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

• Два автора проанализировали всех подростков (от 12 лет), оценённых ими в GIDS с октября 2015 по апрель 2017 года: 156 случаев, сокращённых до 128 после исключения некоторых.
• У 12 из 128 (9,4%) гендерный дистресс начался в подростковом возрасте, в начале они просили о медицинском лечении и перестали его хотеть во время оценки.
• Из 12 семеро стали чувствовать себя комфортно со своим рождённым полом, а пятеро по-прежнему считали себя транс, но больше не хотели гормонов.
• Большинство были девочками (9 из 12) в возрасте 12–16 лет (в среднем 14). У 7 уже был диагноз аутизма, 7 недавно думали о самоубийстве, 7 занимались самоповреждением и 2 недавно пытались покончить с собой.
• Большинство не проходили социальную транзицию (7 из 12), и у большинства не было формального диагноза гендерной дисфории от направившего их специалиста (9 из 12).
• Оценки были длиннее обычных 3–6 сессий клиники: в среднем 6,6 сессии за 9,6 месяца, в основном с семьёй.
• Две истории случаев — 14-летнего мальчика с аутизмом и 14-летней девочки с аутизмом и расстройством пищевого поведения в прошлом — описывают, как дистресс начали понимать через травлю, гомофобию, распад семьи и страх перед пубертатом.
• Авторы призывают к полному обзору записей по всей клинике и долгосрочным исследованиям и говорят, что медицинское лечение по-прежнему помогает некоторым молодым людям.

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.