Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany.
kbo-Isar-Amper-Klinikum Region München, München-Haar, Germany.
Int J Equity Health. 2024 Nov 2;23(1):225. doi: 10.1186/s12939-024-02313-1.
Experiences of discrimination in healthcare lead to poorer mental and physical health for transgender individuals. There is evidence that trans-specialists, i.e. health professionals specializing in transgender care, are an important source of discrimination experienced by transgender individuals in healthcare. In this qualitative interview study, we explored the reasons for this possibly surprising finding by analyzing subjective views of trans-specialists on various issues related to discrimination of transgender individuals.
We conducted 20 semi-structured, qualitative, exploratory interviews with healthcare professionals specializing in transgender care. Interview questions were developed based on an extensive literature analysis and results of previous research on the topic. The interviews were conducted online, were digitally recorded and transcribed. Data analysis was conducted using the methods of content analysis and thematic analysis.
The interviewees had great difficulty giving a consistent definition of the concept of gender identity. Most of them saw it as a self-determination of a transgender individual. Although herewith emphasizing the autonomy of transgender individuals, most trans-specialists felt that they had to be convinced of their patient's transsexuality to carry out treatment. Most trans-specialists reported having had doubts about whether some transgender individuals were suffering from gender incongruence or not. There was also ambiguity among interviewees about whether transsexuality is a mental illness.
We were able to identify specific topics that can cause discrimination experiences on the part of transgender individuals in their contact with trans-specialists. These include the vagueness of the construct of gender identity and the ambivalence between respect for the autonomy of transgender individuals and the validation of the diagnosis "transsexuality". Also, uncertainties regarding the classification of transsexuality as a mental illness can lead to experiences of discrimination. Furthermore, our results imply that trans-specialists might remember own discriminatory behavior less than it actually took place. Our results can contribute to the development of specific measures to avoid discrimination experiences of transgender individuals in contact with trans-specialists. These should include a reflection on one's own gender identity and training on mechanisms of discrimination.
在医疗保健中经历歧视会导致跨性别者的身心健康状况恶化。有证据表明，跨性别专家，即专门从事跨性别护理的健康专业人员，是跨性别者在医疗保健中经历歧视的一个重要来源。在这项定性访谈研究中，我们通过分析跨性别专家对与跨性别者歧视相关的各种问题的主观观点，探讨了这一可能令人惊讶的发现的原因。
我们对专门从事跨性别护理的医疗保健专业人员进行了 20 次半结构化、定性、探索性访谈。访谈问题是根据广泛的文献分析和先前关于该主题的研究结果制定的。访谈是在网上进行的，被数字记录并转录。使用内容分析和主题分析的方法进行数据分析。
受访者很难对性别认同这一概念给出一致的定义。他们中的大多数人将其视为跨性别者的自我决定。尽管这强调了跨性别者的自主权，但大多数跨性别专家认为，他们必须确信自己的病人是跨性别者才能进行治疗。大多数跨性别专家报告说，他们对一些跨性别者是否患有性别认同障碍存在疑虑。受访者对跨性别是否是一种精神疾病也存在模糊性。
我们能够确定一些特定的主题，这些主题可能会导致跨性别者在与跨性别专家接触时产生歧视体验。这些主题包括性别认同结构的模糊性以及在尊重跨性别者自主权和验证“跨性别”诊断之间的矛盾。此外，对跨性别作为一种精神疾病的分类的不确定性也可能导致歧视体验。此外，我们的研究结果表明，跨性别专家可能对自己的歧视行为的记忆比实际发生的要少。我们的研究结果可以为制定具体措施以避免跨性别者在与跨性别专家接触时的歧视体验做出贡献。这些措施应包括对自身性别认同的反思和对歧视机制的培训。
