted by the known rate of trans people in the wider population.
It’s also likely that there are kids who will think they are trans who desist at a later date. It’s important not to play this down — desisters and detransitioners have been calling out to be listened to and not brushed aside for years now, (although much research so far on detransition suggests that most detransitioners don’t necessarily regret transition as such, even among those who cease to identify as trans). Because of the existence of desisters and detransitioners it would be reasonable to expect rather more referrals to GIDS than simply the average number in the population. Maybe they are balanced out by those young people destined to discover they are trans later in life. It’s impossible to say.
In short, if the number of referrals to GIDS corresponds roughly to the rate of trans people we observe in the adult population, even though we would expect to see a surplus of young people referred who ultimately decide they’re not trans. And we would expect there to be many more diagnosed and provided with medical transition support than currently are in practice.
It’s also worth bearing in mind, that the number of adults who currently identify as trans is almost certainly negatively impacted by the degree to which our society suppresses trans identity. These numbers will likely grow as transphobia reduces and people feel safer to come to terms with themselves. I’ve used them as an indicator here because the Canadian census gives us an absolutely clear (and high quality) benchmark for the degree to which people feel safe to identify as trans in Anglo-Commonwealth cultures at this point in time.