God Vård Av Barn Och Ungdomar Med Könsdysfori Metodbeskrivning Och Kunskapsunderlag

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God Vård Av Barn Och Ungdomar Med Könsdysfori Metodbeskrivning Och Kunskapsunderlag God vård av barn och ungdomar med könsdysfori Metodbeskrivning och kunskapsunderlag Denna publikation skyddas av upphovsrättslagen. Vid citat ska källan uppges. För att återge bilder, fotografier och illustrationer krävs upphovsmannens tillstånd. Förord Detta dokument innehåller en beskrivning av de metoder som har använts för att ta fram God vård av barn och ungdomar med könsdysfori – Nationellt kunskapsstöd, och de kunskapsunderlag som ligger till grund för rekommen- dationer i kunskapsstödet. Kunskapsstödet finns på www.socialstyrelsen.se. För att göra kunskapsstödet mer lättläst har Socialstyrelsen valt att separat- publicera denna längre version av den arbetsprocess som ledde fram till kunskapsstödet, tillsammans med den vetenskapliga och kliniska bakgrunden till innehållet i kunskapsstödet. Lars-Erik Holm Generaldirektör Innehåll Förord ......................................................................................................................... 3 Framtagningen av kunskapsstödet ..................................................................... 9 Arbetsgruppens sammansättning ............................................................... 9 Faktaarbetet ................................................................................................. 10 Prioriteringsarbetet ....................................................................................... 13 Hälsoekonomiska bedömningar ............................................................... 15 Andra faktorer som har varit centrala i arbetet ..................................... 15 Om faktaunderlagens överförbarhet ...................................................... 17 Referenser ...................................................................................................... 18 Samtalsbehandling och psykosocialt stöd ...................................................... 19 Bakgrund ........................................................................................................ 19 Resultat av litteratursökningarna ............................................................... 19 Viktigt med transspecifik kompetens ....................................................... 20 Information, stöd och rådgivning till vårdnadshavare ......................... 20 Samtalsbehandling och rådgivning ......................................................... 22 Internationella behandlingsriktlinjer .......................................................... 22 Särskilt viktigt för unga att utforska sin könsidentitet.............................. 22 Psykosocialt stöd för den unga personen ............................................... 23 Psykosocialt stöd till anhöriga och närstående...................................... 24 Grupper för stöd och behandling för unga ............................................ 25 Referenser ...................................................................................................... 25 Metod för litteratursökning ......................................................................... 27 Stöd för att underlätta ett liv i enlighet med könsidentiteten (RLE) ............ 30 Bakgrund ........................................................................................................ 30 Resultat av litteratursökningarna ............................................................... 31 Internationella behandlingsriktlinjer .......................................................... 31 Referenser ...................................................................................................... 31 Metod för litteratursökning ......................................................................... 32 Hormonbehandling .............................................................................................. 33 Sammanfattning .......................................................................................... 33 Kriterier för hormonbehandling ................................................................. 33 Pubertetsbromsande hormonbehandling ...................................................34 Beskrivning av tillstånd och åtgärd ........................................................... 34 Vilka studier har eftersökts? ........................................................................ 35 Vilka studier ingår i granskningen? ........................................................... 35 Kunskap om behandlingens säkerhet ...................................................... 36 Reversibla effekter på pubertetsutvecklingen ........................................ 36 Följdeffekter av GnRHa behandling ......................................................... 37 Psykisk hälsa före och efter GnRHa-behandling ..................................... 38 Behandlingsavbrott och ånger .................................................................. 38 Könskonträr hormonbehandling .................................................................... 39 Beskrivning av tillstånd och åtgärd ........................................................... 39 Vilka studier har eftersökts? ......................................................................... 39 Vilka studier ingår i granskningen? ............................................................ 40 Kunskap om behandlingens säkerhet ...................................................... 40 Könsdysfori och psykisk hälsa före och efter behandling ..................... 41 Behandlingsavbrott och ånger .................................................................. 42 Saknas någon information i studierna? .................................................... 43 Referenser ....................................................................................................... 43 Metod för litteratursökning .......................................................................... 46 Mastektomi och skapande av maskulin bröstkorg ......................................... 49 Allmänt om underlaget ............................................................................... 49 Sammanfattning av det vetenskapliga underlaget .............................. 49 Beskrivning av tillstånd och åtgärd ........................................................... 49 Vilka studier ingår i granskningen? ............................................................ 50 Sammanfattning av studiernas resultat .................................................... 51 Övergripande kommentar om det vetenskapliga underlaget ........... 51 Vilken effekt har åtgärden? ........................................................................ 52 Referenser ....................................................................................................... 52 Metod för litteratursökning .......................................................................... 53 Resultatet av litteratursökningen ............................................................... 53 Reduktion av struphuvudet ................................................................................. 70 Allmänt om underlaget ............................................................................... 70 Sammanfattning ........................................................................................... 70 Beskrivning av tillstånd och åtgärd ........................................................... 70 Vilka studier ingår i granskningen? ............................................................ 71 Vilken effekt har åtgärden? ........................................................................ 71 Referenser ....................................................................................................... 71 Metod för litteratursökning .......................................................................... 72 Resultatet av litteratursökningen ............................................................... 72 Ansiktskirurgi och modifiering av kroppsformen .............................................. 75 Allmänt om underlaget ............................................................................... 75 Sammanfattning av det vetenskapliga underlaget .............................. 75 Beskrivning av tillstånd och åtgärd ........................................................... 76 Vilka studier ingår i granskningen? ............................................................ 77 Sammanfattning av studiernas resultat ................................................... 78 Övergripande kommentar om det vetenskapliga underlaget .......... 78 Vilken effekt har åtgärden? ....................................................................... 78 Referenser ...................................................................................................... 78 Metod för litteratursökning ......................................................................... 79 Resultatet av litteratursökningen ............................................................... 80 Bröstförstoring med implantat ............................................................................ 87 Allmänt om underlaget ............................................................................... 87 Sammanfattning av forskningsläget ........................................................ 87 Bakgrund ........................................................................................................ 87 Studier som berör bröstförstoring hos transkvinnor ................................ 87 Har åtgärden några biverkningar eller oönskade effekter? ............... 88 Referenser .....................................................................................................
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