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

• 在五個研究資料庫中截至 2022 年 4 月找到的 28,000 多筆紀錄中，只有 11 項研究符合資格。八項是單一時間點的快照，只有一項往前追蹤兒童。
• 品質為低至中等，在滿分 8 分中得到 1.5 至 5 分。主要問題是樣本為自願參與或由門診轉介的人，而且只有 3 項研究在追蹤期間之後衡量結果。
• 11 項研究中有五項使用同一個美國計畫，該計畫透過支持團體招募。其家庭比平均更富裕，且多數家長支持及早過渡。
• 進行社會性過渡的兒童與一般人口、手足或配對兒童相比，憂鬱沒有差異。但家長回報他們的焦慮比一般人口和配對兒童更多。
• 在青少年中，使用自選名字與較少的憂鬱症狀和較少的自殺想法有關。但有一項研究發現，在青少年時期而非成年時期進行過渡，與過去一年更多的自殺想法和一生中更多的自殺未遂有關。
• 兩項研究將童年時的社會性過渡與焦慮持續連結起來。一項發現焦慮更可能持續到青少年時期（出生時為男性的兒童特別明顯）。另一項發現約 5.4 年後，92.7% 仍認同為跨性別，且多數接著進行醫療處置。
• 作者的結論是，沒有任何研究以公平的對照組往前追蹤兒童。醫師和指引應承認，無論是益處還是傷害，都沒有強而有力的證據。

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.