为跨性别、性别多元和非二元性别人群提供性别肯定激素治疗：世界跨性别健康专业协会与知情同意护理模式的协调
Gender-Affirming Hormone Therapy for the Trans, Gender Diverse, and Nonbinary Community: Coordinating World Professional Association for Transgender Health and Informed Consent Models of Care.
作者信息
Solanki Pravik, Colon-Cabrera David, Barton Chris, Locke Peter, Cheung Ada S, Spanos Cassandra, Grace Julian, Erasmus Jaco, Lane Riki
机构信息
Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.
Department of Anthropology, School of Social Sciences, Monash University, Clayton, Australia.
出版信息
Transgend Health. 2023 Mar 31;8(2):137-148. doi: 10.1089/trgh.2021.0069. eCollection 2023 Apr.
PURPOSE
Before commencing gender-affirming hormone therapy, people undergo assessments through the World Professional Association for Transgender Health (WPATH) model (typically with a mental health clinician), or an informed consent (IC) model (without a formal mental health assessment). Despite growing demand, these remain poorly coordinated in Australia. We aimed to compare clients attending WPATH and IC services; compare binary and nonbinary clients; and characterize clients with psychiatric diagnoses or longer assessments.
METHODS
Cross-sectional audit of clients approved for gender-affirming treatment (March 2017-2019) at a specialist clinic (WPATH model, =212) or a primary care clinic (IC model, =265). Sociodemographic, mental health, and clinical data were collected from electronic records, and analyzed with pairwise comparisons and multivariable regression.
RESULTS
WPATH model clients had more psychiatric diagnoses (mean 1.4 vs. 1.1, <0.001) and longer assessments for hormones (median 5 vs. 2 sessions, <0.001) than IC model clients. More IC model clients than WPATH model clients were nonbinary (27% vs. 15%, =0.016). Nonbinary clients had more psychiatric diagnoses (mean 1.7 vs. 1.1, <0.001) and longer IC assessments (median 3 vs. 2 sessions, <0.001) than binary clients. Total psychiatric diagnoses were associated with nonbinary identities ( 0.7, =0.001) and health care cards ( 0.4, =0.017); depression diagnoses were associated with regional/remote residence (adjusted odds ratio [aOR] 2.2, =0.011); and anxiety disorders were associated with nonbinary identities (aOR 2.8, =0.012) and inversely associated with employment (aOR 0.5, =0.016).
CONCLUSION
WPATH model clients are more likely to have binary identities, mental health diagnoses, and longer assessments than IC model clients. Better coordination is needed to ensure timely gender-affirming care.
目的
在开始性别肯定激素治疗之前，人们需通过世界跨性别健康专业协会（WPATH）模式（通常由心理健康临床医生进行评估）或知情同意（IC）模式（无需正式心理健康评估）接受评估。尽管需求不断增长，但在澳大利亚，这些评估的协调工作仍很薄弱。我们旨在比较接受WPATH和IC服务的客户；比较二元性别和非二元性别客户；并对患有精神疾病诊断或评估时间较长的客户进行特征描述。
方法
对一家专科诊所（WPATH模式，n = 212）或一家初级保健诊所（IC模式，n = 265）在2017年3月至2019年期间批准接受性别肯定治疗的客户进行横断面审核。从电子记录中收集社会人口统计学、心理健康和临床数据，并通过成对比较和多变量回归进行分析。
结果
与IC模式客户相比，WPATH模式客户有更多的精神疾病诊断（平均1.4例对1.1例，P < 0.001），激素评估时间更长（中位数5次对2次，P < 0.001）。非二元性别客户中，IC模式客户比WPATH模式客户更多（27%对15%，P = 0.016）。与二元性别客户相比，非二元性别客户有更多的精神疾病诊断（平均1.7例对1.1例，P < 0.001），IC评估时间更长（中位数3次对2次，P < 0.001）。总的精神疾病诊断与非二元性别身份（β = 0.7，P = 0.001）和医疗保健卡（β = 0.4，P = 0.017）相关；抑郁症诊断与地区/偏远居住相关（调整优势比[aOR] 2.2，P = 0.011）；焦虑症与非二元性别身份相关（aOR 2.8，P = 0.012），与就业呈负相关（aOR 0.5，P = 0.016）。
结论
与IC模式客户相比，WPATH模式客户更有可能具有二元性别身份、精神健康诊断和更长的评估时间。需要更好地协调以确保及时提供性别肯定护理。
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