German insurance data: diagnosis of gender dysphoria among young people proves highly unstable

A large-scale analysis of German health insurance data challenges the idea that a diagnosis of gender dysphoria in young people is generally a permanent condition. Researchers searched medical claims data from more than 14 million policyholders aged between 5 and 24, covering the period from 2013 through 2022, for diagnosis code F64 (gender identity disorder). The results, discussed by the Society for Evidence Based Gender Medicine (SEGM) based on a publication in the German medical journal Ärzteblatt, show that the diagnosis disappears again within a few years for the majority of young people.

Eightfold increase, but little long-term persistence

The number of F64 diagnoses among German children and young adults increased approximately eightfold over the decade studied. This increase was not evenly distributed: among adolescent girls, the diagnosis rose most sharply, increasing twelvefold since 2013 to a prevalence of 452.2 per 100,000 — approximately 1 in 221 girls. Among young adults aged 20 to 24, the prevalence was more evenly distributed: 306.4 per 100,000 among males compared with 301.5 per 100,000 among females.

The most striking figure, however, concerns not new diagnoses but what happens over time: of all young people who were ever given an F64 diagnosis, only 36.4 percent still had that diagnosis five years later. In other words, for nearly two-thirds of young people, the diagnosis was not stable in the short to medium term. A Dutch study on gender identity changing during adolescence is discussed at transgenderidentiteit.nl. Information on how care is organised in Germany can be found at gender care in Germany.

Major differences by age and sex

The extent to which the diagnosis persists varies considerably between groups. Among adolescent girls, diagnostic stability was lowest: only 27.3 percent still had the diagnosis five years later. Among young men aged 20 to 24, the percentage was highest at 49.7 percent — still less than half. The group that has grown most rapidly in recent years, namely adolescent girls, therefore also appears to be the group in which the diagnosis is least persistent.

The researchers also identify a notable shift between diagnosis codes: the sharp increase in F64 diagnoses coincides with a decline in diagnoses in category F66 (disorders of psychosexual development). This may indicate that some conditions previously classified differently are now being recorded under the heading of gender dysphoria — a shift in classification, not necessarily in the underlying problems.

Psychiatric comorbidity as a recurring theme

More than 70 percent of young people with an F64 diagnosis also had at least one other psychiatric diagnosis: 67 percent of boys and 76 percent of girls. The most common additional diagnoses were depression, anxiety disorders, borderline personality disorder, ADHD and post-traumatic stress disorder. Information on the relationship between ADHD and gender dysphoria can be found at genderautisme.nl. This high rate of comorbidity raises the question of whether gender dysphoria is a standalone condition for a significant proportion of these young people, or rather one manifestation of broader psychological vulnerability.

Why this matters for the policy debate

SEGM concludes from these figures that low diagnostic stability is difficult to reconcile with irreversible medical interventions based on that same diagnosis. If nearly two-thirds of young people no longer have the diagnosis within five years, caution regarding early medicalisation is not a matter of restraint for its own sake, but a direct consequence of what the data show. For readers in the Netherlands and Belgium, this type of research is relevant because the question of the stability of gender dysphoria in young people is also central here to the debate about puberty blockers and the age at which a medical pathway should begin.