Ezra D Oosthoek, Skye Stanwich, Karl Gerritse, David Matthew Doyle, Annelou L C de Vries
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引用次数: 0
Abstract
Background: The scrutiny surrounding gender-affirming medical treatment (GAMT) for youth has increased, particularly concerning the limited evidence on long-term treatment outcomes. The Standards of Care 8 by the World Professional Association for Transgender Health addresses this by outlining research evidence suggesting "effective" outcomes of GAMT for adolescents. However, claims concerning what are considered "effective" outcomes of GAMT for adolescents remain implicit, requiring further reflection.
Methods: Using trans negativity as a theoretical lens, we conducted a theory-informed reflexive thematic analysis of the literature cited in the "Research Evidence" section of the SOC8 Adolescents chapter. We selected 16 articles that used quantitative measures to assess GAMT outcomes for youth, examining how "effective" outcomes were framed and interpreted to uncover implicit and explicit normative assumptions within the evidence base.
Results: A total of 44 different measures were used to assess GAMT outcomes for youth, covering physical, psychological, and psychosocial constructs. We identified four main themes regarding the normative assumptions of "effective" treatment outcomes: (1) doing bad: experiencing distress before GAMT, (2) moving toward a static gender identity and binary presentation, (3) doing better: overall improvement after GAMT, and (4) the absence of regret. These themes reveal implicit norms about what GAMT for youth should achieve, with improvement being the benchmark for "effectiveness."
Discussion: We critically reflect on these themes through the lens of trans negativity to challenge what constitutes "effective" GAMT outcomes for youth. We explore how improvement justifies GAMT for youth and address the limitations of this notion.
Conclusions: We emphasize the need for an explicit discussion on the objectives of GAMT for adolescents. The linear narrative of improvement in GAMT for adolescents is limited and fails to capture the complexity of GAMT experiences. With currently no consensus on how the "effectiveness" of GAMT for adolescents is assessed, this article calls for participatory action research that centers the voices of young TGD individuals.
背景：对青年性别肯定医疗（GAMT）的审查有所增加，特别是关于长期治疗结果的有限证据。世界跨性别健康专业协会的《护理标准》（Standards of Care）阐述了这一问题，概述了研究证据，表明GAMT对青少年的“有效”结果。然而，关于青少年GAMT的“有效”结果的说法仍然是含蓄的，需要进一步的反思。方法：以反式否定作为理论视角，我们对SOC8青少年章节“研究证据”部分引用的文献进行了基于理论的反思性主题分析。我们选择了16篇文章，这些文章使用定量措施来评估青少年的GAMT结果，研究了如何构建和解释“有效”的结果，以揭示证据基础中的隐性和显性规范假设。结果：总共有44种不同的测量方法被用来评估青少年的GAMT结果，包括身体、心理和社会心理结构。我们确定了关于“有效”治疗结果的规范性假设的四个主要主题：(1)做得不好：在GAMT之前经历痛苦；(2)走向静态性别认同和二元表现；(3)做得更好：GAMT之后的整体改善；(4)没有遗憾。这些主题揭示了针对青年的GAMT应该实现的隐性规范，改进是“有效性”的基准。讨论：我们通过反性消极的视角批判性地反思这些主题，以挑战对青年构成“有效”GAMT结果的因素。我们将探讨改善如何证明青少年的gat是合理的，并解决这一概念的局限性。结论：我们强调需要明确讨论青少年GAMT的目标。关于青少年GAMT改善的线性叙述是有限的，并且未能捕捉到GAMT体验的复杂性。由于目前对于如何评估青少年GAMT的“有效性”尚无共识，本文呼吁以青少年TGD个体的声音为中心进行参与性行动研究。
期刊介绍：
BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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