評論文章認為青少年去過渡增多預示著性別肯定照護造成的醫源性傷害

性別醫學中的醫源性傷害

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 將年輕人中去過渡的增加描述為醫療造成的傷害。她把它比作過去的醫療傷害,例如減肥藥造成的心臟瓣膜損傷、某些止痛藥的心臟風險,以及鴉片類藥物危機。
  • 她引用的研究顯示,開始醫療過渡的人有 10 至 30% 在 16 個月至四年內停止。在一項調查中,只有 24% 的去過渡者告訴過他們的性別門診。
  • 她主張,低後悔率的數字主要來自在較嚴格規定下接受治療的成人、許多人退出的研究,以及對後悔的狹隘定義,例如要求恢復法定性別或逆轉手術。
  • 她說心理健康評估經常被當作「守門」而被否定,而汙名被用來解釋心理疾病和自閉症,但這些往往在性別困擾之前就已經開始。
  • 她指出,主要的國際跨性別照護指引(WPATH 第 8 版)沒有關於去過渡的章節,一份重要的荷爾蒙指引沒有關於如何安全停用荷爾蒙的建議,而 2018 年美國小兒科的聲明也沒有提到後悔。
  • 她指出瑞典、芬蘭和英格蘭的官方審查發現證據薄弱,並已轉向對未成年人以談話治療和處理其他心理健康問題優先。
  • 她呼籲公開辯論、研究,以及臨床人員之間的合作,使後悔真正變得罕見,並讓去過渡者被認定為受到照護傷害的人,並得到量身打造的支持。

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.