Lambrou Nickolas H, Cochran Katherine M, Everhart Samantha, Flatt Jason D, Zuelsdorff Megan, O'Hara John B, Weinhardt Lance, Flowers Benton Susan, Gleason Carey E
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
Transgend Health. 2020 Mar 16;5(1):18-32. doi: 10.1089/trgh.2019.0054. eCollection 2020 Mar 1.
We examined health care experiences of transmasculine young adults to clarify factors contributing to mistrust in the health care system and identify tangible and modifiable means to address health disparities through improved patient-provider interactions. Thematic analysis highlights patterns within historical relationships between medical models and transmasculine embodiment, and provides guidance for health care clinicians, researchers, and policy makers to deliver competent services for transgender and gender diverse (TGD) individuals. The study team used qualitative methodology guided by interpretive phenomenological analysis. Semistructured interviews with 12 participants who self-identified as transmasculine were conducted, transcribed, and coded thematically. Participants were a community sample of 12 young adults 18-35 years of age (=23, standard deviation=3.74), who self-identified as transmasculine. Three participants identified as a racial/ethnic minority. Participants were highly educated, with most completing at least some college. The superordinate thematic domain Perspectives on Health Care emerged, under which three subthemes were nested: (1) an essentialist, binary medical model is inaccurate and oppressive, (2) consequences of medicalizing gender (i.e., gender as a diagnosis), and (3) recommendations to improve health care. Qualitative analysis revealed specific ways in which the relationship between transmasculine individuals and current health care systems are fraught with difficulties, including the impact of stigma, gatekeeping, and inaccuracies, in current diagnostic criteria. Participants shared lived experiences and offered innovative ideas to improve health care delivery, such as challenging socialized biases, increased education, and immersion in TGD communities to advocate for change in research, practice, and policy.
我们调查了跨性别男性青年的医疗保健经历，以阐明导致他们对医疗保健系统不信任的因素，并确定通过改善医患互动来解决健康差距的切实可行且可调整的方法。主题分析突出了医学模式与跨性别男性身体体现之间历史关系中的模式，并为医疗保健临床医生、研究人员和政策制定者提供指导，以便为跨性别和性别多样化（TGD）个体提供合格的服务。研究团队采用了以解释性现象学分析为指导的定性方法。对12名自我认定为跨性别男性的参与者进行了半结构化访谈，访谈内容进行了转录并按主题编码。参与者是一个社区样本，由12名年龄在18至35岁之间（平均年龄=23岁，标准差=3.74）的青年组成，他们自我认定为跨性别男性。三名参与者被认定为少数种族/族裔。参与者受教育程度较高，大多数至少完成了一些大学学业。出现了“对医疗保健的看法”这一上级主题领域，其下嵌套了三个子主题：（1）本质主义的二元医学模式不准确且具有压迫性，（2）将性别医学化（即把性别作为一种诊断）的后果，以及（3）改善医疗保健的建议。定性分析揭示了跨性别男性个体与当前医疗保健系统之间的关系充满困难的具体方式，包括耻辱感、把关以及当前诊断标准不准确所带来的影响。参与者分享了生活经历，并提出了改善医疗保健服务的创新想法，例如挑战社会化偏见、增加教育以及融入TGD社区以倡导在研究、实践和政策方面进行变革。
