Shelemy Lucas, Cotton Sue, Crane Catherine, Knight Matthew
Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Warneford Hospital, Oxford, UK.
Northamptonshire Gender Identity Clinic, Danetre Hospital, UK.
Int J Transgend Health. 2024 Apr 3;26(3):480-500. doi: 10.1080/26895269.2024.2333525. eCollection 2025.
Many transgender and gender diverse (TGD) people experience high levels of mental health difficulties. Different gender-affirmative interventions exist which aim to alleviate gender dysphoria, with the hope that this in turn will improve the mental health and quality of life of TGD people.
This systematic review aims to examine the effectiveness of affirmative dysphoria-focused interventions for adults in improving mental health outcomes.
Inclusion criteria were published, prospective design studies with pre and post-test intervention mental health outcomes, following a gender affirmative intervention. Single-person case studies and measures of sexual distress and body image were excluded. Database searches were conducted with additional hand-searching (database inception to August 2023). Study quality was double-rated using a validated tool.
Twenty-nine studies (2789 total participants) were identified that quantitatively assessed mental health outcomes (including depression, anxiety and self-esteem) following hormone, surgical and/or psychotherapeutic interventions. No eligible qualitative research or studies of voice and communication therapy or hair removal/electrolysis were found. The majority of studies of hormone treatments found that mental health, and in particular depression outcomes, significantly improved post-intervention and at follow-up. Improvements following surgical interventions were reported at follow-up time points beyond 6 months after the end of intervention. The majority of surgical intervention studies at post-intervention to 6-month follow-up showed no significant anxiety change, with mixed results for other mental health conditions. The majority of psychological interventions reported improvements in various mental health outcomes. The majority of included studies were assessed as being 'medium' or 'weak' quality.
This review indicates that interventions for gender dysphoria, especially hormone and psychological treatments, may have mental health benefits for TGD people. Further research is required to examine the relationship between mental health post-intervention and minority stressors, visual congruity and intersectional factors.
许多跨性别者和性别多元者经历着高水平的心理健康问题。存在不同的性别肯定干预措施，旨在减轻性别焦虑，希望这反过来能改善跨性别者和性别多元者的心理健康及生活质量。
本系统评价旨在研究针对成年人的以性别焦虑为重点的肯定性干预措施在改善心理健康结果方面的有效性。
纳入标准为已发表的、采用前后测试干预心理健康结果的前瞻性设计研究，这些研究遵循性别肯定干预措施。单人案例研究以及性困扰和身体意象的测量被排除。通过数据库检索并辅以手工检索（数据库起始时间至2023年8月）。使用经过验证的工具对研究质量进行双重评级。
共识别出29项研究（总计2789名参与者），这些研究对激素、手术和/或心理治疗干预后的心理健康结果（包括抑郁、焦虑和自尊）进行了定量评估。未找到符合条件的定性研究或关于嗓音与沟通治疗或脱毛/电解的研究。大多数激素治疗研究发现，干预后及随访时心理健康，尤其是抑郁结果有显著改善。手术干预后的改善在干预结束后6个月以上的随访时间点有报告。大多数干预后至6个月随访的手术干预研究显示焦虑无显著变化，其他心理健康状况的结果不一。大多数心理干预报告了各种心理健康结果的改善。大多数纳入研究被评估为“中等”或“低”质量。
本评价表明，针对性别焦虑的干预措施，尤其是激素和心理治疗，可能对跨性别者和性别多元者有心理健康益处。需要进一步研究以考察干预后心理健康与少数群体压力源、视觉一致性和交叉因素之间的关系。
