Child and adolescent referrals to transgender healthcare centers in the Netherlands and Australia

Introduction: The number of referrals to child and adolescent specialist gender services has become a topic of significant public interest and debate. The current study aims to provide a thorough understanding of recent referral rates and potential patterns in child and adolescent gender clinic referrals by reporting recent referral rates to two large pediatric transgender healthcare centers in the Netherlands and Australia. Methods: The study was conducted at the Center of Expertise on Gender Dysphoria (CEGD) in the Netherlands and the Royal Children’s Hospital Gender Service in Victoria (RCHGS), Australia. Data on all consecutive new referrals ≤ 17 years between January 1^st 2016 and December 31^st 2024 were retrieved from the electronic health records used in the two gender clinics in the Netherlands and Australia. Referral numbers were then normalized to the total population of young people ≤ 17 years in each jurisdiction to facilitate cross-center comparison. Results: From 2016-2024 the CEGD received a total of 5,562 referrals, which corresponded to 2.18 referrals per 10,000 Dutch inhabitants ≤ 17 years. At the same time, the RCHGS received a total of 3,653 child and adolescent referrals, which corresponded to 3.46 referrals per 10,000 inhabitants of Victoria ≤ 17 years. Looking at the annual referrals over this period, there was a transient increase in 2021-2, which overlapped with the COVID pandemic; outside these two years, a plateau was observed, with referrals rising only marginally from 2016 (CEGD and RCHGS 1.66 and 1.95 referrals per 10,000 people ≤ 17 years, respectively) to 2024 (CEGD and RCHGS 1.83 and 2.32 referrals per 10,000 people ≤ 17 years, respectively). Discussion: This study showed that, contrary to popular belief, a plateau in child and adolescent referral numbers has occurred in both the Netherlands and Australia despite a transient increase during the COVID-19 pandemic.