It was in the 1980s, almost forty years ago, that I first recall seeing clinical statistics estimating the prevalence of transsexualism. In those days it was claimed repeatedly that Male to Female (MtF) cases were about 1 in 33,000 and FtMs were about 1 in 104,000.

Take a note of that. It was accepted clinical wisdom that trans women (only they didn’t call us that back then) were three times as common as Trans Men. Except that this wasn’t always the case. In China (and Poland IIRC) the ratio was reversed. The anomaly was regarded as curious

..but nobody was fired up to investigate why that might be and NOBODY wrung their hands and claimed there was a crisis involving our precious men lining up to be women.

Fast forward a decade and the Dutch gender team at the Free University in Amsterdam threw a first spanner in the works. Unlike many other countries the Dutch gender recognition law of 1985 had created a defacto monopoly of reassignment in the Netherlands. If you wanted state..

..legal recognition then you could only achieve that by going through the Amsterdam clinic, led by Professor Louis Gooren, a genial fatherly figure in trans clinical history for whom I came to develop a degree of respect. Having the monopoly of every Dutch reassignment meant..

..also being in the position to COUNT people seeking surgical transition. They also, as we’ve recently learned, retained contact with almost all of their former patients, which means the Dutch have done unparalleled longitudinal research on outcomes.

Speaking at the landmark Colloquy on transsexualism which I attended in Amsterdam in April 1993, Gooren dropped a bombshell: based on their numbers, the incidence of MtF cases was about 1 in 11,900 cases. This raised immediate questions as to how and why clinicians elsewhere..

..were possibly missing 2 out of 3 cases. How could you make such a bloody big error in the numbers. Nevertheless, Gooren still reckoned that the incidence of FtM cases was about a third, other than those pesky outlier numbers that it was easier to ignore than question.

The Gooren numbers suited us at the time. They better explained what we could see with our own eyes in mid nineties Britain. If you relied on the previous estimates you’d only expect to find about 250-300 trans men in the whole of Britain — patently silly — and maybe only 1200..

..trans people overall. Using the Gooren incidence figures gave more sensible numbers, but not so large as to scare politicians. Applying my calculator to the 46 million adults in Britain in 1995 — 1 in 11,900 of 23 million men and 1 in 33,000 of 23 million women gave us..

..a figure of about 4,500 people, which I rounded up to 5,000 people likely to be pursuing the legal recognition we were campaigning for. Still we accepted the established truism that MtF was three times as common as FtM and STILL nobody wrung their hands over the disparity.

Fast forward again to the present time and we now know that transition (given greater awareness and the freedom to ignore clinical gatekeepers) is a lot more common than we thought. About 9,000 people have their gendered change of name protectively flagged on HMRC and DWP records

..and that’s obviously only the binary changes. Non-binary people hadn’t figured at all. And what’s my point? Well, firstly we have to keep revising estimates. If the 2021 census actually COUNTS us I suspect we’ll have to revise them again. When you count you find.

But secondly, nobody ever offered a cogent reason for a disparity between transitions one way or the other. I’ve seen theories but nothing to back them up. And it’s clear nobody wrung their hands when the numbers were biased one way whereas Britain panics when it is the other.

What do I think? Well, when it’s clear we are not counting everyone anyway ... When it’s clear that social factors weigh on young people disproportionately at different ages ... When it’s clear we are still processing a backlog of unmet need caused by ignorance and oppression..

.. Then we have to be very careful about rushing to conclusions about why ratios might swing around somewhat. Who knows? Maybe the next thing will be an increase in MtF cases coming to GIDS. And will we panic about that in the same way? Experience suggests not.