P-524 The influence of age on the timing of milestones in gender identity development and fertility preservation

Study question This study aims to investigate whether the age of milestones in gender identity development (GID) varies between generational cohorts. Summary answer Generational cohort influences the age of reaching milestones in gender identity development (e.g. coming out). What is known already Socio-economic changes and evolving societal perceptions of transgender and gender-diverse (TGD) individuals have had a significant impact on the trajectories of GID among younger generations. Factors such as increased access to genderaffirming healthcare and positive media representation have likely contributed to earlier gender identity awareness among younger TGD individuals. This may subsequently influence key milestones in GID, including coming out and initiating hormone therapy. Study design, size, duration Data for the study was collected between 2017 and 2021 at a single center. The study, which used the Innsbrucker Transgender Quality of Life during Hormone Therapy Questionnaire (iTransQoL), included 212 participants. Participants/materials, setting, methods 212 participants who (a) were at least 18 years old, (b) identified as TGD, and (c) provided informed consent were included in the analysis. Participants were categorised by generational cohort and gender identity. Participants were categorised into four generational cohorts: Generation Z (born 1997-2012, n = 97), Millennials (born 1981-1996, n = 85), Generation X (born 1965-1980, n = 24), and Baby Boomers (born 1946-1964, n = 6). The study sample included 115 trans men, 90 trans women, and 7 non-binary individuals. Main results and the role of chance Compared to older cohorts, younger generations, particularly Generation Z, reported significantly earlier onset of key GID milestones. Generation Z expressed a first desire to transition at 12.4 ± 4.7 years, compared to 40.8 ±22.0 years for Baby Boomers. Furthermore, Generation Z exhibited a shorter interval between the first desire to transition and coming out (4.3 ±3.9 years) than Millennials (8.3 ±7.4 years). A notable intergenerational difference emerged in the distribution of gender identity. Generation Z demonstrated a higher prevalence of trans men, with 66.0% self-identifying as such, compared to 29.2% in Generation X and only 16.7% in Baby Boomers. There was a significant disparity in the use of fertility preservation measures between trans men and women. While 23.6% of trans women used such measures, this figure was significantly lower for transmen at 3.7%. Limitations, reasons for caution Only TGD individuals starting hormone therapy were included in this study, which reduced our study population. Still prevalent discrimination against non-binary individuals in healthcare may have resulted in a small number of non-binary individuals. Wider implications of the findings This study highlights the intergenerational differences in the timing of key GID milestones for TGD individuals. This may reflect progress in the visibility of TGD individuals and their experiences, as well as access to gender-affirming healthcare for TGD individuals. Trial registration number No