Kameg Brayden N, Nativio Donna G
Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
J Am Assoc Nurse Pract. 2018 Sep;30(9):493-498. doi: 10.1097/JXX.0000000000000068.
Primary care providers who encounter children are often the first line of contact for individuals with gender dysphoria, which occurs when sex assigned at birth is incongruent with one's true, expressed sexual identity. Because those with untreated gender dysphoria are at risk of a variety of negative outcomes, including mood symptomatology, suicidality, substance use disorders, and other psychosocial risk factors, it is critical that health care providers are adept in the provision of holistic, patient-centered care. The purpose of this report is to provide an updated review of the current evidence from the literature pertaining to the identification, treatment, and coordination of care among children with gender dysphoria within the primary care setting or medical home.
Using PubMed and CINAHL, a literature review spanning from 2012 to the present was conducted using the following key words: gender dysphoria, transgender health, LGBT health, and hormone therapy. Reference lists of identified articles were also explored for relevance.
Treatment may include a social transition, hormone antagonist therapy, or the administration of cross-sex hormone therapy, with a medical home needed to facilitate coordination of care. Best practice guidelines vary across pediatric and developmental groups and include both reversible and nonreversible modalities. Screening for negative psychosocial sequelae must be completed to include mood symptomatology, suicidality, substance use disorders, and risky sexual behavior, so that appropriate screening, identification, and treatment interventions can be implemented.
The primary care medical home must act as a foundation for the identification of gender dysphoria and/or associated comorbidities and must treat, when able, or refer, when indicated. In addition, because of structural barriers and stigmatization, public policy often fails the transgender community and can exacerbate the aforementioned psychosocial comorbidities faced by the transgender youth community. Health care providers, particularly nurse practitioners, are in a unique position to expand on the face-to-face care provided to the community and engage in advocacy efforts to dismantle structural barriers impeding transgender individuals and communities while also providing primary health care, anticipatory guidance, and care coordination.
接触儿童的初级保健提供者通常是性别焦虑症患者的第一接触人，性别焦虑症是指出生时被指定的性别与其真实表达的性别身份不一致。由于未经治疗的性别焦虑症患者面临多种负面后果的风险，包括情绪症状、自杀倾向、物质使用障碍和其他心理社会风险因素，因此医疗保健提供者熟练提供全面的、以患者为中心的护理至关重要。本报告的目的是对目前文献中有关初级保健环境或医疗之家内性别焦虑症儿童的识别、治疗和护理协调的现有证据进行更新综述。
利用PubMed和CINAHL，使用以下关键词对2012年至今的文献进行综述：性别焦虑症、跨性别健康、LGBT健康和激素疗法。还对已识别文章的参考文献列表进行相关性探讨。
治疗可能包括社会过渡、激素拮抗剂治疗或给予跨性别激素治疗，需要医疗之家来促进护理协调。最佳实践指南因儿科和发育群体而异，包括可逆和不可逆模式。必须完成对负面心理社会后遗症的筛查，包括情绪症状、自杀倾向、物质使用障碍和危险性行为，以便能够实施适当的筛查、识别和治疗干预措施。
初级保健医疗之家必须作为识别性别焦虑症和/或相关合并症的基础，并且必须在能够治疗时进行治疗，或在需要时进行转诊。此外，由于结构性障碍和污名化，公共政策往往使跨性别群体失望，并可能加剧跨性别青年群体面临的上述心理社会合并症。医疗保健提供者，尤其是执业护士，处于一个独特的位置，可以扩展为社区提供的面对面护理，并参与倡导努力，消除阻碍跨性别个体和社区的结构性障碍，同时提供初级卫生保健、预期指导和护理协调。
