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

• Os dois autores revisaram todos os adolescentes (a partir de 12 anos) que avaliaram no GIDS entre outubro de 2015 e abril de 2017: 156 casos, reduzidos a 128 após algumas exclusões.
• 12 dos 128 (9,4%) tinham sofrimento de gênero que começou na adolescência, pediram tratamento médico no início e deixaram de querê-lo durante a avaliação.
• Dos 12, sete passaram a se sentir confortáveis com o sexo de nascimento, enquanto cinco ainda se identificavam como trans, mas não queriam mais hormônios.
• A maioria eram meninas (9 de 12), com idades de 12 a 16 anos (média de 14). 7 já tinham diagnóstico de autismo, 7 haviam pensado recentemente em suicídio, 7 haviam se automutilado e 2 haviam tentado suicídio recentemente.
• A maioria não havia feito a transição social (7 de 12), e a maioria não tinha diagnóstico formal de disforia de gênero por parte de quem os encaminhou (9 de 12).
• As avaliações foram mais longas do que as 3 a 6 sessões habituais da clínica: em média 6,6 sessões ao longo de 9,6 meses, a maioria com a família.
• Dois relatos de caso, um menino autista de 14 anos e uma menina autista de 14 anos com histórico de transtorno alimentar, descrevem o sofrimento passando a ser entendido em termos de bullying, homofobia, rompimento familiar e medo da puberdade.
• Os autores pedem uma revisão completa dos registros de toda a clínica e pesquisas de longo prazo, e dizem que o tratamento médico ainda ajuda alguns jovens.

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.