There are four times more transgender teenagers in the US than previously thought, according to a new study.
Nearly three percent of all 13 to 17-year-olds are trans or gender nonconforming, according to the results.
The study was an analysis of a 2016 survey of nearly 81,000 teens in Minnesota.
It found that almost 2,200 identified as trans, which includes terms such as non-binary, gender nonconforming and genderfluid.
That works out at 2.7 percent of teens, around four times more than the 0.7 percent figure which a UCLA study found last year.
And Nic Rider, a University of Minnesota postdoctoral fellow who is the new study’s lead author, said that the results can be used to estimate numbers across the US.
“Diverse gender identities are more prevalent than people would expect,” he added.
The study, which was published in peer-reviewed medical journal Pediatrics this week, also found that trans teens report worse mental and physical health than other children.
The higher number of trans teens could be explained by changing attitudes, according to Rider.
“With growing trans visibility in the United States, some youth might find it safer to come out and talk about gender exploration,” he said.
Dr Daniel Shumer, a specialist in trans medicine at Michigan University, wrote in Pediatrics that the study supported other research.
He said that when put together, all the findings suggest that the trans teen population has previously been “underestimated by orders of magnitude.”
Dr Shumer added: “Youth are rejecting this binary thinking and are asking adults to keep up.”
It is of increasing importance that adults’ views of trans people do indeed change.
Last year saw a record number of trans people killed in the US.
Since taking office in January last year, President Donald Trump has faced an avalanche of criticism for his treatment of trans people.
A month after becoming President, he revoked protections for trans students.
And in August, he announced a ban on trans people serving in the military.
A study in 2016 found that 40 percent of trans people in the US have attempted suicide.