Dilemas éticos relacionados con la supresión de la pubertad

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María Guadalupe Grimaux
Gustavo Paez
https://orcid.org/0000-0003-3862-7426

Resumen




La disforia de género pediátrica es una patología psiquiátrica cuya incidencia ha crecido significativamente. Se han propuesto diversas terapias, pero aún no hay consenso sobre la conducta a seguir en estos casos. Uno de los tratamientos sugeridos es la supresión de la pubertad, cuyo objetivo es el de disminuir la angustia del niño que padece esta patología. Sin embargo, este tratamiento ha generado diversos dilemas éticos que todavía no han sido despejados. Por este motivo, basándonos en la evidencia actual, no parece prudente su indicación existiendo otras alternativas terapéuticas que no despiertan controversias.




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Grimaux, . M. G. ., & Paez, G. . (2023). Dilemas éticos relacionados con la supresión de la pubertad. Medicina Y Ética, 34(1), 16–48. https://doi.org/10.36105/mye.2023v34n1.01
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Biografía del autor/a

María Guadalupe Grimaux, Universidad Austral

Especialista en Clínica Médica. Miembro del Departamento de Bioética de la Facultad de Ciencias Biomédicas de la Universidad Austral, Pilar, Argentina. Magíster en Bioética por la Universidad Católica San Antonio de Murcia.

Gustavo Paez, Universidad Austral

Miembro del Departamento de Bioética de la Facultad de Ciencias Biomédicas de la Universidad Austral, Pilar, Argentina. Magíster en Bioética y Doctor en Filosofía por la Universidad de Navarra.

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American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders [Internet]. Médica Panamericana [consultado 21 noviembre de 2020]. Disponible en: https://www.eafit.edu.co/ninos/reddelaspreguntas/Documents/dsm-iv-manual-diagnostico-estadistico-trastornos-mentales.pdf

Davy Z. The dsm-5 and the Politics of Diagnosing Transpeople. Arch Sex Behav. 2015; 44:1165-1176. https://doi.org/10.1007/s10508-015-0573-6

wpath. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People [Internet] [consultado 21 de noviembre de 2020]. Disponible en: https://www.wpath.org/media/cms/Documents/SOC%20v7/Standards%20of%20Care%20V7%20-%202011%20wpath.pdf?_t=1605186324

Zou Y, Szczesniak R, Teeters A, Conard L, Grossoehme D. Documenting an epidemic of suffering: low health-related quality of life among transgender youth. Quality of Life Research. 2018; 27:2107-2115. https://doi.org/10.1007/s11136-018-1839-y

Olson J, Garofalo R. The peripubertal gender-dysphoric child: puberty suppression and treatment paradigms. Pediatr Ann. 2014; 43(6):e132-7. https://doi.org/10.3928/00904481-20140522-08

Zucker K. Epidemiology of gender dysphoria and transgender identity. Sex Health. 2017; 14(5):404-411. https://doi.org/10.1071/SH17067

Wallien M, Swaab H, Cohen-Kettenis P. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry. 2007; 46(10):1307-1314. https://doi.org/10.1097/chi.0b013e3181373848

de Vries A, Noens I, Cohen P, van Berckelaer I, Doreleijers T. Autism spectrum disorders in gender dysphoric children and adolescents. J Autism Dev Disord. 2010; 40(8):930-6. https://doi.org/10.1007/s10803-010-0935-9

van der Miesen A, de Vries A, Steensma T, Hartman CA. Autistic Symptoms in Children and Adolescents with Gender Dysphoria. J Autism Dev Disord. 2018; 48(5):1537-1548. https://doi.org/10.1007/s10803-017-3417-5

Sevlever M, MeyerBahlburg H. LateOnset Transgender Identity Development of Adolescents in Psychotherapy for Mood and Anxiety Problems: Approach to Assessment and Treatment. Arch Sex Behav. 2019; 48(7):1993-2001. https://doi.org/10.1007/s10508-018-1362-9

Tobin V, Bockting WO, Hughes T. Mental Health Promotion for Gender Minority Adolescents. J Psychosoc Nurs Ment Health Serv. 2018; 56(12):22-30. https://doi.org/10.3928/02793695-20180601-02

Zucker K, Wood H, Singh D, Bradley S. A developmental, biopsychosocial model for the treatment of children with gender identity disorder. J Homosex. 2012; 59(3):369-97. https://doi.org/10.1080/00918369.2012.653309

Cox P, Carrasco M. Disforia de género en niños y controversias en su tratamiento: dos concepciones distintas sobre la identidad de género. Pers Bioet. 2020; 24(1):57-76. https://doi.org/10.5294/pebi.2020.24.1.5

De Vries A, Cohen-Kettenis P. Clinical management of gender dysphoria in children and adolescents: The Dutch approach. J Homosex. 2012; 59(3):301-20. https://doi.org/10.1080/00918369.2012.653300

Hartman L, Widdershoven G, de Vries, A. Integrative Clinical Ethics Support in Gender Affirmative Care: Lessons Learned. HEC Forum. 2019; 31:241-260. https://doi.org/10.1007/s10730-019-09376-6

APA Task Force on Treatment of Gender Identity Disorder. Report of the APA Task Force on Treatment of Gender Identity Disorder. Am J Psychiatry. 2012; 169:8. https://doi.org/10.1007/s10508-012-9975-x

Simons L, Leibowitz S, Hidalgo M. Understanding gender variance in children and adolescents. PediatrAnn.2014;43(6):e126-e131.https://doi.org/10.3928/0090448120140522-07

Saleem F, Rizvi S. Transgender Associations and Possible Etiology: A Literature Review. Cureus. 2017; 9(12):e1984. https://doi.org/10.7759/cureus.1984

Simons L, Leibowitz S, Hidalgo M. Understanding gender variance in children and adolescents. PediatrAnn. 2014; 43(6):e126-31. https://doi.org/10.3928/0090448120140522-07

de Vries A, Steensma T, Doreleijers T, Cohen-Kettenis P. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011; 8(8):2276-83. https://doi.org/10.1111/j.1743-6109.2010.01943.x

Ehrensaft D. From gender identity disorder to gender identity creativity: true gender self-child therapy. J Homosex. 2011; 59:337-56. https://doi.org/10.1080/00918369.2012.653303

James H, Chang A, Imhof R, Sahoo A, Montenegro M, Imhof N, González C, Lteif A, Nippoldt T, Davidge C. A community-based study of demographics, medical and psychiatric conditions, and gender dysphoria/incongruence treatment in transgender/gender diverse individuals. Biol Sex Differ. 2020; 11(1):55. https://doi.org/10.1186/s13293-020-00332-5

Butler G , De Graaf N, Wren B, Carmichael P. Assessment and support of children and adolescents with gender dysphoria. Arch Dis Child. 2018; 103(7):631-636. https://doi.org/10.1136/archdischild-2018-314992

Butler G, Wren B, Carmichael P. Puberty blocking in gender dysphoria: suitable for all? Arch Dis Child. 2019; 104(6):509-510. https://doi.org/10.1136/archdischild-2018-315984

Levitan N, Barkmann C, Richter H, Schulte M, Becker I. Risk factors for psychological functioning in German adolescents with gender dysphoria: poor peer relations and general family functioning. Eur Child Adolesc Psychiatry. 2019; 28(11):1487-1498. https://doi.org/10.1007/s00787-019-01308-6

Day D, Saunders J, Matorin A. Gender Dysphoria and Suicidal Ideation: Clinical Observations from a Psychiatric Emergency Service. Cureus. 11(11):e6132. https://doi.org/10.7759/cureus.6132

Temple J, Pyne J, Winters K, Feder S. A critical commentary on follow-up studies and “desistance” theories about transgender and gender non-conforming children. International Journal of Transgenderism. 2018; 19:2,212-224. https://doi.org/10.1080 / 15532739.2018.1456390

López J, González C. Valoración de la supresión de la pubertad en menores con problemas de identidad de género. Cuadernos de Bioética. 2018; 29(97):247-56. https://doi.org/10.0.30444/CB.9

Tollit M, Pace C, Telfer M. What are the health out comes of trans and gender diverse young people in Australia? Study protocol for the Trans20 longitudinal cohort study. BMJ Open. 2019; 9:e032151. https://doi.org/10.1136/bmjopen-2019-032151

Kreukels B, Cohen P. Puberty suppression in gender identity disorder: the Amsterdam experience. Nat Rev Endocrinol. 2011; 7(8):466-72. https://10.1038/nrendo.2011.78

James H, Chang A, Imhof R, Sahoo A, Montenegro M, Imhof N, González C, Lteif A, Nippoldt T, Davidge C. A community-based study of demographics, medical and psychiatric conditions, and gender dysphoria/incongruence treatment in transgender/gender diverse individuals. Biol Sex Differ. 2020; 11(1):55. https://doi.org/10.1186/s13293-020-00332-5

Costa R, Carmichael P, Colizzi M. To treat or not to treat: puberty suppression in childhood-onset gender dysphoria. Nat Rev Urol. 2016; 13(8):456-62. https://doi.org/10.1038/nrurol.2016.128

Hruz P, Mayer L, McHugh P. Growing Pains. Problems with Puberty Suppression in Treating Gender Dysphoria. The New Atlantis. 2017; 52:3-36. https://doi.org/10.1177/0024363919873762

Hernández R. Disforia de género infantil: Una reflexión ética a partir de la vulnerabilidad, la responsabilidad y la beneficencia en Colombia. Revista Iberoamericana de Bioética. 2020; 12:01-12. https://doi.org/10.14422/rib.i12.y2020.009

Frith L. The concise argument: choice, choices and the choice agenda. J Med Ethics. 2022; 48(1):1-2. https://doi.org/10.1136/medethics-2021-108052

Turban J, King D, Carswell J, Keuroghlian A. Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. Pediatrics. 2021; 147(4):e2020049767. https://doi.org/10.1542/peds.2020-049767