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“The sex ratio of those being referred had shifted dramatically too. The number of girls (known at that time at GIDS as ‘natal females’, now ‘birth-assigned females’) seeking help had equalled the number of boys for the first time in 2011. Previously, GIDS’s caseload had been nearly three-quarters male for those referred in childhood, or two-thirds overall. At first, this change was understood to be positive – a sort of balancing-out – and attributed to the fact that the girls were perhaps being better supported to seek help. But by 2015 it was clear that, in fact, something bigger was happening. There had been a complete reversal. Referrals for natal girls made up 65 percent of the total. In 2019/20 girls outnumbered boys by a ratio of six to one in some age groups, most markedly between the ages of 12 and 14 … Moreover, the majority were girls whose gender-related distress had begun after the onset of puberty, during adolescence. They didn’t have a history of childhood dysphoria.” — Hannah Barnes