Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia
Authors: Ken C. Pang, Nastasja M. de Graaf, Denise Chew, Monsurul Hoq, David R. Keith, Polly Carmichael, Thomas D. Steensma
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Specialist gender clinics worldwide have witnessed an increase in referrals of transgender and gender diverse (TGD) children and adolescents, but the underlying factors associated with this increase are unknown. <h3>Objective</h3> To determine whether increases in TGD young people presenting to specialist gender clinics are associated with related media coverage. <h3>Design, Setting, and Participants</h3> This cross-sectional study was conducted at 2 publicly funded, pediatric specialist gender services, one located in the UK and the other in Australia. Participants were all children and adolescents aged 0 to 18 years, referred between January 1, 2009, and December 31, 2016, to their respective gender services in the UK and Australia. Data analysis was performed in April 2019. <h3>Exposures</h3> Media coverage of TGD issues. <h3>Main Outcomes and Measures</h3> Referral rates from each gender service were compared with local TGD-related media coverage during the study period. <h3>Results</h3> Referral data for 5242 TGD young people were obtained (4684 in the UK, of whom 1847 [39.4%] were assigned male at birth and 2837 [60.6%] were assigned female at birth; 558 in Australia, of whom 250 [44.8%] were assigned male at birth and 308 [55.2%] were assigned female at birth), and a total of 2614 news items were identified (UK, 2194; Australia, 420). The annual number of TGD young people referred to both specialist gender clinics was positively correlated with the number of TGD-related local media stories appearing each year (Spearman<i>r</i> = 1.0;<i>P</i> &lt; .001). Moreover, weekly referral rates in both the UK for week 1 (β̂ = 0.16; 95% CI, 0.03-0.29;<i>P</i> = .01) and Australia for week 2 (β̂ = 0.12; 95% CI, 0.04-0.20;<i>P</i> = .003) showed evidence of association with the number of TGD-related media items appearing within the local media. There was no evidence of association between referrals and media items appearing 3 weeks beforehand. Media predominantly focused on TGD issues showed some association with increased referral rates. Specifically, TGD-focused stories showed evidence of association with referral numbers at week 1 (β̂ = 0.16; 95% CI, 0.04-0.28;<i>P</i> = .007) and week 2 (β̂ = 0.23; 95% CI, 0.11-0.35;<i>P</i> &lt; .001) in Australia and with referral numbers at week 1 (β̂ = 0.22; 95% CI, 0.01-0.44;<i>P</i> = .04) in the UK. No evidence of association was found between media peripherally related to TGD issues and referral rates. <h3>Conclusions and Relevance</h3> This study found evidence of an association between increasing media coverage of TGD-related topics and increasing numbers of young people presenting to gender clinics. It is possible that media coverage acts as a precipitant for young people to seek treatment at specialist gender services, which is consistent with clinical experiences in which TGD young people commonly identify the media as a helpful source of information and a trigger to seek assistance.