Reflexiones sobre la aplicación de la "Ley Trans” en la atención sanitaria / Reflections on the application of the “trans law” in health care

En este artículo se reflexiona sobre la reciente ley aprobada por el Congreso de los Diputados conocida como Ley 4/2023 para la igualdad real y efectiva de las personas trans y para la garantía de los derechos de las personas LGTBI (BOE-A-2023-5366, 2023). Se analizan inicialmente los artículos que más polémica han causado en el ámbito social, que son los relativos a la rectificación registral (Art. 43-51), y posteriormente los que hacen referencia directa o indirectamente a aspectos sanitarios; 1) el que prohíbe de métodos, programas o las llamadas terapias de conversión (Art. 17), 2) los que definen cómo debe ser en términos generales la atención sanitaria (Art. 56-59), y 3) finalmente el único artículo que menciona a los menores (Art 70). Se comenta que el término utilizado de persona trans, al englobar un amplio abanico de diversidades sexuales, variantes y expresiones de género, incluye tanto a personas que necesitan una atención médica como a otras que no. Se plantea que la rectificación registral acorde con esta ley 2023 al no precisar ningún requisito para su inscripción, ofrece menos garantías que la legislación ya existente de marzo 2007. Se considera que las directrices de la nueva ley se están traduciendo en una toma de decisiones por parte del usuario sin disponer de una valoración o diagnóstico por el equipo de profesionales que atienden el caso. Se destaca que la ley no incluye ninguna referencia a la atención por salud mental. Y en conjunto, se concluye que el texto aprobado, en el ámbito sanitario, puede mermar la calidad de la asistencia integral, sobre todo en menores, o personas con identidades complejas, dudosas, o con comorbilidades, que pueden generar discrepancia entre el criterio del profesional y la opinión del usuario.(AU)

State Restrictions and Geographic Access to Gender-Affirming Care for Transgender Youth.

This study estimates changes in geographic access and drive times to gender clinics following legislation enacted to restrict puberty-suppressing medications and hormones for those younger than 18 years.

Ley Trans, liberum arbitrium / Transgender law, liberum arbitrium

La nueva ley sobre la igualdad de las personas trans y la garantía de derechos de las personas LGTBI (Ley 4/2023, de 28 de febrero) ha sido una ley discutida y criticada por algunos grupos de profesionales de la medicina que atienden a la población infantil. Las críticas desde el ámbito médico y pediátrico se pueden hacer siempre ante cualquier ley que consideremos que afecta a los derechos sanitarios de los menores. Lo que sucede es que algunas de esas críticas son sobre aspectos que no se recogen en la ley. En el siguiente artículo analizaremos lo que dice la ley, lo que dicen algunas asociaciones de profesionales y lo que dice la legislación sobre los derechos sanitarios del menor, con el fin de contribuir al debate de esos controvertidos aspectos de la ley (AU)

The new law on the equality of trans people and the guarantee of rights of LGTBI people (Law 4/2023, February 28th) has been discussed by some groups of medical professionals that have shown their disagreement.In relation to any law, criticism can be made from the medical or pediatric field; whenever it affects the rights of minors. However, criticisms, if they exist, should be made about what the law says, not about other aspects.In the following article we will analyze what the law says, what some professional associations say and what the legislation says about the health rights of minors, in order to contribute to the debate on these controversial aspects of the law. (AU)

Streamlining Interstate Access to Gender-Affirming Surgeries.

This Viewpoint explains the obstacles faced by individuals seeking gender-affirming care and summarizes needed changes to improve quality of care and access to care.

Reflexiones en clave bioética al documento «Guía clínica de atención a menores transexuales, transgéneros y de género diverso» / Reflections in bioethics key to the document «Clinical guidelines for the care of transsexual, transgender and diverse gender minors»

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Medicolegal issues surrounding legal sex designations.

The medical profession is deeply involved in designating and amending the sex designations on legal records that themselves are not used clinically. The assumptions inherent in the current legal sex designation system and the criteria for amending such are being reexamined. The harms of the current legal sex designation system, especially for transgender people, have become increasingly recognized. Consequently, the appropriateness of the health care professional's participation in recording legal sex designations has been called into question. Herein, we describe the medicolegal challenges surrounding legal sex designations and their potential solutions.

"Existimos": Health and social needs of transgender men in Lima, Peru.

BACKGROUND: The health of transgender men (trans men)-individuals who identify as men and were assigned a female sex assigned at birth-is overlooked globally. This mixed-methods exploratory study sought to understand the lived experiences, health, and social needs of trans men in Lima, Peru to bring visibility to specific health needs and inform responsive and holistic public health efforts. METHODS: Between July 2016-January 2017, 46 trans men in Lima, Peru participated in a mixed-methods study. Four focus group discussions were conducted, complemented with 10 one-on-one interviews to explore in-depth issues that arose in groups. Two individuals participated in both a focus group and an interview. All participants completed a brief survey assessing sociodemographic characteristics and experiences with healthcare, mental health, and stigma. Audio files were transcribed verbatim and analyzed using an immersion crystallization approach to identify themes. RESULTS: Participants had a mean age of 24 years (range 18-48). Trans men reported a lack of awareness and information among medical providers, avoidance of healthcare due to discrimination and maltreatment, an absence of public services for medical gender affirmation (hormones, surgeries), and unmet mental health needs. Trans men described health as multidimensional and influenced by social, economic, and legal contexts including family, school, employment and work, legal identity recognition, discrimination in public spaces, and peer support. Violence, stigma, and intersecting forms of oppression were described as limiting social and legal recognition of trans identity a central dimension of health. Peer support, often in an online environment, was described as important to resistance and well-being. CONCLUSIONS: Findings demonstrate that the physical and mental health of trans men, as well as unmet needs for healthcare services, are influenced by a complex set of social, economic, and legal challenges due to the social exclusion of trans people in Peruvian society. Results are a call to action for stakeholders in Peru to guarantee the rights, health, and wellbeing of this community.