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

• 2人の著者は、2015年10月から2017年4月の間にGIDSで評価した12歳以上のすべての10代を振り返りました。156例で、一部を除外して128例になりました。
• 128人のうち12人（9.4%）は、性別への苦痛が10代で始まり、最初は医学的治療を希望していましたが、評価の間にそれを望まなくなりました。
• 12人のうち7人は生まれつきの性別に心地よさを感じるようになり、5人は引き続きトランスだと自認していましたが、もうホルモンを望みませんでした。
• 大半は女子（12人中9人）で、年齢は12～16歳（平均14歳）でした。7人はすでに自閉症と診断されており、7人は最近自殺を考え、7人は自傷をしており、2人は最近自殺を図りました。
• 大半は社会的トランジションをしておらず（12人中7人）、紹介元からの性別違和の正式な診断を受けていない人が大半でした（12人中9人）。
• 評価は、クリニックの通常の3～6回より長く、9.6か月の間に平均6.6回で、その大半は家族との面談でした。
• 2つの症例の話（14歳の自閉症の男子と、過去に摂食障害のあった14歳の自閉症の女子）は、苦痛が、いじめ、同性愛嫌悪、家族の崩壊、思春期への恐れという観点から理解されるようになった過程を描いています。
• 著者らは、クリニック全体の記録の包括的な見直しと長期的な研究を求めており、医学的治療が一部の若者には今も役立つとも述べています。

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.