個案報告：性別重置手術前心理評估的定位與程序探討

A Case Report: The Position and Procedure of the Psychological Assessment before Sex Reassignment Surgery

研究目的：性別不安者為因心理與生理性別不一致而感到不適者，目前可藉由性激素及性別重置手術盡可能使其外表符合心理性別以減輕痛苦。在性別重置手術前的心理評估中，團隊必須評估個案是否適合接受手術。本文將以一位欲接受性別重置手術而前來進行心理評估的個案為例，討論評估相關的議題考量。研究方法：個案現年34歲，生理性別為男性，多年來以女性角色生活，長期因性別不一致而感到痛苦，欲進行性別重置手術而前來進行評估。研究結果：個案的手術動機雖與精神疾病無關，然而其對手術成效抱持過於理想的想像，因此即使手術在生理構造上能夠拉近身心之間的差距，是否就此回到「真實的自己」則值得評估者深思。研究結論：以現行體制而言，評估者除了為協助個案釐清其所欲求以及手術是否能夠滿足其期待的合作者，也同時為決定其是否能夠接受手術的把關者，此雙重關係令一開始的關係建立多了層阻礙，因此相關的具體作法仍有待更多專業人士與社群提供不同角度的思考和建議。

Background: People suffering from gender dysphoria are living a painful life in which their psychological gender is inconsistent with their biological sex. Hormonal therapy and sex reassignment surgery can make their appearance consistent with their psychological gender and relieve their pain. A medical team must assess the client’s mental state to determine whether they are ready for sex reassignment surgery by observing the client’s self-descriptions, behavior, and emotional expressions. To discuss assessment issues, we use a case study of a client seeking assessment in order to have sex reassignment surgery. Methods: The client is a 34 year old whose sex is male and gender is female. The client has been living as a female for many years and suffers from gender dysphoria. Results: This case is too ideal for the surgery. Even if the surgery can reduce the gap between body and mind, it is unclear whether it would reduce subjective distress. Conclusions: A clinical psychologist’s responsibility is to help clients clarify what they really want and what their best option is, including sex reassignment surgery or other possibilities. However, in the current system the assessor also decides whether the client can have the surgery or not. This dual role may increase the difficulty of establishing a relationship between the client and the assessor. This issue and the concrete practices surrounding it still need further discussion.