Pravik Solanki, David Colon-Cabrera, Chris Barton, Peter Locke, Ada S Cheung, Cassandra Spanos, Julian Grace, Jaco Erasmus, Riki Lane
{"title":"变性、性别多元化和非二元群体的性别确认激素疗法：协调世界变性人健康专业协会和知情同意护理模式。","authors":"Pravik Solanki, David Colon-Cabrera, Chris Barton, Peter Locke, Ada S Cheung, Cassandra Spanos, Julian Grace, Jaco Erasmus, Riki Lane","doi":"10.1089/trgh.2021.0069","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>Cross-sectional audit of clients approved for gender-affirming treatment (March 2017-2019) at a specialist clinic (WPATH model, <i>n</i>=212) or a primary care clinic (IC model, <i>n</i>=265). Sociodemographic, mental health, and clinical data were collected from electronic records, and analyzed with pairwise comparisons and multivariable regression.</p><p><strong>Results: </strong>WPATH model clients had more psychiatric diagnoses (mean 1.4 vs. 1.1, <i>p</i><0.001) and longer assessments for hormones (median 5 vs. 2 sessions, <i>p</i><0.001) than IC model clients. More IC model clients than WPATH model clients were nonbinary (27% vs. 15%, <i>p</i>=0.016). Nonbinary clients had more psychiatric diagnoses (mean 1.7 vs. 1.1, <i>p</i><0.001) and longer IC assessments (median 3 vs. 2 sessions, <i>p</i><0.001) than binary clients. Total psychiatric diagnoses were associated with nonbinary identities (<i>β</i> 0.7, <i>p</i>=0.001) and health care cards (<i>β</i> 0.4, <i>p</i>=0.017); depression diagnoses were associated with regional/remote residence (adjusted odds ratio [aOR] 2.2, <i>p</i>=0.011); and anxiety disorders were associated with nonbinary identities (aOR 2.8, <i>p</i>=0.012) and inversely associated with employment (aOR 0.5, <i>p</i>=0.016).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":37265,"journal":{"name":"Transgender Health","volume":"8 2","pages":"137-148"},"PeriodicalIF":2.0000,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10066762/pdf/","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Pravik Solanki, David Colon-Cabrera, Chris Barton, Peter Locke, Ada S Cheung, Cassandra Spanos, Julian Grace, Jaco Erasmus, Riki Lane\",\"doi\":\"10.1089/trgh.2021.0069\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>Cross-sectional audit of clients approved for gender-affirming treatment (March 2017-2019) at a specialist clinic (WPATH model, <i>n</i>=212) or a primary care clinic (IC model, <i>n</i>=265). Sociodemographic, mental health, and clinical data were collected from electronic records, and analyzed with pairwise comparisons and multivariable regression.</p><p><strong>Results: </strong>WPATH model clients had more psychiatric diagnoses (mean 1.4 vs. 1.1, <i>p</i><0.001) and longer assessments for hormones (median 5 vs. 2 sessions, <i>p</i><0.001) than IC model clients. More IC model clients than WPATH model clients were nonbinary (27% vs. 15%, <i>p</i>=0.016). Nonbinary clients had more psychiatric diagnoses (mean 1.7 vs. 1.1, <i>p</i><0.001) and longer IC assessments (median 3 vs. 2 sessions, <i>p</i><0.001) than binary clients. Total psychiatric diagnoses were associated with nonbinary identities (<i>β</i> 0.7, <i>p</i>=0.001) and health care cards (<i>β</i> 0.4, <i>p</i>=0.017); depression diagnoses were associated with regional/remote residence (adjusted odds ratio [aOR] 2.2, <i>p</i>=0.011); and anxiety disorders were associated with nonbinary identities (aOR 2.8, <i>p</i>=0.012) and inversely associated with employment (aOR 0.5, <i>p</i>=0.016).</p><p><strong>Conclusion: </strong>WPATH model clients are more likely to have binary identities, mental health diagnoses, and longer assessments than IC model clients. 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引用次数: 0
摘要
目的：在开始确认性别的激素疗法之前，人们会通过世界变性人健康专业协会（WPATH）模式（通常由心理健康临床医生进行）或知情同意（IC）模式（无需正式的心理健康评估）进行评估。尽管需求不断增长，但在澳大利亚，这些模式的协调性仍然很差。我们的目标是对参加 WPATH 和 IC 服务的客户进行比较；对二元客户和非二元客户进行比较；并对有精神病诊断或较长时间评估的客户进行特征描述：对在专科诊所（WPATH 模式，n=212）或初级保健诊所（IC 模式，n=265）获准接受性别确认治疗的客户（2017 年 3 月至 2019 年 3 月）进行横断面审计。从电子记录中收集了社会人口学、心理健康和临床数据，并进行了配对比较和多变量回归分析：结果：WPATH 模型的客户有更多的精神病诊断（平均 1.4 对 1.1，pp=0.016）。非二元身份客户有更多的精神病诊断（平均 1.7 vs. 1.1，ppβ 0.7，p=0.001）和医疗卡（β 0.4，p=0.017）；抑郁症诊断与地区/偏远居住地相关（调整后的几率比 [aOR] 2.2，p=0.011）；焦虑症与非二元身份相关（aOR 2.8，p=0.012），与就业成反比（aOR 0.5，p=0.016）：结论：与 IC 模式的受助者相比，WPATH 模式的受助者更有可能拥有二元身份、心理健康诊断以及更长的评估时间。需要加强协调，以确保及时提供性别确认护理。
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.
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, n=212) or a primary care clinic (IC model, n=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, p<0.001) and longer assessments for hormones (median 5 vs. 2 sessions, p<0.001) than IC model clients. More IC model clients than WPATH model clients were nonbinary (27% vs. 15%, p=0.016). Nonbinary clients had more psychiatric diagnoses (mean 1.7 vs. 1.1, p<0.001) and longer IC assessments (median 3 vs. 2 sessions, p<0.001) than binary clients. Total psychiatric diagnoses were associated with nonbinary identities (β 0.7, p=0.001) and health care cards (β 0.4, p=0.017); depression diagnoses were associated with regional/remote residence (adjusted odds ratio [aOR] 2.2, p=0.011); and anxiety disorders were associated with nonbinary identities (aOR 2.8, p=0.012) and inversely associated with employment (aOR 0.5, p=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.
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