フィンランドのジェンダークリニック：10代の申請者の87%が出生時は女児で、75%が以前に精神科治療を受けていた

未成年向けジェンダーアイデンティティサービスの2年間：青年期の発達に重い問題を抱える出生時女児の過剰な割合

コホート研究とレジストリ研究自閉症、トラウマ及び併存症状増加する診断数と社会的影響

Authors: Riittakerttu Kaltiala-Heino, Maria Sumia, Marja Työläjärvi, Nina Lindberg
Journal: Child and Adolescent Psychiatry and Mental Health
Year: 2015
Source: https://doi.org/10.1186/s13034-015-0042-y

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

2011年から2013年にタンペレの青少年サービスで性別移行のために評価された10代47人全員が含まれ、到着時の平均年齢は約16.6歳でした。
47人のうち41人（87%）は女性として生まれており、著者らはこの割合を説明できないと述べています。
75%は、性別への苦痛以外の理由で、専門的な児童・思春期のメンタルヘルスケアを受けており、68%は、性別とは無関係な理由で最初にメンタルヘルスサービスに来ていました。
治療された問題には、うつ病（64%）、不安（55%）、自殺念慮または自傷（53%）、自閉症（26%）、声が聞こえるなどの精神病症状（13%）が含まれていました。
64%（47人中30人）は、本人や親が覚えている子ども時代の性別への苦痛や異性の行動がなく、62%は12歳以降に自分の性別に疑問を持ち始めました。
57%はひどいいじめを受けていました。このうち73%では、いじめは性別に関する懸念より前に始まっており、大半は性別とは関係のない理由でした。
最大のグループ（47人中23人）は、自分が何者なのかについてのより広い混乱、孤独、そしてトランジションが問題を解決するという非常に高い期待とともに、10代で性別への苦痛を抱くようになりました。
孤独と社会的孤立が、このグループに属する最も強い兆候でした。孤立している10代は、そのグループに入る確率が約9倍でした。

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.

Methodological limitations

Small group: Only 47 teens (6 born male), which limits comparisons and makes figures less precise. The authors admit the data are too few for complex analyses.
One clinic: Data come from one of Finland's two youth gender services. The claim that the Helsinki service saw similar patients rests on an unpublished personal communication.
Looking back at clinic files: Records were written to care for patients, not for research, and some information was missing.
Earlier diagnoses unclear: Past mental health problems were taken from referral letters and files that often lacked a formal diagnosis. Only problems that led to treatment were counted, so the rates are probably too low.
Childhood relied on memory: Whether a teen had gender distress as a child depended on what they and their parents remembered during assessment, which may be incomplete.
Groupings made by the authors: The five pathways the authors describe were drawn up by the clinic team from case files, with no reported independent check of how cases were sorted.
No comparison group: There was no group of other teen mental health patients to compare with, so it is hard to judge how unusual these profiles are.
Describes, doesn't explain: The study is a single snapshot. It cannot show whether mental health problems cause gender distress or the reverse, and it reports no treatment results.
May not apply elsewhere: It is a Finnish public service with its own laws (legal and surgical transition only from 18). The authors note the findings cannot be applied to all gender-questioning young people.

detrans.ai

Summary

Key findings

Abstract

Conclusion