Psychosocial Counseling of Transgender and Gender Diverse Individuals in Fertility and Reproductive Medicine: a Narrative Review

IF 3.7 3区生物学 Q1 DEVELOPMENTAL BIOLOGY Reproduction Pub Date : 2024-09-01 DOI:10.1530/rep-24-0041

Peter Cummings, Angela K Lawson

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Abstract

Transgender and gender diverse (TGD) individuals experience significantly greater all-cause mortality and mental health disparities compared to their cisgender peers. Gender-affirming hormone therapy (GAHT) is a safe and effective treatment option for gender dysphoria that dramatically improves psychosocial health outcomes but may adversely impact fertility. Guidelines recommend medical fertility preservation (FP) counseling for TGD individuals and pre-fertility treatment psychoeducational implications consultation from qualified reproductive mental health professionals (MHPs) for TGD individuals pursuing FP or third-party reproductive treatment. However, sparce literature exists specific to the structure of mental health psychoeducational consultation for TGD individuals pursuing FP.

This narrative review highlights aspects of mental health implications pre-fertility treatment consultation for the provision of supportive counseling. Results indicate that implications counseling should be conducted by an MHP with specialized training in reproductive mental health with TGD populations to reduce risk of harm and promote successful emotional navigation of fertility treatment. Such counseling should be psychoeducational and not gatekeeping in nature and may include consideration of the psychosocial (e.g., emotional, relational, ethical, spiritual, social) risks and benefits of various family building options. During these consultations, TGD individuals can explore their hopes and fears related to fertility and future family building plans and discuss realistic treatment expectations, individual strengths, coping and communications strategies, and identify key support network members which may aid in navigating the fertility treatment process. MHPs can provide referrals to appropriate resources if necessary to help TGD individuals navigate treatment while coping with psychological symptoms and promote behavior change.

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为生育和生殖医学中的变性者和性别多元化者提供社会心理辅导：叙述性综述

变性人和性别多元化者（TGD）的全因死亡率和心理健康差异明显高于同性别者。性别确认激素疗法（GAHT）是治疗性别障碍的一种安全有效的方法，可显著改善心理社会健康状况，但可能会对生育能力产生不利影响。指南建议为 TGD 患者提供医学生育力保存（FP）咨询，并为寻求生育力保存或第三方生殖治疗的 TGD 患者提供合格生殖心理健康专业人员（MHPs）的生育治疗前心理教育影响咨询。然而，有关为寻求FP的TGD患者提供心理健康心理教育咨询的具体文献却很少。这篇叙述性综述强调了不孕症治疗前心理健康影响咨询的各个方面，以提供支持性咨询。结果表明，影响咨询应由受过生殖心理健康专业培训的心理保健人员为 TGD 群体提供，以降低伤害风险并促进成功的生育治疗情感导航。这种咨询应该是心理教育性质的，而不是把关性质的，可能包括考虑各种家庭建设方案的社会心理（如情感、关系、伦理、精神、社会）风险和益处。在这些咨询过程中，TGD个人可以探讨他们对生育和未来家庭建设计划的希望和恐惧，讨论现实的治疗期望、个人优势、应对和沟通策略，并确定可能有助于度过生育治疗过程的关键支持网络成员。必要时，医疗保健人员可以提供适当的资源转介，以帮助TGD患者在应对心理症状的同时掌握治疗方法，并促进行为改变。

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来源期刊

Reproduction 生物-发育生物学

CiteScore

7.40

自引率

2.60%

发文量

199

审稿时长

4-8 weeks

期刊介绍： Reproduction is the official journal of the Society of Reproduction and Fertility (SRF). It was formed in 2001 when the Society merged its two journals, the Journal of Reproduction and Fertility and Reviews of Reproduction. Reproduction publishes original research articles and topical reviews on the subject of reproductive and developmental biology, and reproductive medicine. The journal will consider publication of high-quality meta-analyses; these should be submitted to the research papers category. The journal considers studies in humans and all animal species, and will publish clinical studies if they advance our understanding of the underlying causes and/or mechanisms of disease. Scientific excellence and broad interest to our readership are the most important criteria during the peer review process. The journal publishes articles that make a clear advance in the field, whether of mechanistic, descriptive or technical focus. Articles that substantiate new or controversial reports are welcomed if they are noteworthy and advance the field. Topics include, but are not limited to, reproductive immunology, reproductive toxicology, stem cells, environmental effects on reproductive potential and health (eg obesity), extracellular vesicles, fertility preservation and epigenetic effects on reproductive and developmental processes.