Melbourne Law School, The University of Melbourne, Melbourne, Victoria, Australia; Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Melbourne Law School, The University of Melbourne, Melbourne, Victoria, Australia; Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Brain and Mind Group, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Parkville, Victoria, Australia; Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.
J Adolesc Health. 2021 Jun;68(6):1189-1196. doi: 10.1016/j.jadohealth.2020.09.028. Epub 2020 Oct 27.
Approximately half of transgender or gender diverse youth identify as gender nonbinary (not entirely or exclusively male or female). This study aimed to explore the views and practices of Australian clinicians working with transgender or gender diverse young people regarding puberty suppression for nonbinary youth, including requests for ongoing puberty suppression into adulthood.
Individual semistructured key informant interviews were conducted with 14 clinicians (medical and mental health) in Australia to explore their practices, views, and decision-making regarding puberty suppression for nonbinary youth. Transcripts were analyzed using inductive content analysis.
Requests for puberty suppression from nonbinary young people are occurring, with 12 of 14 clinicians reporting they have received such requests. Although all clinicians were prepared to support short-term puberty suppression for nonbinary youth, clinicians diverged in their preparedness to support long-term puberty suppression. Clinicians expressed concerns in relation to risks, resource allocation, and medicalization. Some clinicians required nonbinary young people to choose a masculinizing or feminizing puberty. Some clinicians also put forward arguments in favor of long-term puberty suppression, including potential psychosocial harm of discontinuing puberty suppression, respect for autonomy, equity, and harm minimization. Clinicians also highlighted practical challenges of obtaining long-term puberty suppression in the adult setting.
The decision of whether to provide puberty suppression, particularly long-term, to a nonbinary young person is both ethically and clinically complex. There is currently a diversity of practice in this area, and evidence-based ethical guidelines and outcome data could promote more informed decision-making and support clinicians working in this complex area.
大约有一半的跨性别或性别多样化的年轻人认同非二元性别（不完全或完全不是男性或女性）。本研究旨在探讨澳大利亚从事跨性别或性别多样化青年工作的临床医生在为非二元性别青年进行青春期抑制方面的观点和实践，包括要求将青春期抑制持续到成年。
对澳大利亚的 14 名临床医生（医疗和心理健康）进行了个体半结构化关键知情人访谈，以探讨他们在为非二元性别青年进行青春期抑制方面的实践、观点和决策。使用归纳内容分析法对转录本进行分析。
非二元性别青年提出了青春期抑制的请求，14 名临床医生中有 12 名报告说他们收到了这样的请求。尽管所有临床医生都准备支持非二元青年的短期青春期抑制，但临床医生在支持长期青春期抑制的准备程度上存在分歧。临床医生对风险、资源分配和医学化表示关注。一些临床医生要求非二元青年选择男性化或女性化的青春期。一些临床医生还提出了支持长期青春期抑制的论点，包括停止青春期抑制可能带来的潜在心理社会伤害、尊重自主权、公平和伤害最小化。临床医生还强调了在成人环境中获得长期青春期抑制的实际挑战。
是否为非二元性别青年提供青春期抑制，特别是长期青春期抑制，在伦理和临床方面都很复杂。在这一领域目前存在着多样化的实践，基于证据的伦理准则和结果数据可以促进更明智的决策，并为在这一复杂领域工作的临床医生提供支持。
