Hruz Paul W
Washington University School of Medicine, St. Louis, MO, USA.
Linacre Q. 2020 Feb;87(1):34-42. doi: 10.1177/0024363919873762. Epub 2019 Sep 20.
Individuals who experience a gender identity that is discordant with biological sex are increasingly presenting to physicians for assistance in alleviating associated psychological distress. In contrast to prior efforts to identify and primarily address underlying psychiatric contributors to gender dysphoria, interventions that include uncritical social affirmation, use of gonadotropin-releasing hormone agonists to suppress normally timed puberty, and administration of cross-sex steroid hormones to induce desired secondary sex characteristics are now advocated by an emerging cohort of transgender medicine specialists. For patients with persistent gender dysphoria, surgery is offered to alter the appearance of breasts and genital organs. Efforts to address ethical concerns regarding this contentious treatment paradigm are dependent upon reliable evidence on immediate and long-term risks and benefits. Although strong recommendations have been made for invasive and potentially irreversible interventions, high-quality scientific data on the effects of this approach are generally lacking. Limitations of the existing transgender literature include general lack of randomized prospective trial design, small sample size, recruitment bias, short study duration, high subject dropout rates, and reliance on "expert" opinion. Existing data reveal significant intervention-associated morbidity and raise serious concern that the primary goal of suicide prevention is not achieved. In addition to substantial moral questions, adherence to established principles of evidence-based medicine necessitates a high degree of caution in accepting gender-affirming medical interventions as a preferred treatment approach. Continued consideration and rigorous investigation of alternate approaches to alleviating suffering in people with gender dysphoria are warranted.
This paper provides an overview of what is currently known about people who experience a gender identity that differs from their biological sex and the associated desire to engage the medical profession in alleviating associated discomfort and distress. The scientific evidence used to support current recommendations for affirming one's preferred gender, halting normally timed puberty, administering cross-sex hormones, and surgically altering primary and secondary sexual traits are summarized and critically evaluated. Serious deficits in understanding the cause of this condition, the reasons for the marked increase in people presenting for medical care, together with immediate and long-term risks relative to benefit of medical intervention are exposed.
那些经历了与生理性别不一致的性别认同的人越来越多地向医生寻求帮助，以减轻相关的心理困扰。与之前识别并主要解决性别焦虑潜在精神因素的努力不同，包括不加批判的社会肯定、使用促性腺激素释放激素激动剂抑制正常时间的青春期，以及给予跨性别甾体激素以诱导期望的第二性征等干预措施，现在得到了一批新兴的跨性别医学专家的倡导。对于患有持续性性别焦虑的患者，会提供手术来改变乳房和生殖器官的外观。解决关于这种有争议的治疗模式的伦理问题的努力，依赖于关于直接和长期风险与益处的可靠证据。尽管已经对侵入性和潜在不可逆的干预措施提出了强烈建议，但关于这种方法效果的高质量科学数据普遍缺乏。现有跨性别文献的局限性包括普遍缺乏随机前瞻性试验设计、样本量小、招募偏差、研究持续时间短、受试者脱落率高以及依赖“专家”意见。现有数据揭示了与干预相关的显著发病率，并引发了对预防自杀这一首要目标未实现的严重担忧。除了大量的道德问题外，遵循循证医学的既定原则，在将性别肯定性医疗干预作为首选治疗方法时需要高度谨慎。对于缓解性别焦虑患者痛苦的替代方法，仍需持续考虑并进行严格调查。
本文概述了目前对于那些经历了与其生理性别不同的性别认同以及相关的寻求医疗专业帮助以减轻相关不适和困扰的愿望的人群的了解。用于支持当前关于确认首选性别、停止正常时间的青春期、给予跨性别激素以及手术改变第一和第二性征的建议的科学证据，在此进行了总结和批判性评估。暴露了在理解这种情况的原因、寻求医疗护理的人数显著增加的原因，以及相对于医疗干预益处的直接和长期风险方面存在的严重不足。
