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

• 두 저자는 2015년 10월부터 2017년 4월 사이 GIDS에서 평가한 모든 10대(12세 이상)를 검토했습니다. 156건이었고 일부를 제외해 128건이 되었습니다.
• 128명 중 12명(9.4%)은 성별 불쾌감이 10대에 시작되었고, 처음에 의학적 치료를 요청했으며, 평가 중 그것을 더 이상 원하지 않게 되었습니다.
• 12명 중 7명은 출생 성별에 편안해졌고, 5명은 여전히 트랜스로 정체화했지만 더 이상 호르몬을 원하지 않았습니다.
• 대부분이 여아(12명 중 9명)였고 12~16세(평균 14세)였습니다. 7명은 이미 자폐 진단을 받았고, 7명은 최근 자살을 생각했으며, 7명은 자해했고, 2명은 최근 자살을 시도했습니다.
• 대부분은 사회적 전환을 하지 않았고(12명 중 7명), 대부분은 의뢰한 사람으로부터 성별 불쾌감 공식 진단을 받지 않았습니다(12명 중 9명).
• 평가는 클리닉의 통상적인 3~6회기보다 길었습니다. 평균 9.6개월 동안 6.6회기였고 대부분 가족과 함께였습니다.
• 두 가지 사례 이야기, 14세 자폐 남아와 섭식장애 병력이 있는 14세 자폐 여아는 고통이 괴롭힘, 동성애 혐오, 가족 붕괴, 사춘기에 대한 두려움으로 이해되게 된 과정을 설명합니다.
• 저자들은 클리닉 전체 기록의 전면적인 검토와 장기 연구를 요구하며, 의학적 치료가 여전히 일부 젊은이에게 도움이 된다고 말합니다.

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.