Beth Israel Deaconess Medical Center, Boston, Massachusetts (H.L., E.E.R.).
Mount Sinai Hospital, New York, New York (J.D.S.).
Ann Intern Med. 2020 Feb 4;172(3):202-209. doi: 10.7326/M19-3813.
The term transgender refers to persons whose gender identity is different from that recorded at birth. Similar to other marginalized populations, transgender patients commonly experience discrimination in the health care setting, and they may not have access to medical professionals who can provide competent care. In addition to primary medical and preventive health care, transgender patients need access to gender-affirming interventions, including hormone therapy and surgeries. In 2017, the Endocrine Society updated its clinical practice guideline for the care of transgender persons on the basis of the best available evidence from systematic reviews and individual studies. Among its general requirements for adolescents and recommendations for adults were the following: Involvement of a mental health professional who is knowledgeable about the diagnostic criteria for gender dysphoria and criteria for gender-affirming treatment, has training and experience in assessing psychopathology, and is willing to participate in ongoing care. Hormone therapy should be offered to transgender adult patients, with levels maintained within the normal range for gender identity and treatment appropriately monitored. Clinicians involved in the care of transgender adult patients should be knowledgeable about diagnostic criteria for gender dysphoria/gender incongruence, the use of medical and surgical gender-affirming interventions, and appropriate monitoring for reproductive organ cancer risk. Here, 2 clinicians with expertise in this area debate whether psychological evaluation is warranted in a transgender patient requesting gender-affirming hormones or surgery, the potential risks and benefits of estrogen therapy, and the role of the primary care practitioner in the care of transgender persons.
术语“跨性别”是指其性别认同与出生时记录的性别不同的人。与其他边缘化群体一样，跨性别患者在医疗保健环境中经常受到歧视，他们可能无法获得能够提供胜任护理的医疗专业人员。除了基本的医疗和预防保健外，跨性别患者还需要获得性别肯定干预措施，包括激素治疗和手术。2017 年，内分泌学会根据系统评价和个体研究的最佳可用证据更新了其跨性别者护理临床实践指南。其对青少年的一般要求和对成年人的建议包括以下内容：需要有一位熟悉性别焦虑症的诊断标准和性别肯定治疗标准的心理健康专业人员参与，该人员具有评估精神病理学的培训和经验，并愿意参与持续护理。应向跨性别成年患者提供激素治疗，将激素水平维持在符合性别认同和治疗的正常范围内，并适当监测。参与跨性别成年患者护理的临床医生应了解性别焦虑症/性别不一致的诊断标准、医学和手术性别肯定干预措施的使用以及生殖器官癌症风险的适当监测。在这里，两位在该领域具有专业知识的临床医生就以下问题展开了辩论：要求进行性别肯定激素治疗或手术的跨性别患者是否需要进行心理评估、雌激素治疗的潜在风险和益处，以及初级保健医生在跨性别者护理中的作用。
