Time trends in referrals to child and adolescent gender identity services: a study in four Nordic countries and in the UK.

To explore whether the increase observed in referrals to child and adolescent gender identity services (GIDSs) has been similar in four Nordic countries and in the UK. Numbers of referrals per year in 2011-2017 were obtained from all GIDS in Denmark, Finland, Norway, Sweden and the UK and related to population aged <18. A similar pattern of increase in referral rates was observed across countries, resulting in comparable population adjusted rates in 2017. In children, male:female birth sex ratio was even; in adolescents, a preponderance of females (birth sex) was observed, particularly in Finland. The demand for GIDSs has evolved similarly across Nordic countries and the UK. The reasons for the increase are not known but increased awareness of gender identity issues, service availability, destigmatization as well as social and media influences may play a role.