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Gender Identities and Gender Dysphoria in the Netherlands

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Several studies estimate the prevalence of gender dysphoria among adults by examining the number of individuals turning to health services. Since individuals might be hesitant to seek medical care related to gender dysphoria, these studies could underestimate the prevalence. The studies also lack information regarding the variance among different aspects of gender dysphoric conditions. Therefore, the current study estimated the prevalence by examining self-reported gender identity and dysphoria in a Dutch population sample (N = 8,064, aged 15–70 years old). Three measures assessed aspects of gender dysphoria: gender identity, dislike of the natal female/male body, and wish to obtain hormones/sex reassignment surgery. Results showed that 4.6 % of the natal men and 3.2 % of the natal women reported an ambivalent gender identity (equal identification with other sex as with sex assigned at birth) and 1.1 % of the natal men and 0.8 % of the natal women reported an incongruent gender identity (stronger identification with other sex as with sex assigned at birth). Lower percentages reported a dislike of their natal body and/or a wish for hormones/surgery. Combining these figures estimated the percentage of men reporting an ambivalent or incongruent gender identity combined with a dislike of their male body and a wish to obtain hormones/surgery at 0.6 %. For women, this was 0.2 %. These novel findings show that studies based on the number of individuals seeking medical care might underestimate the prevalence of gender dysphoria. Furthermore, the findings argue against a dichotomous approach to gender dysphoria.

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  1. For the current study, the prevalence of ambivalent and incongruent gender identities was examined. This was operationalized as individuals who psychologically experience themselves the sex assigned at birth to the same degree as they experience themselves the other sex (ambivalent) or more as the other sex than the sex assigned at birth (incongruent). However, one could, of course, also argue that individuals reporting neither experiencing oneself as a man or woman (scores 1,1; 2,2; 1,2; 2,1) should be classified as individuals without a gender identity. These data can be found in Table 2.


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We would like to acknowledge the funding for the research project by the Dutch Ministry of Health, Welfare, and Sports and the role played by Floor Bakker (previous lead investigator of the research team) in the design and logistics of the study in its early days. The prevalence figures related to gender identities and gender dysphoric feelings have previously been published in the Dutch journal Tijdschrift voor Seksuologie (Kuyper, 2012).

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Correspondence to Lisette Kuyper.

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Kuyper, L., Wijsen, C. Gender Identities and Gender Dysphoria in the Netherlands. Arch Sex Behav 43, 377–385 (2014).

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