1 Center of Expertise on Gender Dysphoria, VU University Medical Center , Amsterdam, The Netherlands .
2 Department of Psychiatry, VU University Medical Center , Amsterdam, The Netherlands .
LGBT Health. 2017 Apr;4(2):106-114. doi: 10.1089/lgbt.2016.0133. Epub 2017 Feb 7.
Controversy exists as to if, and when, gender affirmative (GA) treatment should be offered to individuals with gender dysphoria (GD) and co-existing psychosis. Concerns exist regarding a high risk of misdiagnosis, regret afterward due to impulsive decision making, and deterioration of psychotic symptoms. This case series aims at extending the sparse literature on GA treatment in this population by identifying challenges in diagnosis and treatment and offering recommendations to overcome them.
The authors present case descriptions of two transgender men and two transgender women in the age range of 29-57 years with a diagnosis of GD and a schizophrenia-related diagnosis. All had undergone GA treatment with a minimum follow-up of 3 years. The gender diagnosis was complicated by the fact that feelings of GD were only shared after the onset of psychosis, and GA treatment was hampered by the persistence of mild psychotic symptoms despite antipsychotic treatment. Close communication with the psychosis treating clinicians proved useful to address these problems. GA treatment was paralleled by a stabilization of psychotic symptoms, and adherence to and satisfaction with the therapy was high.
These case examples show that GA treatment is possible and safe in this vulnerable population.
对于性别焦虑（GD）和伴发精神病的个体，是否以及何时应提供性别肯定（GA）治疗，存在争议。人们担心误诊风险高、冲动决策导致后悔，以及精神病症状恶化。本病例系列旨在通过确定诊断和治疗中的挑战，并提出克服这些挑战的建议，扩展该人群中 GA 治疗的相关文献。
作者介绍了年龄在 29-57 岁之间的 2 名跨性别男性和 2 名跨性别女性的病例描述，他们均被诊断为 GD 和与精神分裂症相关的诊断。所有人都接受了 GA 治疗，随访时间至少为 3 年。性别的诊断很复杂，因为 GD 的感觉仅在精神病发作后才出现，而且 GA 治疗受到抗精神病治疗后仍存在轻度精神病症状的阻碍。与治疗精神病的临床医生密切沟通，有助于解决这些问题。GA 治疗与精神病症状的稳定同时发生，对治疗的依从性和满意度都很高。
这些病例表明，GA 治疗在这个脆弱的人群中是可行和安全的。
