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

• Cei doi autori au revăzut toți adolescenții (de 12 ani și peste) pe care i-au evaluat la GIDS între octombrie 2015 și aprilie 2017: 156 de cazuri, reduse la 128 după excluderea unora.
• 12 din 128 (9,4%) aveau suferință legată de gen începută în adolescență, ceruseră tratament medical la început și au încetat să-l mai dorească în timpul evaluării.
• Dintre cei 12, șapte au ajuns să se simtă confortabil cu sexul lor la naștere, iar cinci încă se identificau ca trans, dar nu mai voiau hormoni.
• Majoritatea erau fete (9 din 12), cu vârste între 12 și 16 ani (media 14). 7 fuseseră deja diagnosticați cu autism, 7 se gândiseră recent la sinucidere, 7 se autovătămaseră și 2 încercaseră recent să se sinucidă.
• Majoritatea nu făcuseră tranziția socială (7 din 12), iar majoritatea nu aveau un diagnostic formal de disforie de gen de la cel care i-a trimis (9 din 12).
• Evaluările au fost mai lungi decât cele 3 până la 6 ședințe obișnuite ale clinicii: în medie 6,6 ședințe pe parcursul a 9,6 luni, mai ales cu familia.
• Două povești de caz, un băiat de 14 ani cu autism și o fată de 14 ani cu autism și o tulburare de alimentație în trecut, descriu suferința ajungând să fie înțeleasă în termeni de bullying, homofobie, destrămarea familiei și teama de pubertate.
• Autorii cer o analiză completă a dosarelor din întreaga clinică și cercetare pe termen lung și spun că tratamentul medical ajută în continuare unii tineri.

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.