The recording of transgender identify in GP patient records has increased five-fold in the past two decades, a study has shown.
An analysis of electronic primary care records from 649 general practices between 2000 and 2018 found the steepest increase was in 16-to-29-year-olds.
Reporting in BMJ Medicine, researchers from University College London said despite a substantial relative rise, overall the number of patients with a code indicating a transgender identity was small at 0.03%.
They also found that rates of people identifying as transgender were more than twice as high in the most socially and economically deprived areas as they were in less deprived areas.
Reasons behind the link with deprivation were at this point unclear but could relate to patients in more affluent areas being more likely to see private care, they concluded.
It is the first such analysis to be done since 1998, they noted, despite a solid grasp of the numbers and ages of those identifying as transgender being essential for appropriate service design, resource allocation, and staff training.
Over the study period looked at, the overall number of people coded for the first time in their medical record as transgender was 2462.
But it did change over time with around one person in every 70,000 newly identified as transgender in 2000 but by 2018, this had risen to around one in every 13,000 people.
A lack of information in the records meant that researchers were only able to estimate the direction of transition for 54% of people. In all 923 had been assigned male gender at birth and 417 had been assigned female gender at birth, the researchers found.
By 2018, the proportion of people identifying as transgender, and coded as such in their medical records, had reached about one in 600 among 16-17-year-olds and one in 800 among 18-29-year-olds.
The researchers stressed that the coding they analysed would not capture the full range of gender identity or decisions made not to transition or to detransition, and contained terms that are now outdated or often misapplied, they said.
As the data only go up to 2018, recording rates of transgender identity in general practice may very well have changed since then, they added.
But the findings did match what had been seen in other studies from the US and the rise in referrals to gender identity clinics.
‘Increasing rates of transgender codes in records may represent increasing numbers of people presenting to primary care with gender related concerns,’ they said.
‘Reasons for such may include increased availability of information, support and resources and increased societal awareness and acceptance, all of which have partially destigmatised transgender identities and may make coming out as transgender easier for individuals.’
Given the substantial increase in relative terms, ‘resources must be allocated to primary and specialist care to meet the healthcare needs of these individuals’, they added.
And more research is needed to explain the fact that people in the most deprived areas were 59% more likely to have a recorded transgender identity than people in the least deprived areas, they concluded.
‘Transgender individuals in wealthier areas may be more able to afford specialist gender care privately, which can be accessed entirely independently of NHS primary care.
‘This trend may be increasing with longer NHS waiting lists. Therefore, individuals from a wealthier background might bypass NHS services entirely,’ they said.
