School of Social Work, York University, Toronto, Ontario, Canada.
School of Social Work, The University of British Columbia, Vancouver, British Columbia, Canada.
JAMA Netw Open. 2022 Jul 1;5(7):e2224717. doi: 10.1001/jamanetworkopen.2022.24717.
IMPORTANCE: Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition. OBJECTIVE: To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice. DESIGN, SETTING, AND PARTICIPANTS: Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed. MAIN OUTCOMES AND MEASURES: In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions. RESULTS: Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs. CONCLUSIONS AND RELEVANCE: This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.
重要性:医学教育、研究和临床指南可用于支持跨性别者和非二元性别者开始接受性别肯定护理。相比之下,对于那些由于性别认同改变而停止或试图逆转性别肯定的医疗或手术干预的人,人们对他们的临床经验知之甚少,通常被称为变性。
目的:研究启动医疗或手术变性逆转的人的身心健康体验,为临床实践提供信息。
设计、地点和参与者:使用建构主义扎根理论作为定性方法,以深入访谈的形式收集数据。使用归纳式 2 阶段编码过程对数据进行分析,对与变性逆转相关的医疗保健体验进行分类和解释,为临床实践提供信息。2021 年 10 月至 2022 年 1 月期间,邀请居住在加拿大的年龄在 18 岁及以上、有停止、转变或逆转性别过渡经历的个人参加半结构化虚拟访谈。研究广告在社交媒体、临床医生和参与者的社交网络中传播。共有 28 名参与者接受了采访,他们停止、转变或逆转了性别过渡。
主要结果和措施:停止或试图逆转先前的性别肯定医疗和/或手术干预的人的身心健康体验的深入、叙述性描述。
结果:在 28 名参与者中,18 名(64%)出生时被指定为女性,10 名(36%)出生时被指定为男性;2 名(7%)自认为是犹太人,1 名是白人,5 名(18%)自认为是混血儿和少数民族(包括阿拉伯人、黑人、原住民、拉丁裔和南亚人),21 名(75%)自认为是白人。参与者最初在各种年龄段寻求性别肯定(15 名[56%]年龄在 18 岁至 24 岁之间)。变性逆转的原因各不相同,例如对性别认同的理解不断发展或健康问题。参与者对他们过去的性别肯定的医疗或手术治疗有不同的看法。一些参与者感到遗憾,但大多数人对性别肯定的医疗或手术治疗结果感到满意。医疗变性逆转通常在身体和心理上都具有挑战性,但人们普遍避免寻求医疗保健。参与者描述了他们经历的耻辱感,并与不准备满足他们变性相关医疗需求的临床医生互动。
结论和相关性:这项研究的结果表明,需要进一步的研究和临床指导,以满足那些停止或试图逆转先前性别肯定干预的人群的未满足需求。
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