Gender dysphoria is the distress that an individual may feel due to their gender identity not matching the sex they were assigned at birth. While gender dysphoria typically affects transgender and gender diverse individuals, it is important to note that not all transgender and gender diverse people experience it, nor does everyone seek gender-affirming care.

Historically, studies aimed at determining the prevalence of gender dysphoria in a population have focused on the number of individuals who have sought gender-affirming care or visited a clinic that focuses on transition-related care. This subset of the population is then divided by the total number of people of an area to gain an estimate of the prevalence of gender dysphoria in said area.

Nevertheless, this method may significantly underestimate the true prevalence of gender dysphoria in a population because not all people experiencing gender dysphoria pursue gender-affirming care. As such, the authors of a recent study in The Journal of Sexual Medicine devised a large population-based study to determine the prevalence of gender dysphoria in Japan using the Utrecht Gender Dysphoria Scale (UGDS).

A total of 20,000 people were identified for this survey, but 3,221 declined to participate and 49 were not eligible for the study. In the end, the study included 7,827 individuals who were classified as male at birth and 8,903 individuals who were classified as female at birth.

All of the participants responded to a screening survey that contained two questions: “How much have you ever perceived yourself as a man?” and “How much have you ever perceived yourself as a woman?” The respondents used a 5-point Likert scale to answer these two questions, with 1 signifying “not at all” and 5 indicating “very much.” When a participant’s scores for these two questions were equal, the gender of this person was considered to be ambivalent. Alternatively, when the participant assigned a lower score to the gender they were assigned at birth than to the other gender, their gender was considered to be incongruent.

After completing the screening survey, the individuals whose gender was determined to be ambivalent or incongruent were asked to complete the UGDS. The UGDS is considered to be a reliable measure of gender dysphoria, and it contains 12 items to be answered on a 5-point Likert scale for a total score ranging from 12 to 60. With this assessment tool, higher scores indicate a higher likelihood of being diagnosed with gender dysphoria (as it is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)).

The researchers used 40 points as the cutoff for potential gender dysphoria, meaning that participants with scores of 41 or higher were considered more likely to be diagnosed with gender dysphoria. Specifically, those who were identified as having incongruent gender and a UGDS score ≥ 41 were classified as having gender dysphoria in a narrow sense, and those who were identified as having ambivalent gender and a UGDS score ≥ 41 were classified as having gender dysphoria in a broad sense.

By these definitions, the authors found that the prevalence of gender dysphoria in Japan was 0.27% among individuals assigned male at birth and 0.35% among individuals assigned female at birth in the narrow sense. In the broad sense, the prevalence of gender dysphoria in Japan was 0.87% among individuals assigned male at birth and 1.1% among individuals assigned female at birth.

These findings indicate that gender dysphoria may be more prevalent than previously determined by clinic-based studies. As such, it is very important that health care providers are cognizant of different gender identities and know how to treat gender diverse patients with respect and dignity.

Resources:

• Oshima, Y., Matsumoto, Y., Terada, S., & Yamada, N. (2022, in press). Prevalence of Gender Dysphoria by Gender and Age in Japan: A Population-Based Internet Survey Using the Utrecht Gender Dysphoria Scale. The Journal of Sexual Medicine. DOI: https://doi.org/10.1016/j.jsxm.2022.03.605