Summary

This early report from Finland's newly opened youth gender service described every young person assessed in Tampere between 2011 and 2013. Nearly nine in ten were born female, most had no gender distress in childhood, and three quarters had already needed specialist mental health care. This was often for depression, anxiety, self-harm or autism, and usually began before gender concerns appeared. The largest group developed gender distress in their teens amid wider confusion about who they were, loneliness and high hopes that transition would fix their problems. The authors said this did not match the typical patient the Dutch treatment approach was based on, and that guidelines should take it into account. The study is small and only describes, but it was one of the first to record the changed patient group, and Finland later revised its national guidance.

Key findings

• 2011 至 2013 年在坦佩雷青少年服務接受性別過渡評估的全部 47 名青少年都被納入；他們抵達時的平均年齡約為 16.6 歲。
• 47 人中有 41 人（87%）出生時為女性，作者表示無法解釋這個比例。
• 75% 曾因性別困擾以外的原因接受兒童與青少年專科心理健康照護，68% 最初因與性別無關的原因來到心理健康服務。
• 接受治療的問題包括憂鬱（64%）、焦慮（55%）、自殺想法或自傷（53%）、自閉症（26%），以及像是聽到聲音的精神病症狀（13%）。
• 64%（47 人中的 30 人）在童年時沒有他們自己或父母能回憶起的性別困擾或跨性別行為，62% 在 12 歲或更晚才開始質疑自己的性別。
• 57% 曾遭受嚴重霸凌。在這些個案中，73% 的霸凌發生在任何性別疑慮之前，多半是因為與性別無關的原因。
• 最大的一組（47 人中的 23 人）在青少年時期出現性別困擾，同時伴隨著對自己是誰更廣泛的困惑、孤獨，以及對過渡能解決他們問題的非常高的期望。
• 孤獨與社交孤立是屬於這一組最強的徵象：孤立的青少年屬於這一組的可能性約為 9 倍。

Abstract

BACKGROUND: Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development. METHODS: Structured quantitative retrospective chart review and qualitative analysis of case files of all adolescent SR applicants who entered the assessment by the end of 2013. RESULTS: The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common. CONCLUSION: The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.

Conclusion

Adolescents seeking sex reassignment represent a variety of developmental pathways differentiated by the timing of onset of gender dysphoria, psychopathology and developmental difficulties. It is important to be aware of the different groups, or developmental pathways, in gender dysphoric adolescents in order to be able to find appropriate treatment options. In the presence of severe psychopathology and developmental difficulties, medical SR treatments may not be currently advisable. Treatment guidelines need to be reviewed extended to appreciate the complex situations.