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

• 2011~2013년 탐페레의 청소년 서비스에서 성별 전환 평가를 받은 10대 47명 전원이 포함되었으며, 도착 시 평균 연령은 약 16.6세였습니다.
• 47명 중 41명(87%)이 출생 시 여성이었는데, 저자들은 이 비율을 설명할 수 없다고 말했습니다.
• 75%는 성별 불쾌감이 아닌 이유로 전문 아동·청소년 정신 건강 진료를 받은 적이 있었고, 68%는 성별과 무관한 이유로 처음 정신 건강 서비스를 찾았습니다.
• 치료받은 문제에는 우울(64%), 불안(55%), 자살 생각 또는 자해(53%), 자폐(26%), 환청 같은 정신병적 증상(13%)이 포함되었습니다.
• 64%(47명 중 30명)는 본인이나 부모가 기억하는 어린 시절 성별 불쾌감이나 반대 성 행동이 없었고, 62%는 12세 이상에서 자신의 성별에 의문을 갖기 시작했습니다.
• 57%는 심하게 괴롭힘을 당했습니다. 이 중 73%에서 괴롭힘은 성별에 대한 고민보다 먼저 시작되었고, 대부분 성별과 무관한 이유였습니다.
• 가장 큰 집단(47명 중 23명)은 10대에 자신이 누구인지에 대한 더 폭넓은 혼란, 외로움, 전환이 문제를 해결해 줄 것이라는 매우 높은 기대와 함께 성별 불쾌감이 생겼습니다.
• 외로움과 사회적 고립이 이 집단에 속한다는 가장 강한 신호였습니다. 고립된 10대는 이 집단에 속할 가능성이 약 9배였습니다.

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.