Summary
Clinicians at an English adult gender clinic reviewed the notes of everyone discharged in one year. They wanted to see who got the treatment they wanted, who dropped out, and who went back to living as their birth sex. Just over half completed the planned treatment. 58% got everything they first asked for. Nearly all who wanted hormones got them, but fewer than half who wanted genital surgery had it. About one in five stopped attending and one in five were referred back soon after leaving. People with autism or similar conditions, more childhood hardship, or drug, alcohol or mental health problems during treatment were less likely to get care as planned. Twelve people (6.9%) detransitioned, far more than an earlier UK clinic figure of 0.3%. Because data came only from notes and follow-up was at most 16 months, the detransition figure is probably too low.
Key findings
- מבין 175 בוגרים ששוחררו בשנה אחת, 56.1% השלימו את הטיפול המתוכנן ו-58% קיבלו את כל הטיפולים שביקשו בתחילה.
- 94% ממי שרצו הורמונים קיבלו אותם, אבל רק 47.7% ממי שרצו ניתוח באיברי המין (56.5% בניתוח מזכר לנקבה ו-25.8% בניתוח מנקבה לזכר).
- 21.7% הפסיקו להגיע למרפאה ו-19.4% הופנו בחזרה בתוך 16 חודשי הנתונים, רובם (24 מתוך 34) בלי שסיימו את הטיפול.
- אוטיזם ומצבים דומים (סיכוי גבוה פי 6 בקירוב), כל סוג נוסף של קושי בילדות (פי 1.5 בקירוב), בעיות סמים או אלכוהול במהלך הטיפול (פי 4 בקירוב) ובעיות בריאות נפשית במהלך הטיפול (פי 2 בקירוב) נקשרו כל אחד לאי קבלת טיפול כמתוכנן.
- שנים עשר אנשים (6.9%) עמדו בהגדרת המחקר לדטרנזישן. לשניים נרשמה חרטה, וארבעה מהשנים עשר הופנו מאוחר יותר בחזרה למרפאה.
- בעיות בריאות נפשית נרשמו במהלך הטיפול אצל 42.9% מהמטופלים, ושלושה אנשים מתו מהתאבדות בזמן הטיפול.
- החוקרים מזהירים שמודלים חדשים ומהירים יותר של שירות עלולים לא לענות על הצרכים של קבוצה מגוונת ומורכבת של מטופלים.
Abstract
Background: UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently 'detransition'. Aims: To describe service users' access to care and patterns of service use, specifically, interventions accessed, reasons for discharge and re-referrals; to identify factors associated with access; and to quantify 'detransitioning'. Method: A retrospective case-note review was performed as a service evaluation for 175 service users consecutively discharged by a tertiary National Health Service adult GIC between 1 September 2017 and 31 August 2018. Descriptive statistics were used for rates of accessing interventions sought, reasons for discharge, re-referral and frequency of detransitioning. Using multivariate analysis, we sought associations between several variables and 'accessing care' or 'other outcome'. Results: The treatment pathway was completed by 56.1%. All interventions initially sought were accessed by 58%; 94% accessed hormones but only 47.7% accessed gender reassignment surgery; 21.7% disengaged; and 19.4% were re-referred. Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7-19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1-1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1-17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1-4.4) as independently associated with accessing care. Twelve people (6.9%) met our case definition of detransitioning. Conclusions: Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.
Conclusion
Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.