Most Young Females With Gender Dysphoria Report No Childhood Symptoms, Study Finds

A new study of adolescent and young adult birth-assigned females experiencing gender dysphoria has found that nearly four in five participants did not report meeting diagnostic criteria for the condition in childhood, adding fresh empirical weight to one of the most contested debates in contemporary clinical psychology. The research, published in the journal Archives of Sexual Behavior, surveyed 138 females aged 16 to 25 and compared those with early-onset gender dysphoria—symptoms dating back to childhood—against those with a late-onset pattern in which distress emerged around puberty or later. The findings point to a strikingly heterogeneous population whose clinical profiles diverge in ways the authors say could reshape how clinicians assess and support young people presenting with gender-related distress.

Gender dysphoria refers to the psychological distress that arises when a person’s gender identity does not align with their sex observed at birth. For decades, the clinical literature described two broad developmental pathways. The early-onset pathway typically begins in early childhood, is marked by pervasive gender-nonconforming behavior, and is strongly associated with same-sex attraction upon sexual maturity. The late-onset pathway, documented extensively in males, emerges during or after puberty and is historically associated with an absence of childhood gender nonconformity and with attraction to the opposite sex. What has changed dramatically over the past fifteen years is the demographic composition of gender clinics: referrals are now dominated by adolescent females, many of whom report no childhood history of gender-nonconforming behavior and many of whom carry significant comorbid psychiatric diagnoses.

The research team, led by Hollie Hammond of Western Sydney University together with colleagues including James S. Morandini, recruited participants through social media platforms such as Facebook and Reddit, as well as word of mouth, rather than through gender clinics. This non-clinical sampling strategy was a deliberate methodological choice. Most previous evidence on the subject came either from clinic-referred samples or from parent-report studies, the latter of which have drawn sustained criticism for relying exclusively on parental accounts and for allegedly conflating transgender identity with a psychiatric diagnosis. By surveying young people directly, the researchers aimed to capture the experiences of a population that rarely appears in clinical datasets. Participants completed an anonymous online survey lasting an average of 37 minutes, and the team applied quality controls including bot detection, minimum completion times, and manual review of responses.

To classify onset type, participants answered eight symptom items adapted from the DSM-5-TR diagnostic criteria for childhood gender dysphoria, recalling their experiences between the ages of 3 and 11. Those who reported meeting at least six symptoms for a minimum of six months—the DSM-5-TR childhood diagnostic threshold—were placed in the early-onset group; those below the threshold were classified as late-onset. The results were lopsided: 29 participants (21 percent) fell into the early-onset category while 109 (79 percent) were late-onset. The late-onset group reported an average of fewer than two childhood symptoms, with the lowest endorsement on internal items such as dislike of one’s sexual anatomy and desire for the physical attributes of the other sex. The early-onset group, by contrast, most often recalled preferences related to clothing and cross-sex roles in make-believe play.

The statistical contrasts between the groups were substantial. Early-onset participants reported significantly more childhood symptoms, with an effect size of Cohen’s d = 3.05—one of the largest reported in this literature. They also adopted a non-cisgender identity earlier, at an average age of 12.68 years compared with 15.01 years for the late-onset group, and came out to others roughly two years sooner. Yet even the early-onset group diverged from classic clinical cohort studies, in which children typically presented to clinics around age six and socially transitioned by age eight. The authors suggest their early-onset subgroup may better be described as a pseudo-early-onset, or late childhood and early adolescent onset, pathway—one that does not replicate the developmental signature of the historical cohorts on which much of the evidence base for early gender-affirming care was built.

Gender identity itself differentiated the groups. Late-onset participants were significantly more likely to identify as non-binary, whereas early-onset participants more frequently endorsed binary identities such as man or male. The authors report that this association between onset type and gender identity has not been documented before, and they flag it as clinically significant given emerging evidence that non-binary identity is associated with poorer mental health outcomes in some meta-analyses and with higher odds of discontinuing gender-affirming medical treatment in others. Transmasculine was the most commonly endorsed identity in both groups, chosen by more than half of participants in each.

Sexual orientation told a different story from the male-dominated literature. Using an adapted Kinsey scale, over half of participants in both groups—51.7 percent of the early-onset and 57.8 percent of the late-onset—reported at least partial same-sex attraction, and only about a fifth to a quarter described themselves as exclusively attracted to males. This represents a dramatic overrepresentation of same-sex attraction relative to general population estimates, in which roughly nine in ten women are heterosexual. Notably, however, orientation did not differ between onset groups, challenging the traditional male-pattern association in which the early-onset pathway is linked to homosexuality and the late-onset pathway to heterosexuality. The authors suggest that typologies developed for males with gender dysphoria may simply not transfer to females.

The clinical picture also split along onset lines. Early-onset participants reported roughly twice as many diagnosed comorbid psychiatric conditions as their late-onset counterparts, with significantly higher rates of attention-deficit/hyperactivity disorder, generalized anxiety disorder, and panic disorder. They also scored significantly higher on measures of dysphoria severity and anxiety, though the two groups did not differ on depression, stress, or well-being—both scoring in the moderate to extremely severe range across distress measures. The late-onset group was far from symptom-free: 56.9 percent reported at least one comorbid diagnosis, a figure that overlaps with the 62.5 percent reported in the controversial 2018 parent-report study by Lisa Littman that first proposed the rapid-onset gender dysphoria hypothesis. The authors note that this self-reported overlap offers some indirect support for aspects of that hypothesis, while stopping short of endorsing it, given that their data cannot establish whether distress preceded dysphoria or followed it.

Peer relationships offered a notable null finding. Participants reported having approximately two to three transgender or gender-diverse friends before realizing their own dysphoria, with no significant differences between onset groups in the number of friends, online friends, or in-person friends. If the late-onset group were primarily composed of the hypothesized sociogenic cohort driven by peer influence, the authors reason, one would expect them to report more transgender friends prior to onset than the early-onset group. That pattern did not emerge, though the authors caution that the sociogenic hypothesis remains deeply contested and that cross-sectional data cannot resolve questions of causality or directionality.

The study’s limitations are considerable and the authors are candid about them. The sample was a small, uneven convenience sample reliant on retrospective self-report, vulnerable to recall bias—particularly given evidence that distressed and neurotic individuals tend to overestimate negative childhood affect, which could inflate early-onset classification among the most distressed participants. A longitudinal design tracking children from early development into adulthood, ideally with corroboration from parents, teachers, or clinicians, would be needed to firmly establish the temporal relationships the present data can only suggest. Still, the authors argue the findings carry practical implications: clinicians should take careful histories of symptom onset, since onset type may signal different comorbidity profiles, different dysphoria severity, and even different identity trajectories. Most adolescent females experiencing gender dysphoria, the study concludes, report little childhood gender nonconformity, and the assumption that historical clinical patterns observed mostly in males apply to today’s predominantly female adolescent population is one that future research can no longer afford to make.

Subject of Research: Early- versus late-onset gender dysphoria in adolescent and young adult birth-assigned females

Article Title: Demographic and Clinical Features of Early-Onset versus Late-Onset Gender Dysphoria Among Adolescent and Young Adult Birth-Assigned Females

Article References: Hammond, H., Walter, E., Daly, M., Morandini, J. S., & Smith, E. (2026). Demographic and Clinical Features of Early-Onset versus Late-Onset Gender Dysphoria Among Adolescent and Young Adult Birth-Assigned Females. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03571-6

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03571-6

Keywords: gender dysphoria, adolescents, late-onset, early-onset, non-binary, transgender, mental health, DSM-5-TR, sexual orientation, comorbidity, Archives of Sexual Behavior, birth-assigned females