Summary

Social transition means changing name, pronouns or appearance to live as another gender. York researchers found only 11 studies of how this affects children and teenagers with gender dysphoria, mostly of low quality. Most were one-off snapshots rather than following children over time. Many recruited through support groups, and five used the same group of US children. Socially transitioned children generally did not differ in mental health from comparison groups. Results for teenagers conflicted: using a chosen name was linked to less depression, but transitioning as a teenager was linked to more suicide attempts than transitioning as an adult. Two studies linked childhood transition to dysphoria lasting longer. The authors conclude that neither benefit nor harm has been shown. The review supports 'we do not know'. Critics have disputed how the York reviews judged study quality.

Key findings

• 在检索五个研究数据库至2022年4月找到的28,000多条记录中，只有11项研究合格。八项是一次性的横断面调查，只有一项向前追踪儿童。
• 质量为低到中等，在8分中得1.5至5分。主要问题是样本由自愿参加或诊所转介的人组成，只有3项研究在随访期之后测量了结果。
• 11项研究中有五项使用了同一个美国项目，该项目通过支持团体招募。其家庭比平均水平更富裕，大多数父母支持早期过渡。
• 进行了社会性过渡的儿童，与普通人群、兄弟姐妹或配对儿童相比，在抑郁方面没有差异。但家长报告的焦虑比普通人群和配对儿童更多。
• 在青少年中，使用自选名字与较少的抑郁症状和较少的自杀想法有关。但一项研究发现，在青少年时期而不是成年后过渡，与过去一年中更多的自杀想法和一生中更多的自杀未遂有关。
• 两项研究将儿童期社会性过渡与焦虑持续联系起来。一项发现它更可能持续到青少年时期（对出生时为男性的儿童明显如此）。另一项发现，约5.4年后92.7%仍认同为跨性别者，大多数人继续接受医学治疗。
• 作者的结论是，没有任何研究以公平的对照组向前追踪儿童。医生和指南应当承认，没有强有力的证据表明有益或有害。

Abstract

BACKGROUND: Increasing numbers of children and adolescents experiencing gender dysphoria or incongruence are being referred to specialist gender services. Historically, social transitioning prior to assessment was rare but it is becoming more common. AIM: To identify and synthesise studies assessing the outcomes of social transition for children and adolescents (under 18) experiencing gender dysphoria/incongruence. METHODS: A systematic review and narrative sythesis. Database searches (Medline, Embase, CINAHL, PsycINFO, Web of Science) were perfomed in April 2022. Studies reporting any outcome of social transition (full or partial) for children and adolescents experiencing gender dysphoria/incongruence were included. An adapted version of the Newcastle-Ottawa Scale for cohort studies was used to appraise study quality. RESULTS: Eleven studies were included (children (n=8) and adolescents (n=3)) and most were of low quality. The majority were from the US, featured community samples and cross-sectional analyses. Different comparator groups were used, and outcomes related to mental health and gender identity reported. Overall studies consistently reported no difference in mental health outcomes for children who socially transitioned across all comparators. Studies found mixed evidence for adolescents who socially transitioned. CONCLUSIONS: It is difficult to assess the impact of social transition on children/adolescents due to the small volume and low quality of research in this area. Importantly, there are no prospective longitudinal studies with appropriate comparator groups assessing the impact of social transition on mental health or gender-related outcomes for children/adolescents. Professionals working in the area of gender identity and those seeking support should be aware of the absence of robust evidence of the benefits or harms of social transition for children and adolescents. PROSPERO REGISTRATION NUMBER: CRD42021289659.

Conclusion

The studies included in this review are of low quality, therefore, it is difficult to assess the impact of social transition in this population. Importantly, there are no prospective longitudinal studies with appropriate comparator groups which have assessed the impact of social transition on the mental health or gender-related outcomes for children or adolescents experiencing gender dysphoria/incongruence. Healthcare professionals, clinical guidelines and advocacy organisations should acknowledge the lack of robust evidence of the benefits or harms of social transition when working with children, adolescents and their families.