This cross-sectional online survey compared demographic and clinical features of early-onset (EO) versus late-onset (LO) gender dysphoria (GD) in 138 birth-assigned female adolescents and young adults (AYAs) aged 16–25, recruited via social media in 2024, using retrospective DSM-5-TR childhood GD criteria to classify onset type.
79% of participants were classified as LO (minimal childhood gender nonconformity, <2 childhood symptoms on average); EO participants had significantly more childhood symptoms (M=6.72 vs. M=1.79), more comorbid diagnoses (difference of ~1.5 diagnoses, d=0.64), higher GD severity (UGDS-GS: M=4.46 vs. 3.96, d=0.82), and higher anxiety on the DASS-21 (M=20.50 vs. 14.75, d=0.53); LO participants were significantly more likely to identify as non-binary.
Retrospective self-report of childhood symptoms is subject to recall bias, and high distress/neuroticism in the EO group may inflate recalled symptom severity. The convenience sample (n=138, uneven groups: 29 EO vs. 109 LO) was non-clinical, recruited via social media, limiting generalizability to clinical populations. Cross-sectional design prevents causal inference about whether GD or comorbid psychopathology came first.
Clinicians assessing adolescent females with GD should routinely document onset history, as late-onset presentations (the large majority in this sample) are linked to a non-binary identity and fewer comorbidities, while early-onset cases carry greater diagnostic burden and more severe dysphoria and anxiety. These two profiles may warrant different clinical pathways and levels of psychiatric support.
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