{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T06:57:30Z","timestamp":1791097050622,"version":"4.1.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2015,3,1]],"date-time":"2015-03-01T00:00:00Z","timestamp":1425168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,3,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The number of adolescents referred to specialized gender identity clinics for gender dysphoria appears to be increasing and there also appears to be a corresponding shift in the sex ratio, from one favoring natal males to one favoring natal females.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>We conducted two quantitative studies to ascertain whether there has been a recent inversion of the sex ratio of adolescents referred for gender dysphoria.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The sex ratio of adolescents from two specialized gender identity clinics was examined as a function of two cohort periods (2006\u20132013 vs. prior years). Study 1 was conducted on patients from a clinic in Toronto, and Study 2 was conducted on patients from a clinic in Amsterdam.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Across both clinics, the total sample size was 748. In both clinics, there was a significant change in the sex ratio of referred adolescents between the two cohort periods: between 2006 and 2013, the sex ratio favored natal females, but in the prior years, the sex ratio favored natal males. In Study 1 from Toronto, there was no corresponding change in the sex ratio of 6,592 adolescents referred for other clinical problems.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Sociological and sociocultural explanations are offered to account for this recent inversion in the sex ratio of adolescents with gender dysphoria.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1111\/jsm.12817","type":"journal-article","created":{"date-parts":[[2015,1,22]],"date-time":"2015-01-22T14:25:39Z","timestamp":1421936739000},"page":"756-763","source":"Crossref","is-referenced-by-count":363,"title":["Evidence for an Altered Sex Ratio in Clinic-Referred Adolescents with Gender Dysphoria"],"prefix":"10.1093","volume":"12","author":[{"given":"Madison","family":"Aitken","sequence":"first","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas D.","family":"Steensma","sequence":"additional","affiliation":[{"name":"Center of Expertise on Gender Dysphoria , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"},{"name":"Department of Medical Psychology , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray","family":"Blanchard","sequence":"additional","affiliation":[{"name":"Department of Psychiatry , Toronto, Ontario , Canada"},{"name":"University of Toronto , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doug P.","family":"VanderLaan","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Wood","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Fuentes","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathy","family":"Spegg","sequence":"additional","affiliation":[{"name":"IM\/IT Corporate Applications , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Wasserman","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Ames","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Lindsay","family":"Fitzsimmons","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan H.","family":"Leef","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Lishak","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elyse","family":"Reim","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Takagi","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Vinik","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Wreford","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peggy T.","family":"Cohen-Kettenis","sequence":"additional","affiliation":[{"name":"Center of Expertise on Gender Dysphoria , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"},{"name":"Department of Medical Psychology , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelou L.C.","family":"de Vries","sequence":"additional","affiliation":[{"name":"Center of Expertise on Gender Dysphoria , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"},{"name":"Department of Child and Adolescent Psychiatry , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baudewijntje P.C.","family":"Kreukels","sequence":"additional","affiliation":[{"name":"Center of Expertise on Gender Dysphoria , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"},{"name":"Department of Medical Psychology , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J.","family":"Zucker","sequence":"additional","affiliation":[{"name":"Gender Identity Service, Child, Youth and Family Services , Toronto, Ontario , Canada"},{"name":"Centre for Addiction and Mental Health , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,3,1]]},"reference":[{"key":"2023010709210200400_bb0010","article-title":"Diagnostic and statistical manual of mental disorders","year":"2013","edition":"5th edition"},{"key":"2023010709210200400_bb0015","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1080\/15532730902799946","article-title":"Epidemiology of gender identity disorder: Recommendations for the standards of care of the World Professional Association for Transgender Health","volume":"11","author":"Zucker","year":"2009","journal-title":"Int J Transgenderism"},{"key":"2023010709210200400_bb0020","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.eurpsy.2010.04.009","article-title":"A European network for the investigation of gender incongruence: The ENIGI initiative","volume":"27","author":"Kreukels","year":"2012","journal-title":"Eur Psychiatry"},{"key":"2023010709210200400_bb0025","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1111\/j.1743-6109.2011.02252.x","article-title":"Distinctive features of female-to-male transsexualism and prevalence of gender identity disorder in Japan","volume":"8","author":"Baba","year":"2011","journal-title":"J Sex Med"},{"key":"2023010709210200400_bb0030","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/BF01542342","article-title":"Transsexualism and anatomic sex ratio reversal in Poland","volume":"17","author":"Godlewski","year":"1988","journal-title":"Arch Sex Behav"},{"key":"2023010709210200400_bb0035","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/0092623X.2012.675022","article-title":"Patterns of referral to a Gender Identity Service for Children and Adolescents (1976\u20132011): Age, sex ratio, and sexual orientation [Letter to the Editor]","volume":"39","author":"Wood","year":"2013","journal-title":"J Sex Marital Ther"},{"key":"2023010709210200400_bb0040","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1080\/00224490902898728","article-title":"The gender identity\/gender dysphoria questionnaire for adolescents and adults: Further validity evidence","volume":"47","author":"Singh","year":"2010","journal-title":"J Sex Res"},{"key":"2023010709210200400_bb0045","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1080\/00224490701586730","article-title":"The gender identity\/gender dysphoria questionnaire for adolescents and adults","volume":"44","author":"Deogracias","year":"2007","journal-title":"J Sex Res"},{"key":"2023010709210200400_bb0050","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1007\/s10508-009-9594-3","article-title":"Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults","volume":"39","author":"Lawrence","year":"2014","journal-title":"Arch Sex Behav"},{"key":"2023010709210200400_bb0055","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1080\/0092623X.2011.611219","article-title":"Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism","volume":"38","author":"Zucker","year":"2012","journal-title":"J Sex Marital Ther"},{"key":"2023010709210200400_bb0060","doi-asserted-by":"crossref","first-page":"486","DOI":"10.13109\/prkk.2014.63.6.486","article-title":"Merkmale von Kindern und Jugendlichen mit Geschlechtsdysphoria in der Hamburger Spezialsprechstunde","volume":"63","author":"Becker","year":"2014","journal-title":"Prax Kinderpsychol Kinderpsychiat"},{"key":"2023010709210200400_bb0065","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1542\/peds.2011-0907","article-title":"Children and adolescents with gender identity disorder referred to a pediatric medical center","volume":"129","author":"Spack","year":"2012","journal-title":"Pediatrics"},{"key":"2023010709210200400_bb0070","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.chc.2011.08.001","article-title":"Treatment of adolescents with gender dysphoria in the Netherlands","volume":"20","author":"Cohen-Kettenis","year":"2011","journal-title":"Child Adolesc Psychiatr Clin N Am"},{"key":"2023010709210200400_bb0075","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1080\/19359705.2011.530574","article-title":"Puberty-blocking hormonal therapy for adolescents with gender identity disorder: A descriptive clinical study","volume":"15","author":"Zucker","year":"2011","journal-title":"J Gay Lesbian Ment Health"},{"key":"2023010709210200400_bb0080","doi-asserted-by":"crossref","first-page":"238","DOI":"10.3928\/00904481-20140522-11","article-title":"Resource list: Clinical care programs for gender-nonconforming children and adolescents","volume":"43","author":"Hsieh","year":"2014","journal-title":"Pediatr Ann"},{"key":"2023010709210200400_bb0085","first-page":"191","article-title":"Normal sexual maturation","volume":"14","author":"Sizonenko","year":"1987","journal-title":"Pediatrician"},{"key":"2023010709210200400_bb0090","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/BF01542067","article-title":"Heterosexual and homosexual gender dysphoria","volume":"16","author":"Blanchard","year":"1985","journal-title":"Arch Sex Behav"},{"key":"2023010709210200400_bb0095","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1111\/j.1743-6109.2010.02142.x","article-title":"Age of onset and sexual orientation in transsexual males and females","volume":"8","author":"Nieder","year":"2011","journal-title":"J Sex Med"},{"key":"2023010709210200400_bb0100","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1007\/s10508-009-9489-3","article-title":"Gay and bisexual identity development among female-to-male transsexuals in North America: Emergence of a transgender sexuality","volume":"38","author":"Bockting","year":"2009","journal-title":"Arch Sex Behav"},{"key":"2023010709210200400_bb0105","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s10508-012-0052-2","article-title":"Measures of clinical health among female-to-male transgender persons as a function of sexual orientation","volume":"42","author":"Meier","year":"2013","journal-title":"Arch Sex Behav"},{"key":"2023010709210200400_bb0110","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1037\/0012-1649.31.1.43","article-title":"Childhood sex-typed behavior and sexual orientation: A conceptual analysis and quantitative review","volume":"31","author":"Bailey","year":"1995","journal-title":"Dev Psychol"},{"key":"2023010709210200400_bb0115","article-title":"A follow-up study of boys with gender identity disorder","author":"Singh","year":"2012"},{"key":"2023010709210200400_bb0120","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.jaac.2013.03.016","article-title":"Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study","volume":"52","author":"Steensma","year":"2013","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"2023010709210200400_bb0125","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1097\/CHI.0b013e31818956b9","article-title":"Psychosexual outcome of gender dysphoric children","volume":"47","author":"Wallien","year":"2008","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"2023010709210200400_bb0130","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S0277-5395(01)00182-0","article-title":"Trans(re)lations: Lesbian and female to male transsexual accounts of identity","volume":"24","author":"Lee","year":"2001","journal-title":"Women's Stud Int Forum"},{"key":"2023010709210200400_bb0135","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1023\/A:1021769215342","article-title":"Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis","volume":"31","author":"Cohen-Kettenis","year":"2003","journal-title":"J Abnorm Child Psychol"},{"key":"2023010709210200400_bb0140","doi-asserted-by":"crossref","first-page":"902","DOI":"10.2307\/1128339","article-title":"Consequences of moderate cross-gender behavior in preschool children","volume":"48","author":"Fagot","year":"1977","journal-title":"Child Dev"},{"key":"2023010709210200400_bb0145","first-page":"542","article-title":"Cross-sex identity:\u2009Peer group integration and the double standard of childhood sex-typing","author":"Green","year":"1980","journal-title":"Childhood and sexuality. Montreal: Editions Etudes Vivantes"},{"key":"2023010709210200400_bb0150","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s10508-009-9517-3","article-title":"Peer group status of gender dysphoric children: A sociometric study","volume":"39","author":"Wallien","year":"2010","journal-title":"Arch Sex Behav"},{"key":"2023010709210200400_bb0155","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1007\/BF01544775","article-title":"Children's appraisals of sex-typed behavior in their peers","volume":"33","author":"Zucker","year":"1995","journal-title":"Sex Roles"},{"key":"2023010709210200400_bb0160","article-title":"Peer relations in adolescents with gender identity disorder","author":"Shiffman","year":"2013"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S174360951530967X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S174360951530967X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/12\/3\/756\/48475718\/jsm_12_3_756.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/12\/3\/756\/48475718\/jsm_12_3_756.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,7]],"date-time":"2023-01-07T09:21:50Z","timestamp":1673083310000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/12\/3\/756\/6966737"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,3,1]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2015,3,1]]},"published-print":{"date-parts":[[2015,3,1]]}},"URL":"https:\/\/doi.org\/10.1111\/jsm.12817","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2015,3]]},"published":{"date-parts":[[2015,3,1]]}}}