Gender-related Clinical Presentation of Non-Binary Children and Adolescents

Importance. The literature on paediatric gender-affirming care has paid little attention to non-binary young people’s clinical presentations, including their desires for gender-affirming interventions.Objective. To describe the gender-related presentation of non-binary children and adolescents first attending a paediatric gender clinic, exploring differences based on birth-registered sex and between young people with non-binary and binary identities.Design. In this cross-sectional study, young people and a parent/caregiver completed online questionnaires prior to their first appointment between Feb 2017-Dec 2023. Analyses were conducted in January 2025.Setting. Multidisciplinary gender clinic at a public children’s hospital in Victoria, Australia. Participants. Of those attending an initial appointment (n=2,303), those included in the analytic sample had available questionnaire data (n=2,138) and reported a gender identity that discorded with their birth-registered sex (n=1,745). Main Outcomes and Measures. Validated measures assessed gender dysphoria, body image, embodiment goals, gender-diverse behaviour, voice dysphoria and chest dysphoria. Gender identity was assessed on the Gender Slider, and social transition via reported changes to presentation, name and pronouns.Results. The ratio of non-binary to binary young people increased over time, from 1:6 in 2017 to 1:1.6 in 2023. The non-binary group exhibited high levels of body dissatisfaction (m=3.3; 95% CI=3.3,3.4) and gender dysphoria (m=42.0; 95% CI=41.2,42.8). They reported similar levels of gender dysphoria to binary young people (m diff=0.3; 95% CI=-2.3,2.9) and slightly less body dissatisfaction (m diff=-0.3; 95% CI=-0.4,-0.2). Among non-binary people, medical/surgical change to breasts was desired most frequently of all body characteristics (90.1%, n=263). Fewer non-binary than binary individuals reported desires to medically/surgically change their body characteristics [e.g. breasts (% diff=-7.5; 95% CI=-11.1,-3.9)]. Some differences were also observed between non-binary young people assigned female at birth and assigned male at birth [e.g., desire to change body hair (% diff=-39.1; 95% CI= -51.7,-26.5)]. Further between-group differences were observed regarding gender-diverse behaviour and social transition.Conclusions and Relevance. Non-binary children and adolescents accessing gender-affirming care experience significant gender dysphoria, body dissatisfaction and desires for medical/surgical affirmation. While it is important for clinicians to be aware of potential differences in clinical presentation based on gender identity, an individualized, person-centered approach remains priority.