Associate Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Sex Reprod Health Matters. 2021;29(3):2045066. doi: 10.1080/26410397.2022.2045066.
Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics more aligned with their gender identity or expression and can be empowering when provided within safe, supportive health systems. To inform World Health Organization guidelines on self-care interventions, we systematically reviewed the evidence for self-administration compared to health worker-administration of gender-affirming hormones. We conducted a comprehensive search for peer-reviewed articles and conference abstracts that addressed effectiveness, values and preferences, and cost considerations. Data were extracted in duplicate using standardised forms. Of 3792 unique references, five values and preferences articles were included; no studies met the criteria for the effectiveness or cost reviews. All values and preferences studies focused on self-administration of unprescribed hormones, not prescribed hormones within a supportive health system. Four studies from the U.S. ( = 2), Brazil ( = 1), and the U.K. ( = 1) found that individuals seeking gender-affirming hormone therapy may self-manage due to challenges finding knowledgeable and non-stigmatising health workers, lack of access to appropriate services, exclusion, and discomfort with health workers, cost, and desire for a faster transition. One study from Thailand found health worker perspectives were shaped by restrictive legislation, few transgender-specific services or guidelines, inappropriate communication with health workers, and medical knowledge gaps. There is limited literature on self-administration of gender-affirming hormone therapy. Principles of gender equality and human rights in the delivery of quality gender-affirming hormones are critical to expand access to this important intervention and reduce discrimination based on gender identity.
自我管理质量性别肯定激素是扩大寻求与性别认同或表达更一致的第二性特征的个体获得激素治疗的一种方法，并且在安全、支持性的健康系统中提供时可以赋予权力。为了为世界卫生组织关于自我保健干预措施的指南提供信息，我们系统地审查了自我管理与卫生工作者管理性别肯定激素相比的证据。我们全面搜索了涉及有效性、价值观和偏好以及成本考虑的同行评议文章和会议摘要。使用标准化表格重复提取数据。在 3792 条独特的参考文献中，有 5 篇价值观和偏好文章被纳入；没有研究符合有效性或成本审查的标准。所有价值观和偏好研究都集中在自我管理未经处方的激素上，而不是在支持性健康系统内管理处方激素。来自美国的四项研究（ = 2）、巴西（ = 1）和英国（ = 1）发现，寻求性别肯定激素治疗的个体可能会自我管理，因为在寻找知识渊博且无污名化的卫生工作者、缺乏适当的服务、排斥和对卫生工作者的不适、成本以及渴望更快过渡方面存在挑战。来自泰国的一项研究发现，卫生工作者的观点受到限制立法、少数跨性别特定服务或指南、与卫生工作者的不当沟通以及医学知识差距的影响。关于性别肯定激素治疗的自我管理的文献有限。在提供高质量性别肯定激素方面，性别平等和人权原则对于扩大获得这一重要干预措施的机会和减少基于性别认同的歧视至关重要。
