A new study published Monday in the journal Pediatrics suggests that far more American teens are identifying as transgender or otherwise gender non-conforming than previously thought.

In 2016, scientists from the University of Minnesota surveyed nearly 81,000 teens between the ninth and 11th grades from across the state. The researchers found that almost 2,200 were gender non-conforming or identified themselves as transgender, reports the Associated Press.

The study puts the number of teens who identify as trans or gender non-conforming at around three percent, far higher than the 0.7 percent estimated in a UCLA study published last year. The CDC does not have original data on the subject because it does not ask about transgender identify on its surveys for youth.

If the Minnesota study’s figures are correct and can be applied to the US population at large, there are about 720,000 teens in the United States that fall outside of the traditional gender binary. The study found that these kids had poorer mental and physical health than other teens; though the survey didn’t address issues like bullying, researchers suggest that it may be one possible explanation. It’s a well-known fact that trans people experience violence at far higher rates than cisgendered individuals, and teens are no exception to this rule.

Some experts attribute the high number of self-identifying transgender teens to the increased visibility of trans people in the United States in recent years.There’s no doubt that the possibility of gender exploration is far more evident in popular culture than in the past, in theatre, television, film, and fashion. Women’s colleges are increasingly allowing trans women to enroll, and trans politicians are winning their races. It could be that young people may finally be starting to feel safe talking about gender identity and fluidity — perhaps even more comfortable than adults.

In an opinion article that accompanied the study, Dr. Daniel Shumer, a specialist in transgender medicine at the University of Michigan, summed it up nicely: “Youth are rejecting this binary thinking and are asking adults to keep up.”

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(Illustration by Sarah Tate / Brit + Co)