Les enjeux éthiques de la prise en charge des personnes transgenres, et par extension, l’évaluation de la transidentité parmi les internes de psychiatrie français ont été analysés. Une revue de la littérature, afin d’aborder l’historicité du sexe, à travers sa définition et ses variations, ainsi que la naissance de la conception du genre a été réalisée. Une réflexion est également menée autour des enjeux éthiques de la prise en charge des personnes trans’, à travers l’autonomie du choix, la bienfaisance et la non-malfaisance de l’accès à la transition hormonochirurgicale (THC), et les enjeux sociétaux entraînés par l’évolution de la considération du genre. Les internes de psychiatrie français ont été interrogés sur leur opinion concernant le respect de l’autonomie des personnes transgenres lors de l’évaluation et l’accompagnement psychiatrique. Cette réflexion s’est élargie à travers l’enquête à la non-malfaisance du diagnostic de dysphorie de genre et au principe de justice dans la prise en charge des personnes transgenres en France. Les réponses recueillies sont majoritairement en faveur d’une autonomie de la personne trans’, avec une mise en avant de sa capacité et sa liberté d’autodétermination. L’examen psychiatrique préalable à une THC reste perçu comme nécessaire afin d’éliminer les diagnostics différentiels et d’évaluer le consentement éclairé de la personne, bien qu’il renvoie un sentiment de pathologisation aux personnes concernées. Ce sentiment de pathologisation est en revanche perçu comme moindre si cette consultation est faite par un psychologue.

This article focuses on the ethical issues surrounding gender-affirming care for transgender people (i.e. A person whose gender does not correspond to their sex assigned at birth), particularly the respect of the rights of transgender patients to autonomy during psychiatric evaluations. This topic gives leave to a deeper investigation into the principles of non-maleficence when diagnosing gender dysphoria and into the principles of justice when providing essential medical care for transgender people in France.

Firstly, a review of the literature was carried out in order to explore the historicity of sex, its definition and variations, and the concept of gender identity. To establish the latter's relationship to psychiatry, the evolution of gender dysphoria through psychiatric classifications and guidelines was reviewed, as well as the role of the psychiatrist in the process of gender-affirming treatment. A reflection was also carried out concerning the ethical issues of the medical care of trans people, through the autonomy of choice, beneficence and non-maleficence of access to the hormonal-surgical transition, and the societal issues involved in the evolution of the consideration of gender. A study was conducted via a websurvey and a questionnaire was sent to psychiatric residents completing their studies in France. A total of 70 respondents were included. The questionnaire asked residents to give their opinion on transgender people's right to autonomy (and how to respect them) during psychiatric assessments and psychological inputs.

The answers from the residents indicate that they are mainly in favor of upholding transgender people's right to autonomy, with an emphasis on their capacity and their right to self-determination. Conversely, 15% of the respondents viewed transgender identities as a mental disorder and were more in favor of a medicalized model of treating gender dysphoria. A psychiatric assessment prior to receiving gender-affirming care was still perceived as necessary in order to eliminate differential diagnoses and to evaluate the capacity for informed consent, however, this may be perceived as excessive pathologization for transgender people. On the other hand, this feeling of pathologization is perceived as diminished if this consultation is performed by a psychologist. These answers suggest the necessity of carrying out a comparison with the feelings of the concerned individuals, for a more ethical management of transidentity.

The issue of meeting the demands of the transgender population is still being debated. It is legitimate to ask whether we can, under cover of their freedom of choice, let the persons concerned make the decision without having first undergone a medical evaluation, and whether the individual's autonomy must take precedence over potential irreversible negative outcomes. Through this study, it appears that the sampled psychiatry residents sense that those individuals seeking transgender care have the feeling of pathologization that is induced by a consultation with a psychiatrist before starting gender-affirming care. On the other hand, if the consultation is conducted by a psychologist this feeling of pathologization is less a factor. This assumption should obviously be affirmed with the concerned persons.