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

• 两位作者回顾了他们在2015年10月至2017年4月期间于GIDS评估的所有青少年（12岁及以上）：156个病例，排除一些后剩余128个。
• 128人中有12人（9.4%）的性别痛苦始于青少年时期，一开始要求医学治疗，并在评估期间不再想要。
• 这12人中，七人开始对自己的出生性别感到自在，另五人仍认同为跨性别者但不再想要激素。
• 大多数是女孩（12人中有9人），年龄12至16岁（平均14岁）。7人此前已被诊断为自闭症，7人最近曾想过自杀，7人曾自伤，2人最近曾自杀未遂。
• 大多数人没有进行过社会性过渡（12人中有7人），大多数人没有转介者给出的性别焦虑正式诊断（12人中有9人）。
• 评估比诊所通常的3至6次会谈更长：平均在9.6个月内进行6.6次会谈，多数有家人参与。
• 两个案例故事，一名14岁的自闭症男孩和一名14岁有饮食障碍病史的自闭症女孩，描述了痛苦逐渐被理解为与霸凌、恐同、家庭破裂和对青春期的恐惧有关。
• 作者呼吁对诊所的记录进行全面审查并开展长期研究，并说医学治疗仍然对一些年轻人有帮助。

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.