Gender conflict manifests early in childhood and can persist for years before patients undergo counseling and treatment, according to a Cedars-Sinai study.

The findings also reveal that untreated gender dysphoria can result in poor quality of life for transgender people, beginning in childhood and lasting throughout adolescence and adulthood.

Gender dysphoria refers to the strong discomfort or distress often caused by a discrepancy between a person’s gender identity and their biological sex assigned at birth.

Gender dysphoria worsens as those experiencing it grapple with expected social gender roles and sex characteristics that do not align with, or reflect, their internal sense of gender identity, the study found.

Federal and state population studies from 2016 estimate that 1.4 million to 1.65 million U.S. adults — or 0.6%-0.7% of the U.S. population — identify as transgender, according to the Williams Institute at the UCLA School of Law.

The Cedars-Sinai study, published in JAMA Network Open, a journal of the American Medical Association, was led by Dr. Maurice Garcia, a urologist and director of the Cedars-Sinai Transgender Surgery and Health Program.

The study included 155 transgender women — those who identify as women but whose sex assigned at birth was male — and 55 transgender men — those who identify as men but whose sex assigned at birth was female. All of the participants were adult patients seeking gender-affirming surgery.

The study findings revealed that 73% of the transgender women and 78% of the transgender men first experienced gender dysphoria by age 7.

The authors also sought to compare the age of earliest general — non-gender-related — memories with the age of participants’ first gender conflict experiences. The study results showed that the mean age of the transgender women’s earliest general memory and first experience of gender dysphoria were 4.5 and 6.7 years, respectively. For transgender men they were 4.7 and 6.2 years, respectively.

“While policies regarding transgender people’s rights are evolving, what is still clear and unchanged is the unequivocal need for accessible health care for transgender and gender nonconforming people of all ages,” Garcia said.

On Monday, the U.S. Supreme Court ruled that the Civil Rights Act of 1964 prohibits workplace discrimination against gay and transgender workers, which could help transgender patients who rely on employer-sponsored health insurance.

That decision followed a rule finalized by the Trump Administration last week that overturns protections for transgender people against sex discrimination in health care. Those protections, established in the 2010 Affordable Care Act, generally allowed people to choose how they identify rather than be determined by the sex assigned at birth.

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