ArticleHealthcare (Basel, Switzerland)2026
Fifteen-Year Referral Trends and the Gender-Affirming Care Pathway in a Predominantly Adult Gender Dysphoria Cohort: A Retrospective Cohort Study from a University-Based Center in Türkiye.
Article in Healthcare (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND/
objectivesMost long-term cohort data on gender-affirming care come from adolescent and young adult populations in Western Europe and North America. In a Muslim-majority setting where legal gender recognition is contingent on a court ruling, presentation trends and the care pathway of an adult-service gender dysphoria cohort remain unknown. This single-center, retrospective study describes 15-year presentation trends and the gender-affirming care pathway at a university-based center in Türkiye.
methodsClinical records of 199 individuals presenting to a university gender identity clinic (2010-2024) were retrospectively reviewed, under routine institutional research consent obtained in writing from patients at intake; nine presented before age 18, and an adult-only sensitivity analysis was performed. Annual presentation counts were modeled with negative-binomial regression (accounting for overdispersion), with separate sub-period slopes estimated from 2015 and from 2017. Care-pathway stages (hormone board, surgical board, legal name change) were defined by board decision dates and cross-tabulated to show their overlap. Time-to-stage was analyzed with Kaplan-Meier estimation (with numbers at risk); predictors of reaching the hormone and surgical boards were assessed with Cox proportional-hazards models, censoring at the database closing date (25 November 2024).
resultsThe cohort comprised 67.3% trans men (AFAB) and 32.7% trans women (AMAB), approximately 2:1. Median age at presentation was 23.3 years (IQR 20.0-27.6). Annual presentations increased overall (negative-binomial IRR 1.21/year, 95% CI 1.06-1.37,
conclusionsThis predominantly adult Turkish cohort shows an overall long-term increase in referrals-concentrated in the earlier years-with age at presentation and the recorded AFAB/AMAB distribution statistically stable across 15 years. Residence relative to the center was associated with surgical-board attainment in exploratory analysis only.
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