{"p"=>"Key discussions in current research on transgender and gender diverse children and adolescents include rising referral rates of adolescents assigned female at birth (AFAB) compared to adolescents assigned male at birth (AMAB) to specialized gender identity services and shifts in demographic and clinical characteristics of clients. The present study aimed to investigate two things: (1) a potential linear increase in the proportion of AFAB (vs. AMAB) referrals over time; and (2) to identify distinct clinical patterns based on time, sex assigned at birth, and clinical characteristics, such as psychological functioning and onset age. A clinical sample of children and adolescents (n = 779) attending a specialized gender identity service in Germany (Hamburg GIS) over ten years, between September 2013 and September 2023, was assessed. Cross-sectional information provided by parents and clinicians included the year of initial visit, sex assigned at birth, psychological functioning (Child Behavior Checklist), and onset age of gender dysphoria (pre-pubertal vs. post-pubertal onset of gender dysphoria based on DSM-5 criteria in childhood and adolescence). A logistic regression analysis was used to test for a linear time trend in sex assigned at birth. A latent class analysis (LCA) was performed on the year of initial visit, sex assigned at birth, and clinical characteristics (psychological functioning and onset age) in order to identify potential clinical patterns. Even though the sample consisted of almost four times more AFAB compared to AMAB referrals, there was no significant linear increase in the proportion of AFAB children and adolescents over time. LCA revealed two distinct cohorts: an earlier one (mean year of initial visit: mid-2016) and a more recent one (mean year of initial visit: around 2021). These cohorts differed significantly with regard to all demographic and clinical characteristics. The more recent (2021) cohort included a higher proportion of AFAB individuals, less problematic psychological functioning in the clinical range, and more cases of post-pubertal onset (late onset) compared to childhood (early onset) gender dysphoria than the earlier cohort (2016). In conclusion, there was no evidence of a linear increase in the proportion of AFAB children and adolescents over time. However, two distinct clinical patterns were identified, one earlier cohort (referred around 2016) and one more recent cohort (referred around 2021), and these differed in various demographic and clinical characteristics. Long-term research is required to determine how these patterns fit with particular clinical needs."}