Eine interessante Studie betrachtet Jungen, die wegen einer Geschlechtsidentitätsstörung in Behandlung waren:
This study reports follow-up data on the largest sample to date of boys clinic-referred for gender dysphoria (n = 139) with regard to gender identity and sexual orientation. In childhood, the boys were assessed at a mean age of 7.49 years (range, 3.33–12.99) at a mean year of 1989 and followed-up at a mean age of 20.58 years (range, 13.07–39.15) at a mean year of 2002. In childhood, 88 (63.3%) of the boys met the DSM-III, III-R, or IV criteria for gender identity disorder; the remaining 51 (36.7%) boys were subthreshold for the criteria. At follow-up, gender identity/dysphoria was assessed via multiple methods and the participants were classified as either persisters or desisters. Sexual orientation was ascertained for both fantasy and behavior and then dichotomized as either biphilic/androphilic or gynephilic. Of the 139 participants, 17 (12.2%) were classified as persisters and the remaining 122 (87.8%) were classified as desisters. Data on sexual orientation in fantasy were available for 129 participants: 82 (63.6%) were classified as biphilic/androphilic, 43 (33.3%) were classified as gynephilic, and 4 (3.1%) reported no sexual fantasies. For sexual orientation in behavior, data were available for 108 participants: 51 (47.2%) were classified as biphilic/androphilic, 29 (26.9%) were classified as gynephilic, and 28 (25.9%) reported no sexual behaviors. Multinomial logistic regression examined predictors of outcome for the biphilic/androphilic persisters and the gynephilic desisters, with the biphilic/androphilic desisters as the reference group. Compared to the reference group, the biphilic/androphilic persisters tended to be older at the time of the assessment in childhood, were from a lower social class background, and, on a dimensional composite of sex-typed behavior in childhood were more gender-variant. The biphilic/androphilic desisters were more gender-variant compared to the gynephilic desisters. Boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation. The implications of the data for current models of care for the treatment of gender dysphoria in children are discussed.
Die Studie ist aus dem Jahr 2021, also eine recht neue Studie. Man hat geschaut, ob die Leute, die wegen einer Geschlechtsidentitätsstörung zur Behandlung waren, dann später tatsächlich immer noch unzufrieden mit ihrem ursprünglichen Geschlecht waren. Das war wohl nur bei 12,2% der Fall, die Mehrheit, 87,8% hingegen war nach der Pubertät nicht mehr unzufrieden. Ein ganz erheblicher Anteil war homosexuell.
Auch ganz interessant aus der Studie:
For the 64 participants where the GIDYQ-AA was used to determine gender identity status at follow-up, 12 were classified as persisters and 52 were classified as desisters. All 52 desisters had a mean score >3.00 on the GIDYQ-AA. Of the 12 persisters, 10 had a mean score ≤ 3.00 and two had mean scores that were >3.00. In spite of having mean scores on the GIDYQ-AA that were above the recommended cutoff for caseness (95), these two participants were considered persisters because their clinical interview data indicated that they were experiencing significant gender dysphoria. Thus, clinical judgment was used to make the final classification for these two participants.
Diejenigen, die bei entsprechenden Tests auf Genderidentitätsstörung einen höheren Wert erreicht haben hatten also häufiger auch später noch eine solche, bei denen mit niedrigeren Werten war es nicht so wahrscheinlich.
Aus den Ergebnissen:
The present study provided follow-up data with regard to gender identity and sexual orientation in boys referred clinically for gender dysphoria. There were three key findings:
(1) the persistence of gender dysphoria was relatively low (at 12%), but obviously higher than what one would expect from base rates in the general population;
Ein vergleichsweise niedriger Wert, der dann die Frage aufwirft, ob frühe geschlechtsangleichende Operationen ein guter Weg sind, wenn die Diagnose nicht eindeutig ist.
(2) the percentage who had a biphilic/androphilic sexual orientation was very high (in fantasy: 65.6% after excluding those who did not report any sexual fantasies; in behavior: 63.7% after excluding those who did not have any interpersonal sexual experiences), markedly higher than what one would expect from base rates in the general population;
Auch das passt grundsätzlich gut zu den „Hormontheorien“, wonach das Gehirngeschlecht und auch die sexuelle Präferenz während bestimmter Phasen im Mutterleib durch pränatales Testosteron ausgebildet wird.
(3) we identified some predictors (from childhood) of long-term outcome when contrasting the persisters with a biphilic/androphilic sexual orientation with the desisters with a biphilic/androphilic sexual orientation and when contrasting the desisters with a biphilic/androphilic sexual orientation and the desisters with a gynephilic sexual orientation.
Auch das eben passend zu den Hormontheorien
The 12% persistence rate was somewhat lower than the overall persistence rate of 17.4% from the prior follow-up studies of boys combined. When compared to the three most methodologically sound follow-up studies, the persistence rate was higher than the 2.2% rate found by Green (47), but lower than the 20.3% rate found by Wallien and Cohen-Kettenis (52) and the 29.1% rate found by Steensma et al. (51).
Auh ein interessanter Überblick.
There is one methodological caveat regarding the Steensma et al. study that is worth noting. In their study, the mean interval between assessment and follow-up was relatively short (7.21 years). The patients were eligible for follow-up if they were at least 15 years of age. Given the relatively short interval between the assessment in childhood and the follow-up assessment in adolescence, this meant that patients who had been assessed at younger ages in childhood would not have been old enough to participate in the follow-up assessment. Given that Steensma et al. found that (older) age at the time of the assessment in childhood was a significant predictor of persistence, it is conceivable that their persistence rate was an overestimate. Nonetheless, in the broadest sense, our data were quite consistent with the general finding from the prior follow-up studies that desistance from gender dysphoria is by far the more common outcome.
In our study, we did not find that persistence was more common among boys who were threshold for the diagnosis of GID when compared to the boys who were subthreshold (13.6% vs. 9.8%) although the pattern was in the same direction as that found by Wallien and Cohen-Kettenis (52) and Steensma et al. (51). We would, therefore, argue that the threshold-subthreshold distinction should not be abandoned in future follow-up studies although such studies might profit from using a symptom count of DSM indicators in addition to the dichotomous coding of the diagnosis as threshold vs. subthreshold. Consistent with both Wallien and Cohen-Kettenis and Steensma et al., our composite measure of sex-typed behavior in childhood was a significant predictor of outcome in that the patients classified as persisters with a biphilic/androphilic sexual orientation had more severe gender-variant behavior than the patients classified as desisters with a biphilic/androphilic sexual orientation; in addition, desisters with a biphilic/androphilic sexual orientation had more gender-variant behavior than the desisters with a gynephilic sexual orientation. Thus, dimensional measurement of gender identity and gender role behaviors from childhood provides added nuance in characterizing longer term trajectories with regard to both gender identity and sexual orientation.
With regard to sexual orientation at follow-up, the percentage of patients with a biphilic/androphilic sexual orientation in either fantasy or behavior was reasonably similar to those reported on in the prior follow-up studies which included standardized assessment measures (47, 51, 52). This finding also converges with three representative, general population prospective studies (118–120) and many retrospective studies (43) which document a significant association between patterns of gender-typed behavior in childhood and later sexual orientation.
The multinomial logistic regression analysis (Table 4) also showed a trend for the persisters with a biphilic/androphilic sexual orientation to be older at the time of the assessment in childhood compared to the desisters with a biphilic/androphilic sexual orientation; however, when the composite measure of sex-typed behavior in childhood was added to the equation (Table 5), age at assessment in childhood no longer showed such a trend [cf. Steensma et al. (51)]. In our smaller study of girls with GID (46), the persisters were, on average, 2.5 years older than the desisters at the time of the assessment in childhood (11.08 vs. 8.59 years) although the difference was not significant. It is our view that age at the time of a childhood assessment in relation to long-term outcome should continue to be examined in future follow-up studies.
Social class was a significant predictor of outcome: the persisters with a biphilic/androphilic sexual orientation were from a lower social class background compared to the desisters with a biphilic/androphilic sexual orientation (even after controlling for the other demographic variables). Why might this be the case? Because we had not made formal a priori predictions of outcome regarding any of our demographic variables, it is, of course, important to see whether or not it will be replicated in new follow-up studies. At present, our interpretation of the social class effect reflects on its relationship to other literatures.
One possibility pertains to the notion that acceptance of a gay or homosexual sexual identity is less in “working class” subculture (121). If this is, in fact, the case, it has been argued that transitioning from male to female—the so-called “homophobic” hypothesis with regard to gender dysphoria in adults (122)–would allow an androphilic sexual orientation to be more acceptable. Future studies would need to systematically examine whether boys with persistent GID first attempt to live as gay men before transitioning to the female gender role and whether or not this temporal sequence, when it occurs, is related to social class background.
Also die These, dass es in bestimmten sozialen Schichten akzeptierter war, das Geschlecht zu wechseln als auf das gleiche Geschlecht zu stehen. Was dann dort die Transsexualität als „Lösung“ des Problems darstellen würde.
In the present study, it could be hypothesized that the parents of persisters held less favorable views of androphilia (homosexuality) compared to the desisters and thus predisposed to persistence in order to “normalize” one’s sexual orientation. However, this is simply a conjecture as parental attitudes toward homosexuality were not measured in the study sample. Indeed, none of the follow-up studies to date on boys with gender dysphoria have specifically examined attitudes toward homosexuality as a predictor of outcome.
Social class could also be a proxy for other explanatory factors. For example, in the present study, a lower social class background was significantly correlated with age at assessment in childhood (r = 0.44) and families where there had been a separation/divorce, etc. (r = 0.58). If one wanted to make the case that a later age at assessment might be associated with persistence (for a variety of reasons), perhaps social class is associated with a “delay” in seeking out an assessment and possible treatment (e.g., family stress, various other mental health challenges in the child and/or the family, etc.). In one study comparing the demographic characteristics of children vs. adolescents clinic-referred for gender dysphoria, it was found that the adolescents were more likely than the children to come from a lower social class background and from families in which there had been a separation/divorce, etc. (123).
Also dann die These, dass man in bestimmten Schichten eher nur dann ein Behandlung sucht, wenn man sich ganz sicher ist?
What clinical implications might be drawn from our data on the persistence and desistence rates of gender dysphoria in children? First, it should be recognized that the boys in the current study were seen during a period of time when treatment recommendations, if such were made, often aimed to reduce the gender dysphoria between the child’s felt gender identity and biological sex. If one peruses the treatment literature, such recommendations were carried out using many therapeutic modalities: psychotherapy or psychoanalysis, behavior therapy, group therapy, parent-counseling, and interventions in the naturalistic environment, such as encouragement of same-sex peer relations [see, e.g., (124–126); for reviews, see (127, 128)].18 In our own sample, the kinds of treatments that the boys received, if any, were quite variable but it is beyond the scope of this article to describe them in general [however, for examples, see (136, 140, 141)]. It can, however, be said with certainty that the vast majority of boys were seen during a particular period of time when the therapeutic approach of recommending or supporting a gender social transition prior to puberty was not made. Indeed, in the current study, there was only one patient who had socially transitioned prior to puberty (at the suggestion and support of the professionals involved in this individual’s care) and this particular patient was one of the persisters with a biphilic/androphilic sexual orientation. Second, it should also be recognized that, for the boys seen in the current study, none who were in late childhood and had (likely) entered puberty (Tanner Stage 2) had received puberty-blocking hormone treatment (GnRH analogs) to suppress somatic masculinization (142, 143) until sometime during adolescence.
Es könnte also auch Auswirkungen gehabt haben, dass bei keinem Hormonblocker eingesetzt worden sind und sie daher auch schlicht andere körperliche Veränderungen hatten, die entweder eine größere Zufriedenheit mit dem bisherigen Geschlecht bewirkten oder aber bereits so umfangreich waren, dass es dann nicht mehr passte?
In contrast, in recent years, it has become more common for some clinicians to recommend a gender social transition prior to puberty [e.g., (69, 144–147); for discussion, see (148–150)]. It has also become more common for parents to have already implemented a gender social transition on their own, without any formal input from a health professional (151). As argued by Zucker (64, 152), this is a very different type of psychosocial treatment designed to reduce gender dysphoria when compared to the other kinds of treatments noted above that have been recommended over the years.
The study by Steensma et al. (51), which found the highest rate of persistence, included some patients who had made a partial or complete gender social transition prior to puberty and this variable proved to be a unique predictor of persistence (see the Introduction). Rae et al. (153) recruited from a variety of community groups a sample of 85 markedly gender non-conforming children (Mean age, 7.5 years), none of whom had socially transitioned at a baseline assessment. At the time of follow-up, at a mean of 2.1 years later, 36 (42.3%) had socially transitioned and 49 (57.6%) had not. Using a composite of various metrics of gender identity and gender role behaviors, Rae et al. found that those who subsequently socially transitioned had more extreme gender-variant behavior at baseline than those who had not. Thus, this short-term follow-up study was consistent with the longer-term findings reported on by Wallien and Cohen-Kettenis (52), Steensma et al. (51), and the present study.
To date, however, there are no long-term follow-up studies of clinic-referred samples of children who had all socially transitioned prior to puberty. Future follow-up studies should be able to capture a much larger subgroup of such children and compared to those who have not with regard to long-term outcome with regard to persistence and desistance [e.g., (154)]. The persistence-desistance rates found in this study and the ones preceding it can be used as a comparative benchmark for samples in which a social transition took place prior to puberty.
Man darf gespannt sein, wie die Zahlen in 10 Jahren sind.