Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 9;11(1):16168.
doi: 10.1038/s41598-021-95421-9.

Validity of the Gender Dysphoria diagnosis and incidence trends in Sweden: a nationwide register study

Malin Indremo  1 , Richard White  2 , Thomas Frisell  3 , Sven Cnattingius  3 , Alkistis Skalkidou  4 , Johan Isaksson  5 , Fotios C Papadopoulos  5
Affiliations

Validity of the Gender Dysphoria diagnosis and incidence trends in Sweden: a nationwide register study

Malin Indremo et al. Sci Rep. .

Abstract

The aim of this study was to examine the validity of the Gender Dysphoria (GD) diagnoses in the Swedish National Patient Register (NPR), to discuss different register-based definitions of GD and to investigate incidence trends. We collected data on all individuals with registered GD diagnoses between 2001 and 2016 as well as data on the coverage in the NPR. We regarded gender confirming medical intervention (GCMI) as one proxy for a clinically valid diagnosis and calculated the positive predictive value (PPV) for receiving GCMI for increasing number of registered GD diagnoses. We assessed crude and coverage-adjusted time trends of GD during 2004-2015 with a Poisson regression, using assigned sex and age as interaction terms. The PPV for receiving GCMI was 68% for ≥ 1 and 79% for ≥ 4 GD-diagnoses. The incidence of GD was on average 35% higher with the definition of ≥ 1 compared to the definition of ≥ 4 diagnoses. The incidence of GD, defined as ≥ 4 diagnoses increased significantly during the study period and mostly in the age categories 10-17 and 18-30 years, even after adjusting for register coverage. We concluded that the validity of a single ICD code denoting clinical GD in the Swedish NPR can be questioned. For future research, we propose to carefully weight the advantages and disadvantages of different register-based definitions according to the individual study's needs, the time periods involved and the age-groups under study.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Gender confirming medical intervention (GCMI) by occurrence of F64 diagnoses in the NPR, 2006–2014. The upper graphs depict the occurrence of GCMI by exactly one, two etc. F64 diagnoses; the lower graphs depict the occurrence GCMI by at least one, two etc. F64 diagnoses.
Figure 2
Figure 2
Crude (A) and coverage-adjusted (B) incidence rates of GD in Sweden 2004–2015 defined by ≥ 1 diagnosis, ≥ 4 diagnoses, ≥ 1 diagnosis with GCMI, stratified by birth assigned sex, along with legal sex rates and coverage in the NPR.
Figure 3
Figure 3
Crude (A) and coverage-adjusted (B) incidence rates of GD in Sweden 2004–2015, defined by ≥ 1 diagnosis, ≥ 4 diagnoses and ≥ 1 diagnosis with GCMI, stratified by birth-assigned sex and age.
Figure 4
Figure 4
Crude (A) and coverage-adjusted (B) incidence rates of GD, defined by ≥ 4 diagnoses, in Sweden 2004–2015, stratified by birth assigned sex and age.
See this image and copyright information in PMC

References

    1. Arcelus J, et al. Systematic review and meta-analysis of prevalence studies in transsexualism. Eur. Psychiatry. 2015;30:807–815. doi: 10.1016/j.eurpsy.2015.04.005. - DOI - PubMed
    1. de Graaf NM, Carmichael P, Steensma TD, Zucker KJ. Evidence for a change in the sex ratio of children referred for gender dysphoria: Data from the gender identity development service in London (2000–2017) J. Sex Med. 2018;15:1381–1383. doi: 10.1016/j.jsxm.2018.08.002. - DOI - PubMed
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorder. 5. American Psychiatric Association; 2013.
    1. World Health Organization. International classification of diseases for mortality and morbidity statistics (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en (2018).
    1. Reed GM, et al. Disorders related to sexuality and gender identity in the ICD-11: Revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations. World Psychiatry. 2016;15:205–221. doi: 10.1002/wps.20354. - DOI - PMC - PubMed

Publication types