Mehringer Jamie, Dowshen Nadia L
Craig A Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Craig A Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Curr Probl Pediatr Adolesc Health Care. 2019 Sep;49(9):100684. doi: 10.1016/j.cppeds.2019.100684. Epub 2019 Nov 14.
Sexual and reproductive health are an integral part of all youths' health and wellbeing, including youth who are transgender and gender-expansive. This article will discuss general approaches to the sexual and reproductive health care of transgender and gender-expansive youth, and review the topics of contraception and menstrual suppression, fertility preservation and family building, and the prevention and treatment of sexually transmitted infections and HIV in this population. Although transgender youth on testosterone therapy often become amenorrheic, ovulation and pregnancy can still occur, and thus all youth on testosterone therapy should be counseled on the potential for pregnancy and have access to effective contraception. Many forms of hormonal contraceptives are both safe and efficacious when used by youth on testosterone therapy. Hormonal contraceptives may also be used to provide menstrual suppression for those experiencing dysphoria from unwanted uterine bleeding. All transgender youth should receive counseling on fertility preservation and reproductive options prior to starting pubertal blockers and/or gender-affirming hormones, therapies that have varying effects on long-term fertility potential. Several different methods of fertility preservation exist, however there are numerous barriers to transgender youth receiving fertility preservation services, and rates of utilization of these services is low. Transgender individuals suffer from a disproportionate burden of HIV compared to their peers-thought to result from stigma, marginalization, and lack of access to appropriate care. All providers caring for youth should be informed about HIV pre-exposure prophylaxis (PrEP) and HIV post-exposure prophylaxis (PEP), which may help to prevent HIV acquisition.
性健康和生殖健康是所有青少年健康与福祉不可或缺的一部分，包括跨性别和性别认同多元的青少年。本文将讨论为跨性别和性别认同多元的青少年提供性健康和生殖健康护理的一般方法，并回顾该人群中避孕与月经抑制、生育力保存与组建家庭，以及性传播感染和艾滋病毒的预防与治疗等主题。尽管接受睾酮治疗的跨性别青少年通常会闭经，但仍可能发生排卵和怀孕，因此应对所有接受睾酮治疗的青少年进行怀孕可能性的咨询，并提供有效的避孕措施。许多形式的激素避孕药在接受睾酮治疗的青少年中使用时既安全又有效。激素避孕药也可用于为那些因意外子宫出血而感到烦躁不安的人抑制月经。所有跨性别青少年在开始使用青春期阻滞剂和/或性别确认激素之前，都应接受关于生育力保存和生殖选择的咨询，这些疗法对长期生育潜力有不同影响。存在几种不同的生育力保存方法，然而跨性别青少年获得生育力保存服务存在诸多障碍，且这些服务的利用率较低。与同龄人相比，跨性别者感染艾滋病毒的负担过重——这被认为是由耻辱感、边缘化以及缺乏获得适当护理的机会导致的。所有照顾青少年的医疗服务提供者都应了解艾滋病毒暴露前预防（PrEP）和艾滋病毒暴露后预防（PEP），这可能有助于预防艾滋病毒感染。
