Understanding Transgender Identities: A Comprehensive Global Overview

This article was created with the help of ChatGPT’s deep research tool. Although insightful, sources should still be double-checked.

Binary transgender identities refer to individuals who identify strictly as the opposite gender from their sex assigned at birth – i.e., trans men (male gender identity, assigned female at birth) and trans women (female gender identity, assigned male at birth). This report provides an in-depth exploration of binary transgender identities across the world, covering their broad classifications, scientific insights into origins, treatment approaches (psychological and medical), and global prevalence. All data and studies are cited with their country or region of origin for context. The report is organized into four main sections as requested, with data tables summarizing key metrics on treatment outcomes and prevalence.

1. Broad Classifications of Binary Transgender Identities

Binary transgender people can be classified by various typologies that capture differences in age of onset, life history, and psychological patterns. Below we outline some broad types of binary transgender identity development noted in scientific literature, along with characteristic traits:

• Early-Onset vs. Late-Onset Gender Incongruence:
  Many trans individuals report experiencing gender incongruence (feeling one’s true gender differs from assigned sex) in early childhood. For example, a multi-country European study (ENIGI network across Netherlands, Belgium, Germany, Norway) found 66% of transgender participants had early-onset gender incongruence in childhood, versus 34% with late-onset after childhood. Early-onset trans people often recall cross-gender identification or dysphoria by age 5–7, whereas late-onset individuals may first experience dysphoria around or after puberty. In one U.S. survey, 87% of transgender people felt gender incongruence by age 15, but a minority (especially some trans women) only recognize or act on it in adolescence or adulthood.
• Childhood Gender Nonconformity vs. “Rapid” Adolescent Onset:
  The life history patterns can vary. Early-onset trans women typically present as feminine boys in childhood (e.g., preferring girls’ clothes, toys, playmates), and early-onset trans men as masculine girls (often “tomboys”). By contrast, some trans youth (notably assigned female at birth) show little childhood gender nonconformity but experience a sudden onset of gender dysphoria around puberty. This controversial pattern has been termed “rapid-onset gender dysphoria” (ROGD), based on parent reports in a 2018 U.S. study. However, a 2024 Austrian analysis found no solid evidence that social contagion causes new transgender identities; instead, puberty may simply be the point when some youths realize their transgender identity. Clinicians note that even in these adolescent-onset cases, co-occurring factors (like mental health issues or increased online transgender visibility during COVID-19) may play a role. Early vs. late/rapid onset subtypes are being studied, but experts caution against invalidating anyone’s identity based on age of onset alone.
• Sexual Orientation and Transgender Typologies:
  Among trans women, research (notably by sexologist Ray Blanchard in Canada) has distinguished two major typologies:
  1. Androphilic (Attracted to Men) – Often correlates with early-onset gender dysphoria. These individuals (sometimes termed “homosexual transsexuals” in older literature) are exclusively attracted to males, present very feminine in childhood, and usually transition earlier in life.
  2. Gynephilic (Attracted to Women) – Often correlates with later-onset transitions. Many in this group (pejoratively termed “autogynephilic” by Blanchard) initially live as men and may experience erotic arousal from the idea of themselves as female. They often transition in mid-life and were not strongly gender-nonconforming as children. Blanchard’s theory posits that differences in childhood behavior, fetishism history, and age of transition can stem from these categories. This typology remains controversial – critics argue it is unfalsifiable and not all gynephilic trans women report autogynephilia. Nonetheless, studies in Brazil and Spain have observed that trans women attracted to men tend to have more older brothers, akin to cisgender gay men (consistent with the fraternal birth-order effect). This supports a biological basis for androphilic trans women’s development via prenatal factors (the maternal immune hypothesis).
  For trans men, less formal typology exists in research. Many trans men (female-to-male) report early childhood dysphoria (assigning male roles to themselves in play, rejecting female puberty). Sexual orientation among trans men varies widely post-transition; surveys in the U.S. and Canada show trans men often identify as straight men (attracted to women) or queer/bisexual rather than exclusively gay. (In one U.S. survey of ~3,000 trans women, 60% were attracted to women and 55% to men – indicating overlap​en.wikipedia.org, whereas trans men’s attractions were not summarized similarly). Overall, the majority of binary trans people identify as LGB+ in sexual orientation after transition – e.g., a U.S. sample found 72% of trans men and 77% of trans women identified as lesbian, gay, bi, queer, etc., rather than straight.
• Primary vs. Secondary Transsexualism (Historical Terms):
  Earlier clinicians (e.g., in Germany and U.S. mid-20th century) sometimes labeled trans individuals with persistent, early cross-gender identification as “primary transsexuals,” and those who transitioned later after living in their birth gender role (sometimes with cross-dressing habits) as “secondary transsexuals.” These roughly correspond to early and late-onset categories above. While such labels are now antiquated, they underscore that age of awareness and life history create distinct experiences. A 2021 U.S. study by Zaliznyak et al. found trans people recognizing their gender by age ~6 on average (with dysphoria persisting ~20+ years before coming out), highlighting the long internal struggle in early-onset cases.
• Binary vs. Non-Binary (Identity Scope):
  Within transgender populations, an important distinction is between those with binary identities (trans men/women) versus non-binary identities (genderqueer, bigender, etc.). Many research studies historically excluded non-binary participants or analyzed them separately. Non-binary people have different average patterns (for instance, first feeling gender incongruence later, often post-puberty). Non-binary individuals are increasingly recognized (e.g., estimated 24–50% of gender-diverse populations in recent surveys are non-binary). In Brazil, a 2018 survey found non-binary identities more common than binary trans (1.2% vs 0.7% of adults). This report focuses on binary trans identities, but notes that the “binary vs. spectrum” classification is itself a broad way to categorize gender-diverse experiences.

In summary, binary transgender identities cannot be reduced to a single profile. Some trans people know their gender identity from toddler age, others come to it in adolescence or adulthood. Some trans women follow a life path of effeminate boyhood and attraction to men, others live as heterosexual men for years before transitioning. Trans men often have childhood dysphoria, though some may only transition after experiencing female puberty. These classifications provide context for understanding the diversity within trans men and trans women, but they are not rigid “types” – each individual’s journey is unique.

2. Origins of Binary Transgender Identity: Nature, Nurture, and Psychology

The origins of a person’s transgender identity have been the subject of extensive research in fields like psychology, psychiatry, neuroscience, and endocrinology. Modern consensus is that multiple factors – biological, environmental, and psychological – likely interact. Here we review key findings on possible causes or correlates of binary transgender identity, with global research perspectives:

• Biological Factors (Genetics and Brain Structure):
  Twin studies strongly suggest a genetic component to gender identity. For example, a 2013 international twin study (led by researchers in Hawaii, USA) found that about 33% of identical male twin pairs were concordant for transgender identity, versus only 2.6% of non-identical male twins. Among trans feminine (MtF) identical twins, 13 of 39 pairs (33%) both were trans, and for trans masculine (FtM) identical twins 8 of 35 (23%) both were trans. By contrast, almost no fraternal twin pairs both turned out trans if raised together. This indicates a significant genetic influence, since identical twins share more DNA. Another Belgian twin study by Heylens et al. reported a similar pattern with 39% concordance in identical twins vs 0% in fraternal twins for gender dysphoria. However, not all identical twin pairs are concordant (many have only one trans twin), implying genes are influential but not solely determinative – likely a complex heritability with multiple genes of small effect. Specific gene candidates remain elusive, but some linkage to genes in sex hormone pathways (steroidogenesis) has been noted. Brain structure studies also support a biological basis. Neuroanatomical research, largely in Spain and Netherlands, finds that certain brain regions in trans people resemble those of their identified gender. A review of brain scans (MRI) in 2016 noted trans women’s brains show “complex mixtures” of masculine and feminine features, distinct from cisgender males​pmc.ncbi.nlm.nih.gov. Trans men’s brains likewise have unique patterns of “defeminization” in some areas​pmc.ncbi.nlm.nih.gov. These brain differences exist before hormone treatment in studies focusing on trans women who are androphilic (attracted to men), suggesting an intrinsic neurodevelopmental factor​pmc.ncbi.nlm.nih.gov​pmc.ncbi.nlm.nih.gov. Such findings lend credence to the neurohormonal theory – i.e., atypical sex hormone exposure in the womb may lead to a brain that develops partially in line with the opposite sex. Indeed, prenatal hormonal environment is a leading hypothesis: for example, if an XY fetus has reduced androgen signaling in certain brain regions, a female gender identity could result despite male anatomy. Direct evidence in humans is hard to obtain, but analogies are drawn from conditions like CAH (congenital adrenal hyperplasia) in XX females (excess prenatal androgens can masculinize gender-related traits). Some studies have examined finger length ratios (2D:4D) as a proxy for prenatal hormones and found correlations with trans identities, though results are mixed. Another fascinating biological finding involves the fraternal birth order effect. Research in Canada, UK, and Brazil has confirmed that trans women who are androphilic (attracted to men) are significantly more likely to have older brothers, mirroring the classic pattern observed in gay men. Each older brother increases odds that a male-born person will be androphilic (whether cisgender gay or trans woman) – a well-documented phenomenon explained by the maternal immune hypothesis. Essentially, a mother’s immune system may produce antibodies after male pregnancies that influence brain development in subsequent sons, affecting gender identity or sexual orientation. A Brazilian study (2017) found trans women attracted to men had significantly more older brothers than control males. This biological pattern was not seen in trans women attracted to women. Thus, the innate factors leading to a transgender identity may overlap with those for sexual orientation, at least for those trans women who are effectively “female-identified gay men” from childhood. In contrast, it appears trans men’s birth order does not show a consistent pattern in studies – one Spanish study found no birth order difference for trans men, but data are limited.
• Environmental and Psychosocial Factors:
  No evidence exists that parenting styles, childhood trauma, or social upbringing cause someone to be transgender – gender identity is considered a deep-seated aspect of self. However, certain environmental factors are hypothesized to contribute. One is prenatal environment as mentioned (which straddles biology and environment – e.g., maternal stress or hormone levels during pregnancy might influence fetal brain gendering). There is also interest in whether early childhood social environment (like exposure to gender variance) affects transgender outcomes, but studies do not show, for instance, that having transgender friends or media alone can make someone genuinely trans. The idea of “social contagion” causing teens to declare trans identities (the ROGD theory) has not been backed by clinical evidence. On the contrary, the uptick in visible transgender youth in some Western countries likely reflects greater social acceptance allowing youths to come out, rather than environment creating gender dysphoria out of nowhere. A new 2024 study (Austria) explicitly analyzed ROGD and concluded that while some adolescents have a later onset of dysphoria, their identification could represent realizations triggered by puberty or stress, and these youths often have other co-occurring mental health issues that merit support. Cultural factors do shape how transgender identity is experienced and expressed. For example, in cultures with recognized third genders (such as Hijra in South Asia, Kathoey in Thailand, Mahu in Polynesia), an individual assigned male might live as a feminine third gender rather than a binary “woman,” even if in Western terms they might be considered trans women. These traditions indicate that social environment can influence the identity label or role a gender-diverse person adopts, though the innate gender variance remains. Additionally, stigma and lack of language can delay self-recognition: a Korean or Middle Eastern transgender person might only come to identify in middle-age due to repressive environments, whereas someone in Sweden might do so in childhood. The availability of role models and terminology (“transgender,” etc.) plays an environmental role in timing of coming out.
• Associated Psychological Conditions (Comorbidity):
  Transgender individuals have higher rates of certain neurodevelopmental and mental health conditions, suggesting possible shared etiologies or stress effects. A large 2020 study from Cambridge University, UK found autism spectrum disorder (ASD) is 3–6 times more prevalent among transgender and gender-diverse people than in cisgender people. A meta-analysis in 2022 estimated about 11% of transgender and gender-diverse individuals are autistic​pmc.ncbi.nlm.nih.gov – far above the ~1-2% baseline. Conversely, about 13% of autistic adults in one survey identified as transgender or non-cisgender. Researchers hypothesize that autism’s characteristic lessened concern for social norms might allow gender-variant individuals to recognize their identity despite societal expectations. Prenatal factors (like hormone exposures) might also underlie both autism and gender diversity in some cases. Clinically, this overlap means many trans youth also require support for autism or ADHD. Other common co-occurring issues include anxiety, depression, and trauma-related disorders – often as a result of dysphoria or minority stress rather than a cause. For instance, exposure to conversion therapy (attempts to forcefully change one’s gender identity) is strongly associated with psychological harm. A 2024 Stanford University (USA) study of 4,000 LGBTQIA+ adults found those subjected to gender identity conversion practices had much higher rates of depression, PTSD, and suicidal ideation. This underscores that an unaccepting environment (family rejection, discrimination) can worsen mental health in trans people, but does not “turn” someone trans in the first place. Some older theories suggested transgender identity might arise as a coping mechanism for other psychiatric conditions, but no evidence supports a primary mental illness cause. Gender dysphoria is not caused by disorders like schizophrenia or dissociative identity disorder, though these can co-occur at normal rates. One area of investigation is body-image and body-ownership differences in trans individuals. Neurostudies indicate that the brain’s body map in trans people might be more aligned with their identified gender (leading to dysphoria toward sex characteristics). This could intersect with conditions like body dysmorphia, but gender dysphoria is distinct in that aligning the body with identity (through transition) typically resolves the dysphoria.
• Nature and Nurture Interaction:
  In summary, the current understanding is that being transgender is rooted in biological factors (genes, prenatal development of the brain) – essentially, nature lays the groundwork. Environmental factors (social acceptance, information, cultural framing) then affect how and when an individual recognizes and expresses their gender identity, i.e., nurture influences the outcome. The presence of certain psychological traits (like autism or resilience to social cues) may make some individuals more likely to realize and assert a transgender identity despite societal pressures. All credible studies indicate that transgender identities are a naturally occurring variation of human development, not the result of pathology or parenting. As the American Psychological Association (APA) notes, being transgender is not a mental disorder in itself; gender dysphoria only refers to the distress from incongruence, which for many is relieved by transition and supportive environments.

3. Treatments Sought by Binary Transgender Individuals and Outcomes

Trans men and trans women may pursue a variety of treatments to alleviate gender dysphoria and to live comfortably as their identified gender. These treatments range from psychological support to medical interventions like hormones and surgeries. Here we survey the types of treatments across age groups, and summarize data on outcomes and satisfaction:

3.1 Behavioral and Psychotherapeutic Treatments

• Psychotherapy and Counseling:
  Many transgender people (youth and adults alike) seek therapy to explore their gender identity, cope with dysphoria, and navigate transition decisions. In progressive care models (such as WPATH Standards of Care, used broadly in North America, Europe, etc.), therapy is supportive and affirmative. Common approaches include:
  • Gender-affirming counseling: Helps individuals explore their gender feelings in a non-judgmental way and supports coming-out and social transition plans.Cognitive Behavioral Therapy (CBT): To manage anxiety or minority stress, build resilience, and address any internalized transphobia.Family therapy: Particularly for transgender youth, to educate and involve family members, reducing conflict and improving support at home.
  The goal of therapy is not to change the person’s gender identity (conversion therapy is widely discredited and harmful), but rather to help them through the transition process or decision-making. Therapy can also assist with comorbid issues (for example, treating depression, PTSD from discrimination, or autism-related social skills training). Global note: In some regions (e.g., parts of Asia or Africa where medical transition may be less accessible), transgender individuals rely heavily on peer support groups and counseling from community organizations as their primary “treatment” to cope with dysphoria.
• Social Transition and Real-Life Experience:
  A non-medical but critical step often recommended (especially historically in European clinics) is living in the identified gender role full-time – sometimes called Real-Life Experience (RLE) or social transition. This includes adopting a name and pronouns aligned with one’s gender, changing gender expression (clothing, hairstyle), and possibly legal gender marker changes. For youth, this might start as a part-time or trial social transition (e.g., using a nickname of the desired gender at a new school). Social transition is often an early “treatment” because it can greatly relieve dysphoric feelings without medical interventions. Many trans people report improved mental health once living as their true gender in daily life, even prior to any hormones or surgery. For instance, data from the 2022 U.S. Trans Survey (USTS) show an overwhelming majority of those who have transitioned (socially and/or medically) feel it improved their life satisfaction (94% reported being more satisfied after transitioning). Age considerations: For transgender children (pre-puberty), the main interventions are social (letting the child present as their affirmed gender) and therapeutic (to help with any distress). No medical treatments are done pre-puberty aside from treating any co-occurring issues. For adolescents, supportive therapy and possibly puberty blockers (see next section) are used to buy time and prevent trauma from unwanted pubertal changes.
• Voice and Communication Therapy:
  Another non-invasive treatment, particularly for trans women, is voice therapy with a speech-language pathologist. This helps modulate vocal pitch and speech mannerisms to be congruent with gender identity (e.g., raising pitch and using feminine speech patterns for trans women, deepening or resonance training for trans men if needed beyond hormone effects). Such therapy can reduce dysphoria around one’s voice and improve social comfort. Similarly, facial hair removal (electrolysis or laser) for trans women, or binding and padding techniques (chest binders for trans men, hip padding for trans women) are common non-medical steps that transgender individuals use as part of their transition journey. These could be considered “behavioral” or non-pharmacological interventions that significantly impact daily well-being.
• Outcomes of Psychotherapy:
  Quality psychotherapy and support correlate with better mental health outcomes. Studies consistently show that affirmative care (as opposed to denial of identity) is associated with lower rates of depression and suicidality. For example, a U.S. study of trans and nonbinary youth found those who received gender-affirming medical care had 60% lower odds of depression and 73% lower odds of suicidality over 12 months, compared to those who wanted care but did not receive it. While that study focused on medical interventions, the psychosocial support component is intertwined. Conversely, conversion therapy or rejection is linked with extremely poor outcomes: a recent Stanford study (2024) noted strong associations between having undergone conversion efforts and higher PTSD symptoms and suicide attempts in LGBTQ adults. Table 1 below summarizes mental health outcome differences:

Table 1. Mental Health Outcomes by Type of Psychosocial Experience (Select Findings)

<small>Note: These are associative outcomes; affirmative care is linked to improvements, whereas conversion efforts correlate with harms. Causality is supported by consensus of clinical experts and ethical guidelines against conversion practices.</small>

3.2 Medical Treatments: Hormone Therapy and Surgeries

Gender-affirming medical treatments are often pursued by binary transgender individuals to align their physical characteristics with their gender identity. The two main categories are hormone therapy and surgical interventions. Treatment sought can depend on age: for instance, adolescents may start with puberty blockers; adults may go straight to hormones or surgery if desired. We detail each and present outcome data:

• Puberty Blockers (Hormone Suppression in Youth):
  For transgender youth in early puberty (typically ages 10–16), doctors in many countries (e.g., USA, Canada, Netherlands, UK) use GnRH agonists to pause puberty. This treatment (sometimes called by the drug name “Lupron”) is fully reversible and gives the young person time to mature and confirm their gender identity without the distress of unwanted physical changes (such as breast development or voice deepening). Puberty blockers have been shown to lower rates of suicidal ideation in trans teens by preventing trauma associated with dysphoria. They also make future transitions smoother (less need for surgeries like mastectomy or facial surgeries if natal puberty is halted early). In a U.S. study, young adults who had access to puberty suppression in adolescence had significantly lower odds of lifetime suicidal thoughts than those who wanted it but could not get it. Outcome/Satisfaction: A 2023 survey of transgender youth (Trans Youth Project in the U.S. and Canada) looked at those who had puberty blockers and/or hormone therapy in their teens. Among 220 such youth (average age ~16, surveyed after several years), 98% were either satisfied or not regretful of their treatment decision. Only 9 individuals expressed any regret (some regret blockers but not hormones, or vice versa), and most of those still continued treatment. Overall, youth overwhelmingly felt positive about having pursued puberty suppression or hormones in adolescence. This counters fears that many trans youth later regret early treatment – current evidence suggests regret is rare when youth are properly assessed. Notably, some European countries (e.g., Sweden, Finland, UK) have recently tightened eligibility for youth hormonal care, citing need for more data, but others (like Spain, Germany) continue gender-affirming care as an established standard.
• Hormone Replacement Therapy (HRT):
  The cornerstone for adult trans treatment is HRT – estrogen (with anti-androgens) for trans women, and testosterone for trans men. Effects of HRT are profound on secondary sex characteristics:
  • Trans women (MtF): Estrogen leads to breast development, softer skin, fat redistribution to hips/breasts, reduced muscle mass, and slowed body hair growth. It also usually reduces libido and causes some shrinkage of testicular tissue.
  • Trans men (FtM): Testosterone induces a deeper voice, facial and body hair growth, increased muscle and body mass, clitoral enlargement, cessation of menses, and a more angular facial appearance.
  Many trans people consider HRT life-saving or life-changing. Dysphoria often significantly diminishes once physical changes begin aligning with identity. Psychological well-being improvements are well-documented. A 2015 comprehensive review of 100+ studies (Cornell University’s “What We Know” project) found strong evidence that hormone therapy improves gender dysphoria and overall quality of life in transgender adults. The USTS 2022 data showed 98% of trans respondents on HRT felt it made them more satisfied with life (84% “a lot more,” 14% “a little more”). Age groups: Adolescents typically start gender-affirming hormones around age 15–17 (often after a period on blockers). Adults can start at any age; even those in their 60s or 70s have initiated HRT with benefit. There is no upper age limit if medically cleared, although results (e.g., body feminization/masculinization) may be less dramatic with older age due to less physical plasticity. Satisfaction and Continuation: Adherence to HRT is high when access is unfettered. In a U.S. cohort study, after 5 years on HRT, the vast majority were still continuing therapy, and regret rates were extremely low. According to a systematic review (2021), regret after hormone therapy in youth was under 2%. Common reasons for stopping HRT, when it occurs, include health concerns or transitioning to non-binary identity (choosing to halt at an androgynous state), rather than wishing to detransition fully. It should be noted that detransition (stopping or reversing transition) does happen for a small minority. Studies suggest detransition often occurs due to external pressures (family, social stigma, or lack of support) rather than a change in internal gender identity. A recent survey of detransitioners (several countries, 2021) found the most common reasons were difficulty in life after transition (e.g., employment or family rejection), not that they realized they weren’t trans. Many detransition temporarily. Permanent detransition with regret of transition is estimated around 1% or less of those who transition medically, as discussed below with surgical regret data.
• Gender-Affirming Surgeries:
  These include a range of procedures, broadly categorized as “top surgery” (chest reconstruction), “bottom surgery” (genital reconstruction), and other feminization/masculinization surgeries (face, voice, body contouring). Not all trans people desire or have surgeries – it varies individually. Survey data indicate a significant number do pursue some form of surgery eventually, especially top surgery. For example, studies in Europe and U.S. found that among trans men, chest surgery (mastectomy) rates range  ~8–25%, and among trans women, genital surgery (vaginoplasty) rates ~4–13% in general trans populations. Those numbers have likely grown in recent years with better access. The USTS 2015 (U.S.) found about 25% of trans women had some form of surgical transition, and 55% of trans men had chest surgery (trans men often prioritize chest surgery). Common Surgeries:
  • For trans women: Orchiectomy (removal of testes, eliminates testosterone source), Vaginoplasty (creation of a vagina and vulva, typically by penile inversion or other graft techniques), Breast augmentation (if HRT doesn’t yield desired growth), Facial Feminization Surgery (FFS) such as jaw, brow, and nose reshaping, Tracheal shave (reducing Adam’s apple), and Voice surgery (shortening vocal cords).
  • For trans men: Double mastectomy with chest masculinization (top surgery), Hysterectomy (removal of uterus, often with ovaries), Phalloplasty (construction of a penis, usually using forearm or thigh tissue, often multi-stage), or Metoidioplasty (creating a smaller phallus from the testosterone-enlarged clitoris). Some trans men also get Scrotoplasty with testicular implants. Many trans men opt not to do full phalloplasty due to cost, complexity, and sometimes satisfactory results with just top surgery and hormones.
  Outcomes and Satisfaction: Surgical outcomes have high satisfaction in modern studies. A landmark 2010 meta-analysis (Murad et al.) found very high rates of subjective satisfaction and improved dysphoria post-surgery, concluding surgery is beneficial. More recent data reinforce this:
  • A 2021 systematic review and meta-analysis (covering studies from Europe, North America, East Asia) reported an extremely low prevalence of regret after gender-affirming surgery – about 1% on average. Specifically, regret among trans women (transfeminine surgeries) was ~1% and among trans men (transmasculine surgeries) <1%. This is notably lower than regret rates for many other elective surgeries (for instance, some cosmetic surgeries have higher dissatisfaction percentages). Table 2 provides some data points from that meta-analysis:

Table 2. Regret Rates After Gender-Affirming Surgeries (Meta-Analysis 2021)

<small>Note: Regret here was defined as patients who later sought reversal or expressed persistent regret. The extremely low rates reflect careful patient selection and advances in care. Older data from the 1980s-90s showed higher regret (~10-14%), but those included many who lost to follow-up; current refined surgical techniques and support result in far lower regret.</small>

In terms of satisfaction (which is not just absence of regret but actively being pleased with results), studies find the vast majority are satisfied:

• A Netherlands study on surgical outcomes found 98% of trans women were satisfied with vaginoplasty results, and around 96-100% of trans men were satisfied with their various surgeries (one series reported 94% satisfaction with chest surgery, 100% with phalloplasty, though phalloplasty often has higher complication rates).
• Another survey in Sweden found over 90% of trans people felt surgery improved their quality of life.
• Even among youth who had only just reached adulthood, a 2022 U.S. study (JAMA) of trans adolescents who underwent early gender-affirming surgeries (primarily chest surgery) showed overwhelmingly positive outcomes: they experienced significant relief of dysphoria and no regrets in follow-up.

Quality of Life (QoL): After surgery, studies report improvements not only in dysphoria but in overall QoL and mental health. However, some research (e.g., Lindqvist et al., Sweden 2017) notes that long-term (5-10 years post-op), trans women’s health-related quality of life can decline, potentially due to aging or issues like finding partners, etc.. Importantly, that study still found trans women’s QoL remained better than pre-transition on average. It suggests ongoing support post-surgery is important – transition is not a one-time fix for all life difficulties, though it markedly addresses the gender-related distress.

• Examples of Age-Differentiated Treatment Seeking:
  Adolescents: may start with blockers (~early teens), then HRT (~mid-teens), rarely surgeries before 18 except possibly chest surgery for trans boys in late teens. Parental consent and multi-disciplinary team evaluations are usually required. Outcome data shows high satisfaction and continuation of care as noted (in the Trans Youth Project, 98% continued care into young adulthood). Young Adults (18–30): often pursue HRT and, for trans men, top surgery in this age range. Many trans women also get facial or breast procedures in their 20s if possible. Fertility preservation (sperm banking or egg freezing) is a consideration discussed before hormones or gonadectomy at these ages. Older Adults: Some who come out later in life may skip certain steps – e.g., a trans woman at 50 might go on estrogen and orchiectomy but perhaps not bother with full vaginoplasty if not desired, or vice versa. Older trans individuals can still have successful medical transitions, though surgery risks are a bit higher with age. That said, even older transitioners report reduced gender dysphoria and high personal fulfillment after transitioning.

3.3 Treatment Outcome Data and Satisfaction Levels

To summarize the treatment outcomes, we provide Table 3 which consolidates some key metrics from recent studies on satisfaction and outcomes for different treatment paths. All data include the country or region of the study for context:

Table 3. Outcomes and Satisfaction by Treatment Type (Selected Studies)

From the above, it’s evident that gender-affirming treatments have high success and satisfaction rates across the board. Mental health outcomes generally improve when transgender individuals receive the care they seek. The data also show that regret and reversal are exceedingly uncommon, especially in supportive environments. It is worth noting regional differences: in countries where transgender healthcare is well-established (e.g., Netherlands, Belgium), long-term studies also show positive outcomes – one Dutch study found 88% of trans people reported significant improvement in psychological well-being after all stages of treatment. In contrast, in places where access to care is limited (many developing countries), trans individuals forced to turn to unsafe or unsupervised methods (black-market hormones or DIY surgeries) face worse outcomes, not due to their identity but due to suboptimal treatment conditions.

In conclusion for this section, binary transgender individuals seek a combination of therapeutic support, hormone therapy, and surgeries depending on their needs and life stage. When provided under competent care, these interventions show excellent outcomes: alleviation of gender dysphoria, high personal satisfaction, and improved overall quality of life. The primary challenges remain access and societal acceptance, rather than efficacy of the treatments themselves.

4. Global Prevalence of Binary Transgender Identities

Estimating the prevalence of trans men and trans women globally is challenging due to differences in survey methods, social acceptance, and definitions. However, multiple sources provide insight into how common binary transgender identities are in various regions. Here we compile prevalence data by country/region, noting whether figures include non-binary people or not (some surveys combine them under a broad transgender umbrella). Unless specified, the percentages below refer to the portion of the population identifying as transgender (binary or umbrella) in that region:

• Global Estimate: Most studies and expert assessments indicate that less than 1% of the worldwide population is transgender (binary), with some broader estimates including non-binary individuals up to about 1–2%. The often-cited range is 0.1% to 0.6% for binary trans people globally. However, a 2021 analysis by the UCLA Williams Institute and others suggests about 1% of adults worldwide might be transgender if given the opportunity to identify so (their figure includes non-binary). Cultural differences in willingness to report make global aggregation difficult.
• North America:
  • United States: A 2022 Pew Research Center survey found 1.6% of U.S. adults (approximately 4.1 million people) are transgender or non-binary, with a striking generational difference: about 5% of young adults (18–29) identify as trans or non-binary. Earlier estimates from the Williams Institute (2021) put the figure around 0.5–0.6% of adults specifically transgender, and 1.4% of youth 13-17. The trend has been a visible increase in youth openly identifying. By raw numbers, it’s estimated there are about 1.6 million transgender people (age 13+) in the U.S. as of 2022.
  • Canada: The 2021 Canadian census was the first in the world to explicitly count transgender and non-binary populations. It found 0.33% of Canadians (age ≥15) are transgender or non-binary​www150.statcan.gc.ca​comoxvalleyrecord.com. This breaks down to 0.19% transgender (binary) and 0.14% non-binary. In raw numbers, 59,460 Canadians identified as trans men or trans women, and 41,355 as non-binary​www150.statcan.gc.ca​www150.statcan.gc.ca. This is roughly 1 in 300 people being trans or NB. The relatively lower percentage in Canada (compared to the U.S.) could be due to methodology (census vs. anonymous survey) or the age cutoff of 15+.
  • Mexico: Hard data is sparse, but a 2017 national survey in Mexico reported about 0.5% of respondents identified as a gender different from birth sex (the figure is not well-documented). Social stigma remains high in parts of Latin America, affecting disclosure.
• Europe:
  • Western/Northern Europe: Generally more accepting environments show higher reported prevalence. An Ipsos global survey (2023) across 30 countries found that Germany and Sweden had the highest share of transgender/non-binary identifying people at 3% each. Several other Western European countries (Spain, UK, Netherlands, France, etc.) had around 2% identifying as trans/NB. These were online survey data, which might skew a bit high due to sampling, but they indicate a significant presence. Official data: The UK (England & Wales) 2021 Census reported 0.5% of people have a gender identity different from sex at birth​ons.gov.uk​theguardian.com (262,000 people age 16+). In Scotland, a later census found ~0.4% trans proportion​theguardian.com. These government stats likely undercount somewhat, given some people might skip the question or not be out.
  • Eastern Europe: Fewer statistics are available. Social stigma and legal barriers (no recognition in some places) mean fewer people openly identify. Surveys in Russia, Poland, etc., typically show <0.1% openly transgender. However, community groups estimate slightly higher numbers in reality. For example, Ukraine’s LGBTQ survey (2020) indicated ~0.1% trans.
  • Scandinavia: Very accepting – Sweden’s surveys (as above) ~2-3%. Norway, Denmark likely similar (~0.5–1% binary trans).
• Latin America:
  • Brazil: A 2018 landmark study (Spizzirri et al. 2021) in Brazil found 0.69% of adults are transgender (binary) and 1.19% are non-binary. Combined, ~1.9% of Brazilian adults (about 3 million people) have a gender-diverse identity. This is one of the highest quality estimates for a non-Western population. Another Brazilian survey by a government institute in 2019 got slightly lower figures (0.7% trans, 0.3% “travesti,” etc.), but overall ~1-2% gender diverse seems consistent. Notably, Brazil’s non-binary percentage was higher than binary, suggesting many gender-diverse Brazilians don’t strictly identify as men or women.
  • Other Latin American countries: Data are limited. An Argentinian survey (2018) found ~0.5% trans in younger cohorts. Colombia, Chile have no official counts, but activists estimate tens of thousands of trans individuals. Mexico, as mentioned, perhaps ~0.5%. One sign of prevalence is the demand for legal gender changes – e.g., Argentina saw over 12,000 people change gender markers in the first years after its 2012 gender identity law, in a country of ~45 million (suggesting at least 0.03% of the population immediately came forward, with more likely not doing paperwork).
• Asia:
  • South Asia: In countries like India, Bangladesh, Pakistan, transgender often falls under third gender cultures (Hijra/Khwaaja Sira). India’s 2011 census counted around 490,000 “third gender” people, ~0.04% of the population. However, this is believed to be a severe undercount; advocacy groups claim the true number of trans (including binary trans men/women and hijras) in India is in the millions. Social stigma is extremely high, which suppresses open identification. Nepal’s 2021 census included a third gender category: preliminary figures suggested about 0.3% marked “other” (which includes all gender minorities). Nepal’s figure was around 30,000 people out of 10 million, but this may also be underreported.
  • East Asia: Thailand has a prominent trans community (“kathoey”), but no official stats; anecdotal estimates say Thailand might have one of the highest prevalences. Japan and China: Surveys are scarce. Japan had about 7,000 diagnosed GID cases recorded by 2017 (tiny fraction of population, but again, only those in clinics). A rough estimate by Japanese LGBT groups is ~0.1% trans. In China, an unscientific estimate often cited is ~0.25% (which would be 3-4 million trans people), but data are unreliable.
  • Southeast Asia: Indonesia recognizes trans women as “waria” culturally; some local surveys in Java found up to 0.1% of males live as waria. Malaysia and Philippines have active communities, but no prevalence research.
• Middle East & Africa:
  • Very limited data. Many of these regions have cultural or legal hostility making it difficult to survey. Iran is an outlier in that the government allows and even subsidizes sex reassignment surgeries (for gay people coerced or for trans people legitimately), and Iran reportedly has one of the highest rates of SRS surgeries globally for MtF (some thousands per year). But prevalence is not published; it may be on the order of 0.1–0.3%.
  • Israel has noted ~0.05% of population officially registered as transgender in health system records, but actual self-identity might be higher.
  • In sub-Saharan Africa, NGOs report small but growing trans visibility. South Africa, being more liberal, might have the highest number – activists estimate tens of thousands of trans women and men across the country (perhaps ~0.1%). In other countries (Uganda, Nigeria, etc.), trans people exist but almost entirely closeted due to legal danger.

Given these variations, we provide Table 4 summarizing prevalence data from select countries/regions where data is available or reliably estimated:

Table 4. Prevalence of Transgender Identities by Country/Region

Interpretation: Highly accepting countries via surveys show higher numbers (1-3%), whereas official counts (census) tend to show around 0.3-0.6% due to various factors. The true underlying prevalence of people with binary transgender identities might be around 0.5%–1% of adults in societies without stigma, based on converging data. For youth, it can be higher (as seen in the U.S. Gen Z at 5%), possibly reflecting both reduced stigma and developmental exploration. Non-binary identities are also sizable and sometimes outnumber binary trans in youth cohorts, but again, those are beyond this report’s main scope.

It’s important to emphasize regional differences in visibility. Latin America (like Brazil) and some Asia-Pacific areas show that once measured, gender diversity is not solely a Western phenomenon – similar proportions exist elsewhere when people feel safe to identify. Countries that have only recently begun measuring (Canada, UK) have provided a baseline that roughly 1 in 200 to 1 in 300 people are trans (binary) even in relatively conservative counting. We expect these numbers to be refined with ongoing research and future censuses (e.g., India’s next census, US in 2030, etc.).

Lastly, while prevalence of binary transgender identities is relatively low as a percentage, the absolute number globally is substantial. With ~8 billion people worldwide, even 0.5% would equate to 40 million trans men and trans women around the world. More conservative estimates of 0.3% would be ~24 million. Many of these individuals still lack legal recognition or access to care in their countries. This underscores the global scope of transgender identities and the importance of understanding and supporting this population through evidence-based knowledge as provided in this report.

Sources:

1. Zaliznyak et al. (2021, USA): survey on age of gender dysphoria onset.
2. ENIGI European Network study (Nieder et al. 2011, Netherlands/Belgium/Germany/Norway): early vs late onset percentages.
3. PMC study (2023, South Korea): age first experienced incongruence ~10.6 years avg.
4. Ray Blanchard’s typology (1980s-90s, Canada): homosexual vs autogynephilic transsexual categories.
5. Freund et al. (1982, Canada): first to distinguish androphilic vs gynephilic trans women causes.
6. PMC review on trans brain structure (2016, Spain): brain differences in trans people​pmc.ncbi.nlm.nih.gov​pmc.ncbi.nlm.nih.gov.
7. “Causes of Gender Incongruence” – Wikipedia summary (2023): twin studies ~33% MZ vs 2.6% DZ; genetic heritability evidence.
8. Spizzirri et al. (2021, Brazil): national survey found 0.69% trans, 1.19% non-binary.
9. VanderLaan et al. (2017, Brazil/Canada): fraternal birth order effect in Brazilian trans women (androphilic).
10. Warrier et al. (2020, UK): Nature Communications study – higher autism rates in trans folks.
11. Kallitsounaki & Williams (2022, UK): meta-analysis ~11% of trans/GD individuals are autistic​pmc.ncbi.nlm.nih.gov.
12. Stanford Medicine (2024, USA): conversion practices linked to depression/PTSD.
13. Turban et al. (2020, USA): gender-affirming care linked to lower odds of suicide in youth.
14. U.S. Transgender Survey (2022 Early Insights, USA): 98% on HRT more satisfied; 97% after surgery more satisfied.
15. Cornell “What We Know” meta-review (2018, USA): high satisfaction and benefits from surgery.
16. Bustos et al. (2021, Global): Systematic review of regret after surgery – ~1% regret.
17. Olson et al. (2023, USA): Trans Youth Project – satisfaction with puberty blockers/hormones (JAMA Pediatrics).
18. World Population Review (2023, International): summary – ~2% global average trans/NB, highest 3% in Germany/Sweden.
19. Statistics Canada (2021 Census, Canada): 0.33% trans/NB (59,460 trans, 41,355 NB)​www150.statcan.gc.ca​www150.statcan.gc.ca.
20. Pew Research (2022, USA): 1.6% of Americans trans/NB (5% of under-30).
21. Office for National Statistics (2023, UK): 0.5% trans in England & Wales census​theguardian.com.
22. The Guardian (2023, UK): commentary on ONS data and potential misinterpretation​theguardian.com​theguardian.com.
23. Nature Scientific Reports – Costa et al. (2018, Brazil): another estimate ~1.9% gender diverse Brazil.
24. Healthline (2022, USA): general global estimate 0.6–3%, 1.6 million in US.