Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey.
Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; PROUD Gender Center of New Jersey, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
Endocr Pract. 2023 Jun;29(6):465-470. doi: 10.1016/j.eprac.2023.03.003. Epub 2023 Mar 9.
The World Professional Association for Transgender Health Standards of Care Version 7 recommended that before initiating gender-affirming hormone therapy (GAHT), patients should seek a psychosocial evaluation from a mental health professional documenting a diagnosis of persistent gender dysphoria. The Endocrine Society published guidelines in 2017 recommending against an obligatory psychosocial evaluation, which was affirmed in the recently published World Professional Association for Transgender Health Standards of Care Version 8 from 2022. Little is known about how endocrinologists ensure appropriate psychosocial assessment for their patients. This study assessed the protocols and characteristics of U.S.-based adult endocrinology clinics that prescribe GAHT.
An anonymous electronic survey sent to members of a professional organization and the "Endocrinologists" Facebook group was responded by 91 practicing board-certified adult endocrinologists who prescribe GAHT.
Thirty-one states were represented by the respondents. Overall, 83.1% of GAHT-prescribing endocrinologists reported accepting Medicaid. They reported working in university practices (28.4%), community practices (22.7%), private practices (27.3%), and other practice settings (21.6%). Overall, 42.9% of the respondents reported that their practice required documentation of a psychosocial evaluation from a mental health professional before initiating GAHT.
Endocrinologists who prescribe GAHT are divided about requiring a baseline psychosocial evaluation before prescribing GAHT. Further work is needed to understand the impact of psychosocial assessment on patient care and facilitate the uptake of new guidelines into clinical practice.
世界专业跨性别健康协会第 7 版护理标准建议，在开始进行性别肯定激素治疗（GAHT）之前，患者应寻求心理健康专业人员进行社会心理评估，记录持续性性别不安的诊断。内分泌学会于 2017 年发布了指南，建议反对强制性的社会心理评估，这一观点在 2022 年最近发布的世界专业跨性别健康协会第 8 版护理标准中得到了肯定。对于内分泌学家如何确保其患者进行适当的社会心理评估，知之甚少。本研究评估了为患者开 GAHT 的美国成人内分泌诊所的协议和特征。
向专业组织的成员和“内分泌学家”Facebook 群组发送了匿名电子调查，91 名从事 GAHT 处方的认证成人内分泌学家对此进行了回复。
受访者来自 31 个州。总体而言，83.1%的 GAHT 处方内分泌医生表示接受医疗补助。他们报告在大学诊所（28.4%）、社区诊所（22.7%）、私人诊所（27.3%）和其他诊所工作（21.6%）。总体而言，42.9%的受访者报告称，他们的诊所要求在开始 GAHT 之前提供心理健康专业人员的社会心理评估文件。
开 GAHT 的内分泌医生对在开 GAHT 之前是否需要进行基线社会心理评估存在分歧。需要进一步努力了解社会心理评估对患者护理的影响，并促进新指南在临床实践中的应用。
