Health Needs of Transgender People Remain Unmet
Fran Lowry
June 17, 2016
Despite the recent flurry of media attention that has been directed toward transgender people, they and their health needs remain poorly understood, experts say.
专家们说，尽管最近一系列的媒体关注已经指向了变人人，他们和他们的健康需求仍难以被理解。
In a series of articles published online June 17 in the Lancet, experts on the transgender community outline some of the social and legal conditions in which transgender people live, as well as some of the medical perspectives that frame the provision of healthcare for these individuals.
在6月17号的《柳叶刀》的网上发表了一系列的文章，专家们在变性人团体中描述了变性人生活中面临的一些社会的和法律的情况，同样这些个体的一些构建医疗保健的医学观点。 The series was published to coincide with the World Professional Association for Transgender Health 24th Biennial Scientific Symposium, in Amsterdam, the Netherlands.
这一系列文章的发布附合了在荷兰阿姆斯特丹举行的24屉两年一次的世界专业协会科学研究会关于变性人的健康的主题。
"Many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health," write Sam Winter, PhD, Curtin University, Perth, Australia, and colleagues in the first of three articles in the series.
许多变性人生活在社会的边缘，面对侮辱，歧视，孤立，暴力和疾病。
"Many of the health challenges faced by transgender people are exacerbated by laws and policies that deny them gender recognition," Dr Winter said in a statement.
变性人因法律和政策否识对他们性别的认知导致他们面对的许多健康挑战更加恶化。 "In no other community is the link between rights and health so clearly visible as in the transgender community. Faced with stigma, discrimination and abuse, transgender people are pushed to the margins of society, excluded from the workplace, their families and health care. Many are drawn into risky situations or behaviors, such as unsafe sex or substance abuse, which leave them at risk of further ill health," he said.
没有其他团体像变性人团体那样权利和健康的联系是那么的显而可见。面对侮辱、歧视和虐待，变性人被迫到社会的边缘，被工作场所、他们的家庭和卫生保健排除在外。许多人进被拉进危险的场所或行为，像是不安全的性行为或滥用药物，这会导致将来不健康的风险加重。 In the second article in the series, Kevan Wylie, MD, Porterbrook Clinic, Sheffield, United Kingdom, and colleagues note that although some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialized facilities, most healthcare needs can be delivered by a primary care physician.
在系列里的第二篇文章，P 和他的同事提到尽管一些变性人的医疗组织，包括变性手术，最好是在具备专业设备的地方进行，其余大部分健康需求只需要找初级医生。
They add that although there is a dearth of educational programming about transgender health for healthcare professionals in general, there is support for introducing the topic early during medical school training and in the education of allied health professionals.
他们补充尽管关于变性人健康的卫生保健的教育项目普遍缺乏，尽早在医学培训和联合医学教育中引入这一主题是支持的。
The majority of countries worldwide do not offer legal or administrative measures enabling gender recognition for transgender people. In Europe, eight countries fail to offer legal recognition to transgender people, and 17 countries still impose sterilization on people who seek gender recognition.
世界上大部分国家没有提供法律的或行政的方法确保变性人的性别得到认可。可欧洲，8个国家不提供变性人的法律认可，17个国家仍然 寻求性别认同。
As of June 2016, Argentina, Denmark, Malta, Ireland, and Norway had laws that allow transgender people to determine their gender through an administrative process. Furthermore, Argentina and Malta affirm the right of transgender people to appropriate healthcare.
在2016年6月，一系列国家允许变性人确定他们的性别通过行政过程。而且，阿根廷和马其他确定了变性人获得相对应的医疗权利。
Several countries, including New Zealand, Australia, Nepal, Pakistan, and India, are also starting to recognize gender diversity beyond male and female, Dr Winter and colleagues write. 几个国家，包括„„开始认识到在男和女之外的性别的多样化。
The series authors call for the following courses of action:
这一系列的作者提倡以下的行动方案：
Revisions should be made to the World Health Organization's (WHO's) diagnostic manual, due in 2018, that would remove the diagnoses for transgender people from the chapter relating to mental and behavioral disorders to a chapter concerning conditions related to sexual health. "A mental health diagnosis is widely regarded as inappropriate and potentially harmful by reinforcing stigma. Such a move would be truly historic," the series authors state.
到了2018年，世卫组织的诊断指南需要重新较正，这会从关于精神和行为障碍章节中去除变性人的诊断，进入到涉及关于性别健康的章节。一个精神健康的诊断广泛地被认为不恰当和潜在加重侮辱的伤害。这种行动会成为历史性的。
The WHO should reconsider the highly controversial diagnosis of "gender incongruence in childhood" for children who have not yet reached puberty and should focus efforts on providing children with access to better support and information for understanding and expressing their gender identity.
世卫组织应该重新考虑高度具有争议性的诊断，如“童年性别不一致”，当孩子还没到青春期时和致力于提供给孩子更容易得到的支持和信息去理解和表达他们的性别认同。
Healthcare for transgender people, including feminizing and masculinizing hormonal treatment, should be funded on the same basis as healthcare for nontransgender persons.
变性人的医疗保健，包括女性化和男性化的激素治疗，应该获得同样的像非变性人一样的资助。
Physicians should be trained to understand the health needs of transgender people.
Governments should be prevented from instituting gender-reparative therapies for children, adolescents, and adults. Such measure are widely condemned as unethical.
医生应该培训去明白变性人的健康需求。政府应该被阻止为儿童，青年和成人设立性别修复
治疗。这些方法受到广泛的遣责因为不道德。
"A comprehensive public health approach to address the health of transgender people requires access to gender affirmation services, evidence-based health-care delivery systems, and effective partnerships with local transgender communities," write Sari L. Reisner, ScD, Boston Children's Hospital, Harvard Medical School, and colleagues in the third article in the series
一个全面的公众的健康方法去处理变性人的健康需要获得性别确认服务，以证据为基础的健康传送系统，和与当地变性人团体有效的关系。
Although there are substantial gaps in empirical research on transgender issues, "there are sufficient actionable data highlighting unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people that need interventions," Dr Reisner and colleagues write.
尽管在变性人经验主义的调查中有大量的差异。有足够的行动证据去强调独特的生物学的，行为学的和上下文结构的因素围绕着需要干预的变性人的健康风险和弹性。
"There are huge gaps in our understanding of transgender health stemming from a fundamental challenge of defining this diverse group and a failure to recognize gender diversity," Dr Reisner said in a statement.
在理解变性人健康存大巨大差异源于一个根本性的挑战去定义这个不同的团体和不能识别性别的多样性。
"Nevertheless, we know enough to act. High rates of depression and HIV are all linked to the context in which transgender people are forced to live. In the past 15 years, there has been a dramatic shift from viewing transgender people as having a disorder towards a better
understanding of gender diversity, but much more needs to be done," she said.
然而，我们知道足够去行动。抑郁和艾滋的高发生率与变性人被迫生存的环境密切联系。在过去15年里，人们的观点从认为变性人是一种病到更好地理解性别多样化发生了巨大的改变，但更多的是需要行动。
"Visibility of transgender people and support for transgender rights have increased dramatically in recent years," Dr Reisner, Mark A. Schuster, MD, PhD, and Sarah E. Onorato, from Boston Children's Hospital, write.
变性人的透明度和对变性人权利的支持已经明显增加在近见年。
"In 2015, a total of 375 Fortune 500 companies prohibited discrimination on the basis of gender identity, up from 15 in 2002. Nineteen states and the District of Columbia include gender identity in employment nondiscrimination laws," they write.
在2015年，总共有375个福利500间公司阻止性别认同的基础上的歧视，超过2002年的15间。19个州和哥伦比亚区将性别认同纳入就业非歧视法。
Nevertheless, transgender people still face substantial discrimination, they note.
"Beyond bathroom accessibility, discrimination is associated with increased stress, anxiety, depressive symptoms, post-traumatic stress disorder, substance abuse, and suicide. It is also associated with increased risk of bullying, verbal harassment, sexual assault, and nonsexual violence, as well as decreased healthcare utilization," they write.
虽然，变性人仍然面对大量歧视。除了浴视的获得，歧视与增加的压力，焦虑，抑郁，创伤后应激障碍，药物滥用，和自杀密切相关。同样增加了购物，语言骚挠，性暴力和与非性暴，和减少医疗利用率的风险。
The authors suggest that the medical community can play a crucial role in advocacy for
transgender people and can provide a key voice in legislative hearings and amicus briefs. 作者要求医疗团队在关键时刻去维护变性人和在立法听证和陈述中为变性人发声。 "Establishing legal protection for transgender people in the United States may take time.
Eliminating the need for such protection will no doubt take much longer. But being transgender, like being left-handed, may someday be recognized as merely another inherent human quality, no longer conferring a need for protection," they write.
在美国建立合法的变性人保护机制需要时间。消除这些保护的需要无疑更费时间。但作为变性人，像左撇子，有一天会被认为只是另外的内在的人类特性，不再授予保护的需要。 But until then, "the health care community can better address transgender health needs, help ensure that transgender people feel safe in seeking health care, promote resilience in the face of prejudice, and expand our knowledge of how best to promote transgender health and well-being."
但在那之前，健康医疗团体要更好地处理变性人的医疗需要，帮助确保变性人感到安全地寻求健康治疗，促进弹性面对偏见，和扩大我们的知识，知道促进变性人健康是多好的一件事。 The series of articles in the Lancet was funded by the United Nations Development Programme. The authors have disclosed no relevant financial relationships.
Lancet. Published online June 17, 2016. Abstracts
N Engl J Med. Published online June 15, 2016.
Health Needs of Transgender People Remain Unmet
Fran Lowry
June 17, 2016
Despite the recent flurry of media attention that has been directed toward transgender people, they and their health needs remain poorly understood, experts say.
专家们说，尽管最近一系列的媒体关注已经指向了变人人，他们和他们的健康需求仍难以被理解。
In a series of articles published online June 17 in the Lancet, experts on the transgender community outline some of the social and legal conditions in which transgender people live, as well as some of the medical perspectives that frame the provision of healthcare for these individuals.
在6月17号的《柳叶刀》的网上发表了一系列的文章，专家们在变性人团体中描述了变性人生活中面临的一些社会的和法律的情况，同样这些个体的一些构建医疗保健的医学观点。 The series was published to coincide with the World Professional Association for Transgender Health 24th Biennial Scientific Symposium, in Amsterdam, the Netherlands.
这一系列文章的发布附合了在荷兰阿姆斯特丹举行的24屉两年一次的世界专业协会科学研究会关于变性人的健康的主题。
"Many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health," write Sam Winter, PhD, Curtin University, Perth, Australia, and colleagues in the first of three articles in the series.
许多变性人生活在社会的边缘，面对侮辱，歧视，孤立，暴力和疾病。
"Many of the health challenges faced by transgender people are exacerbated by laws and policies that deny them gender recognition," Dr Winter said in a statement.
变性人因法律和政策否识对他们性别的认知导致他们面对的许多健康挑战更加恶化。 "In no other community is the link between rights and health so clearly visible as in the transgender community. Faced with stigma, discrimination and abuse, transgender people are pushed to the margins of society, excluded from the workplace, their families and health care. Many are drawn into risky situations or behaviors, such as unsafe sex or substance abuse, which leave them at risk of further ill health," he said.
没有其他团体像变性人团体那样权利和健康的联系是那么的显而可见。面对侮辱、歧视和虐待，变性人被迫到社会的边缘，被工作场所、他们的家庭和卫生保健排除在外。许多人进被拉进危险的场所或行为，像是不安全的性行为或滥用药物，这会导致将来不健康的风险加重。 In the second article in the series, Kevan Wylie, MD, Porterbrook Clinic, Sheffield, United Kingdom, and colleagues note that although some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialized facilities, most healthcare needs can be delivered by a primary care physician.
在系列里的第二篇文章，P 和他的同事提到尽管一些变性人的医疗组织，包括变性手术，最好是在具备专业设备的地方进行，其余大部分健康需求只需要找初级医生。
They add that although there is a dearth of educational programming about transgender health for healthcare professionals in general, there is support for introducing the topic early during medical school training and in the education of allied health professionals.
他们补充尽管关于变性人健康的卫生保健的教育项目普遍缺乏，尽早在医学培训和联合医学教育中引入这一主题是支持的。
The majority of countries worldwide do not offer legal or administrative measures enabling gender recognition for transgender people. In Europe, eight countries fail to offer legal recognition to transgender people, and 17 countries still impose sterilization on people who seek gender recognition.
世界上大部分国家没有提供法律的或行政的方法确保变性人的性别得到认可。可欧洲，8个国家不提供变性人的法律认可，17个国家仍然 寻求性别认同。
As of June 2016, Argentina, Denmark, Malta, Ireland, and Norway had laws that allow transgender people to determine their gender through an administrative process. Furthermore, Argentina and Malta affirm the right of transgender people to appropriate healthcare.
在2016年6月，一系列国家允许变性人确定他们的性别通过行政过程。而且，阿根廷和马其他确定了变性人获得相对应的医疗权利。
Several countries, including New Zealand, Australia, Nepal, Pakistan, and India, are also starting to recognize gender diversity beyond male and female, Dr Winter and colleagues write. 几个国家，包括„„开始认识到在男和女之外的性别的多样化。
The series authors call for the following courses of action:
这一系列的作者提倡以下的行动方案：
Revisions should be made to the World Health Organization's (WHO's) diagnostic manual, due in 2018, that would remove the diagnoses for transgender people from the chapter relating to mental and behavioral disorders to a chapter concerning conditions related to sexual health. "A mental health diagnosis is widely regarded as inappropriate and potentially harmful by reinforcing stigma. Such a move would be truly historic," the series authors state.
到了2018年，世卫组织的诊断指南需要重新较正，这会从关于精神和行为障碍章节中去除变性人的诊断，进入到涉及关于性别健康的章节。一个精神健康的诊断广泛地被认为不恰当和潜在加重侮辱的伤害。这种行动会成为历史性的。
The WHO should reconsider the highly controversial diagnosis of "gender incongruence in childhood" for children who have not yet reached puberty and should focus efforts on providing children with access to better support and information for understanding and expressing their gender identity.
世卫组织应该重新考虑高度具有争议性的诊断，如“童年性别不一致”，当孩子还没到青春期时和致力于提供给孩子更容易得到的支持和信息去理解和表达他们的性别认同。
Healthcare for transgender people, including feminizing and masculinizing hormonal treatment, should be funded on the same basis as healthcare for nontransgender persons.
变性人的医疗保健，包括女性化和男性化的激素治疗，应该获得同样的像非变性人一样的资助。
Physicians should be trained to understand the health needs of transgender people.
Governments should be prevented from instituting gender-reparative therapies for children, adolescents, and adults. Such measure are widely condemned as unethical.
医生应该培训去明白变性人的健康需求。政府应该被阻止为儿童，青年和成人设立性别修复
治疗。这些方法受到广泛的遣责因为不道德。
"A comprehensive public health approach to address the health of transgender people requires access to gender affirmation services, evidence-based health-care delivery systems, and effective partnerships with local transgender communities," write Sari L. Reisner, ScD, Boston Children's Hospital, Harvard Medical School, and colleagues in the third article in the series
一个全面的公众的健康方法去处理变性人的健康需要获得性别确认服务，以证据为基础的健康传送系统，和与当地变性人团体有效的关系。
Although there are substantial gaps in empirical research on transgender issues, "there are sufficient actionable data highlighting unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people that need interventions," Dr Reisner and colleagues write.
尽管在变性人经验主义的调查中有大量的差异。有足够的行动证据去强调独特的生物学的，行为学的和上下文结构的因素围绕着需要干预的变性人的健康风险和弹性。
"There are huge gaps in our understanding of transgender health stemming from a fundamental challenge of defining this diverse group and a failure to recognize gender diversity," Dr Reisner said in a statement.
在理解变性人健康存大巨大差异源于一个根本性的挑战去定义这个不同的团体和不能识别性别的多样性。
"Nevertheless, we know enough to act. High rates of depression and HIV are all linked to the context in which transgender people are forced to live. In the past 15 years, there has been a dramatic shift from viewing transgender people as having a disorder towards a better
understanding of gender diversity, but much more needs to be done," she said.
然而，我们知道足够去行动。抑郁和艾滋的高发生率与变性人被迫生存的环境密切联系。在过去15年里，人们的观点从认为变性人是一种病到更好地理解性别多样化发生了巨大的改变，但更多的是需要行动。
"Visibility of transgender people and support for transgender rights have increased dramatically in recent years," Dr Reisner, Mark A. Schuster, MD, PhD, and Sarah E. Onorato, from Boston Children's Hospital, write.
变性人的透明度和对变性人权利的支持已经明显增加在近见年。
"In 2015, a total of 375 Fortune 500 companies prohibited discrimination on the basis of gender identity, up from 15 in 2002. Nineteen states and the District of Columbia include gender identity in employment nondiscrimination laws," they write.
在2015年，总共有375个福利500间公司阻止性别认同的基础上的歧视，超过2002年的15间。19个州和哥伦比亚区将性别认同纳入就业非歧视法。
Nevertheless, transgender people still face substantial discrimination, they note.
"Beyond bathroom accessibility, discrimination is associated with increased stress, anxiety, depressive symptoms, post-traumatic stress disorder, substance abuse, and suicide. It is also associated with increased risk of bullying, verbal harassment, sexual assault, and nonsexual violence, as well as decreased healthcare utilization," they write.
虽然，变性人仍然面对大量歧视。除了浴视的获得，歧视与增加的压力，焦虑，抑郁，创伤后应激障碍，药物滥用，和自杀密切相关。同样增加了购物，语言骚挠，性暴力和与非性暴，和减少医疗利用率的风险。
The authors suggest that the medical community can play a crucial role in advocacy for
transgender people and can provide a key voice in legislative hearings and amicus briefs. 作者要求医疗团队在关键时刻去维护变性人和在立法听证和陈述中为变性人发声。 "Establishing legal protection for transgender people in the United States may take time.
Eliminating the need for such protection will no doubt take much longer. But being transgender, like being left-handed, may someday be recognized as merely another inherent human quality, no longer conferring a need for protection," they write.
在美国建立合法的变性人保护机制需要时间。消除这些保护的需要无疑更费时间。但作为变性人，像左撇子，有一天会被认为只是另外的内在的人类特性，不再授予保护的需要。 But until then, "the health care community can better address transgender health needs, help ensure that transgender people feel safe in seeking health care, promote resilience in the face of prejudice, and expand our knowledge of how best to promote transgender health and well-being."
但在那之前，健康医疗团体要更好地处理变性人的医疗需要，帮助确保变性人感到安全地寻求健康治疗，促进弹性面对偏见，和扩大我们的知识，知道促进变性人健康是多好的一件事。 The series of articles in the Lancet was funded by the United Nations Development Programme. The authors have disclosed no relevant financial relationships.
Lancet. Published online June 17, 2016. Abstracts
N Engl J Med. Published online June 15, 2016.