Summary

Two clinicians at England's former national youth gender clinic (GIDS) looked back over 18 months of their own cases. They describe teenagers whose gender distress began in adolescence and who, after a longer assessment, no longer wanted puberty blockers (drugs that pause puberty) or hormones. They found 12 such young people out of 128 cases (9.4%). Most were girls, many were autistic, and many were self-harming or suicidal. Two case stories show how bullying, homophobia, family breakdown and distress about puberty came to be seen differently over time. The authors argue that assessment should allow unhurried exploration, while noting that many others do go on to medical treatment. It is a small case review by the treating clinicians, with no comparison group, no standard measurements and no long-term follow-up. It shows one path, but not how common it is or what caused the change.

Key findings

• راجع المؤلفان جميع المراهقين (بعمر 12 فأكثر) الذين قيّماهم في GIDS بين أكتوبر 2015 وأبريل 2017: 156 حالة، خُفضت إلى 128 بعد استبعاد بعضها.
• كان لدى 12 من الـ 128 (9.4%) كرب جندري بدأ في سن المراهقة، وطلبوا علاجاً طبياً في البداية، وتوقفوا عن الرغبة فيه أثناء التقييم.
• من بين الـ 12، شعر سبعة براحة مع جنسهم عند الولادة، بينما ظل خمسة يعرّفون أنفسهم كمتحولين لكنهم لم يعودوا يريدون الهرمونات.
• كان معظمهم فتيات (9 من 12)، بأعمار 12 إلى 16 (المتوسط 14). كان 7 قد شُخّصوا بالتوحد، و7 فكروا مؤخراً في الانتحار، و7 آذوا أنفسهم، و2 حاولوا الانتحار مؤخراً.
• لم يتحول معظمهم اجتماعياً (7 من 12)، ولم يكن لدى معظمهم تشخيص رسمي لعدم الارتياح الجندري من الجهة المحيلة (9 من 12).
• كانت التقييمات أطول من المعتاد في العيادة (3 إلى 6 جلسات): 6.6 جلسة في المتوسط على مدى 9.6 أشهر، معظمها مع الأسرة.
• تصف حالتان، صبي مصاب بالتوحد في الرابعة عشرة وفتاة مصابة بالتوحد في الرابعة عشرة وسابقة اضطراب أكل، كرباً صار يُفهم في ضوء التنمر ورهاب المثلية وانهيار الأسرة والخوف من البلوغ.
• يدعو المؤلفان إلى مراجعة كاملة للسجلات في العيادة وإلى بحث طويل الأمد، ويقولان إن العلاج الطبي ما زال يفيد بعض الشباب.

Abstract

As the number of young people referred to specialist gender identity clinics in the western world increases, there is a need to examine ways of making sense of the range and diversity of their developmental pathways and outcomes. This article presents a joint case review of the authors' caseloads over an 18-month period, to identify and describe those young people who presented to the Gender Identity Development Service (GIDS) with gender dysphoria (GD) emerging in adolescence, and who, during the course of assessment, ceased wishing to pursue medical (hormonal) interventions and/or who arrived at a different understanding of their embodied distress. From the 12 cases identified, 2 case vignettes are presented. Implications for the development of clinical practice, service delivery and research are considered.

Conclusion

In conclusion, the adolescents included in this review met criteria for GD and initially requested medical interventions to resolve their difficulties. Over the course of the psychosocial assessment, they came to understand their distress and its alleviation (at that particular point in time) differently and eventually chose not take a medical (hormonal) pathway and/or identified their gender identity as broadly aligned with their biological sex. Of course, this is not the case for many other young people presenting to the service and it is important to hold onto the multiplicity of possible outcomes. The study highlights the need for the psychosocial assessment to nurture a space in between the internal and external worlds of these young people. Such an assessment would need to be properly located in a developmental framework which takes seriously the inescapable in between-ness of adolescence and joins with young people and their families to broaden the narratives available to them, to make sense of gender-based distress.