Robinson Isabel S, Carswell Jeremi M, Boskey Elizabeth, Agarwal Cori A, Brassard Pierre, Bélanger Maud, Zhao Lee C, Bluebond-Langner Rachel
From the Hansjörg Wyss Department of Plastic Surgery.
Department of Medicine, Division of Endocrinology.
Plast Reconstr Surg. 2023 Oct 1;152(4):737e-750e. doi: 10.1097/PRS.0000000000010325. Epub 2023 Feb 27.
The number of transgender adolescents seeking gender-affirming surgery (GAS) in increasing. Surgical care of the adolescent transgender patient is associated with several unique technical, legal, and ethical factors. The authors present a review of the current literature on gender-affirming surgery for individuals under the age of legal majority and propose directions for future research.
A scoping review of recent literature was performed to assess evidence on gender-affirming surgery in individuals under the age of legal majority. Articles were included that examined either ethical or technical factors unique to pediatric GAS. Study characteristics and conclusions were analyzed in conjunction with expert opinion.
Twelve articles were identified that met inclusion criteria. Ten of these articles discussed ethical challenges in adolescent GAS, seven discussed legal challenges, and five discussed technical challenges. Ethical discussions focused on the principles of beneficence, nonmaleficence, and autonomy. Legal discussions centered on informed consent and insurance coverage. Technical discussions focused on the effects of puberty blockade on natal tissue.
Surgical care of the adolescent transgender patient involves important ethical, legal, and technical considerations that must be addressed by the clinical team. As the population of individuals seeking GAS after puberty blockade increases, future research is needed describing functional and psychosocial outcomes in these individuals.
寻求性别肯定手术（GAS）的跨性别青少年数量正在增加。青少年跨性别患者的手术治疗涉及一些独特的技术、法律和伦理因素。作者对目前关于法定成年年龄以下个体性别肯定手术的文献进行了综述，并提出了未来研究的方向。
对近期文献进行了范围综述，以评估法定成年年龄以下个体性别肯定手术的证据。纳入了研究儿科性别肯定手术独特的伦理或技术因素的文章。结合专家意见对研究特征和结论进行了分析。
确定了12篇符合纳入标准的文章。其中10篇文章讨论了青少年性别肯定手术中的伦理挑战，7篇讨论了法律挑战，5篇讨论了技术挑战。伦理讨论集中在行善、不伤害和自主原则上。法律讨论集中在知情同意和保险覆盖方面。技术讨论集中在青春期阻断对原生组织的影响上。
青少年跨性别患者的手术治疗涉及临床团队必须解决的重要伦理、法律和技术考虑因素。随着青春期阻断后寻求性别肯定手术的人数增加，需要开展未来研究来描述这些个体的功能和心理社会结果。
