評論
打印
Gender medicine
性別醫學
Second thoughts
三思
Doubts are growing about therapy for gender-dysphoric children
對于性別焦慮癥兒童的治療方法，人們的質疑越來越多
Gender medicine was once an obscure specialty. Patients with gender dysphoria were typically middle-aged men wishing to live as women. Things are different now. First, there are many more patients. Referrals to a specialist clinic attached to the Free University of Amsterdam rose 20- fold between 1980 and 2015. The Gender Identity Development Service (GIDS), England and Wales's only paediatric gender clinic, sees 30 times more people than a decade ago. The patients have changed, too. Most are now female and in their teens. Many are treated with drugs to block the onset of puberty. These are often followed by hormones to promote development of physical characteristics of the opposite sex, as part of an approach called affirmation therapy.
性別醫學曾經是一個不起眼的專業。性別焦慮癥患者通常是希望像女性一樣生活的中年男性。現在情況不同了。首先，病人更多了。從1980年到2015年，到阿姆斯特丹自由大學的一家附屬專家診所就診的人數增加了20倍。性別認同發展服務(GIDS)是英格蘭和威爾士唯一的一家兒科性別診所，就診人數是10年前的30倍。患者也發生了變化，現在大多數都是十幾歲的女性。許多人用藥物來阻止青春期的開始，通常伴隨著用荷爾蒙來促進異性身體特征的發展，是“肯定療法”的一種。
Last June, though, Finland revised its guidelines to prefer psychological treatment to drugs. In September Britain launched a top-down review of the field. In December the High Court of England and Wales ruled that under-16s were unlikely to be able to consent meaningfully to taking puberty blockers, leading GIDS to suspend new referrals, though a subsequent ruling held that parents could consent on their children's behalf. On April 6th Arkansas passed laws that make prescribing puberty blockers and cross-sex hormones to children illegal. Also in April the Astrid Lindgren Children's Hospital in Stockholm, a part of the Karolinska Institute, announced that it would stop prescribing puberty blockers and cross-sex hormones to those under 18, except in clinical trials.
然而，去年6月，芬蘭修訂了其指導方針，將心理治療置于藥物之上。9月，英國對該領域展開了一項自上而下的審查。去年12月，英格蘭和威爾士高等法院裁定，16歲以下的青少年不太可能有意義地同意服用青春期阻滯藥，這導致GIDS暫停了新的轉診，盡管隨后的裁決認為父母可以代表孩子同意。4月6日，阿肯色州通過了一項法律，規定給兒童開青春期阻斷劑和跨性別激素是非法的。同樣在4月，斯德哥爾摩的阿斯特里德·林德格倫兒童醫院(隸屬于卡羅林斯卡研究所)宣布，除臨床試驗外，將停止給18歲以下兒童開青春期阻斷劑和跨性別激素的處方。
Those sceptical of affirmation therapy point out two problems. Evidence is lacking, and what exists is not reassuring. A reviewby Sweden's health authorities in2019 found little research, mostly of poor quality. Britain's National Institute for Health and Care Excellence found that puberty blockers did little to dispel gender dysphoria or improve patients' mental health (though they do not make such feelings worse). Moreover, existing studies suggest that, without intervention, most children with gender dysphoria end up reconciled to their natal sex as adults.
那些對“肯定療法”持懷疑態度的人指出了兩個問題。缺乏證據，現有的證據也不可靠。瑞典衛生當局2019年的一項評估發現，針對這方面的研究極少，而且研究質量差。英國國家健康和卓越保健研究所發現，青春期阻斷劑對消除性別焦慮或改善患者的心理健康沒有什么作用(盡管不會讓患者感覺更焦慮)。此外，現有的研究表明，如果不進行干預，大多數患有性別焦慮癥的兒童最終會在成年后接受他們的出生性別。
譯文由可可原創，僅供學習交流使用，未經許可請勿轉載。
