Manejo médico de personas transgénero en la niñez y la adolescencia

Abstract

Transgender or gender nonconforming (GN) persons identify themselves with a gender which is different from that correspondent to their birth sex. The demand for health services by families with transgender children or adolescents tends to increase. The prevalence of GN in children is unknown; however, it has been estimated to be > 1% in adolescents. Transgender persons are at increased risk of depression, suicide, illicit drug abuse, human immunodeficiency virus infection, and non-accidental injury. The most accepted model for the care of transgender persons assumes that these adverse outcomes are the consequence of social margination rather than the GI condition itself. Social and physical gender transition seem to be effective in increasing the well-being of people with GI and reducing associated health risks. Mental health professionals can support the child in the process of social transition. The pediatric endocrinologist may offer puberty blockade and cross-sex induction of puberty. Surgical sex reassignment interventions are reserved for adults. Gender identity, gender expression and sexual orientation are three relatively independent categories that can take any value, which is not necessarily binary (male/female) or fixed. Health professionals should be familiar with these concepts in order to offer the best resources available to optimize the well-being of each transgender child or adolescent with an individualized approach.

Best Nursing Practice: Safe and Inclusive Healthcare Environments for Transgender People: A Systematic Review

“…Most of the available evidence reports the need to equip nurses and other healthcare workers with specific skills to provide high-quality holistic care for trans people based on trust, respect, and inclusivity [11,14,28,29,32,33,39,43,44,55,61]. However, only a few studies present learning tools and recommendations to do so.…”

“…As such, training should begin at the undergraduate level, and postgraduate training programmes should be implemented that include both the identification of risk factors in the trans community and the management of sensitive situations regarding healthcare practices and mental health support. These two aspects are particularly important, as the lack of information and training is one of the main obstacles to healthcare and leads to pathologised healthcare [20,30,40,45,61], with many users reporting discriminatory attitudes, abuse, or outright harm when receiving healthcare [45].…”

“…If the health professional needs to perform a physical examination, they should do so only when strictly necessary, continuously assessing the person's comfort and willingness to undergo the examination [55,58,59] and ensuring that the person remains in control at all times [60]. In line with this, multiple studies report on the benefits of having a supportive trusted person present during the examination process [55,61].…”

Ciudadanía sexual y discordancia de género: revisión teórica y reflexiones problemáticas.

“…Las anteriores posturas teóricas se han presentado históricamente como mutuamente excluyentes e imposibles de conciliar y alrededor de ellas están los estudios sobre condiciones bio-psicosocioculturales, los cuales conforman un conjunto amplio de estudios de sujetos "trans" o "no binarios" asociados con diversas condiciones como la salud física, especialmente aspectos relacionados a la terapia de remplazo hormonal y endocrinología (Dahl, Feldman, Goldberg y Jaberi, 2006;Bradford, Reisner, Honnold y Xavier, 2013;den Heijer, Bakker y Gooren, 2017), VIH y factores de riesgo (De Santis, 2009), salud mental y psiquiatría (Zarazúa, Salinas, Negrete y Ruíz, 2015;Grossman y D'Augelli, 2007;Prunas, et al 2014;Heylens, et al 2014) aspectos oncológicos (Gooren, Bowers, Lips y Konings, 2015), aspectos pediátricos (Castilla-Peón, 2018;Olson, Durwood, DeMeules y McLaughlin, 2016), aspectos del bienestar/malestar psicosocial (Bockting, Miner, Swinburne, Hamilton y Coleman, 2013;Boza y Nicholson, 2014;Rimes, Goodship, Ussher, Baker y West, 2019;Bouman, et al 2017;Stewart, O'Halloran y Oates, 2018), así como de estándares y protocolos de acompañamiento bio-psico-social (Coleman, et al 2012;Dèttore, et al 2015;López-Guzmán, 2018;Ehrensaft, Giammattei, Storck, Tishelman y Keo-Meier, 2018;Domínguez, Ramírez y Arrivillaga, 2018;Ortega-Pavesio, 2019).…”