從系統觀點看臺灣跨性別女性走向性別轉換的適應歷程——以接受賀爾蒙治療的跨性別女性為例

Abstract

2018年底一場性平教育公投，讓我們理解到臺灣社會對跨性別族群的理解與重視仍遠遠不足，更遑論跨性別個人在性別轉換歷程中可能需要面對的生理、心理與社會環境的巨大變化與過程中的適應。探究接受賀爾蒙治療的跨性別女性的性別轉換適應，不僅將有助於心理健康專業實務工作，更能促進其他不同健康專業對跨性別女性的經驗有所理解，能從全人的觀點提供跨性別女性適當的協助。因此本研究有以下目的：一、探討選擇接受賀爾蒙治療的臺灣跨性別女性在成長脈絡中走向性別轉換的適應歷程中重要的生物、心理、社會的影響因素；二、探討選擇接受賀爾蒙治療的臺灣跨性別女性在其適應歷程中的重要變動與探討選擇接受賀爾蒙治療的臺灣跨性別女性如何達成適應。 本研究透過半結構式訪談，訪談5位選擇接受賀爾蒙治療之跨性別女性，平均年齡為 34 歲，透過紮根理論之質性分析方法，進行資料編碼歸類分析，個別深入瞭解她們生命中與性別相關的重要事件與背後相關生物心理社會因素並搜集有關性別之重要背景資料，歸納出跨性別女性走向性別轉換之適應歷程。 研究結果顯示：（1）臺灣跨性別女性走向性別轉換之適應歷程可以區分為三階段，依序為: 初萌階段、性別拓展嘗試階段以及性別轉換適應階段。（2）各階段內分別存在不同的主軸現象，反映不同階段的適應主題，依序為性別二元環境中性別不一致無從拓展的順應、跨性別拓展選擇：走向性別轉換以及跨性別轉換的動態適應。（3）接觸跨性別帶來的跨性別相關資源能帶動跨性別女性階段轉變，促使拓展性別選擇從而邁向性別轉換。（4）適應歷程中的友善開放、安全與肯認資源挹注將影響個人因應與性別選擇的能動性，但個人所選擇的因應型態更影響適應的雙元經驗。 本研究依結果提出七點討論:（1）生物心理社會因素能夠單獨或共構成重要的影響因子。生物心理因素的性別殊異與社會因素的性別二元環境兩影響因素共同形成適應歷程的前置壓力，後續個人不斷受社會因素下跨性別不符性別常規的壓力困境持續壓迫，且轉換過程的生理不適可能與醫病關係共構雙重困境。（2）跨性別女性為了追尋能夠自在安適的性別展現與身份的生活，須不斷經歷在資源與外在的性別二元規訓等困境之間來回移動的辯證歷程。（3）跨性別行動會形成資源隊伍拓展性別的重要變動，有利的資源緊扣著階段發展，依序為友善開放、安全以及肯認資源，反映個人性別轉換階段所需要的資源不同。（4）跨性別女性在變動歷程中隨資源獲得而開拓自我，在初始的資源獲得後不斷產生行動，催化改變獲取新資源，形成資源獲得螺旋帶來適應。（5）性別安適可被視為一個人內在資源，跨性別女性在初始的性別嘗試與轉換獲取該資源而願意進一步拓展個人性別展現。（6）性別轉換在適應歷程中實現，是跨性別女性用以獲取對自我性別安適資源的因應行動，同時也是個人用來回應性別二元規訓的因應行動，幫助個人獲得適應的結果。（7）達成適應歷程中個人的因應具辯證性質，介於積極催化與迴避兩端光譜之間，且會隨著階段開展，有更加多元的因應行動。最後，本研究亦提出研究的限制與建議。

Taiwanese referendum in 2018 showed that there were still lots of prejudice and misunderstanding to transgender people and their gender transition. It is helpful to explore the transgender women’s adjustment process in gender transition for health professions to provide appropriate health services from holistic perspectives. Due to this reason, the aims of the current study were to explore (1) biopsychosocial factors, (2) important shifts, and (3) how did transgender women achieve adjustment in their adjustment process heading for gender transition. Using a grounded theory approach, this qualitative study sought to examine adjustment processes and important life event related to gender among transgender women. The sample included 5 participants who self-identified as women or other feminine gender role which is different from their assigned male sex at birth. Results yielded three phases in adjustment process heading for gender transition: germination, gender exploration, and adjusting during gender transition. Three phases reflected different theme and phenomenon in adjustment. Contacting with transgender individuals or community, transgender women acquired trans-related resources to expand their gender choice, and finally heading for gender transition. Openness to gender, security, and affirmation were three resources that supported individual’s agency to cope and choose their gender during the process. However, the coping strategies chosen by individuals determined the dual experience between adaptive and maladaptive adjustment. Based on the analysis, 7 discussions were presented in current study: (1) biopsychosocial factors could exist independently or co-construct the important factors in tans women’s adjustment process. Gender variance and gender binary co-constructed as initial stress, and then individual was oppressed by social gender minority stress for gender-incongruence. In addition, health issue and doctor-patient relationship might co-construct as stress, evoking individual to cope; (2) transgender women’s adjustment process was the dialectical process between resources and gender-minority-stress situations; (3) trans-related resource would connect as resource caravan and prompt important shift in adjustment process. And the favorable resources would change as phase shifted in process. (4) resources evoke transwomen to take action for gender exploration, coping, and cultivating more resources; therefore, there was resource gain spirals phenomenon existed in transwomen’s adjustment; (5) gender comfort might be personal resource which prompted transwomen to be willing to take more action for gender transition; (5) gender transition was a kind of coping strategy for gaining more gender comfort but also coping the gender minority stress; (7) coping strategies in adjustment process were dialectical between facilitative and avoidant coping. As process shifted, individual would have more diverse coping strategies for achieving adjustment. Finally, based on the results and discussion, the limitation of current study and suggestions for future research were proposed.