PDF(Pubmed)
Abstract：
UNASSIGNED: Gender-affirming hormones (hormones)-the use of sex hormones to induce desired secondary sex characteristics in transgender and nonbinary (TGNB) individuals-are vital health care for many TGNB people. Some hormone providers require a letter from a mental health provider before hormone initiation. We explore the perspectives of TGNB individuals regarding the impact of the letter requirement on their experience of care.
UNASSIGNED: We conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (n=12) and were not (n=8) required to provide a letter. An Advisory Board of transgender individuals guided the methodology. Interviews were transcribed verbatim and coded both inductively and deductively.
UNASSIGNED: We identified three themes related to the letter requirement: (1) Mental health: While participants appreciated the importance of therapy, the letter requirement did not serve this purpose; (2) Trans identity: The process of obtaining a letter created doubt in participants\' own transness, along with a resistance to the pathologization and conflation of mental illness with transness; and (3) Care relationships: The letter requirement negatively impacted the patient-provider relationship. Participants felt the need to self-censor or to perform a version of transness they thought the provider expected; this process decreased their trust in care professionals.
UNASSIGNED: A letter requirement did not improve mental health and had several negative consequences. Removal of this requirement will improve access to hormones and may paradoxically improve mental health.
UNASSIGNED: We conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (n=12) and were not (n=8) required to provide a letter. An Advisory Board of transgender individuals guided the methodology. Interviews were transcribed verbatim and coded both inductively and deductively.
UNASSIGNED: We identified three themes related to the letter requirement: (1) Mental health: While participants appreciated the importance of therapy, the letter requirement did not serve this purpose; (2) Trans identity: The process of obtaining a letter created doubt in participants\' own transness, along with a resistance to the pathologization and conflation of mental illness with transness; and (3) Care relationships: The letter requirement negatively impacted the patient-provider relationship. Participants felt the need to self-censor or to perform a version of transness they thought the provider expected; this process decreased their trust in care professionals.
UNASSIGNED: A letter requirement did not improve mental health and had several negative consequences. Removal of this requirement will improve access to hormones and may paradoxically improve mental health.
摘要：
■性别确认激素（激素）-使用性激素在变性人和非二元（TGNB）个体中诱导所需的第二性征-是许多TGNB人的重要医疗保健。一些激素提供者在激素开始之前需要精神健康提供者的来信。我们探讨了TGNB个人关于信函要求对其护理经验的影响的观点。
■我们对21名寻求或正在接受激素的TGNB个体进行了半结构化访谈。我们有目的地抽样了(n=12)和不(n=8)需要提供信件的受访者。跨性别者咨询委员会指导了该方法。访谈被逐字转录，并被归纳和演绎编码。
■我们确定了与信函要求相关的三个主题：（1）心理健康：尽管参与者赞赏治疗的重要性，信件要求没有达到这个目的；（2）跨身份：获得信件的过程在参与者自己的超越性中产生了怀疑，伴随着对精神疾病与变性的病态化和融合的抵抗；（3）护理关系：字母要求对患者与提供者的关系产生负面影响。参与者认为有必要进行自我审查或执行他们认为提供者期望的过渡版本；这个过程降低了他们对护理专业人员的信任。
■字母要求并没有改善心理健康，并产生了一些负面影响。消除这种需求将改善激素的获取，并可能矛盾地改善心理健康。
■我们对21名寻求或正在接受激素的TGNB个体进行了半结构化访谈。我们有目的地抽样了(n=12)和不(n=8)需要提供信件的受访者。跨性别者咨询委员会指导了该方法。访谈被逐字转录，并被归纳和演绎编码。
■我们确定了与信函要求相关的三个主题：（1）心理健康：尽管参与者赞赏治疗的重要性，信件要求没有达到这个目的；（2）跨身份：获得信件的过程在参与者自己的超越性中产生了怀疑，伴随着对精神疾病与变性的病态化和融合的抵抗；（3）护理关系：字母要求对患者与提供者的关系产生负面影响。参与者认为有必要进行自我审查或执行他们认为提供者期望的过渡版本；这个过程降低了他们对护理专业人员的信任。
■字母要求并没有改善心理健康，并产生了一些负面影响。消除这种需求将改善激素的获取，并可能矛盾地改善心理健康。
