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The of patients presenting for care at gender clinics is increasing, yet the proportion of adults in the general population who want gender-affirming medical treatment remains essentially unknown. We measured the wish for cross-sex hormones or gender-affirming surgery, as well as other aspects of gender incongruence, among the general adult population of Stockholm County, Sweden. A population-representative sample of 50, Stockholm County residents ages 22 and older comprise the Stockholm Public Health Cohort. They were enrolled in, and and followed-up in roughly 4-year intervals, with questions on health, lifestyle and social characteristics.

For each item, any of the three affirmative answer choices were considered as some level of agreement. The desire for cross-sex hormones or surgery was reported by 0. Feeling like someone of a different sex was reported by 2. Wanting to live as or be treated as a person of another sex was reported by 2.

These findings greatly exceed estimates of the of patients receiving gender-affirming medical care. Clinicians must be prepared to recognize and care for patients experiencing discomfort due to gender incongruence and those who would like gender-affirming medical treatment. This is Adult wants sex Geneva Alabama open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The board may be contacted at the following e-mail address: sphc. Interested researchers would be able to access these data in the same manner as the authors. The authors did not have any special access privileges that others would not have. The data linkages and staff costs have also been supported by grants from the Stockholm County Council GrantSwedish Council for Working Life and Social Research Grant —Swedish Research Council Grantand Swedish Regional agreement on medical training and clinical research.

The study sponsors had no role in the de and conduct of the study; the analysis or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Competing interests: The authors have declared that no competing interests exist. Some people Adult wants sex Geneva Alabama distress due to gender incongruence. Individuals with gender dysphoria often express a need to alter the sex characteristics of the body.

Some may seek gender-affirming medical care, including cross-hormone treatment and gender-affirmation surgery, in order to ease bodily dysphoria. Other options, such as socially transitioning to another gender, also play an important role in helping alleviate gender dysphoria for many. There exist few estimates of the of individuals in the population affected by gender dysphoria. Often, these estimates have been extrapolated from the s of patients who have been diagnosed clinically, or the who are undergoing gender care or treatment in a specialist clinic.

Two recent meta-analyses estimate the global prevalence of diagnosed gender dysphoria at 4. The meta-analytical rate of gender-affirmation surgeries is estimated at 5. Relying on solely clinical cases, though, underestimates the of affected individuals[ 5 ], as many who desire gender-affirming medical treatment cannot, or do not, access this care.

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Around the world, recent years have seen increasing s of patients presenting for care at gender clinics[ 367 ], and receiving transsexualism diagnoses. Accessed August 3, Individuals may continue to increasingly come forward seeking gender-affirming medical interventions. Estimation of the of adults in the general population who want gender-affirming medical care is essential, so that health care systems and providers can be prepared.

To date, there is no direct estimation of how many adults in a general population want gender-affirming medical treatment.

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In one Dutch sexual health study, where participants were recruited from an internet panel, 1. However, weaknesses of that study include a response rate of In the present study, among a large and well-characterized probability sample of the general population, we directly asked all study participants if they would like cross-sex hormones or gender-affirming surgery.

We also surveyed for other aspects of gender incongruence among the random sample of 50, adults, ages 22 and older, across Stockholm County, Sweden. The Stockholm Public Health Cohort SPHC [ 10 ] is a population-based longitudinal cohort study with respondent recruitment occurring in successive waves, and follow-up surveys taking place in roughly 4-year intervals, For each wave, an area-stratified random sample of approximately 50, adults aged 18—84 years, or 18 years and older was invited to complete self-administered health questionnaires.

The public health surveys included assessments of physical and mental health, lifestyle and socioeconomic characteristics. Data were collected using postal or web-based questionnaires in Swedish, English, Arabic and Polish, languages commonly spoken around Stockholm.

The follow-up questionnaire also contained three items on gender incongruence. At the time of the follow-up survey, study participants were age 22 and above. Participants provided written informed consent and gave permission for record linkages to registries. There are some individuals with gender dysphoria who identify as an alternative gender[ 1 ], transcending a binary male or female classification[ 1314 ].

Finally, the measures were agreed upon for inclusion in the Stockholm Public Health Survey based Adult wants sex Geneva Alabama the statement of an expert panel from the Stockholm Gender Team, Karolinska University Hospital. Similar measures have been used ly in population-based surveys[ 815 — 17 ]. The Longitudinal Integration Database for Health Insurance and Labor Market Studies LISA [ 18 ] provided the data on educational attainment 9 years or less, secondary school, and university or post-secondaryand civil status as ever married including same- and opposite-sex marriages, widows and separated or divorced or never married.

The prevalence of adults wanting gender-affirming medical care or agreeing with the other aspects of gender incongruence are reported using survey-weighted univariate statistics in percentages and confidence intervals as measures of precision. Calibration weights were used to correct for the stratified random sample de as well as systematic non-response at baseline and follow-up[ 19 ].

Statistics Sweden provided the calibration weights based on available auxiliary variables from national registries, their association with selected survey variables, and association with probability of participating in the survey. The auxiliary variables included sex, age, country of birth, civil status, income, educational level, disability allowance and area of residence sampling strata. A detailed description of the weights development is available from Statistics Sweden[ 20 ].

All analyses were performed using SAS software version 9. Approximately 0. The wish for gender-affirming medical intervention was similar among males and females 0. About 2. A similar proportion of women and men agreed with this measure 2. There were 2.

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More females than males agreed with this item 3. Positive responses to this measure differed across age groups, with 6. Across all three items, prevalence increased with lower age for both registered males and registered females.

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Overall, 3. Of those who feel like someone of a different sex, about half agreed that they wished to live as or be treated as someone of a different sex. In other words, roughly 1 in 6 individuals experiencing either of these aspects of gender incongruence wished to pursue gender-affirming medical care. This is the first large-scale study measuring the wish for gender affirming medical care in a representative sample of the general population.

The proportion wanting hormones or surgery was similar among registered men and women. Other aspects of gender incongruence were more commonly reported: 2. There are few representative population-based studies of gender incongruence conducted ly, and our survey is the first that enabled a random sample of adults in the general population to directly report if they would like cross-sex hormones or surgery. As well, unique to our study, the items in our survey were deed using non-binary gender terminology, so as not to exclude any individuals who may not necessarily identify as a man or as a woman.

In the Netherlands, a survey of an internet-panel assessed rates of psychologically experiencing oneself as a man or a woman[ 8 ], opposite to the sex ased at birth. Participants who identified equally or stronger with the opposite sex than with the sex ased at birth were asked if they wanted hormones or surgery, ing 0. A total of 3. Our findings are similar to those in the Dutch study mentioned above[ 8 ], where 4. In a representative population-based study from Flanders, Belgium, using similar measures as the Dutch study, 2. In contrast, in a large-scale representative survey conducted across 19 US states, 0.

The proportion of adults in our population-based study who would like gender-affirming medical interventions vastly exceeds estimates drawn from clinical cases. The meta-analytic prevalence for receipt of gender affirmation treatments globally is estimated to be 5.

Nevertheless, the of individuals, particularly young, seeking care at gender clinics has increased sharply in Sweden and around the globe[ 3 ]. The reasons for these increases may include greater access to information about Adult wants sex Geneva Alabama identity-related problems, increased awareness among referring providers, improved access to quality gender care, or greater acceptance of gender variance.

As gender identity-related problems receive greater media attention, and society becomes more open, more individuals may seek gender-affirming medical treatment. Our findings indicate that far more persons than ly thought would like gender-affirming medical interventions, and health care systems and providers must be prepared to facilitate care for these individuals. Though it has ly been implied that physicians will not meet large s of transsexuals in practice[ 2324 ], our findings suggest the average general practice physician with a panel size greater than 1,[ 25 ] may indeed encounter a couple dozen patients with gender incongruence.

Critically, though, providers in many settings report they need more training to appropriately care for gender incongruent persons[ 26 — 28 ].

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The population-based survey de of the present study necessitates that some important considerations are kept in mind. Swedish society is reportedly tolerant toward gender variant individuals[ 29 ] and our may not be readily generalizable to countries with a low tolerance towards gender diversity[ 3 ] or where gender-affirming treatment is not available or accessible[ 30 ]. While confidentiality is ensured for survey participants, some may hesitate to report aspects of gender incongruence, which would result in an underestimation. Additionally, it is unknown if gender incongruence is more or less common among survey non-responders.

However, we used calibration weights to reduce the risk of such bias.

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Sexuality (and Lack Thereof) in Adolescence and Early Adulthood: A Review of the Literature