Summary
Social transition means changing name, pronouns or appearance to live as another gender. York researchers found only 11 studies of how this affects children and teenagers with gender dysphoria, mostly of low quality. Most were one-off snapshots rather than following children over time. Many recruited through support groups, and five used the same group of US children. Socially transitioned children generally did not differ in mental health from comparison groups. Results for teenagers conflicted: using a chosen name was linked to less depression, but transitioning as a teenager was linked to more suicide attempts than transitioning as an adult. Two studies linked childhood transition to dysphoria lasting longer. The authors conclude that neither benefit nor harm has been shown. The review supports 'we do not know'. Critics have disputed how the York reviews judged study quality.
Key findings
- از بیش از 28,000 رکورد یافت‌شده در پنج پایگاه داده پژوهشی تا آوریل 2022، فقط 11 مطالعه واجد شرایط بود. هشت مطالعه تصویرهای لحظه‌ای بودند و فقط یکی کودکان را رو به جلو پیگیری کرد.
- کیفیت پایین تا متوسط بود، با امتیاز 1.5 تا 5 از 8. مشکل اصلی نمونه‌هایی از افرادی بود که شرکت را انتخاب کرده بودند یا کلینیک‌ها ارجاع داده بودند، و فقط 3 مطالعه نتایج را پس از یک دورهٔ پیگیری سنجیدند.
- پنج مطالعه از 11 مطالعه از یک پروژهٔ آمریکایی بودند که از طریق گروه‌های حمایتی جذب می‌کرد. خانواده‌هایش مرفه‌تر از میانگین بودند و بیشتر والدین از گذار زودهنگام حمایت می‌کردند.
- کودکانی که گذار اجتماعی کردند در افسردگی تفاوتی با عموم جمعیت، خواهر و برادرها یا کودکان همسان نشان ندادند. اما والدین اضطراب بیشتری نسبت به عموم جمعیت و کودکان همسان گزارش کردند.
- در نوجوانان، استفاده از نام انتخابی با علائم افسردگی کمتر و افکار خودکشی کمتر مرتبط بود. اما یک مطالعه دریافت گذار در نوجوانی به‌جای بزرگسالی با افکار خودکشی بیشتر در سال گذشته و اقدام‌های خودکشی بیشتر در طول زندگی مرتبط بود.
- دو مطالعه گذار اجتماعی دوران کودکی را با ادامهٔ دیسفوریا مرتبط دانستند. یکی احتمال ماندگاری تا نوجوانی را بیشتر یافت (به‌روشنی برای کودکان مردمتولد). دیگری یافت 92.7% حدود 5.4 سال بعد هنوز خود را ترنسجندر می‌دانستند و بیشتر به درمان پزشکی ادامه دادند.
- نویسندگان نتیجه می‌گیرند هیچ مطالعه‌ای کودکان را رو به جلو با یک گروه مقایسهٔ منصفانه پیگیری نکرده است. پزشکان و رهنمودها باید بپذیرند شواهد قوی نه از فایده و نه از آسیب وجود ندارد.
Abstract
BACKGROUND: Increasing numbers of children and adolescents experiencing gender dysphoria or incongruence are being referred to specialist gender services. Historically, social transitioning prior to assessment was rare but it is becoming more common. AIM: To identify and synthesise studies assessing the outcomes of social transition for children and adolescents (under 18) experiencing gender dysphoria/incongruence. METHODS: A systematic review and narrative sythesis. Database searches (Medline, Embase, CINAHL, PsycINFO, Web of Science) were perfomed in April 2022. Studies reporting any outcome of social transition (full or partial) for children and adolescents experiencing gender dysphoria/incongruence were included. An adapted version of the Newcastle-Ottawa Scale for cohort studies was used to appraise study quality. RESULTS: Eleven studies were included (children (n=8) and adolescents (n=3)) and most were of low quality. The majority were from the US, featured community samples and cross-sectional analyses. Different comparator groups were used, and outcomes related to mental health and gender identity reported. Overall studies consistently reported no difference in mental health outcomes for children who socially transitioned across all comparators. Studies found mixed evidence for adolescents who socially transitioned. CONCLUSIONS: It is difficult to assess the impact of social transition on children/adolescents due to the small volume and low quality of research in this area. Importantly, there are no prospective longitudinal studies with appropriate comparator groups assessing the impact of social transition on mental health or gender-related outcomes for children/adolescents. Professionals working in the area of gender identity and those seeking support should be aware of the absence of robust evidence of the benefits or harms of social transition for children and adolescents. PROSPERO REGISTRATION NUMBER: CRD42021289659.
Conclusion
The studies included in this review are of low quality, therefore, it is difficult to assess the impact of social transition in this population. Importantly, there are no prospective longitudinal studies with appropriate comparator groups which have assessed the impact of social transition on the mental health or gender-related outcomes for children or adolescents experiencing gender dysphoria/incongruence. Healthcare professionals, clinical guidelines and advocacy organisations should acknowledge the lack of robust evidence of the benefits or harms of social transition when working with children, adolescents and their families.