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

• I due autori hanno riesaminato tutti gli adolescenti (dai 12 anni in su) da loro valutati al GIDS tra ottobre 2015 e aprile 2017: 156 casi, ridotti a 128 dopo l'esclusione di alcuni.
• 12 dei 128 (9,4%) avevano un disagio di genere iniziato in adolescenza, avevano chiesto un trattamento medico all'inizio e hanno smesso di volerlo durante la valutazione.
• Dei 12, sette hanno raggiunto una serenità con il proprio sesso di nascita, mentre cinque si identificavano ancora come trans ma non volevano più gli ormoni.
• La maggior parte erano ragazze (9 su 12), di età compresa tra 12 e 16 anni (media 14). 7 avevano già una diagnosi di autismo, 7 avevano pensato di recente al suicidio, 7 si erano autolesionati e 2 avevano tentato di recente il suicidio.
• La maggior parte non aveva fatto la transizione sociale (7 su 12), e la maggior parte non aveva una diagnosi formale di disforia di genere da parte di chi li aveva inviati (9 su 12).
• Le valutazioni sono state più lunghe delle usuali 3-6 sedute della clinica: in media 6,6 sedute in 9,6 mesi, per lo più con la famiglia.
• Due storie di casi, un ragazzo autistico di 14 anni e una ragazza autistica di 14 anni con un passato di disturbo alimentare, descrivono un disagio che è arrivato a essere compreso in termini di bullismo, omofobia, rottura familiare e paura della pubertà.
• Gli autori chiedono una revisione completa delle cartelle in tutta la clinica e una ricerca a lungo termine, e affermano che il trattamento medico aiuta comunque alcuni giovani.

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.