Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research.

Rand health quarterly Pub Date : 2025-03-17 eCollection Date: 2025-03-01
Alex R Dopp, Allison Peipert, John Buss, Robinson De Jesús-Romero, Keytin Palmer, Lorenzo Lorenzo-Luaces
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Abstract

Transgender and gender-expansive (TGE) youth often experience gender dysphoria, defined as distress related to a mismatch between one's gender identity and physical development. This study summarizes the rapidly evolving state of evidence on interventions for gender dysphoria and related health problems in TGE youth. The authors conducted a systematic review of studies that assessed interventions for gender dysphoria in TGE youth (age 25 or younger), published from 1990 to 2023, and summarized the amount, clinical significance, and certainty of evidence available. The authors reviewed and summarized the available evidence for beneficial and harmful outcomes associated with intervention categories currently recommended as the standards of care (i.e., gender-affirming psychosocial, hormonal, surgical, and reproductive health interventions) for addressing gender dysphoria and related health problems, as well as proposed alternatives to the standards of care (gender identity and expression change efforts and treatment for co-occurring mental disorders to reduce gender dysphoria). Across intervention categories and outcomes, limitations in the available evidence made it difficult to estimate with certainty the strength (and sometimes direction) of associations between intervention and outcome. Yet practitioners and policymakers can incorporate the best available science when making decisions about health care for TGE youth using evidence-informed approaches to account for these conditions of uncertainty. The authors also discuss implications for researchers seeking to improve this body of evidence so that it provides greater certainty about intervention effects and has greater practice and policy relevance.

对跨性别和性别膨胀青年的性别焦虑和相关健康问题的干预:对实践、政策和研究的益处和风险的系统回顾
跨性别和性别膨胀(TGE)青少年经常经历性别焦虑,这被定义为一个人性别认同和身体发育之间不匹配的痛苦。本研究总结了TGE青年性别焦虑和相关健康问题干预措施的快速发展的证据状态。作者对1990年至2023年间发表的评估TGE青年(25岁或以下)性别焦虑症干预措施的研究进行了系统回顾,并总结了现有证据的数量、临床意义和确定性。作者回顾并总结了目前推荐作为治疗标准的干预类别(即性别肯定的社会心理、激素、外科和生殖健康干预)对解决性别焦虑和相关健康问题的有益和有害结果相关的现有证据。以及拟议的替代护理标准(性别认同和表达改变的努力和治疗共同发生的精神障碍,以减少性别不安)。在干预类别和结果方面,现有证据的局限性使得难以确定地估计干预和结果之间关联的强度(有时是方向)。然而,从业人员和政策制定者在对TGE青年的卫生保健作出决定时,可以采用现有的最佳科学,采用循证方法来解释这些不确定条件。作者还讨论了对寻求改进这一证据体系的研究人员的影响,以便为干预效果提供更大的确定性,并具有更大的实践和政策相关性。
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