Summary

Clinicians at an English adult gender clinic reviewed the notes of everyone discharged in one year. They wanted to see who got the treatment they wanted, who dropped out, and who went back to living as their birth sex. Just over half completed the planned treatment. 58% got everything they first asked for. Nearly all who wanted hormones got them, but fewer than half who wanted genital surgery had it. About one in five stopped attending and one in five were referred back soon after leaving. People with autism or similar conditions, more childhood hardship, or drug, alcohol or mental health problems during treatment were less likely to get care as planned. Twelve people (6.9%) detransitioned, far more than an earlier UK clinic figure of 0.3%. Because data came only from notes and follow-up was at most 16 months, the detransition figure is probably too low.

Key findings

• 1년 동안 퇴원한 성인 175명 중 56.1%가 계획된 치료를 마쳤고 58%가 처음 요청한 치료를 모두 받았습니다.
• 호르몬을 원한 사람의 94%가 받았지만 생식기 수술을 원한 사람은 47.7%만 받았습니다(남성에서 여성으로의 수술 56.5%, 여성에서 남성으로의 수술 25.8%).
• 16개월의 자료 안에서 21.7%가 클리닉 출석을 중단했고 19.4%가 다시 의뢰되었으며, 대부분(34명 중 24명)이 치료를 마치지 못한 상태였습니다.
• 자폐 및 유사한 상태(오즈 약 6배), 아동기 어려움의 종류가 하나 늘 때마다(약 1.5배), 치료 중 약물·알코올 문제(약 4배), 치료 중 정신 건강 문제(약 2배)가 각각 계획대로 진료를 받지 못하는 것과 관련이 있었습니다.
• 12명(6.9%)이 이 연구의 디트랜지션 정의에 해당했습니다. 2명은 후회가 기록되었고 12명 중 4명은 나중에 클리닉에 다시 의뢰되었습니다.
• 환자의 42.9%에서 치료 중 정신 건강 문제가 기록되었고, 3명이 치료 중 자살로 사망했습니다.
• 저자들은 새롭고 더 빠른 서비스 모델이 다양하고 복잡한 환자 집단의 필요를 충족하지 못할 수 있다고 경고합니다.

Abstract

Background: UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently 'detransition'. Aims: To describe service users' access to care and patterns of service use, specifically, interventions accessed, reasons for discharge and re-referrals; to identify factors associated with access; and to quantify 'detransitioning'. Method: A retrospective case-note review was performed as a service evaluation for 175 service users consecutively discharged by a tertiary National Health Service adult GIC between 1 September 2017 and 31 August 2018. Descriptive statistics were used for rates of accessing interventions sought, reasons for discharge, re-referral and frequency of detransitioning. Using multivariate analysis, we sought associations between several variables and 'accessing care' or 'other outcome'. Results: The treatment pathway was completed by 56.1%. All interventions initially sought were accessed by 58%; 94% accessed hormones but only 47.7% accessed gender reassignment surgery; 21.7% disengaged; and 19.4% were re-referred. Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7-19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1-1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1-17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1-4.4) as independently associated with accessing care. Twelve people (6.9%) met our case definition of detransitioning. Conclusions: Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.

Conclusion

Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.