Reacción a "Reactions: average age of gender dysphoria diagnoses is falling"

The authors acknowledge in the limitations that the study may be confusing because they use two criteria, gender identity disorder (ICD-10; WHO; recently replaced by gender incongruence in ICD-11) and gender dysphoria (DSM-5; DSM5-TR). Eighty percent of the population they study is American, where DSM-5 is applied, but they use ICD-10 to embrace more countries. They could have adopted another strategy, focusing on the American population with DSM-5 and presenting the foreign data in supplementary material and conducting joint analyses of the two samples.  

The data are consistent with previous research over the last ten years, which shows two facts: that it is at puberty that gender dysphoria emerges most strongly and, secondly, that the ratio: assigned-boy-at-birth-who-is-conscious-of-being-girl/assigned-girl-at-birth-who-is-conscious-of-being-boy has changed in recent years in favour of girls who are consciously aware of being boys.    

Limitations relate to the use of diagnostic classifications and the use of terminology that is not interchangeable.  

The two graphs presented in the paper on the prevalence of gender dysphoria and how it is presenting earlier and earlier year by year are very illustrative. However, the authors provide an explanation of the data by vague social variables. The concept of gender identity is a complex issue that encompasses genetic, epigenetic, hormonal, brain and social variables. It is unlikely that social variables alone are the cause. It would be better to think of an interaction of all variables. It should also be remembered that transgender people, like cisgender people, are not immune to primary psychopathology.