Clínica de género finlandesa: el 87 % de los adolescentes nació niña y el 75 % tenía tratamiento psiquiátrico previo

Dos años de servicio de identidad de género para menores: sobrerrepresentación de chicas natales con problemas graves en el desarrollo adolescente

Estudios de cohorte y registros Autismo, trauma y condiciones concurrentes Aumento de diagnósticos e influencia social

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

Se incluyó a los 47 adolescentes evaluados para la transición de género en el servicio juvenil de Tampere en 2011 a 2013; su edad media al llegar era de unos 16,6 años.
41 de los 47 (87 %) habían nacido mujer, una proporción que los autores dijeron no poder explicar.
El 75 % había estado en atención especializada de salud mental infantil y adolescente por motivos distintos del malestar de género, y el 68 % acudió por primera vez a los servicios de salud mental por motivos no relacionados con el género.
Los problemas tratados incluían depresión (64 %), ansiedad (55 %), pensamientos suicidas o autolesiones (53 %), autismo (26 %) y síntomas psicóticos como oír voces (13 %).
El 64 % (30 de 47) no tuvo malestar de género ni conducta propia del otro sexo en la infancia que ellos o sus padres pudieran recordar, y el 62 % empezó a cuestionarse su género a los 12 años o más.
El 57 % había sufrido acoso grave. En el 73 % de estos casos el acoso empezó antes de cualquier inquietud de género, sobre todo por motivos no relacionados con el género.
El grupo más numeroso (23 de 47) desarrolló malestar de género en la adolescencia junto con una confusión más amplia sobre quiénes eran, soledad y esperanzas muy altas de que la transición resolviera sus problemas.
La soledad y el aislamiento social fueron la señal más fuerte de pertenecer a este grupo: los adolescentes aislados tenían unas 9 veces más probabilidades de estar en él.

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.

detrans.ai

Summary

Key findings

Abstract

Conclusion