사회적 전환을 한 아동에서 정신건강 차이 발견되지 않음

아동 및 청소년에서 성별 관련 사회적 전환의 영향: 체계적 문헌 고찰

Authors: Ruth Hall, Jo Taylor, Catherine Elizabeth Hewitt, Claire Heathcote, Stuart William Jarvis, Trilby Langton, Lorna Fraser
Journal: Archives of Disease in Childhood
Year: 2024
Source: adc.bmj.com/content/109/Suppl_2/s12

Summary

Social transition means changing name, pronouns or appearance to live as another gender. York researchers found only 11 studies of how this affects children and teenagers with gender dysphoria, mostly of low quality. Most were one-off snapshots rather than following children over time. Many recruited through support groups, and five used the same group of US children. Socially transitioned children generally did not differ in mental health from comparison groups. Results for teenagers conflicted: using a chosen name was linked to less depression, but transitioning as a teenager was linked to more suicide attempts than transitioning as an adult. Two studies linked childhood transition to dysphoria lasting longer. The authors conclude that neither benefit nor harm has been shown. The review supports 'we do not know'. Critics have disputed how the York reviews judged study quality.

Key findings

2022년 4월까지 연구 데이터베이스 다섯 곳에서 찾은 28,000건 넘는 기록 중 11건의 연구만 자격을 갖췄습니다. 8건은 한 시점의 단면 연구였고, 아동을 시간 순으로 추적한 것은 1건뿐이었습니다.
질은 낮거나 중간이었고 8점 만점에 1.5~5점이었습니다. 주된 문제는 참여를 선택했거나 클리닉에서 의뢰된 표본이었고, 추적 기간 후 결과를 측정한 연구는 3건뿐이었습니다.
11건 중 5건은 지지 모임을 통해 모집한 같은 미국 프로젝트를 이용했습니다. 이 가족들은 평균보다 부유했고 대부분의 부모는 이른 전환을 지지했습니다.
사회적으로 전환한 아동은 일반 인구, 형제자매, 짝지은 아동과 비교해 우울에 차이를 보이지 않았습니다. 그러나 부모는 일반 인구와 짝지은 아동보다 불안이 더 많다고 보고했습니다.
청소년에서는 선택한 이름을 쓰는 것이 우울 증상과 자살 생각이 적은 것과 관련이 있었습니다. 그러나 한 연구는 성인이 아닌 10대에 전환한 것이 지난 1년의 더 많은 자살 생각과 평생 더 많은 자살 시도와 관련이 있다고 밝혔습니다.
두 연구는 어린 시절의 사회적 전환이 불쾌감의 지속과 관련 있다고 했습니다. 한 연구는 10대까지 지속될 가능성이 더 높다고 했고(출생 시 남성 아동에서는 분명히), 다른 연구는 약 5.4년 후에도 92.7%가 여전히 트랜스젠더로 정체화했으며 대부분 의학적 치료로 이어졌다고 했습니다.
저자들은 공정한 비교 집단과 함께 아동을 시간 순으로 추적한 연구가 없다고 결론짓습니다. 의사와 지침은 이익이든 해든 강한 근거가 없음을 인정해야 합니다.

Abstract

BACKGROUND: Increasing numbers of children and adolescents experiencing gender dysphoria or incongruence are being referred to specialist gender services. Historically, social transitioning prior to assessment was rare but it is becoming more common. AIM: To identify and synthesise studies assessing the outcomes of social transition for children and adolescents (under 18) experiencing gender dysphoria/incongruence. METHODS: A systematic review and narrative sythesis. Database searches (Medline, Embase, CINAHL, PsycINFO, Web of Science) were perfomed in April 2022. Studies reporting any outcome of social transition (full or partial) for children and adolescents experiencing gender dysphoria/incongruence were included. An adapted version of the Newcastle-Ottawa Scale for cohort studies was used to appraise study quality. RESULTS: Eleven studies were included (children (n=8) and adolescents (n=3)) and most were of low quality. The majority were from the US, featured community samples and cross-sectional analyses. Different comparator groups were used, and outcomes related to mental health and gender identity reported. Overall studies consistently reported no difference in mental health outcomes for children who socially transitioned across all comparators. Studies found mixed evidence for adolescents who socially transitioned. CONCLUSIONS: It is difficult to assess the impact of social transition on children/adolescents due to the small volume and low quality of research in this area. Importantly, there are no prospective longitudinal studies with appropriate comparator groups assessing the impact of social transition on mental health or gender-related outcomes for children/adolescents. Professionals working in the area of gender identity and those seeking support should be aware of the absence of robust evidence of the benefits or harms of social transition for children and adolescents. PROSPERO REGISTRATION NUMBER: CRD42021289659.

Conclusion

The studies included in this review are of low quality, therefore, it is difficult to assess the impact of social transition in this population. Importantly, there are no prospective longitudinal studies with appropriate comparator groups which have assessed the impact of social transition on the mental health or gender-related outcomes for children or adolescents experiencing gender dysphoria/incongruence. Healthcare professionals, clinical guidelines and advocacy organisations should acknowledge the lack of robust evidence of the benefits or harms of social transition when working with children, adolescents and their families.

Methodological limitations

Weak studies: 8 of the 11 studies were one-time snapshots, quality scores ranged from 1.5 to 5 out of 8, and none followed children forward with a fair comparison group. So the review cannot say social transition caused any result (the authors agree).
The same children counted more than once: Five studies came from one US project and two from the Amsterdam clinic. 'Consistent' findings partly reflect the same children being counted again.
Poor comparison groups: None of the community studies of children had a suitable comparison group. Several compared transitioned children with the general population or with siblings without dysphoria, which cannot show whether transition helped or harmed.
Other explanations for lasting dysphoria: Children with stronger dysphoria may be more likely to transition. That could explain the link with dysphoria lasting, rather than transition causing it.
Results tallied, not combined: The studies were too different to combine mathematically, so the review mostly counted which direction results pointed. This ignores how big or how precise each result was.
Many tests in small studies: Small studies tested many outcomes (one study tested six measures of suicidality, and two came out positive). Single striking results in either direction may be chance (the authors note this).
Out of date and English only: Searches ended in April 2022 and only English-language journal studies were included (the authors note this), so later studies are missing.
Unclear measurement: Social transition was defined broadly and mostly reported by parents or the young people themselves. Only 3 studies measured it in a standard way, and definitions varied a lot.
May not apply to today's clinic patients: Most studies were US-based and drew on community or support-group samples. These may not resemble the mostly female teenagers whose dysphoria began in adolescence who now make up most clinic referrals.
Published criticism of the York reviews: Noone et al. (2025) and a Yale Integrity Project paper (McNamara et al., 2024) argued that the way the York reviews judged quality, and their conclusions, were flawed. Others have defended the reviews.
Paid for by NHS England: The review was funded to inform the Cass Review. The authors declare no conflicts and say the funder played no part in how it was done or interpreted.

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