评论文章认为青少年去过渡增多预示着性别肯定护理造成的医源性伤害

性别医学中的医源性伤害

Authors
Sarah C. J. Jorgensen
Journal
Journal of Sex & Marital Therapy
Year
2023

Summary

Detransition is often called rare. In this short opinion piece, Sarah Jorgensen argues that the rising number of young people who regret transition should be seen as harm caused by medical care, like past cases where drugs later proved harmful. She says the gender-affirming approach skips proper assessment, plays down risks, blames mental health problems mostly on stigma, and rests on weak evidence, as official reviews in Sweden, Finland and England found. She notes the main guidelines give little advice on detransition. She calls for open debate, more research, and recognition and support for detransitioners. It is a clear statement of concerns, but it is opinion, not new research. Its 10 to 30% figures come from a few studies that counted people stopping treatment, which is not the same as regret.

Key findings

  • Jorgensen把年轻人中不断增加的去过渡描述为医疗造成的伤害。她将其与过去的医疗伤害相比,如减肥药导致的心脏瓣膜损伤、某些止痛药的心脏风险和阿片类药物危机。
  • 她引用的研究表明,开始医学过渡的人中有10%至30%在16个月至四年内停止。在一项调查中,只有24%的去过渡者告诉了他们的性别诊所。
  • 她认为,低后悔率主要来自在更严格规则下接受治疗的成年人、许多人退出的研究,以及对后悔的狭义定义,例如要求恢复法律性别或手术。
  • 她说,心理健康评估常被斥为“把关”,而污名被用来解释那些往往在性别痛苦之前就已出现的精神疾病和自闭症。
  • 她指出,主要的国际跨性别护理指南(WPATH第8版)没有关于去过渡的章节,一项重要的激素指南没有提供如何安全停用激素的建议,美国2018年的儿科声明也没有提及后悔。
  • 她指出,瑞典、芬兰和英国的官方评估发现证据薄弱,并转向对未成年人以谈话治疗和治疗其他心理健康问题为先。
  • 她呼吁公开辩论、开展研究并促进临床医生之间的合作,使后悔真正变得罕见,并呼吁承认去过渡者是受到护理伤害的人,为他们提供有针对性的支持。

Abstract

Although transition regret and detransition are often dismissed as rare, the increasing number of young detransitioners who have come forward in recent years to publicly share their experiences suggests that there are cracks in the gender-affirmation model of care that can no longer be ignored. In this commentary, I argue that the medical community must find ways to have more open discussions and commit to research and clinical collaboration so that regret and detransition really are vanishingly rare outcomes. Moving forward, we must recognize detransitioners as survivors of iatrogenic harm and provide them with the personalized medicine and supports they require.

Conclusion

The medical community must find ways to have more open discussions and commit to research and clinical collaboration so that regret and detransition really are vanishingly rare outcomes. Last, we must recognize detransitioners as survivors of iatrogenic harm and provide them with the personalized medicine and supportive care that they need.