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
- همهٔ 47 نوجوان ارزیابی‌شده برای گذار جنسیتی در خدمت جوانان تامپره در 2011 تا 2013 شامل شدند؛ میانگین سن هنگام ورود حدود 16.6 بود.
- 41 نفر از 47 نفر (87%) زن‌متولد بودند، سهمی که نویسندگان گفتند نمی‌توانند توضیح دهند.
- 75% به دلایلی غیر از ناراحتی جنسیتی در مراقبت تخصصی سلامت روان کودک و نوجوان بودند، و 68% نخستین‌بار به دلایل نامرتبط با جنسیت به خدمات سلامت روان آمده بودند.
- مشکلات تحت درمان شامل افسردگی (64%)، اضطراب (55%)، افکار خودکشی یا آسیب به خود (53%)، اوتیسم (26%) و علائم روان‌پریشی مانند شنیدن صدا (13%) بود.
- 64% (30 نفر از 47 نفر) در کودکی ناراحتی جنسیتی یا رفتار مغایر جنس نداشتند که خودشان یا والدینشان به یاد بیاورند، و 62% پرسش دربارهٔ جنسیتشان را در 12 سالگی یا بعد آغاز کردند.
- 57% به‌شدت قلدری شده بودند. در 73% این موارد قلدری پیش از هر نگرانی جنسیتی آغاز شد، بیشتر به دلایل نامرتبط با جنسیت.
- بزرگ‌ترین گروه (23 نفر از 47 نفر) ناراحتی جنسیتی را در نوجوانی همراه با سردرگمی گسترده‌تر دربارهٔ اینکه چه کسی هستند، تنهایی، و امید بسیار بالا که گذار مشکلاتشان را حل کند پیدا کردند.
- تنهایی و انزوای اجتماعی قوی‌ترین نشانهٔ تعلق به این گروه بود: احتمال عضویت نوجوانان منزوی در آن حدود 9 برابر بود.
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.