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

• Los dos autores revisaron a todos los adolescentes (de 12 años en adelante) que evaluaron en GIDS entre octubre de 2015 y abril de 2017: 156 casos, reducidos a 128 tras excluir algunos.
• 12 de los 128 (9,4 %) tenían un malestar de género que empezó en la adolescencia, pidieron tratamiento médico al principio y dejaron de quererlo durante la evaluación.
• De los 12, siete llegaron a sentirse cómodos con su sexo de nacimiento, mientras que cinco seguían identificándose como trans pero ya no querían hormonas.
• La mayoría eran chicas (9 de 12), de 12 a 16 años (media de 14). 7 ya tenían un diagnóstico de autismo, 7 habían pensado en el suicidio recientemente, 7 se habían autolesionado y 2 habían intentado suicidarse recientemente.
• La mayoría no había hecho una transición social (7 de 12), y la mayoría no tenía un diagnóstico formal de disforia de género de quien los derivó (9 de 12).
• Las evaluaciones fueron más largas que las 3 a 6 sesiones habituales de la clínica: de media 6,6 sesiones a lo largo de 9,6 meses, sobre todo con la familia.
• Dos historias de casos, un chico autista de 14 años y una chica autista de 14 años con un trastorno alimentario previo, describen cómo el malestar pasó a entenderse en términos de acoso escolar, homofobia, ruptura familiar y miedo a la pubertad.
• Los autores piden una revisión completa de los registros de toda la clínica e investigación a largo plazo, y dicen que el tratamiento médico sigue ayudando a algunos jóvenes.

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.