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

• 兩位作者回顧了 2015 年 10 月至 2017 年 4 月在 GIDS 評估的所有青少年（12 歲以上）：156 個案例，排除部分後剩下 128 個。
• 128 人中有 12 人（9.4%）的性別困擾在青少年時期開始，一開始要求醫療處置，並在評估期間不再想要。
• 12 人中，7 人開始對自己的出生性別感到自在，5 人仍認同為跨性別，但不再想要荷爾蒙。
• 多數為女孩（12 人中有 9 人），年齡 12 至 16 歲（平均 14 歲）。7 人已被診斷有自閉症，7 人近期曾想過自殺，7 人曾自傷，2 人近期曾企圖自殺。
• 多數沒有進行過社會性過渡（12 人中有 7 人），多數沒有轉介者所給的正式性別焦慮診斷（12 人中有 9 人）。
• 評估比門診通常的 3 至 6 次會談更長：平均在 9.6 個月內進行 6.6 次會談，多半與家人一起。
• 兩個案例故事，一名 14 歲有自閉症的男孩，和一名 14 歲、曾有飲食障礙的自閉症女孩，描述了痛苦逐漸被從霸凌、恐同、家庭破裂和對青春期的恐懼來理解。
• 作者呼籲對全門診的紀錄進行全面審查和長期研究，並表示醫療處置仍然對某些年輕人有幫助。

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.