Finsk kønsklinik: 87 % af teenageansøgerne var fødselspiger, og 75 % havde tidligere psykiatrisk behandling

To års kønsidentitetstjeneste for mindreårige: overrepræsentation af fødselspiger med alvorlige problemer i ungdomsudviklingen

Kohorte- & registerstudier Autisme, trauma & samtidige tilstande Stigende diagnoser & social indflydelse

Authors: Riittakerttu Kaltiala-Heino, Maria Sumia, Marja Työläjärvi, Nina Lindberg
Journal: Child and Adolescent Psychiatry and Mental Health
Year: 2015
Source: https://doi.org/10.1186/s13034-015-0042-y

Summary

This early report from Finland's newly opened youth gender service described every young person assessed in Tampere between 2011 and 2013. Nearly nine in ten were born female, most had no gender distress in childhood, and three quarters had already needed specialist mental health care. This was often for depression, anxiety, self-harm or autism, and usually began before gender concerns appeared. The largest group developed gender distress in their teens amid wider confusion about who they were, loneliness and high hopes that transition would fix their problems. The authors said this did not match the typical patient the Dutch treatment approach was based on, and that guidelines should take it into account. The study is small and only describes, but it was one of the first to record the changed patient group, and Finland later revised its national guidance.

Key findings

Alle 47 teenagere, der blev vurderet til kønstransition på Tamperes ungdomsservice i 2011 til 2013, blev inkluderet; deres gennemsnitsalder ved ankomsten var omkring 16,6 år.
41 af de 47 (87 %) var født som kvinder, en andel som forfatterne sagde, at de ikke kunne forklare.
75 % havde været i specialiseret børne- og ungdomspsykiatrisk behandling af andre grunde end kønslidelse, og 68 % kom første gang til psykiatrien af årsager, der ikke var relateret til køn.
Behandlede problemer omfattede depression (64 %), angst (55 %), selvmordstanker eller selvskade (53 %), autisme (26 %) og psykotiske symptomer såsom at høre stemmer (13 %).
64 % (30 af 47) havde ingen kønslidelse eller tværkønnet adfærd i barndommen, som de selv eller deres forældre kunne huske, og 62 % begyndte at stille spørgsmål ved deres køn i en alder af 12 år eller ældre.
57 % var blevet groft mobbet. I 73 % af disse tilfælde begyndte mobningen, før der var nogen bekymringer om køn, mest af årsager, der ikke var relateret til køn.
Den største gruppe (23 af 47) udviklede kønslidelse i teenageårene sammen med bredere forvirring om, hvem de var, ensomhed og meget store forhåbninger om, at transition ville løse deres problemer.
Ensomhed og social isolation var det stærkeste tegn på at tilhøre denne gruppe: isolerede teenagere havde cirka 9 gange så stor sandsynlighed for at være i den.

Abstract

BACKGROUND: Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development. METHODS: Structured quantitative retrospective chart review and qualitative analysis of case files of all adolescent SR applicants who entered the assessment by the end of 2013. RESULTS: The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common. CONCLUSION: The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.

Conclusion

Adolescents seeking sex reassignment represent a variety of developmental pathways differentiated by the timing of onset of gender dysphoria, psychopathology and developmental difficulties. It is important to be aware of the different groups, or developmental pathways, in gender dysphoric adolescents in order to be able to find appropriate treatment options. In the presence of severe psychopathology and developmental difficulties, medical SR treatments may not be currently advisable. Treatment guidelines need to be reviewed extended to appreciate the complex situations.

Methodological limitations

Small group: Only 47 teens (6 born male), which limits comparisons and makes figures less precise. The authors admit the data are too few for complex analyses.
One clinic: Data come from one of Finland's two youth gender services. The claim that the Helsinki service saw similar patients rests on an unpublished personal communication.
Looking back at clinic files: Records were written to care for patients, not for research, and some information was missing.
Earlier diagnoses unclear: Past mental health problems were taken from referral letters and files that often lacked a formal diagnosis. Only problems that led to treatment were counted, so the rates are probably too low.
Childhood relied on memory: Whether a teen had gender distress as a child depended on what they and their parents remembered during assessment, which may be incomplete.
Groupings made by the authors: The five pathways the authors describe were drawn up by the clinic team from case files, with no reported independent check of how cases were sorted.
No comparison group: There was no group of other teen mental health patients to compare with, so it is hard to judge how unusual these profiles are.
Describes, doesn't explain: The study is a single snapshot. It cannot show whether mental health problems cause gender distress or the reverse, and it reports no treatment results.
May not apply elsewhere: It is a Finnish public service with its own laws (legal and surgical transition only from 18). The authors note the findings cannot be applied to all gender-questioning young people.

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Summary

Key findings

Abstract

Conclusion