韓莉雅塔在黃金州 生活習醫療癒劄記

原來劉阿姨的作法是有根據的1

五月開始，我為了賀爾蒙治療（hormone therapy）跟榮總的李大媽、長庚的劉阿姨、和家裡的母親之間周旋了很長的時間，跑來跑去很多回合。最後在兩位醫師幫忙之下，work出一個不用為難她們的方法。對精神科和新陳代謝科，甚至整形外科醫師來說，都怕在專業上的考量明明OK，通過評估，卻還是會面對家屬的騷擾—即便患者已滿十八歲，理論上也應該要能夠為自己的決定負責。

有點長的故事略過。

最後的作法是，劉阿姨在便條紙（而不是處方簽）上寫下最保險的劑量，交待我自己去檢驗所做相關的血液尿液等檢查項目，才開始用藥，然後一個月後回去找她，她再幫我用健保方式納入醫療。為了我的荷包，可能也為了不造成困擾，兩三次去請教她用藥問題以及請她幫忙，她都幫我退掛，我等於只花交通費。

當時我想過，劉阿姨的想法，大概就是先造成「已經自行用藥」的既成事實，然後讓醫師基於「維護病人健康」的天職，與其讓其自行用藥，不如那入醫療體系的監督，避免自行用藥不當的副作用。

今天在Anne Lawrence（美國一位知名的外科醫師，也是MtF (male to female)）的網頁上，看到一段文字，證明了我當初的猜想：

Readers of this site should remember that the newest HBIGDA Standards of Care now permit physicians to prescribe hormones without a recommendation from a mental health professional for persons who are already taking hormones without medical supervision. Individuals who have been taking hormones from Internet pharmacies without supervision should consider using this opportunity to seek medically prescribed, medically supervised hormone therapy. Some clinics in major U.S. cities will prescribe under this so-called “harm reduction” model, as will some private practitioners, including myself.

我查了一下Lawrence引用的東西，全名叫The Harry Benjamin International Gender Dysphoria Association’s Standards of Care for Gender Identity Disorders。美國人真是專業，裡面的規定與建議之縝密，讓人驚歎。裡面對於賀爾蒙治療（hormone therapy）的適用規定有三要件（eligibility criteria），原文如下：

The administration of hormones is not to be lightly undertaken because of their medical and social risks. Three criteria exist.

1. Age 18 years;
2. Demonstrable knowledge of what hormones medically can and cannot do and their social benefits and risks;
3. Either:
   1. A documented real-life experience (以異性穿著過異性生活) of at least three months prior to the administration of hormones; or
   2. A period of psychotherapy of a duration specified by the mental health professional after the initial evaluation (usually a minimum of three months).

但為了避免有些人逕行自行購藥服用，醫師還是可以對這些已自行用藥的人提供醫療協助，以免他們的藥物來路不明或品質有問題或劑量不對，危害健康：

In selected circumstances, it can be acceptable to provide hormones to patients who have not fulfilled criterion 3 – for example, to facilitate the provision of monitored therapy using hormones of known quality, as an alternative to black-market or unsupervised hormone use.

歷年的今天…

• 2007: 心有所感
• 2007: NTU的教學評鑑 續集
• 2006: 嚇阿娘
• 2006: 關於語言治療

Posted under: Transition (性別轉換)