Diagnosis Of Gender Dysphoria Research Articles

Estimating Transgender and Gender-Diverse Youth Populations in Health Systems and Survey Data.

To identify and examine demographic variation in estimates of gender-diverse youth (GDY) populations from the PEDSnet learning health system network and the Youth Risk Behavior Survey (YRBS). The PEDSnet sample included 14- to 17-years-old patients who had ≥2 encounters at a member institution before March 2022, with at least 1 encounter in the previous 18 months. The YRBS sample included pooled data from 14- to 17-year-old in-school youth from the 2017, 2019, and 2021 survey years. Adjusted logistic regression models tested for associations between demographic characteristics and gender dysphoria (GD) diagnosis (PEDSnet) or self-reported transgender identity (YRBS). The PEDSnet sample included 392 348 patients and the YRBS sample included 270 177 youth. A total of 3453 (0.9%) patients in PEDSnet had a GD diagnosis and 5262 (1.9%) youth in YRBS self-identified as transgender. In PEDSnet, adjusted logistic regression indicated significantly lower likelihood of GD diagnosis among patients whose electronic medical record-reported sex was male and among patients who identified as Asian, Black/African American, and Hispanic/Latino/a/x/e. In contrast, in the YRBS sample, only youth whose sex was male had a lower likelihood of transgender identity. GDY are underrepresented in health system data, particularly those whose electronic medical record-reported sex is male, and Asian, Black/African American, and Hispanic/Latino/a/x/e youth. Collecting more accurate gender identity information in health systems and surveys may help better understand the health-related needs and experiences of GDY and support the development of targeted interventions to promote more equitable care provision.

Effect of Facial Feminization Surgery (FFS) on Eyelid Anatomic Features.

Facial feminization surgery (FFS) improves gender dysphoria. The brows and eyes are crucial in perceived gender, yet brow and eyelid surgeries are relatively under-utilized. This study aimed to determine rates of brow and eyelid surgeries as part of FFS and characterize pre- and post-operative periocular features. We conducted a retrospective review to identify all patients with the diagnosis of gender dysphoria who underwent FFS at a single academic institution from 2019-2022. Thirty-four patients comprising 38 surgical cases were included. Twelve (35%) eyelid surgeries and 27 (79%) brow lifts were performed. Baseline eyelid measurements did not differ between brow lift and non-brow lift cases. Those undergoing brow lift and eyelid surgery were older in age (p=0.022), had a higher rate of negative canthal tilt (p=0.050), and smaller baseline margin-reflex distance 1 (p=0.014) than patients who had brow lift alone. Brow lift increased tarsal platform show (p=<0.001) and lash-to-brow distance (p=<0.001), and upper blepharoplasty increased tarsal platform show (p=0.01). Rates of brow lift are high at our institution, and patients are appropriately selected for eyelid surgery in FFS. Brow lift and upper blepharoplasty can feminize anatomical features when using standards described for cisgender cohorts. The impact of periocular features on gender perception in transgender patients warrants further study.

Genital Tucking Practices in Transgender and Gender Diverse Patients.

Genital tucking (tucking) is the practice of hiding or minimizing the appearance of one's genitals and gonads. We aimed to better understand the prevalence of tucking and its potential effect on behavior and health. An online questionnaire was distributed to adults with a diagnosis of gender dysphoria or gender incongruence (n = 98). The risk of side effects increased with the length of tucking sessions (P = 0.046) with many patients avoiding medical care despite experiencing side effects. Health care providers should empathetically discuss tucking and its potential risks and benefits with transgender and gender diverse patients. Further research is needed to better quantify the potential risks involved with tucking and to assist in developing educational resources.

Gender dysphoria and gender-affirming surgery: The New York state experience

Transgender and gender nonconforming (TGNC) individuals experience incongruence between their self-identified gender versus their birth-assigned sex. In some cases, TGNC patients undergo gender-affirming surgical (GAS) procedures. Although GAS is an evolving surgical field, there is currently limited literature documenting patient characteristics and procedures. Addressing this knowledge gap, this retrospective cohort analysis described the characteristics of New York State's TGNC residents with gender dysphoria (GD) diagnosis, including patients undergoing at least one gender-affirming surgical procedure. Using the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2002 to 2018, we identified patients' first-time TCNC records and their risk characteristics. Patients who received GAS procedures were sub-classified as top-only, bottom-only, or combined top/bottom procedures and were compared with TGNC patients who did not receive GAS. Of 24,615 records extracted from TGNC SPARCS database, 11,427 (46.4%) were transmasculine (female-to-male) and 13,188 (53.6%) were transfeminine (male-to-female). Overall, 2.73% of transgender patients received at least one GAS procedure. Of these patients, 78.2% had masculinizing and 21.8% had feminizing surgeries. After a diagnosis of GD, the positive predictors for a GAS-based procedure included female birth sex, pediatric age (<18 years) or older age (60+ years), commercial insurance coverage, and Hispanic race. In contrast, negative GAS predictors included male birth sex and government insurance coverage (i.e., Medicare and Medicaid). Compared with transgender women, transgender men were more likely to receive at least one GAS procedure. Because the race, ethnicity, and payor status of TGNC patients can impact GAS treatment rates, additional research is warranted to examine post-diagnosis GAS treatment disparities among TGNC patients.

(144) Contemporary Trends in Testicular Prosthesis Placement: An Analysis Of U.S. Claims Data

Abstract Introduction Testicular prosthesis placement (TPP) is a procedure associated with high patient satisfaction that improves body image and quality of life following orchiectomy. However little information exists regarding contemporary TPP as placement for metastatic prostate cancer has fallen out of favor and gender affirming surgery is on the rise. Objective This study sought to describe current trends in TPP in the United States. Methods Using the IBM® MarketScan® Research Databases (DOI 10.57761/ray7-1g16) we performed a retrospective analysis from 2007 to 2021 and identified 1,059 adult men who had undergone placement of a testicular prosthesis based on ICD-9 codes. Results The median age of TPP was 34 (IQR 23-44; range 18-80). At least 433 (35.5%) men were married. A total of 536 (43.8%) men had orchiectomy concurrently at the time of TPP. Just under half of the cases prescribed antibiotics postoperatively (44.9%). The five most common indications at the time of TPP were malignancy (54.7%), gender dysphoria (10.4%), cryptorchidism (9.6%), atrophy/hypofunction (6.6%), and testicular torsion (3.9%). A total of 46 (3.8%) of men underwent subsequent removal of their prosthesis. A diagnosis of gender dysphoria was associated with prosthesis removal (odds ratio (OR) 4.51, 95% CI 2.10-9.86). No significant associations were seen for other indications, Charlson Comorbidity Index scores, post-operative antibiotic use, tobacco use, psychiatric diagnoses, or prior pain diagnoses. Rates of testicular prosthesis placement for a diagnosis of gender dysphoria are rapidly increasing while placement for prostate cancer is increasingly rare. Conclusions Among the studied population the primary indication for testicular prosthesis placement is for testicular cancer, contradicting the findings of earlier series. We also show that TPP for gender dysphoria is increasingly common. Additionally, we report rates of explanation and complications related to prosthesis that are higher than what is described in the literature. Disclosure No.

Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Anti-Depressant Use in Patients with Gender Dysphoria.

Patients with gender dysphoria face significant health disparities and barriers to care. Transition-related care includes hormonal therapy, mental healthcare, and gender-affirming surgeries. Studies have described favorable surgical outcomes and patient satisfaction, however, the degree to which these procedures impact mental health conditions is not fully understood. The purpose of this study was to evaluate the effect of gender-affirming plastic surgery on mental health and substance abuse in the transgender population. A national insurance claims-based database was used for data collection. Patients with a diagnosis of gender dysphoria were propensity score-matched for the likelihood of undergoing gender-affirming surgery (no surgery being the control cohort), based on comorbidities, age, and sex. Primary outcomes included post-operative antidepressant use and the prevalence of mental health conditions. A total of 3,134 patients with gender dysphoria were included in each cohort. Patients in the surgery group had overall lower rates of mental health conditions, substance abuse, and SSRI/SNRI use. There was an absolute decrease of 8.8% in SSRI or SNRI prescription after gender-affirming plastic surgery (p<0.001), and significant decreases in post-operative depression (7.7%), anxiety (1.6%), suicidal ideation (5.2%) and attempts (2.3%), alcohol abuse (2.1%), and drug abuse (1.9%). Gender-affirming surgery in appropriately selected gender dysphoric patients is associated with decreased postoperative rates of SSRI or SNRI use and improved mental health.

“I Feel Like You Don’t Need Dysphoria to be Trans.”: Emerging Understandings of Gender Dysphoria Among Transgender and Gender Diverse Adolescents

A diagnosis of gender dysphoria remains the primary requirement for transgender people to receive medical and legal gender affirmation services. Three focus groups conducted in 2018 with transgender and gender diverse (TGD) adolescents were assessed to understand how they define and use the term dysphoria and how the clinical discourse of gender dysphoria relates to their sense of self and overall wellness. The 21 participants (age 12–18) were primarily White (n = 19, 90%; Hispanic n = 2, 10%). Thirteen adolescents had a masculine identity, 2 feminine, and 6 genderqueer/nonbinary. TGD youth understood the clinical definition of gender dysphoria but expanded its use; reported stigma as the cause of some of their dysphoria; and used their conceptualization of dysphoria to find self-acceptance. This study highlights the perceived harm and potential limitations of using diagnostic language to define identity. However, through rescripting and self-definition, TGD youth exercise personal agency and reject stigma.

Demographic Differences in Gender Dysphoria Diagnosis and Access to Gender-Affirming Care Among Adolescents.

Purpose: The goal of this article was to identify demographic differences in receipt of gender dysphoria (GD) diagnosis and access to gender-affirming care (GAC) among adolescents whose gender identity and/or pronouns differed from their sex assigned at birth. Methods: Data were from 2444 patients who were 13-17 years old and had a documented gender identity and/or pronouns that differed from their sex assigned at birth in the electronic health record. Adjusted logistic regression models explored associations between demographic characteristics (sex assigned at birth, gender identity, race and ethnicity, language, insurance type, rural status) and presence of GD diagnosis and having accessed GAC. Results: The average predicted probability (Pr) of having received a GD diagnosis was 0.62 (95% confidence interval [CI] = 0.60-0.63) and of having accessed GAC was 0.48 (95% CI = 0.46-0.50). Various significant demographic differences emerged. Notably, Black/African American youth were the least likely to have received a GD diagnosis (Pr = 0.43, 95% CI = 0.33-0.54) and accessed GAC (Pr = 0.32, 95% CI = 0.22-0.43). Although there were no significant differences in GD diagnosis by insurance type, youth using Medicaid, other government insurance, or self-pay/charity care were less likely to have accessed GAC compared with youth using commercial/private insurance. Conclusion: Results indicate significant differences in both receipt of GD diagnosis and accessing GAC by various demographic characteristics, particularly among Black/African American youth. Identification of these differences provides an opportunity to further understand potential barriers and promote more equitable access to GAC among adolescents who desire this care.

Trends in Gender-Affirming Surgeries in the United States from 2010 to 2021.

Introduction: In 2017, an estimated 1.6 million adults and 150,000 teenagers identified as transgender in the United States. With ever-changing legislative developments regarding health care benefits for this population and the increasing number of patients presenting for gender-affirming surgery (GAS), there is a scarcity of literature on the temporal trends within the past decade. The objective of this study was to examine the temporal trends of the utilization of GAS. Methods: We conducted a cross-sectional study using TriNetX, a federated research network containing deidentified aggregate patient data. Using International Code of Disease (ICD) and Current Procedural Terminology (CPT) codes, we identified patients with a diagnosis of gender dysphoria who underwent GAS from 2010 to 2021. Basic demographic information and complications were analyzed. Complications of interest included site failure, infection, and systemic complications. Results: We identified a total of 8,403 patients who underwent GAS between January 2010 and December 2021. The number of procedures per year increased nearly 500% between 2016 and 2021 from 421 procedures to 2,224 procedures. Our demographic results were consistent with previous survey-based studies. The average age of patients who underwent masculinizing surgeries was consistently younger than those who underwent feminizing surgeries. Most patients undergoing GAS were of white race. The overall complication rate was 4.7%. Conclusion: In conclusion, our study reveals a significant and rapid rise in the utilization of GAS in the United States, with a fivefold increase in procedures between 2016 and 2021. The demographic characteristics and low complication rates observed highlight the evolving landscape of health care for transgender individuals and the need for ongoing assessment and support in this field.

Measuring Quality Care for Adult ADHD Patients: How Much Does Gender and Gender Identity Matter?

Objective: Studies show adult ADHD presents differently in men and women, however few studies contrast ADHD in cisgender and gender diverse adults. We assessed care differences between these groups using previously identified quality measures (QMs). Methods: Using EHR data, we matched a group of male ADHD patients to a female group. We followed the same procedure with a cisgender group and one identified as gender diverse through a gender dysphoria diagnosis. QM achievement was measured using logistic regression models. Results: Most QMs exhibited increasing achievement over time for all groups. Variations in care quality between males and females persisted, with female patients achieving QMs more often. There were no appreciable differences between the cisgender and gender diverse groups. Conclusion: Though quality care for adult ADHD improved from 2010 to 2020, differences between male and female patients lingered. This effect was not observed in cisgender and gender diverse patients.

Antidepressant prescribing in transgender and nonbinary individuals diagnosed with gender dysphoria and mood or anxiety disorders.

Transgender and nonbinary (TGNB) individuals are highly stigmatized members of society and are significantly at higher risk of having mood or anxiety-related disorders compared to non-TGNB individuals. In this retrospective cohort study, antidepressant prescribing data were collected from TGNB adults diagnosed with gender dysphoria (GD) and mood or anxiety-related disorder between January 2005 and October 2021. The primary outcome was to compare the number of active outpatient antidepressant prescriptions at the time of GD diagnosis between gender identities. The secondary outcomes were to compare antidepressant class utilization between gender identities as well as the prevalence of concurrent mood or anxiety-related disorder diagnoses between gender identities. Of 131 patients who met inclusion criteria, there was no significant difference in number of active antidepressant prescriptions between gender identities at the time of the GD diagnosis (p = .357). However, transgender females were prescribed bupropion at significantly higher rates than other gender identities (p = .046). Approximately 38% of patients did not have an active antidepressant prescription at the time of GD diagnosis despite concurrent mood or anxiety-related diagnoses. The prevalence of generalized anxiety disorder was significantly greater among transgender males (p = .044). Although the number of active antidepressant prescriptions between gender identities were similar in this study, we found 38% of patients were not prescribed any antidepressants at time of GD and mood or anxiety-related disorders. This serendipitous finding elucidates a potential gap in mental health care among transgender adults.

OR31-02 Persistence Of Gender Identity And Hormone Therapy Use In Transgender Adolescents: A Retrospective Cohort Study

Abstract Disclosure: P. Gupta: None. B.C. Patterson: None. S. Gold: None. L. Chu: None. H. Yeung: None. M. Goodman: None. V. Tangpricha: None. Introduction: Adolescents with gender dysphoria often seek feminizing or masculinizing hormone therapy to affirm their gender identity. While receipt of gender-affirming hormone therapy (GAHT) has been associated with improved quality of life and well-being, the incidence of discontinuation of GAHT and the reasons for discontinuation are not known. The purpose of this study was to 1) assess the discontinuation rate of GAHT, and 2) explore the reasons for GAHT discontinuation. Methods: This was a retrospective cohort study approved by Emory University’s and Children’s Healthcare of Atlanta’s Institutional Review Board. Medical charts of transgender adolescents seen at Children’s Healthcare of Atlanta were reviewed. Patients met the inclusion criteria if they were prescribed GAHT (estradiol or testosterone) between 01/01/2016 to 01/01/2019. We defined continuation of GAHT if the participant was still taking estradiol or testosterone as of 01/01/2019. If the participant stopped taking hormonal therapy prior to 01/01/19, they were deemed to have discontinued hormonal therapy and the reason for discontinuation was collected from the chart if documented. If the reason was not documented or if the status of hormone discontinuation was not known, the participant was contacted via telephone to ascertain whether still taking GAHT or not and to ascertain the GAHT discontinuation reason if not taking GAHT as a part of phase II of the study. Results: This study included 82 participants; 36 (43.9%) transgender girls, 45 (54.9%) transgender boys, and 1 (1.2%) non-binary adolescent. The mean age of participants was 16.7 (SD= 1.7) years and the majority were white (N= 71; 86.6 %) and non-Hispanic or Latino (N=76; 92.7%). The majority (N= 59, 72.0 %) of the participants were privately insured. The mean duration of hormonal therapy was 21.5 (SD= 15.4) months spanning over a maximum of 66 months. Only 3 participants had discontinued GAHT therapy: one participant stopped hormonal therapy due to insurance issues, one participant stopped GAHT temporarily to conceive a baby and one stopped testosterone to transition to a non-binary gender. No participant re-transitioned to the gender congruent with the sex assigned at birth. Conclusion: Discontinuation of GAHT in this group of transgender adolescents was infrequent. No participant re-transitioned to the gender congruent with the sex assigned at birth while 3 participants discontinued GAHT due to external factors. Pediatric providers should prescribe GAHT in accordance with the Endocrine Society guidelines if the adolescent needing GAHT meets the diagnosis of gender dysphoria, has parental consent, and is pubertal. Presentation: Sunday, June 18, 2023

Phenomenological Interview and Gender Dysphoria: A Third Pathway for Diagnosis and Treatment.

Gender dysphoria (GD) is marked by an incongruence between a person's biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called "wait-and-see" approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of a "third pathway" for the diagnosis and treatment of GD in youths. To make our case, we draw on a recent development in bioethics: the phenomenological approach. Scholars such as Slatman and Svenaeus have argued that the extent to which the body can (or should be) manipulated or reconstructed through medical intervention is not only determined by consideration of ethical frameworks and social and legal norms. Rather, we must also take account of patients' personal experience of their body, the personal and social values associated with it, and their understanding of its situation in their life: their narrative identities. We apply this phenomenological approach to medicine and nursing to the diagnosis and treatment of GD in youth. In particular, we discuss Zahavi and Martiny's conception of the phenomenological interview, in order to show that narrative techniques can assist in the process of gender identification and in the treatment of youth presenting with GD. We focus on two case studies that highlight the relevance of a narrative-based interview in relations between patients, HCPs, and family, to expose the influence of social ideologies on how young people presenting with GD experience their bodies and gender.

Medical care for children and adolescents with gender dysphoria and gender inconsistency in the light of current recommendations - how to implement the "primum non nocere" principle?

Gender identity is one of the essential aspects of human functioning. The diagnosis of gender dysphoria or gender incongruence applies to people who do not have any developmental defects of the genital organs or sex hormone secretion disorders, while the problem is the lack of acceptance of functioning in their own body and the desire to become a person of the opposite sex. This phenomenon is increasingly observed in children and adolescents. In recent years there has been a trend towards earlier use of puberty blockers and sex steroids in minors with gender dysphoria or gender inconsistency in order to inhibit the development of sexual characteristics in the direction of their own sex (referred to as the sex assigned at birth) and to mimic them to the opposite sex, i.e. according to their gender identification. In addition, surgical procedures are performed to remove the gonads and change the appearance of the genitals (and/or breast) in the desired direction (these procedures are allowed in adults, although there are many advocates of performing them in adolescents). Such therapies have been described as "gender-affirming", as opposed to "conversion" therapies, i.e. interventions aimed at restoring the acceptance of one's own sex. The literature emphasizes the lack of evidence regarding the effectiveness and safety of these procedures, allowing for an unequivocal recommendation of their application in children and adolescents, as well as the possible relationship between the increase in the frequency of gender identity disorders and the influence of peer groups, in particular the media creating a climate of affirmation of transsexualism (and non-binary gender identification). Therefore some countries (e.g. Sweden) have tightened their legal regulations in this area. The most serious long-term consequence of gender-affirming therapies is infertility. This paper aims to present these problems based on current medical literature. Extremely important bioethical and legal aspect of these issues will only be indicated, although they undoubtedly require special attention and separate studies.

Fixation of the Compressive Dressing for Nipple-areola Complex Graft during Double Incision Chest Contouring Surgery for Assigned-female-at-birth Persons with Diagnosis of Gender Dysphoria: Sutures or Staples?

When transplanting skin grafts, a compressive dressing is usually used to hold the skin graft in place. Dressing fixation can be achieved with either sutures or staples. The purpose of this study was to compare sutures and staples as a method of fixation for the compressive dressings of the nipple-areola complex (NAC) grafts, during double incision chest contouring surgery in assigned-female-at-birth persons with diagnosis of gender dysphoria. The two methods of fixation were compared according to pain at removal, time consumption, difficulty of removal, costs, and sustainability. Forty patients were randomized to dressing fixation with either sutures or staples. Timing for dressing fixation during surgery and removing the dressing was measured. Pain during removal was measured using vNRS-11. Difficulty of removal was measured with VAS-100. Costs of materials were compared. All NAC grafts survived, and no complications such as infection or bleeding occurred. Staples were significantly more painful to remove when compared to sutures [mean vNRS-11 2.98 (SD ± 2.43) versus 1.25 (SD ± 0.92), P < 0.001]. Fixation with staples was faster than fixation with sutures (5.3 versus 94.6 s). No difference in removal time was found. Nurses found staples easier to remove. Sutures were slightly less costly (18 SEK) compared to staples (30 SEK). Finally, sutures produce less material waste. Being that all other outcomes are similar or insignificant, the less-pain experienced at removal of sutures makes this the preferable method for fixation of the compressive dressing for NAC grafts during double incision chest contouring surgery.

Enjeux éthiques de la chirurgie de réassignation sexuelle

Gender reassignment raises complex ethical issues. It questions gender identity and the right to self-determination. Some highlight the right to access the medical care necessary to live according to one's perceived gender. Others worry about the potential rush into major medical decisions, especially among minors. The need for a medical diagnosis of gender dysphoria can be seen as pathologizing. The requirement for surgery for marital status change, while not mandatory in many places, remains controversial. The balance between informed consent and access to treatment, as well as stigma and discrimination, contribute to the complexity of ethical issues. Finally, the issues surrounding the competence of health professionals, the quality of care and the integration of individual needs make these decisions particularly sensitive from an ethical point of view.

Acceptance and Use of Sensor Technology in Diagnosis of Gender Dysphoria

Acceptance and Use of Sensor Technology in Diagnosis of Gender Dysphoria

Validity and reliability of the Thai version of the Utrecht Gender Dysphoria Scale-Gender Spectrum (UGDS-GS) in Thai youths and young adults with gender dysphoria

BackgroundMany people who are gender variant have undiagnosed gender dysphoria, resulting in delayed receipt of gender-affirming support and prolonged distress in living with their gender-non-conforming sex. The Utrecht Gender Dysphoria...

Mental Health of Transgender Youth: A Comparison of Assigned Female at Birth and Assigned Male at Birth Individuals.

Gender dysphoric adolescents report a gender identity which is incongruent with their assigned sex at birth, whereby the experienced incongruence is accompanied by clinically relevant distress. The aim of the study was to assess and compare the mental health of transgender youth by assigned sex at birth. A total of n = 49 adolescents (n = 29 assigned females at birth, n = 20 assigned male at birth) aged 12 to 18 years with the diagnosis of gender dysphoria according to DSM-5 were included in the study. The adolescents underwent a psychological assessment in a child and adolescent psychiatry outpatient department prior to starting gender-affirming medical treatment, completing relevant mental health questionnaires. Although no differences were found in psychiatric disorders, more externalizing problems above the clinical threshold were reported by parents in assigned female at birth (AFAB) adolescents. On the other hand, internalizing problems, both in general and within the clinical range, were found to be more prevalent in assigned male at birth (AMAB) adolescents, as indicated by self-report. Our results suggest that a comprehensive assessment of mental health in gender dysphoric adolescents is crucial for understanding the diverse range of challenges they may face and tailoring appropriate interventions to address their specific needs.

Co-occurring Autism Spectrum Disorder and Gender Dysphoria in Adolescents.

Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses. This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis. Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth. Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.