Size and Distribution of Transgender and Gender Nonconforming Populations: A Narrative Review

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Key points

  • •
    Accurate estimates of the number and the proportion of transgender and gender nonconforming (TGNC) people in a population are necessary for developing data-based policy and for planning and funding of health care delivery and research.
  • •
    The literature addressing this topic spans five decades and presents data from 17 countries.
  • •
    On balance, the data indicate that people who self-identify as TGNC represent a sizable proportion of the general population with realistic estimates ranging from 0.1% to

Proportions of individuals receiving or referred for gender-affirmation therapy

Nine studies focused on individuals who received or requested gender-affirming treatment (Table 1). Of those, seven publications have estimated the proportions of TGNC people by considering only those who received or were referred for gender-affirming surgery.10, 11, 12, 13, 14, 15, 16 The numerators for most of these estimates were based on clinical case series or surveys of practitioners providing transgender care, whereas the denominators were typically approximated from demographic data for

Proportions of individuals who met the criteria for transgender and gender nonconforming–related diagnoses

Of the 18 publications listed in Table 2, 13 studies calculated the proportions of TGNC people using diagnostic codes for “transsexualism,” “gender dysphoria,” or “gender identity disorder”.19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 Methodologically, most studies that relied on TGNC diagnoses are similar to those that defined TGNC as having received gender-affirming therapy. Most used general demographic information to define the denominator and relied on clinical case series or survey

Proportions of adults with self-reported transgender and gender nonconforming identity

Nine studies listed in Table 3 used survey-based data to estimate the proportion of adults (persons older than age 18 years) who self-identified as TGNC.37, 38, 39, 40, 41, 42, 43, 44, 45 The use of self-report greatly increased the likelihood that an individual would meet the criteria for inclusion in the numerator. The resulting proportions were also orders of magnitude higher and thus could be expressed as percentages.
In the United States, several studies took advantage of the Behavioral

Proportions of children and adolescents with self-reported transgender and gender nonconforming identity

The literature on the proportion of TGNC youth (persons younger than 19 years of age) in the general population is sparse. Four recent studies examined this question by conducting surveys among school children (Table 4).46, 47, 48, 49
Almeida and colleagues46 used data from the 2006 survey of 9th to 12th grade students in Boston public schools. The survey participants were asked whether they considered themselves transgender (yes, no, do not know), although the precise definition of

Proportions of people requesting legal name or gender changes

Three studies calculated proportions of people who applied for or underwent administrative sex or name change. Two of these studies were conducted in Germany, and one used data from New Zealand.
Weitze and Osburg50 relied on the 1981 German Transsexuals’ Act, which allowed applicants to change their name or documented gender. Within 10 years following implementation of the law, the courts issued 683 decrees on first-name changes and 733 rulings on legal affirmation of gender identity. These

Evaluation of temporal changes

Virtually all studies evaluating secular trends reported dramatic increases in the numbers (and therefore the population proportions) of TGNC people in recent decades. These observations are confirmed independently regardless of the geographic area of interest, TGNC definition, or statistical methodology. For example, frequency of requests to undergo gender-affirming surgery or hormone therapy were reported to increase between 1960 and 2010 in Sweden,15 between 1975 and 1992 in the Netherlands,

Discussion

The current literature on the number and proportion of TGNC people is highly heterogeneous. Whereas in most studies focusing on individuals who seek or receive TGNC-related care at specialized institutions, the estimates of interest generally ranged between 1 and 30 per 100,000 individuals, self-reported TGNC identity was found to be orders of magnitude more frequent. The reported proportions of people self-identified as TGNC ranged from 100 to 2000 per 100,000 or 0.1% to 2% among adults. The

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