デトランシショナー向けのプロトコルは存在しない：臨床リーダーが緊急の研究とサービスを要請

討論：性別のディシスター／デトランジショナーに対する研究とサービスの切実な必要性

Authors: Catherine Butler, Anna Hutchinson
Journal: Child and Adolescent Mental Health
Year: 2020
Source: acamh.onlinelibrary.wiley.com/doi/abs/10.1111/camh.12361

Summary

This paper calls for research and clinical guidance for people who stop or reverse a gender transition. The authors note these people turn up in every follow-up study of young people with gender distress, yet professionals and activists have largely ignored them. They review figures on how common desistance is, theories about why it happens, and big gaps in the research, especially that today's patients are very different from those in older studies. They suggest early advice: support without judgement, accept that gender and sexuality can change, and keep medical teams on hand to help reverse treatment. They argue that with referrals rising, building evidence and clear guidance is urgent. It is a reasonable call to action, but it is opinion based on selected older studies, not new research, and its advice is not yet tested.

Key findings

デシストする人やデトランジションする人は、性別への苦痛のある若者を対象としたすべての追跡研究に現れます。しかし著者らは、トランジションの指針は詳細なのに、彼らを支えるための指針がなかったと指摘しています。
引用された推定では、性別への苦痛のある子どもの73～98%は違和感がなくなりました（RistoriとSteensma、2016）。古い研究には、性別規範に合わないが性別への苦痛はない子どもが含まれていた可能性があります。
成人の追跡研究は、多くの人が脱落し、約1年にとどまることが多くあります。あるスウェーデンの研究では、後悔が表れるまで平均8年かかったため、現在の後悔の数字は今日の患者を反映していない可能性があります。
患者の5つの変化を挙げています。若年の紹介が大幅に増えたこと、女性として生まれた人が増えたこと、ノンバイナリーが増えたこと、すでに社会的トランジションをしている人が増えたこと、思春期に苦痛が始まった人が増えたことです。
現在の患者の多くは、他のメンタルヘルスの状態や自閉症も抱えており、以前の研究ではほとんど調べられていませんでした。
助言は、批判せずに支えること、性別や性的指向の自認は変わりうるものとして扱うこと、家族や社会生活に注意を払うこと、さまざまな仲間のグループにつなぐこと、治療を元に戻す手助けができる医療チームを利用可能にしておくことです。

Abstract

The number of people presenting at gender clinics is increasing worldwide. Many people undergo a gender transition with subsequent improved psychological wellbeing (de Vries et al., 2014). However, some people choose to stop this journey, ‘desisters’, or to reverse their transition, ‘detransitioners’. It has been suggested that some professionals and activists are reluctant to acknowledge the existence of desisters and detransitioners, possibly fearing that they may delegitimise persisters’ experiences (Zucker, 2018). Certainly, despite their presence in all follow-up studies of young people who have experienced Gender Dysphoria (GD), little thought has been given to how we might support this cohort. Levine (2017) reports that the 8th edition of the WPATH Standards of Care will include a section on detransitioning - confirming that this is an increasingly witnessed phenomenon worldwide. It also highlights that compared to the extensive protocols for working with children, adolescents and adults who wish to transition, nothing exists for those working with desisters or detransitioners. With very little research and no clear guidance on how to work with this population, and with numbers of referrals to gender services increasing, this is a timely juncture to consider factors that should be taken into account within clinical settings and areas for future research.

Conclusion

Research with populations who desist and detransition is in its infancy and little is known about how best to work with this growing population. While there is increasing recognition of the need for support for those who require it, there are still no clear guidelines on how to do this work. We are at an important juncture where our evidence-base is based on previous cohorts that may not be applicable to the current population of desisters and detransitioners; it is prudent to consider their needs alongside those who go on to identify as trans for life.

Methodological limitations

Short opinion piece: This is a three-page debate article with no search method, rules for choosing studies or quality checks. The evidence it cites is hand-picked and may be incomplete.
No new data: It has no new data, interviews or analysis. Its advice for clinicians is expert opinion.
Disputed figures on children growing out of it: The 73 to 98% figures come from older Dutch and North American studies whose methods are disputed, for example including children without a diagnosis, or counting people who dropped out as having desisted. The authors mention the diagnosis issue but not the wider debate (Temple Newhook et al., 2018), apart from citing Zucker's reply.
Benefit claim rests on one study: The claims that many people improve after transition, and that no teenager on hormones desisted after a year, both come from one Dutch study (de Vries et al., 2014). Whether it applies to today's patients has since been questioned (for example by Abbruzzese, Levine and Mason, 2023).
Old evidence for a new group: The authors argue that today's patients are very different from earlier ones, but they have to rely on research about those earlier patients. So their advice rests only partly on evidence about today's patients.
Little evidence about detransitioners themselves: Almost all the evidence cited is about children growing out of gender distress or adults regretting surgery. There were basically no studies of detransitioners' needs at the time, so the advice for them is guesswork from other groups.
Sexual orientation claim not examined: The claim that all the young people whose gender distress persisted in Steensma et al. (2011) were attracted to the same sex, and took this to confirm they were the other sex, comes from one small interview study, and its small size isn't discussed.
Author perspective: Hutchinson co-wrote a 2020 letter supporting research into 'rapid-onset gender dysphoria' (the idea that gender distress can appear suddenly under social influence) with Midgen and Spiliadis. No competing interests were declared.

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