Gender Dysphoria: Are we missing the big picture?

Looking beyond chromosomes to question the unprecedented rise in gender dysphoria—and what our environment might be telling us about human development.

In our quest to create a more inclusive society, we sometimes embrace explanations that feel compassionate without fully examining their implications. Today I encountered such a moment when I came across biologist Rebecca Helm's widely-shared 2019 thread on biological sex and gender. There’s a popular share of it here (on Facebook)¹. The thrust of her message is summed up in these two statements:

“Biological classifications exist. XX, XY, XXY XXYY and all manner of variation which is why sex isn't classified as binary.”

“… please be kind, respect people’s right to tell you who they are, and remember that you don’t have all the answers. Again: biology is complicated. Kindness and respect don’t have to be.”

While her intent to reduce stigma is admirable and very much needed in today’s hyper-polarised world, I found myself wondering: are we conflating rare biological variations with a rapidly growing social phenomenon? And in doing so, might we be overlooking environmental factors—both social and physical—that deserve our urgent attention?

As someone who has spent over 35 years studying, researching, and practicing in the realm of holistic health and a broad range of societal issues, I felt compelled to look deeper into the matter. Though I'm not a biologist by formal training, I've assembled research that I believe adds crucial context to this conversation. I remain open to correction if I've misunderstood aspects of the chromosomal variations described.

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The Statistical Disparity

The biological variations described in Helm's thread—SRY gene translocations, chromosomal differences, hormone receptor variations—and many others she didn't mention, exist within the grand tapestry of human biology. Yet these differences appear in merely 0.018-0.05% of births (approximately 1 in 2,000 to 5,000). This stands in stark contrast to recent data showing transgender and non-binary identification at significantly higher rates.

The 2022 Pew Research reveals about 5% of adults under 30 identify as transgender or non-binary², while Gallup polling shows 2.1% of Gen Z adults identify as transgender—compared to just 0.2% of Baby Boomers³. This generational acceleration demands our attention.

Some reasonably argue that historical stigma and lack of terminology led to significant underreporting among older generations—that many Baby Boomers with gender dysphoria simply lacked the language, social acceptance, or safe spaces to express their authentic identities. This perspective deserves consideration and compassion. However, even accounting for substantial underreporting, the generational increase in transgender and non-binary identification is striking: recent U.S. Census data show that Gen Z adults are 10 to 20 times more likely to identify as transgender than Baby Boomers, with similar patterns in non-binary identification⁴⁵. Canadian census data echo this trend, with Gen Z rates three to seven times higher than those of Boomers⁶.

While increased social acceptance and awareness have undoubtedly contributed to greater willingness to report gender diversity, these factors alone are unlikely to account for the entire magnitude of the shift. Notably, research on other stigmatized conditions that became more socially acceptable over time-such as left-handedness or certain mental health diagnoses-typically showed more modest increases after stigma declined, generally two- to threefold, rather than the order-of-magnitude jump now observed in gender identification⁷⁸. Moreover, if reduced stigma were the sole driver, we would expect increases across all age groups, not just among the youngest generations, but this is not what the data show⁹¹⁰.

We stand at a curious and yet critical threshold. The statistical disparity between biological variations and gender identity suggests something profound is occurring beyond chromosomal differences alone. What we're witnessing may not be simply natural variation but the consequence of our increasingly artificial environment—a human-designed reality divorced from the biological coherence that shaped our evolution.

These numbers tell a story that goes beyond chromosomes—one that points toward environmental influences reshaping human development at unprecedented speed.

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The Chemical Deluge

The modern human develops within a complex web of unprecedented environmental influences. Beyond the well-documented endocrine disruptors in plastics and industrial chemicals, we face a constellation of factors potentially rewiring human development.

Research from Stephen Harrod Buhner’s “The Lost Language of Plants” (2002) reveals just how sensitive biological systems are to hormonal influences. Male fish exposed to as little as 0.1 parts per trillion of synthetic estrogen (ethinyl estradiol from birth control pills) began exhibiting intersex characteristics. At just 1,000 parts per trillion—still an incredibly minute amount—all male fish transformed into females¹¹.

This sensitivity extends to human development. The average age of puberty for girls has declined significantly since pre-industrial times. Historical evidence suggests that in the 1800s, girls typically began menstruating around age 16–17¹²¹³¹⁴. By the early 1900s, this had decreased to about 14–15 years, and today, the average is approximately 12–13 years, with some girls showing signs as young as 8 or 9¹⁵. Even more concerning, the onset of puberty in girls has shifted earlier in recent decades, with a significant proportion now showing signs before age 8. Several studies have documented an increase in the incidence of clinically diagnosed precocious puberty over the past 20 years. Researchers have linked these trends, in part, to increased exposure to environmental estrogens and estrogen-mimicking chemicals, which can disrupt normal hormonal development¹⁶¹⁷¹⁸¹⁹²⁰.

Agrochemicals permeate our food supply, with glyphosate and other pesticides shown to disrupt gut microbiome composition—the very microbial ecosystem now recognised as crucial to neurological development and hormone regulation²¹. Our microbiome, that ancient conversation between our cells and the living world, speaks a language increasingly distorted by these chemical interventions.

Persistent pharmaceutical residues in water supplies and the dramatic increase in medication use during pregnancy and early childhood introduce synthetic compounds that interact with developing neural and endocrine systems in ways we’ve barely begun to understand. As Buhner documents in his research, many pharmaceuticals—including numerous antibiotics, antidepressants, and synthetic hormones—are designed with molecular structures that resist natural biodegradation entirely. Unlike organic compounds that eventually decompose, these synthetic molecules can persist indefinitely in the environment unless subjected to extreme conditions like intense heat or prolonged ultraviolet radiation. In essence, we’ve unwittingly created ‘forever pharmaceuticals’ that mirror the environmental permanence of industrial forever chemicals. Hundreds of millions of tons of these biologically active compounds have now been released into Earth’s water systems, soils, and food webs—creating a pharmaceutical legacy that will continue influencing biological development for countless generations, perhaps indefinitely.

Alongside these pharmaceutical residues, we face an unprecedented exposure to industrial chemicals designed for durability rather than biological compatibility. Phthalates and other plasticisers—ubiquitous in everything from food packaging to children’s toys—leach into our bodies and mimic hormonal signals. PFAS compounds (per- and polyfluoroalkyl substances), aptly named ‘forever chemicals,’ resist degradation for thousands of years and bioaccumulate throughout the food chain. These synthetic compounds have been detected in virtually every human tested, including newborn infants, with studies linking them to disrupted hormonal development, reduced fertility, and altered neurodevelopment. The average child now develops within a biochemical context utterly foreign to our evolutionary biology—their cellular signalling systems navigating a molecular landscape their bodies were never designed to interpret.

Perhaps equally profound is our severed relationship with sunlight—that primordial electromagnetic force that has shaped human biology since our emergence. Most children now develop with minimal exposure to full-spectrum sunlight. This is largely due to parents who have had the fear of UV-associated cancer drummed into them—a fear that, while not entirely baseless, has become arguably exaggerated and misrepresented.

This sunlight deficiency affects children at the cellular level. Their mitochondria and cellular signalling systems become deprived of the photonic information they've evolved to expect. This natural light orchestrates numerous biological processes—from vitamin D synthesis to melatonin regulation and even the coherent structuring of cellular water.

As these chemical influences reshape our biology, they inevitably affect how we experience and express our identities—creating a complex interplay between environment and self-perception.

When Health (or Disease) Becomes Identity

Could these physiological disruptions—from microbiome perturbation to mitochondrial dysfunction to hormonal dysregulation—be playing a significant role in the gender identification issues facing society today? I suspect that’s highly likely. Yet remarkably, this biological perspective remains largely unexplored in mainstream discourse. The taboo around doing anything but affirming and normalising gender dysphoria is so intense that few dare to go out on a limb and question it.

Part of the challenge lies in how deeply intertwined certain health conditions become with our sense of identity. Conditions that manifest visibly—like weight, skin appearance, race, or gender expression—become inextricably linked to how we view ourselves and how others perceive us. Unlike having cancer or heart disease, which don’t fundamentally alter our social identity, these conditions become part of who we believe ourselves to be.

This entanglement creates a peculiar dilemma: how do we address potentially harmful conditions without making people feel wrong about who they fundamentally are?

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The Obesity Parallel

We’ve seen this dilemma play out in how society has responded to rising obesity rates. As metabolic disorders have become increasingly common, we’ve witnessed campaigns promoting body positivity and acceptance. On one level, this represents a compassionate response—reducing shame and stigma that can themselves be harmful.

Yet in normalising obesity as simply another way of being, we risk overlooking the profound environmental disruptions driving it: industrial food systems, endocrine-disrupting chemicals, light pollution affecting circadian rhythms, and other factors that fundamentally alter human metabolism. Rather than addressing these root causes, we’ve often opted to reframe the condition as an identity to be embraced and to even be proud of.

The consequences are profound. By normalising what is ultimately a serious state of disease with numerous health consequences, we do a disservice both to individuals suffering these conditions and to our collective understanding of what creates genuine wellbeing.

Learning from Mental Health Approaches

A more nuanced approach can be found in how we’ve evolved our response to depression and anxiety. Here, we’ve worked to reduce stigma not by normalising these conditions as immutable aspects of identity, but by encouraging people to recognise them as treatable conditions warranting attention and care.

We don’t tell someone experiencing depression, “This is just who you are—embrace your depressed identity.” Instead, we acknowledge their experience without judgment while encouraging them to seek resolution. We recognise depression as a signal that something requires attention, not as an identity to be celebrated.

I don’t necessarily agree with contemporary approaches to that resolution—talk therapy as generally practiced often proves ineffective compared to what’s possible, and psychopharmaceuticals frequently masks symptoms (whilst introducing many more) rather than addressing root causes. But the fundamental approach of reducing stigma while still acknowledging the condition as something to be addressed rather than embraced offers a valuable model.

This distinction—between reducing stigma and normalising a condition—becomes even more crucial when we consider how technology is reshaping the very foundation of identity formation.

The Digital Distortion of Self

The above analysis hasn’t yet touched on the profound sociological factors amplifying these biological vulnerabilities. Today’s children develop their sense of self primarily through the synthetic mediation of screens and social media—digital platforms engineered not for human flourishing but for capturing and monetising attention.

This digital environment creates unprecedented psychological conditions: identity formation occurs increasingly through disembodied, algorithmically-curated interactions rather than through the grounded, multi-sensory experience of embodied community. We’re witnessing epidemic levels of depression, anxiety, and profound disconnection from bodily experience among young people—conditions that create fertile ground for identity confusion.

Developing brains marinate in the blue-dominant artificial light from screens—a narrow-band electromagnetic signal bearing little resemblance to the full symphony of natural light. Infants increasingly find themselves “nannied” by these screens, their neurological patterning shaped not by the subtle, complex cues of human faces and natural environments, but by the hypnotic flicker of digital displays.

The profound impact of light on neurological development and behaviour has been documented since the at least the 1970s. Dr. John Ott, a pioneer in photobiology, demonstrated through time-lapse photography how artificial lighting dramatically affects biological systems²². In his 1974 documentary "Exploring the Spectrum," Ott documented a remarkable classroom transformation. One particular child exhibited extreme hyperactivity and learning difficulties under standard fluorescent lighting²³. After installing full-spectrum bulbs that mimicked natural sunlight, the child's behaviour transformed completely—he voluntarily moved to the front of the class, ceased fidgeting, and began to excel academically.

This simple intervention—changing the light spectrum—accomplished what today might “require” pharmaceutical intervention for an ADHD diagnosis. The entire class showed improved behaviour and academic performance merely by altering the light environment to more closely match what our biology evolved with. If something as seemingly innocuous as light spectrum can so profoundly affect neurological functioning and behaviour, what might the cumulative effect be of all the environmental disruptions children now face?

Photo by Aaron Piang on Unsplash

Recent research has confirmed these early observations, with a 2018 study in JAMA Pediatrics finding that adolescents with higher screen time showed significantly altered brain structure and lower cognitive performance²⁴.

This example illuminates a crucial pattern: rather than addressing environmental factors that disrupt natural development, we tend to medicalise and normalise the resulting conditions. We've done this with attention disorders, obesity, and now potentially with gender dysphoria—labelling as identity what may in fact be socially- and environmentally-induced biological dysregulation.

Is it merely coincidence that gender dysphoria has accelerated alongside these dramatic shifts in how children relate to their own bodies and to others? Perhaps what presents externally as gender confusion reflects a deeper existential disorientation—the natural outcome of developing within environments that systematically disconnect consciousness from embodied experience.

The Persistence of Discontent

What's particularly telling is that even after embracing transgender or non-binary identities, many individuals continue to experience significant social anxiety and discomfort with themselves. Research supports this observation—a 2018 study in the journal LGBT Health found that even after gender-affirming interventions, transgender individuals showed significantly higher rates of depression, anxiety, and psychological distress compared to the general population²⁵. A 2020 follow-up study in the Journal of Sexual Medicine examining long-term outcomes found that while gender-affirming surgery improved some aspects of gender dysphoria, it did not resolve broader mental health concerns at rates comparable to control populations²⁶.

This shouldn't surprise us—most people in modern society, regardless of gender identity, struggle with negative self-image and disconnection from their embodied experience. Research from the University of Queensland found that 94% of adolescent girls and 64% of adolescent boys experienced body dissatisfaction²⁷. Even individuals widely perceived as conventionally attractive often experience significant dissatisfaction with their appearance. Studies confirm that the internalisation of beauty ideals perpetuated by media and social networks leads to persistent feelings of inadequacy regardless of objective appearance²⁸. The psychological toll is considerable, with many experiencing chronic shame and anxiety over perceived flaws that others don't even notice.

Men face similar struggles with body image, though often manifested differently. Recent research indicates that muscle dysmorphia—a pathological preoccupation with muscularity that can lead to dangerous behaviors such as steroid use and extreme exercise—affects about 2.8% of boys and men in the United States and Canada²⁹. Higher rates have been observed in specific subgroups, such as male weightlifters, where prevalence estimates range from 13.6% to 44%³⁰. More broadly, surveys suggest that 20% to 40% of men are dissatisfied with aspects of their appearance, including muscle size and tone, and nearly 28% have felt anxious because of body image issues³¹. These concerns have increased in recent decades, paralleling the rise of digitally enhanced and unrealistic male body ideals in media³².

The beautiful model who develops an eating disorder, the man obsessed with inadequate muscularity, and the person with obesity who embraces "fat positivity" are all responding to the same underlying social dysfunction—a profound disconnection from authentic embodied experience and the wisdom of the living world.

Photo by Fernando @cferdophotography on Unsplash

Transitioning to another gender rarely resolves this underlying disconnection. It may provide temporary relief through the hope of a fresh start or a more authentic expression, but the fundamental alienation from embodied wisdom often remains.

This raises important questions about what we’re actually affirming with “gender-affirming care.” Are we truly caring for the whole person, or are we enabling a condition that may itself be symptomatic of deeper environmental and social disruptions? What we need to affirm is the child’s overall wellbeing and health—physiologically, psychologically, and (perhaps only possible in a more enlightened society) their spiritual wellbeing.

The pattern of treating symptoms while ignoring underlying causes appears throughout modern healthcare. Just today I had a conversation with a friend who works in a herb and tea shop. She mentioned the number of men asking for herbal blends to help with erectile dysfunction, presumably as “healthier” alternatives to drugs like Viagra®. While herbs like Damiana and horny goat weed can effectively address their immediate symptom, I explained that erectile dysfunction itself is a serious red flag indicating systemic circulatory issues.

This symptom often signals that capillary function throughout the body is compromised—a warning sign of potential cardiovascular disease, increased risk of heart attack, or even neurodegenerative disorders like dementia and Alzheimer’s. By focusing only on the immediate symptom rather than the underlying condition, we miss an opportunity to address potentially life-threatening issues.

Similarly, by focusing exclusively on affirming gender identity without investigating what might be driving unprecedented increases in gender dysphoria, we may be overlooking crucial opportunities to address environmental factors affecting human development at its most fundamental levels.

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A More Balanced Approach

This isn't about invalidating anyone's lived experience—every human deserves dignity and respect. But research suggests we should approach irreversible interventions with careful consideration, particularly for youth. Longitudinal studies show varying outcomes for children with gender dysphoria. Classic follow-up studies from the 1970s through early 2010s found that between 60% and 90% of children diagnosed with gender dysphoria eventually aligned with their birth sex by adolescence³³ ³⁴. However, more recent research indicates that children who undergo early social transition with family support show much higher rates of persistence in their transgender identity—a 2022 study in Pediatrics found only about 2.5% retransitioned to their birth gender over a five-year follow-up period³⁵.

These different outcomes highlight how significantly social context and support influence gender identity development. Every human being deserves to be raised and treated in a way that optimises their chances of feeling content, happy, and at one with Life and with themselves. To be treated in a way that minimises their suffering, not with commercially driven pharmacological and surgical interventions, but instead with helping address the underlying causes—whether those be affirming their authentic identity or exploring the complex environmental factors that may influence gender development.

Some will argue that gender identity is entirely innate—fixed before birth and impervious to environmental influence. This perspective deserves respect, particularly from those who have found peace through transition. However, the dramatic generational increases in gender dysphoria suggest additional factors at play. Rather than positioning these views as mutually exclusive, we might consider that both innate predispositions and environmental influences could interact in complex ways that vary between individuals. This nuanced view allows us to honour personal experience while still investigating broader patterns.

Rather, it’s about recognising that by normalising these rapidly increasing trends as simply natural variations, we risk overlooking the profound environmental disruptions potentially driving them. We may be witnessing not diversity but dysregulation—a biological system responding to an unprecedented constellation of artificial inputs.

True compassion requires both honouring individual experience and courageously examining the larger patterns emerging in our collective biology. We can simultaneously treat everyone with dignity while asking essential questions about how our increasingly synthetic world may be rewiring human development itself.

The fine line between reducing stigma and enabling harmful disease states requires careful navigation. We must create space for people to exist without shame while still recognising that certain conditions may signal profound imbalances in our relationship with the Natural Living Matrix of Earth, and the implications of the artificial matrix or world we’ve superimposed upon ourselves and all life on Earth.

The Path Forward

The path forward requires both heart and clarity—extending kindness to all while refusing to blind ourselves to the possibility that what we’re witnessing may be another signal that our relationship with the living world requires profound healing.

Perhaps what presents as gender dysphoria in many cases reflects a deeper biological dysphoria—cells and systems struggling to find coherence in an environment increasingly alien to our evolutionary design. By framing it solely as an identity issue rather than potentially an environmentally-induced condition, we may miss crucial opportunities to address the underlying factors affecting not just gender identity but countless aspects of human health and development.

As parents and caregivers, we must begin by examining how our own disconnection from natural living systems affects the children in our care. This disconnection isn't merely a personal matter—it represents a multi-generational unravelling of our relationship with the living world. We are inheritors of a genetic heritage developed over millions of years of evolution—a remarkably intelligent and organised information system that has been passed down with extraordinary fidelity until very recently.

The work of Dr. Weston A. Price, documented in “Nutrition and Physical Degeneration,” (1939) offers a sobering glimpse of how quickly this inheritance can be compromised. Price observed that by just the third generation after indigenous peoples adopted processed Western foods, they exhibited the same dental malformations and health issues common among industrialised populations. What took millions of years to develop can be significantly altered within mere decades.

Photo by Marc Najera on Unsplash

Today, several critical factors are accelerating the degradation of this genetic inheritance: an industrial food system designed for profit rather than nourishment; our increasing separation from nature and full-spectrum sunlight; excessive exposure to screens and artificial blue light; and the chemical soup in which modern humans now develop. These factors, which I explore more fully in my forthcoming book on Real Health, represent core areas where intentional changes must begin.

We should be clear-eyed about the challenge: the dramatic increase in gender dysphoria, alongside rises in childhood obesity, attention disorders, autoimmune conditions, and other modern ailments, cannot be reversed in a single generation. The path toward recovery will likely span generations, just as the decline has. However, we must start where we are.

Small steps matter—increasing children’s time in nature, reducing chemical exposures through whole foods and natural products, limiting screen time, and fostering embodied rather than digital social connections. These aren’t merely lifestyle choices but fundamental recalibrations of our relationship with the living world. By addressing these environmental influences, we may not only support healthier gender development but enhance overall wellbeing across all dimensions of human experience.

What I propose is not a rejection of compassion, but rather a more holistic compassion—one that honours individual experience while courageously investigating the environmental factors that may be reshaping human development at its most fundamental levels. Only by addressing these deeper patterns can we create a world where all beings can thrive in authentic relationship with themselves and the living matrix that sustains us all.

1. Current shares of Helm’s 5+ year old post are plentiful. Here’s the latest on Facebook.

2. Pew Research Center, "Americans' Complex Views on Gender Identity and Transgender Issues," 2022

3. Jones, J.M., "LGBT Identification in U.S. Ticks Up to 7.1%," Gallup, 2022

4. U.S. Census Household Pulse Survey, 2023

5. TIME Magazine. “Why More Americans Than Ever Identify as Transgender,” June 2023.

6. Statistics Canada. “The gender diversity of Canadians in 2021.”

7. BMJ. “Sharp rise in gender dysphoria referrals among youth,” 2025.

8. Cass Review. “Independent Review of Gender Identity Services for Children and Young People,” 2024.

9. Generation Tech Blog. “Gen Z and Gender Identity: What the Data Really Show,” 2023.

10. GIDMK. “Trends in Gender Identity and Reporting: A Review,” 2024.

11. Kidd et al., “Collapse of a Fish Population After Exposure to a Synthetic Estrogen,” Proceedings of the National Academy of Sciences, 2007

12. Papadimitriou, A. (2016). The Evolution of the Age at Menarche from Prehistorical to Modern Times. Journal of Pediatric and Adolescent Gynecology, 29(6), 527-530.

13. Reddit summary referencing historical data and PubMed sources. https://www.reddit.com/r/todayilearned/comments/17d7h5r/til_average_onset_of_menstruation_for_girls_in/

14. Her Half of History, “11.12 Coming of Age: A History of Puberty” (2024). https://herhalfofhistory.com/2024/01/04/11-12-coming-of-age-a-history-of-puberty/

15. Wikipedia, “Menarche.” https://en.wikipedia.org/wiki/Menarche

16. Biro, F. M., et al. (2010). Pubertal Assessment Method and Baseline Characteristics in a Mixed Longitudinal Study of Girls. Pediatrics, 126(3), e583-e590. https://doi.org/10.1542/peds.2009-3079

17. Kim, S. H., et al. (2015). A Significant Increase in the Incidence of Central Precocious Puberty among Korean Girls from 2004 to 2010. PLoS ONE, 10(11): e0141844. https://doi.org/10.1371/journal.pone.0141844

18. Ozen, S.,, Darcan, S. (2011). Effects of Environmental Endocrine Disruptors on Pubertal Development. Journal of Clinical Research in Pediatric Endocrinology, 3(1), 1–6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380228/

19. Roy, J. R., Chakraborty, S.,, Chakraborty, T. R. (2009). Estrogen-like endocrine disrupting chemicals affecting puberty in humans-a review. Medical Science Monitor, 15(6), RA137–RA145. https://www.medscimonit.com/abstract/index/idArt/869199

20. Environmental Working Group (EWG), 2024. “New study suggests environmental chemicals can trigger early puberty.” https://www.ewg.org/news-insights/news/2024/03/new-study-suggests-environmental-chemicals-can-trigger-early-puberty

21. Mao et al., “The Ramazzini Institute 13-week Pilot Study on Glyphosate and Roundup Administered at Human-equivalent Dose to Sprague Dawley Rats: Effects on the Microbiome,” Environmental Health, 2018

22. Ott, J.N., "Health and Light: The Effects of Natural and Artificial Light on Man and Other Living Things," 1973

23. Video reference:

24. Hutton et al., "Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children," JAMA Pediatrics, 2020

25. Valentine, S. E., & Shipherd, J. C. (2018). A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. LGBT Health, 5(3), 155-169.

This systematic review examined the relationship between social stressors and mental health outcomes among transgender and gender non-conforming (TGNC) people in the U.S. The authors found that, even after accounting for gender-affirming interventions, TGNC individuals continued to experience significantly higher rates of depression, anxiety, and psychological distress compared to the general population.

The review highlights that these elevated mental health burdens are closely linked to social stressors such as discrimination, stigma, and lack of social support, rather than being inherent to transgender identities themselves.

26. Bränström, R., & Pachankis, J. E. (2020). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. American Journal of Psychiatry, 177(8), 727–734.

This Swedish population-based study analyzed health records of 2,679 individuals with gender incongruence diagnoses and examined whether gender-affirming surgery and hormone treatment were associated with improved mental health outcomes. The original findings suggested that increased time since gender-affirming surgery was associated with reduced mental health treatment utilization (adjusted odds ratio=0.92, 95% CI=0.87–0.98). However, compared to the general population, transgender individuals continued to show much higher rates of mood and anxiety disorders, antidepressant and anxiolytic prescriptions, and hospitalisations after suicide attempts.

A subsequent correction and debate clarified that, after comparison with a control group of transgender individuals who had not undergone surgery, there was no statistically significant advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions. The study’s findings remain a subject of ongoing discussion regarding the long-term mental health outcomes of gender-affirming surgery.

27. Diedrichs, P. C., & colleagues (2015). “Body image in adolescents: prevalence and sociodemographic correlates.”

28. Body Perceptions and Psychological Well-Being - PubMed Central https://pmc.ncbi.nlm.nih.gov/articles/PMC11276240/

29. Griffiths, S., Murray, S. B., & Murray, K. (2025). Prevalence and correlates of muscle dysmorphia in a sample of boys and men in Canada and the United States. Journal of Eating Disorders, 13, Article 14. https://pmc.ncbi.nlm.nih.gov/articles/PMC11916914/

30. Griffiths, S., et al. (2023). Exploring risk factors of drive for muscularity and muscle dysmorphia among competitive bodybuilders in South Africa. Scientific Reports, 13, Article 46863. https://www.nature.com/articles/s41598-023-46863-w

31. Pope, H. G., Gruber, A. J., Choi, P., Olivardia, R., & Phillips, K. A. (2000). Muscle Dysmorphia in Male Weightlifters: A Case-Control Study. American Journal of Psychiatry, 157(8), 1291-1296. https://psychiatryonline.org/doi/full/10.1176/appi.ajp.157.8.1291

32. Butterfly Foundation. (2023). The Rise of Muscle Dysmorphia. https://butterfly.org.au/the-rise-of-muscle-dysmorphia/

33. Singh, D., Bradley, S. J., & Zucker, K. J. (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychiatry, 12, 632784.

This is a recent, large follow-up study of boys diagnosed with gender dysphoria. It found that about 88% desisted (no longer identified as transgender) by adulthood, and only 12% persisted.

34. Zucker, K. J. (2018). The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018). International Journal of Transgenderism, 19(2), 231–245. https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1468292

35. Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2022). Gender Identity 5 Years After Social Transition. Pediatrics, 150(2), e2021056082. https://publications.aap.org/pediatrics/article/150/2/e2021056082/188295/Gender-Identity-5-Years-After-Social-Transition

This is the recent Pediatrics study showing that among socially transitioned children, only about 2.5% retransitioned to their birth gender over five years, indicating much higher persistence.