RESUMO
Transgender people are at risk of being in worse health than the cisgender population. On the one hand, they encounter specific health problems, mostly related to the impact of minority stress on their mental and somatic health. On the other hand, the preventive recommendations usually do not account for gender-affirming hormonal or surgical treatments that can alter their biologic or anatomic risk profile. The health of transgender people is an area in which research is yet sparse, professionals seldom trained, and where uncertainty remains. The aim of this review article is to summarize the current state of knowledge and propose recommendations for clinical practice.
Les personnes transgenres sont à risque d'avoir une moins bonne santé que la population cisgenre. D'une part, elles rencontrent des problématiques de santé spécifiques, majoritairement en lien avec l'impact du stress minoritaire sur leur santé mentale et somatique. D'autre part, les conseils de prévention habituels ne prennent que rarement en compte l'éventuel recours à des traitements hormonaux ou chirurgicaux d'affirmation de genre pouvant modifier les profils de risque sur les plans biologiques ou anatomiques. La prévention chez les personnes transgenres est une thématique pour laquelle la recherche est peu fournie, les professionnel-le-s peu formé-e-s et l'incertitude présente. Cet article a pour objectif de faire le point sur l'état actuel des connaissances et de proposer des recommandations pour la pratique clinique.
Assuntos
Pessoas Transgênero , Humanos , Feminino , MasculinoRESUMO
This article outlines the management of transgender and non-binary adolescents at CHUV. The current rise in visibility of this topic is associated with an increased demand for intervention and at the same time with an increased generation of continuously expanding medical evidence to guide interventions. The close collaboration among various specialized adolescent health services enables an interdisciplinary evaluation of diagnostic elements and indications for potential psychological, social or medical interventions. This article underscores the significance of an interdisciplinary and individualized approach to transgender and non-binary adolescents, respecting the diversity of the human being.
Cet article présente la prise en charge des adolescent-e-s transgenres et non binaires (TNB) au Centre hospitalier universitaire vaudois (CHUV). L'actuel gain en visibilité de la thématique conduit à une augmentation des demandes de prise en charge et, parallèlement, à une augmentation de la production d'évidence médicale pour orienter les prises en charge. La collaboration étroite entre les différents services spécialisés en santé des adolescents permet une évaluation interdisciplinaire des éléments diagnostiques et des indications aux éventuelles interventions psychologiques, sociales ou médicales. Cet article souligne l'importance d'une approche interdisciplinaire, basée sur l'évidence médicale et individualisée des adolescent-e-s TNB, dans le respect de la diversité de l'être humain.
Assuntos
Pessoas Transgênero , Adolescente , Humanos , Estudos InterdisciplinaresRESUMO
While several recent studies suggest that approximately 1 in 6 young people in Switzerland are part of the rainbow diversity, a high proportion of health professionals have never had a course on LGBTIQ+ (lesbian, gay, bisexual, transgender, intersex, queer, questioning or other) health. This situation leads to significant gaps in the medical care of LGBTIQ+ persons as well as difficulties in accessing equitable, culturally appropriate and quality care. This article presents the ambitious and novel e-learning project I-CARE (Improving Care and Access for Rainbow Equity) which should contribute, from the end of this year, to filling the current gaps in the undergraduate and continuing education of health professionals.
Alors que plusieurs études récentes suggèrent qu'environ 1 jeune sur 6 fait partie de la diversité arc-en-ciel en Suisse, une proportion élevée des professionnel-les de santé n'a jamais eu de cours sur la santé des personnes LGBTIQ+ (lesbiennes, gays, bisexuelles, transgenres, intersexuées, queers, en questionnement ou autres). Cette situation entraîne d'importantes lacunes dans la prise en charge médicale des personnes LGBTIQ+, ainsi qu'une difficulté d'accès à des soins équitables, culturellement appropriés et de qualité. Cet article présente l'ambitieux et inédit projet de formation par apprentissage en ligne I-CARE (Improving Care and Access for Rainbow Equity) qui devra contribuer, à partir de la fin de cette année, à combler les lacunes actuelles dans la formation prégraduée et continue des professionnel-les de santé.
Assuntos
Instrução por Computador , Transtornos do Desenvolvimento Sexual , Minorias Sexuais e de Gênero , Pessoas Transgênero , Transexualidade , HumanosRESUMO
How trans youth realize about their gender identity and come out to their significant others is under-researched and very few studies include both youth and parental perspectives. This study was developed in Switzerland, a country where families with trans youth are just beginning to break invisibility. The research protocol draws on grounded theory methodology, is participative and developed in collaboration with a local trans NGO and a pan Canadian project. We conducted 20 semi-structured interviews with 10 trans youth and their caregivers/parents (10 interview). At least three developmental pathways seem to emerge: a) the affirmed children who affirm themselves very early, (b) the silent children who spend their childhood in a state of internal tension without being able to position themselves and (c) the neutral children who become aware of their gender difference at puberty following a childhood in which gender was not problematic. In all cases puberty is a crossroads, lived painfully with significant manifestations of both social and body dysphoria. A better understanding of the process of gender development in trans children and youth will help improve our interventions to better serve young people and their families, and help them overcome the different levels of oppressions they face.
Assuntos
Desenvolvimento Infantil , Identidade de Gênero , Pais , Autorrevelação , Pessoas Transgênero , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Distância Psicológica , Pesquisa Qualitativa , Suíça , Adulto JovemRESUMO
Transgender, non-binary and questioning teenagers are increasingly visible. However, they face barriers in accessing appropriate care that meet their needs, both specific and regarding their general health. Primary care physicians increasingly see them in consultations but often lack elements of communication and recent knowledge that is needed to accompany them and their close ones in their -individual trajectories. This article aims to answer this need and provides a synthesis about recent evidence and suggested communication approaches for primary care physicians, who play a central role for the health of all patients.
Les adolescents transgenres, non binaires ou en questionnement sont de plus en plus visibles et font face à de nombreux obstacles pour accéder à des soins appropriés, tant pour leurs besoins de santé spécifiques que généraux. Les médecins de premier recours les rencontrent au cabinet et peuvent manquer d'éléments de communication et de connaissances spécifiques récentes pour mener la consultation et accompagner ces personnes et leurs proches dans leurs trajectoires individuelles. Cet article propose une synthèse des éléments et des ressources utiles pour le médecin de premier recours, dont le rôle est central pour la santé de tous les patients.
Assuntos
Comunicação , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta , Pessoas Transgênero , Transexualidade , Adolescente , HumanosRESUMO
Since 2011, a significant amount of evidence has been published on transgender children and adolescents, highlighting their needs and the best health and social practices. They are more at risk of suicide, discrimination, depression. Today, we better understand that the main causal factor linked with negative experiences is to be found in direct and indirect discriminations, subsequently causing personal and relational difficulties. When transgender youth are fully accepted and supported in their desired gender, they do not significantly differ from other youth. We need to build informed and respectful practices. Three kind of interventions are now urgently needed in Switzerland: access to hormonal management of puberty (medical), family centered interventions (psychosocial), and prevention of bullying in schools (sociopolitical).
Depuis 2011, les besoins, enjeux et protocoles de soins destinés aux jeunes trans sont largement documentés et il ressort des travaux récents que ces jeunes sont plus à risque de suicide, discrimination, dépression, que leurs pairs. Or, la compréhension des facteurs causaux a changé, il devient évident que les expériences négatives liées à la discrimination sont responsables de ces difficultés psychiques et relationnelles. Lorsque les enfants sont acceptés et soutenus dans leur genre trans, ils ne diffèrent pas des autres enfants. Les structures de soins adaptées offrant un accompagnement respectueux et acceptant la différence de genre sont nécessaires. Trois axes d'intervention sont identifiés : les traitements hormonaux de retard de puberté, voire de puberté croisée, l'accompagnement des familles et la lutte contre le harcèlement scolaire.
