Demographic and Clinical Features of Early-Onset versus Late-Onset Gender Dysphoria Among Adolescent and Young Adult Birth-Assigned Females

Abstract This study examined differences in demographic and clinical features between early- and late-onset gender dysphoria (GD) in a sample of 138 birth-assigned female adolescents and young adults (AYAs) aged 16–25 years. Participants were recruited through social media and word of mouth and completed an online survey. Onset type was determined using retrospective self-report on adapted DSM-5-TR criteria for childhood GD. Results showed most participants (79%) were classified as late-onset. Late-onset participants were significantly more likely to identify as non-binary, while the early-onset group more frequently endorsed binary identities (e.g., man/male). Early-onset participants reported significantly more childhood gender nonconformity, comorbid diagnoses, and more severe GD and anxiety. Participants classified as late-onset reported limited evidence of childhood gender nonconformity. These findings support the notion that GD is heterogeneous with regard to onset, severity, and comorbidity in AYA birth-assigned females. Further research is needed to investigate these divergent pathways and their clinical implications.