我們對性別焦慮症真正了解多少?
資料來源:William G. Wilkoff,醫學博士 / 2022 年 9 月 9 日 / Medscape / 財團法人台灣紅絲帶基金會編譯
冒著失去一兩個數字的風險,我將把腳趾浸入性別肯定照護的渾水,有時被稱為跨性別照護。近日,美國兒科學會主席 Moira Szilagyi 醫學博士發表了兩份聲明,一份在 2022 年 8 月 22 日的《華爾街日報》,另一份總結在 2022 年 8 月 25 日的美國兒科學會 (AAP) 每日簡報中,她試圖澄清學院在性別肯定照護方面的立場。
他們是措辭得體和英勇的嘗試來淨化空氣。我擔心這些解釋無助於鼓勵在根深蒂固且分歧的任何一方的人之間進行知情和禮貌的討論,不幸的是,這種分歧正在媒體機構和州立法機構而不是初級保健醫生和專家辦公室上演。
當前的混亂就是一個例子,說明當缺乏可靠的數據、過多的情緒以及一個以即時新聞和聲音為食的系統而對科學應該如何運作知之甚少時會發生什麼。
威廉·G·威爾科夫,醫學博士
一些動盪是對這樣一種觀念的回應,即在某些情況下,性別焦慮可能是一種可以透過接觸其他性別焦慮個體來學習或模仿的狀況。兩篇論文錨定了辯論的任何一方。第一篇論文由當時的布朗大學健康專家於 2018 年發表,她假設存在一種她稱之為「快速發作的性別焦慮症 [ROGD] 」的疾病。
可以想像,「社會傳染」可能被認為是這種假設狀況的潛在貢獻者之一。不幸的是,該論文的發表引發了一部分倡導跨性別社區的人群的批評風暴,促使大學和於線上之出版商放棄並重新評估該論文所依據的研究質量。
發表時表達的擔憂之一是,該研究可用於支持一些希望禁止性別肯定照護的州立法機構的跨性別議程。目前尚不清楚該文件在當前的大量立法中發揮了多大作用。我懷疑它很小。但是,不能否認潛力的存在。
跨越到 2022 年,第二篇論文發表在《兒科學》8 月刊上,作者試圖檢驗「快速發作的性別焦慮症 [ROGD] 」假說並質疑社會傳染的推論。
研究人員發現,在 2017 年和 2019 年,跨性別多元化 (transgender-diverse, TGD) 個體的出生率不利於指定的出生時女性性別 (assigned female-sex-at-birth , AFAB) 個體。他們還發現,在他們的總體樣本中,自認為跨性別多元化 (TGD) 的青少年比例有所下降。毫不奇怪,「與順性別的同齡人相比,TGD 青年的欺凌受害和自殺率更高」。作者得出的結論是,他們的發現「與假設社會傳染的 ROGD 假設不一致」,也不應該被用來限制獲得性別肯定照護的機會。
現在你有了它的發表,我們是否更接近於理解性別焦慮及其起源?我不這麼認為。媒體不那麼困惑了。美國國家廣播公司電視網 (NBC) 新聞 2022 年 8 月 3 日的線上新聞標題為「研究發現,『社會傳染』並沒有導致更多的年輕人變性」。
我的感覺是,普通人群認為性別焦慮症的盛行率有所增加。這種看法很可能主要反映了很大一部分人口中更富有同情心和受過教育的態度,這使得性別焦慮的年輕人浮出水面較不具挑戰。然而,一些家長和觀察者擔心這種增加的盛行率的一部分是社會傳染的結果,這並不讓我們感到驚訝。我們也不應該感到驚訝的是,一些支持跨性別人口的人會感到受這一假設的威脅。
這些研究都沒有真正回答某些性別焦慮症是否是社會傳染結果的問題。兩者都是使用受到質疑的方法的小樣本。底線是我們需要更多的研究,並且必須對他們的結果持開放態度。這就是科學應該如何運作的方式。
威爾科夫在緬因州布倫瑞克從事初級保健兒科工作近 40 年。他撰寫了幾本關於行為兒科的書籍,包括《如何對你的孩子說不》。威爾科夫報告說沒有什麼需要揭露的。
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How Much Do We Really Know About Gender Dysphoria?
William G. Wilkoff, MD / September 09, 2022 / Medscape
At the risk of losing a digit or two I am going to dip my toes into the murky waters of gender-affirming care, sometimes referred to as trans care. Recently, Moira Szilagyi, MD, PhD, president of the American Academy of Pediatrics, released two statements, one in the Aug. 22, 2022, Wall Street Journal, the other summarized in the Aug. 25, 2022, AAP Daily Briefing, in which she attempts to clarify the academy’s position on gender-affirming care.
They were well-worded and heroic attempts to clear the air. I fear these explanations will do little to encourage informed and courteous discussions between those entrenched on either side of a disagreement that is unfortunately being played out on media outlets and state legislatures instead of the offices of primary care physicians and specialists where it belongs.
The current mess is an example of what can happen when there is a paucity of reliable data, a superabundance of emotion, and a system that feeds on instant news and sound bites with little understanding of how science should work.
William G. Wilkoff, MD
Some of the turmoil is a response to the notion that in certain situations gender dysphoria may be a condition that can be learned or mimicked from exposure to other gender-dysphoric individuals. Two papers anchor either side of the debate. The first paper was published in 2018 by a then-Brown University health expert who hypothesized the existence of a condition which she labeled “rapid-onset gender dysphoria [ROGD].”
One can imagine that “social contagion” might be considered as one of the potential contributors to this hypothesized condition. Unfortunately, the publication of the paper ignited a firestorm of criticism from a segment of the population that advocates for the transgender community, prompting the university and the online publisher to backpedal and reevaluate the quality of the research on which the paper was based.
One of the concerns voiced at the time of publication was that the research could be used to support the transphobic agenda by some state legislatures hoping to ban gender-affirming care. How large a role the paper played in the current spate of legislation in is unclear. I suspect it has been small. But, one can’t deny the potential exists.
Leaping forward to 2022, the second paper was published in the August issue of Pediatrics, in which the authors attempted to test the ROGD hypothesis and question the inference of social contagion.
The investigators found that in 2017 and 2019 the birth ratios of transgender-diverse (TGD) individuals did not favor assigned female-sex-at-birth (AFAB) individuals. They also discovered that in their sample overall there was a decrease in the percentage of adolescents who self-identified as TGD. Not surprisingly, “bullying victimization and suicidality were higher among TGD youth when compared with their cisgender peers.” The authors concluded that their findings were “incongruent with an ROGD hypothesis that posits social contagion” nor should it be used to restrict access to gender-affirming care.
There you have it. Are we any closer to understanding gender dysphoria and its origins? I don’t think so. The media is somewhat less confused. The NBC News online presence headline on Aug. 3, 2022, reads “ ’Social contagion’ isn’t causing more youths to be transgender, study finds.”
My sense is that the general population perceives an increase in the prevalence of gender dysphoria. It is very likely that this perception is primarily a reflection of a more compassionate and educated attitude in a significant portion of the population making it less challenging for gender-dysphoric youth to surface. However, it should not surprise us that some parents and observers are concerned that a percentage of this increased prevalence is the result of social contagion. Nor should it surprise us that some advocates for the trans population feel threatened by this hypothesis.
Neither of these studies really answers the question of whether some cases of gender dysphoria are the result of social contagion. Both were small samples using methodology that has been called into question. The bottom line is that we need more studies and must remain open to considering their results. That’s how science should work.
Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” , Wilkoff reports having nothing to disclose.