Research into detransition in RCPsych journal

[WarriorN]

Conclusions
Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.

www.cambridge.org/core/journals/bjpsych-open/article/access-to-care-and-frequency-of-detransition-among-a-cohort-discharged-by-a-uk-national-adult-gender-identity-clinic-retrospective-casenote-review/3F5AC1315A49813922AAD76D9E28F5CB

A very insightful piece of research

Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7–19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1–1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1–17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1–4.4) as independently associated with accessing care.

Can anyone explain this information in a way that’s easier to understand please? I don’t understand what an Odds Ratio is. Can it be converted into percentage of people affected, for example, or is it a measure of how much more likely something is compared to a control group? I did look it up, but the explanation makes no sense to me in the context of the linked study.

Sorry, I can't. We need Helen Joyce!

The fact it's in the abstract conclusion leads me to think that the numbers are significantly high.

You could try actually reading the paper - the percentages are in there.

The median age was ... 36 years for natal males and 20 years for natal females.

!!!!!!

The difference between Odds Ratio and Relative Risk are artefacts of the study design and analysis. If you had 4 identical horses in a race, the risk of one winning is 1/4. The odds of one winning is 1:3 (the likelihood of winning verses the likelihood of losing).

So: "coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7–19)" means that people in the groups with neurodevelopmental disorders are 5.7 times more likely to seek treatment than those without. You can be 95% confident that the true value lies between 1.7 times and 19 times. This is wide, which is the result of a fairly small sample, but as the 95% CI doesn't cross 1, you can feel sure that there is a significant, positive association.

Thanks Alexa

@kesstrel

The median age was ... 36 years for natal males and 20 years for natal females.

!!!!!!

!!!!! Indeed!

It makes for rather sad reading. I’ll read it properly when I have more time but from a quick skim I noticed that in addition to neurodevelopmental disorders, there do seem to be very high rates of adverse childhood experiences, though I couldn’t see a definition for those. And a surprisingly high number of personality disorders.

Also I think this study shows just how much we need proper research to help the different groups of people who wish to transition and find out what their different needs are.

It would be interesting to see more information in this study about what types of physical illness this group experiences and more of a breakdown between male and female transitioners in terms of things like what their adverse childhood experiences are, and what personality disorders they suffer from.

The high numbers of mental health disorders, neurodevelopmental disorders, personality disorders, eating disorders and physical health problems in this group are really worrying. I do wish trans lobby groups would put their efforts and money into researching and improving mental health support for trans identifying people rather than trying to convince everyone else that they’re evil bigots.

Some people might call it clinical but I would term "masculinising chest surgery" or "feminising genital reconstruction surgery" etc. euphemisms (Table 3). There is only one place where "masculinising chest surgery" is explained and then it's in brackets and not fully informative: partial mastectomy .

This was a good summary:

The traditional model of care in adult GICs is based on experience with older transwomen, not younger transmen or non-binary service users. There is a need to better understand the specific needs of this new younger generation of service users and shape services accordingly, while simultaneously not disadvantaging those who may benefit from a streamlined assessment approach.

Given our finding of an association between neurodevelopmental disorders and ACEs and not accessing care, we would advocate careful attention to these factors during assessment. Agreeing realistic goals and considering any necessary adaptations to the treatment pathway is vital if service users’ needs are to be met. Consent to irreversible treatments must entail a discussion about the real possibility of not completing transition as envisaged, in order that expectations are managed. It is not currently known what it means for service users to access hormones but not surgery where desired. Furthermore, it is necessary to optimise support for those with coexisting substance misuse or mental health concerns during treatment.

Nothing in this surprises me.

I think the politically incorrect, but more truthful imo, interpretation of the much-touted connection between trans and mental health issues leading to suicide is that many of those who attempt or commit suicide are not suicidal because they need to transition and are being prevented from doing so: they are transitioning because they are trying to deal with already-existing suicidal feelings whose causes are linked to childhood abuse and/or neglect - which they then find to their despair and detriment are not solved after transitioning.

Yes I'd agree.

@WhatMattersMost

I think the politically incorrect, but more truthful imo, interpretation of the much-touted connection between trans and mental health issues leading to suicide is that many of those who attempt or commit suicide are not suicidal because they need to transition and are being prevented from doing so: they are transitioning because they are trying to deal with already-existing suicidal feelings whose causes are linked to childhood abuse and/or neglect - which they then find to their despair and detriment are not solved after transitioning.

Sadly there were three suicides within this cohort (all males under 25). As you say, these are people in the process of transitioning, not people being prevented from doing so.

I can’t remember where I read it or the name of the clinician, but he (I think it was a psychiatrist) said that it was important to explain to people wanting to transition the realities of the outcome and that it might not be the wonder cure they are hoping for. He said one of the most useful things he did was to put together groups of people before and after transition so the ‘before’ group who were often in a state of euphoria once they’d embarked on the process could understand exactly what they were letting themselves in for and have more realistic expectations. Unfortunately some of them really seemed to believe that they would actually change sex once they transitioned and the reality could have a huge impact on their mental health.

If you look up ACE questionnaire on the CDC website or many others you'll see a10 question questionnaire with each yes answer scoring one.

I can’t remember where I read it or the name of the clinician

I saw that discussed on MN quite recently but don't recall more about it.

I just did the quiz on npr.org and my score is zero. I am very aware of my privilege as the kids say.

@WindowsSmindows

I just did the quiz on npr.org and my score is zero. I am very aware of my privilege as the kids say.

I scored 8 which surprises me.

@TimeToDateAgain

I can’t remember where I read it or the name of the clinician

I saw that discussed on MN quite recently but don't recall more about it.

I think it might be this article...

www.transgendertrend.com/interview-az-hakeem/

Dr Az Hakeem is a consultant psychiatrist, medical psychotherapist and a Fellow of the Royal College of Psychiatrists. He is also a qualified Group Analyst who has used this training to develop and facilitate the unique therapeutic practice of mixed group therapy sessions with gender dysphoric patients both pre- and post-transition. He is author of Trans: Exploring Gender Identity and Gender Dysphoria and his website can be found here. We are grateful to Dr Hakeem for writing the following article for us, in response to questions we put to him.

I think it might be this article...

Thank you, that let me find it through AS;

www.mumsnet.com/Talk/womens_rights/4359978-Transgender-Trend-fascinating-article-from-Dr-Az-Hakeem-psychotherapist-specialising-in-gender

Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.

No shit, Sherlock.

Is this a reputable study in a reputable journal?

[quote TimeToDateAgain]I think it might be this article...

Thank you, that let me find it through AS;

www.mumsnet.com/Talk/womens_rights/4359978-Transgender-Trend-fascinating-article-from-Dr-Az-Hakeem-psychotherapist-specialising-in-gender[/quote]
Yes, that’s the person I was thinking of, thank you.

ACEs are tricky as they entirely ignore BCEs. (Benevolent childhood experiences.)

But therapists and supportive people in the child's life should be making changes to provide those BCEs not encouraging transition

Also though I see lgbtq youth clubs offering a support network that could be seen as benevolent to the individual, in that it offers a chance to meet others who are struggling and provide a frame work of identity and inclusion, but actually obviously lead them to incorrect thoughts about what will save them, and not accessing correct help.

I've seen the same happen with a very evangelical Christian group I had a couple of friends/ acquaintances in. People who really needed professional help but were led to believe the church and god would sort it all. They were a ready made group of friends who had a lot of social opportunities. (Group folded after several affairs among leaders were exposed.)

I was going through a bad patch and my gosh the coercion I got from my (then) friend to join the church was quite disturbing. I liked her as a person but found that aspect of conversion hunting very unsettling. It was relentless till I outright had to tell her to stop.

I do see similarities with how young teens get sucked into lgbtq groups.

ACEs are tricky as they entirely ignore BCEs. (Benevolent childhood experiences.)

I scored 1 for BCE.

But therapists and supportive people in the child's life should be making changes to provide those BCEs not encouraging transition

I'd agree that the above would be more constructive.