Participant demographic characteristics.

BackgroundThose who detransition have received increased public and scholarly attention and their narratives are often presented as evidence of limitations with contemporary gender-affirming care practices. However, there are scant empirical studies about how this population experienced their own process of gaining access to gender-affirming medical/surgical interventions, or their recommendations for care practice.AimsTo qualitatively explore the care experiences and perspectives of individuals who discontinued or reversed their gender transitions (referred to as detransition).MethodsBetween October 2021-January 2022, Canadian residents aged 18 and older with experience of stopping, shifting, or reversing a gender transition were invited to participate in semi-structured, one-on-one, virtual interviews. A purposive sample of 28 was recruited by circulating study adverts over social media, to clinicians in six urban centres, and within participants’ social networks. Interviews ranged between 50–90 minutes, were audio-recorded, and transcribed verbatim. Following constructivist grounded theory methodology, interview data were analyzed inductively and thematically following a two-phase coding process to interpret participants’ experiences of, and recommendations for, gender care.ResultsParticipants were between the ages of 20–53 (71% were between 20–29). All participants identified along the LGBTQ2S+ spectrum. Twenty-seven out of 28 of the participants received medical/surgical interventions (60% were ages 24 and younger). A majority (57%) reported three or more past gender identities, with 60% shifting from a binary transgender identity at the time of initiating transition to a nonbinary identity later in their transition journey. To access medical/surgical interventions, most participants were assessed via the gender-affirming care model pathway and also engaged in talk therapy with a mental healthcare provider such as a psychologist or psychiatrist. Some participants experienced their care as lacking the opportunity to clarify their individual treatment needs prior to undergoing medical/surgical transition. Decisional regret emerged as a theme alongside dissatisfaction with providers’ “informed consent” procedures, such that participants felt they would have benefitted from a more robust discussion of risks/benefits of interventions prior to treatment decision-making. Overall, participants recommended an individualized approach to care that is inclusive of mental healthcare supports.ConclusionsTo optimize the experiences of people seeking and receiving gender care, a thorough informed consent process inclusive of individualized care options is recommended, as outlined by the World Professional Association of Transgender Health, standards of care, version 8.【研究背景】脱性别过渡（detransition）群体受到了越来越多的公众与学界关注，其相关叙述常被用作佐证当代性别肯定照护（gender-affirming care）实践存在局限的依据。然而，针对该群体获取性别肯定医学/外科干预措施（gender-affirming medical/surgical interventions）的亲身经历，以及他们对照护实践的建议，目前尚缺乏充足的实证研究。 【研究目的】本研究旨在以质性研究方法，探究终止或逆转性别过渡（即脱性别过渡）者的照护经历与观点。 【研究方法】2021年10月至2022年1月期间，本研究邀请年满18岁、曾有终止、调整或逆转性别过渡经历的加拿大居民参与半结构化一对一虚拟访谈。研究通过社交媒体发布招募广告、联系六个城市中心的临床医师以及依托参与者社交网络进行传播，最终完成28例的目的性抽样。访谈时长为50至90分钟，全程录音并逐字转录。本研究采用建构主义扎根理论方法论（constructivist grounded theory methodology），通过两阶段编码流程对访谈数据进行归纳式主题分析，以解读参与者的性别照护经历与相关建议。 【研究结果】参与者年龄介于20至53岁之间，其中71%的参与者年龄在20至29岁区间。所有参与者均隶属于LGBTQ2S+群体光谱。28名参与者中有27人接受过医学/外科干预措施，其中60%的干预接受者年龄不超过24岁。多数参与者（57%）报告曾拥有3种及以上的既往性别身份认同，且60%的参与者在启动过渡阶段时为二元跨性别身份认同，后续在过渡历程中调整为非二元性别身份认同。为获取医学/外科干预措施，大多数参与者通过性别肯定照护模型路径完成评估，并同时接受了由心理学家、精神科医师等精神医疗服务提供者开展的谈话治疗。部分参与者反映，在接受医学/外科性别过渡干预前，他们未获得足够机会明确自身个体化的治疗需求。研究主题中同时出现了决策后悔与对服务提供者“知情同意（informed consent）”流程的不满：参与者认为，若能在治疗决策前更充分地讨论干预措施的风险与获益，他们将从中获益。总体而言，参与者建议照护实践应采用个体化方案，并纳入精神医疗支持服务。 【研究结论】为优化寻求与接受性别照护人群的体验，建议采用包含个体化照护选项的全面知情同意流程，这契合世界跨性别健康专业协会（World Professional Association of Transgender Health）发布的《护理标准第8版》中的相关规范。