Referrals to a Spanish Gender Identity Unit Increase Tenfold Over Ten-Year Period

Referrals to a Spanish Gender Identity Unit Increase Tenfold Over Ten-Year Period

A person’s gender identity refers to their deeply held sense of self with regard to their gender. This gender identity can match the sex a person is assigned at birth (i.e., cisgender individuals) or it may be the “opposite” of the sex a person is assigned at birth (i.e., transgender individuals). Furthermore, some individuals have a gender identity that lies between or beyond the binary view of gender and may identify as nonbinary, genderqueer, gender fluid, gender expansive, or another identity.

Gender dysphoria is the distress that a person may feel when their gender identity does not match the sex they were assigned at birth. Such distress can lead to anxiety, depression, disruptions in day-to-day life, self-harm, or even suicidal ideation. Currently, gender-affirming hormone therapy, gender-affirming surgery, and psychological support such as counseling are treatment options for gender dysphoria and may be accessible to individuals via a gender identity unit.

Previous international data reports have shown an increase in referrals to gender identity units in countries around the world, particularly in the last several years. Researchers from the Dr Peset University Hospital in Valencia, Spain sought to explore the evolution of referrals to their gender identity unit between the years of 2012 to 2021, including the total number of referrals, the age of applicants at their first visit, the assigned sex ratio of patients, and the number of individuals who identified as nonbinary.

Between 2012 and 2021, a total of 913 people were referred to this gender identity unit. Referrals increased tenfold during this ten-year period, from 18 referrals in 2012 to 189 in 2021.

Regarding the individuals’ age at their first visit, 97 were younger than 12 years, 293 were between 12 to 17 years, 316 were between 18 to 25 years, 177 were between 25 to 45 years, and 30 were older than 45 years. The authors’ analysis revealed that the age of patients at their first visit decreased by 0.662 years per calendar year over the study period.

More people who were assigned female at birth (AFAB) than people who were assigned male at birth (AMAB) were referred to this gender identity unit. Over the ten-year period, 519 AFAB individuals and 394 AMAB individuals received a referral to the unit, creating a 1.32:1 AFAB:AMAB ratio.

Lastly, the researchers discovered that 21 nonbinary individuals were referred to the gender identity unit between 2017 and 2021. There were no records of nonbinary individuals seeking care at the unit before 2017.

These findings are in line with previous research on the trends in referrals to specialist gender identity units in other parts of the world. While there are significant increases in referrals of patients to these units, it does not mean that the number of people experiencing gender dysphoria is necessarily increasing. Instead, this increase could be due to the greater availability of information on health care resources for gender dysphoria, the reduced stigma around gender diversity, and the growing awareness of the issues that impact transgender and gender diverse individuals around the world.


  • Expósito-Campos, P., Gómez-Balaguer, M., Hurtado-Murillo, F., & Morillas-Ariño, C. (2023). Evolution and trends in referrals to a specialist gender identity unit in Spain over 10 years (2012-2021). The Journal of Sexual Medicine20(3), 377-387.

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