The study is a review of secondary sources, i.e. databases from different countries, but it does not specify in detail the collection it makes and the inclusion and exclusion criteria. 

The analyses are set according to categories that are also not very well defined, but I understand that the analyses it does show how treatment can be accessed earlier. 

The most interesting part of the study is part of its conclusions: they say that "the phenomenon could be related to increased accessibility to care". I do not agree with what they say about a "favourable social context", seeing the increase in hate speech, and more so in the populations they have indicated. This nuance is important to avoid any confusion or hypothesis that talks about the notion of social contagion as a hypothesis about the genesis of transgender people.

The authors acknowledge in the limitations that the study may be confusing because they use two criteria, gender identity disorder (ICD-10; WHO; recently replaced by gender incongruence in ICD-11) and gender dysphoria (DSM-5; DSM5-TR). Eighty percent of the population they study is American, where DSM-5 is applied, but they use ICD-10 to embrace more countries. They could have adopted another strategy, focusing on the American population with DSM-5 and presenting the foreign data in supplementary material and conducting joint analyses of the two samples.  

The data are consistent with previous research over the last ten years, which shows two facts: that it is at puberty that gender dysphoria emerges most strongly and, secondly, that the ratio: assigned-boy-at-birth-who-is-conscious-of-being-girl/assigned-girl-at-birth-who-is-conscious-of-being-boy has changed in recent years in favour of girls who are consciously aware of being boys.    

Limitations relate to the use of diagnostic classifications and the use of terminology that is not interchangeable.  

The two graphs presented in the paper on the prevalence of gender dysphoria and how it is presenting earlier and earlier year by year are very illustrative. However, the authors provide an explanation of the data by vague social variables. The concept of gender identity is a complex issue that encompasses genetic, epigenetic, hormonal, brain and social variables. It is unlikely that social variables alone are the cause. It would be better to think of an interaction of all variables. It should also be remembered that transgender people, like cisgender people, are not immune to primary psychopathology.

The study shows how the age of health care for transgender children has been decreasing in recent years and how care for people assigned female at birth is earlier. Although this is the conclusion they reach, the study is clear about its limitations, such as the use of different diagnostic codifications (ICD-10 and DSM-V), which in some cases result in already discarded diagnostic labels such as "gender dysphoria". 

These data, despite technical limitations, may be due to two complementary realities: greater social respect for trans identities and the age of onset of puberty. 

The latter case is congruent with the previous knowledge that puberty in people assigned female at birth is earlier than in those assigned male. This means that the appearance of secondary sexual characteristics is at an earlier age and therefore attention is also demanded earlier.

With regard to improving social respect for transgender people, one of the benefits is improved access to specific care for transgender people when they need it. In previous times, due to stigma, discrimination and vulnerability, the social expression of gender identity was delayed to later ages, leading to an approach when puberty had already begun and without being able to reverse body changes. Moreover, not being able to access care, it entailed (and still entails) a high risk of emotional distress and suicide, as studies show.

Therefore, social alarm should not be created around these data, but they should be understood as a logical evolution of respectful health care for transgender children.