Transsexuals Are Transitioning Younger – Right?

Not so fast. The story is more complicated than that.

I distinctly recall conversations in the mid-1970s from transwomen at the Stanford Gender Dysphoria Clinic that they universally wished that they had transitioned young as a teenager like I did, often expressed with both admiration and envy. Most of them were over thirty years old, while a very small number had transitioned in their mid-20s. As a corollary to these wistful sighs, was the common prediction that now that it was legally and medically possible, due to clinics like Stanford’s, that all transsexuals would be transitioning young.

It didn’t happen.

Now, in the mid-2020s, I’m hearing that very same prediction, that soon all transsexuals would be transitioning young.

It won’t happen.

It won’t happen for the simple reason that “late onset” gender dysphoria is progressive. It takes time to proceed from secretive cross-dressing in private to reaching the crisis point where it becomes necessary to transition.  The majority of non-exclusively-androphilic males who become gender dysphoric and come to identify as women report autogynephilia in adolescence which seems to mellow even as their need to cross-dress and their gender dysphoria increases, reaching a threshold, a crisis point, most commonly in their mid-30’s.  As Prince (herself an autogynephile) and Doctor documented, “Among our subjects, 79% did not appear in public cross dressed prior to age 20; at that time, most of the subjects had already had several years of experience with cross dressing. The average number of years of practice with cross dressing prior to owning a full feminine outfit was 15. The average number of years of practice with cross dressing prior to adoption of a feminine name was 21. Again, we have factual evidence indicative of the considerable time required for the development of the cross-gender identity.”

We can see the two type taxonomy and age of transition in more recent studies as a bimodal distribution of both age of onset of severe gender dysphoria and of seeking SRS.

Then, there is the curious real world data from Sweden in which the age of transition from 1972 to 2002 changed. According to the prediction I heard in the 1970s, the age should have gone down. But instead,

“The results showed that the incidence of transsexualism was not stable during the study period of three decades. The sex ratio changed from almost 1:1 in the late 1960s to almost 2:1 in favor of male-to-female (MF) transsexuals in the 1990s. The number of SRSs performed rose considerably after the mid-1980s. On average, MF transsexuals are now 6 years older than female-to-male (FM) transsexuals when they apply for SRS, and MF transsexuals are currently about 8 years older at the time of application than they were 20 years ago.”

The age went up!

How do we explain this? It’s actually rather simple. It is not that the age of transition of members of each of the two taxons, HSTS and AGP (“early” & “late” onset respectively) went up, it is that the number of late onset individuals seeking transition services went up, both absolutely and as a percentage, pulled the average up.

But when looking at more recent data from a clinic in the United States,

“Through June 2017, a total of 421 transgender individuals were seen who initiated hormonal therapy after 1990. Over the past 25 years, there has been a significant increase in the number of individuals seen. The mean age at initiation has remained higher in MTF than in FTM but has decreased steadily in both groups with the overall average dropping <30 years since 2015 (27.5±10.6). Since 1990, there has been a steady increase in the percentage of FTM such that it is now equivalent to MTF.”

This number 27.5±10.6 includes both MTF and FTM and the percentage of FTMs has increased, which since they seek medical transition services at a younger age, have pulled the average age down faster than the MTF age alone.

So, it appears that in the late 1960s, “early onset” / homosexual transsexuals, of both sexes, were holding down the age of transition. This makes sense when one reviews the attitudes of the clinics against non-homosexual transsexuals during the ’60s & ’70s. This changed in the late ’70s, early 80s due largely to Dr. Fisk introducing the term “gender dysphoria”. Then the number of “late onset” / non-homosexual transsexuals went up, while the number of early onset MTFs remained stable, pulling the average age up for a while. Since the 1990s, it seems like the number of non-homosexual FTMs went up, pulling down the average age once again.

Further Reading:

Essay on attitudes of clinicians in the 1960s and ’70s.

References:

Zavlin, D. et Al., “Age-Related Differences for Male-to-Female Transgender Patients Undergoing Gender-Affirming Surgery”, Journal of Pediatric Surgery (2019)
https://doi.org/10.1016/j.esxm.2018.11.005

Olsson, SE., Möller, A.R. On the Incidence and Sex Ratio of Transsexualism in Sweden, 1972–2002. Arch Sex Behav 32, 381–386 (2003). https://doi.org/10.1023/A:1024051201160

Leinung, M. et al., “Changing Demographics in Transgender Individuals Seeking Hormonal Therapy: Are Trans Women More Common Than Trans Men?” https://doi.org/10.1089/trgh.2019.0070