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Endokrinolog opozarja, da stare nizke stopnje obžalovanja morda ne veljajo več, ker detranzicija narašča

Detranzicija med transspolnimi in spolno raznolikimi ljudmi – vse pogostejši in vse zapletenejši pojav

Komentarji & analizeDetransicija & obžalovanjeKrižni spolni hormoni
Authors
Michael S. Irwig
Journal
Journal of Clinical Endocrinology & Metabolism
Year
2022
Source
https://doi.org/10.1210/clinem/dgac356

Summary

In this short opinion piece, a hormone doctor at Beth Israel Deaconess and Harvard reacts to a US military health study in which about 30% of patients had stopped hormones within four years. He compares this with older figures, such as Dutch regret rates under 1%, which are weakened because 36% of people were lost to follow-up. He also points to surveys of detransitioners, who often never told their doctors. His argument is that care has changed: hormones are easier to get on consent alone, there are fewer mental health checks, and more patients are young, female-born or nonbinary. So old low regret figures may not hold, and detransition is probably rising. He urges full information about permanent effects before treatment, research comparing ways of providing care, and kind support for detransitioners. It is a reasoned expert opinion, not a study.

Key findings

  • Roberts in drugi (2022) so ugotovili, da jih je 70 % od 952 bolnikov iz ameriških vojaških družin (povprečna starost okoli 19 let) po 4 letih še jemalo hormone: 81 % trans žensk, a samo 64 % trans moških.
  • Verjetnost prenehanja je bila pri trans moških več kot dvakrat večja, pri osebah, ki so hormone začele pri 18 letih ali pozneje, pa približno 1,7-krat večja, čeprav razlogi za prenehanje niso bili znani.
  • Avtor opozarja, da so nizozemske stopnje obžalovanja po odstranitvi mod ali jajčnikov (0,6 % pri trans ženskah, 0,3 % pri trans moških) morda prenizke, ker je bilo 36 % ljudi izgubljenih iz spremljanja.
  • Navaja anketo, v kateri je le 24 % detranzicionarjev povedalo svojim zdravnikom, zato štetja na podlagi zapisov klinik verjetno zgrešijo mnogo primerov.
  • Trdi, da hormoni, dani samo na podlagi privolitve, manj pregledov duševnega zdravja in premik k bolnikom, rojenim kot ženske, in nebinarnim naredijo porast detranzicije verjeten.
  • Zaključuje, da starejše nizke stopnje obžalovanja in detranzicije morda ne veljajo za današnje bolnike, in poziva k raziskavam, ki primerjajo oskrbo samo s privolitvijo z nizozemskim pristopom, ki temelji na ekipi.

Conclusion

Irwig concludes that a proportion of transgender and gender-diverse patients discontinue hormone therapy, which endocrinologists may overlook because many who detransition stop attending clinics. Several factors give reason to believe detransition may increase and that low regret rates from earlier populations may no longer apply: rising numbers, the shift to the informed consent model, a likely smaller share receiving adequate mental health evaluation, and a shift toward more patients assigned female at birth and nonbinary. Endocrinologists should ensure patients receive adequate, comprehensive information on benefits and risks, especially irreversible effects. Research should compare outcomes of informed-consent and Dutch-style interdisciplinary models. Care for those who detransition should remain compassionate.