Gender-related Clinical Presentation of Non-Binary Children and Adolescents
Abstract
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.
Related
- Ten years of a gender identity service for children and adolescents in Germany: demographic and clinical patterns
- Caregiver-Related Factors Associated with HIV Status Disclosure and Treatment-Related Indicators Among Children and Adolescents Receiving ART in Rural Eastern Cape, South Africa
- Sepsis-related hospitalisation risk in preterm-born and term-born children and adolescents: a nationwide registry study
- Epilepsy-Related Mortality Among Children and Adolescents
- Associations between behavioral intervention dose and outcomes in children and adolescents with obesity: meta-regression of randomized clinical trials
BibTeX
@misc{buckingham2026genderrelated,
title = {{Gender-related Clinical Presentation of Non-Binary Children and Adolescents}},
author = {Pip Buckingham and Denise Chew and Sam Hay and Tahlia de Ieso and Zeffie Poulakis and Michelle Tollit and Dr Kenneth Pang},
howpublished = {PsyArXiv},
year = {2026},
month = oct,
doi = {10.31234/osf.io/t48g2_v2},
url = {https://osf.io/preprints/psyarxiv/t48g2_v2/},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - Gender-related Clinical Presentation of Non-Binary Children and Adolescents
AU - Pip Buckingham
AU - Denise Chew
AU - Sam Hay
AU - Tahlia de Ieso
AU - Zeffie Poulakis
AU - Michelle Tollit
AU - Dr Kenneth Pang
PY - 2026
DA - 2026/10/20
PB - PsyArXiv
DO - 10.31234/osf.io/t48g2_v2
UR - https://osf.io/preprints/psyarxiv/t48g2_v2/
AB - 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.
ER -