Key Findings

• Joint case review of 18 months of caseloads at the Gender Identity Development Service (GIDS)
• 12 young people with adolescent-onset gender dysphoria ceased wishing to pursue medical interventions during assessment
• Some cases arrived at a different understanding of their embodied distress through extended clinical assessment
• 2 detailed case vignettes illustrate the diversity of developmental pathways
• Argues for the value of extended psychosocial assessment before medical intervention decisions
• Addresses the increasing referrals to specialist gender identity clinics and the need to understand diverse outcomes
• Published in Clinical Child Psychology and Psychiatry, Vol 24(2), pp 338-352

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.

Summary

This 2019 article by Anna Churcher Clarke and Anastassis Spiliadis, published in Clinical Child Psychology and Psychiatry, presents a joint case review of 12 adolescents at the Tavistock GIDS who presented with adolescent-onset gender dysphoria but ceased wishing to pursue medical interventions during the course of assessment. Two detailed case vignettes illustrate how extended psychosocial assessment allowed young people to arrive at a different understanding of their embodied distress. The paper argues for the value of thorough clinical exploration before medical decisions and has implications for clinical practice, service delivery, and research.

Conclusion

Extended clinical assessment at the Gender Identity Development Service can identify adolescents presenting with adolescent-onset gender dysphoria who, during the course of thorough assessment, cease wishing to pursue medical interventions or arrive at a different understanding of their embodied distress. Of 12 cases identified over 18 months, the findings demonstrate the value of taking time to explore the multiple factors contributing to gender identity difficulties rather than rushing to medical intervention. Implications include the need for comprehensive psychosocial assessment and the development of clinical practice guidelines that support extended exploration before medical decisions.