A formal Gender Dysphoria classification— as outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders— is a prerequisite for the reimbursement of both gender-affirming medical care and transgender mental health care in the Netherlands. Gender Dysphoria and its conceptual precursors have always been moving targets: moving due to research, policy, care practices and activism both within and outside of medicine. This raises the question of what Gender Dysphoria is exactly. To elucidate this question, we turn to the people who use the concept in clinical practice to come to a diagnosis and treatment indication: mental health professionals working in gender-affirming medical care and transgender mental health care. Using a material semiotics approach, we reflect upon how Gender Dysphoria is done in clinical practice. Based on an analysis of seventeen practice-based interviews with clinicians as well as an examination of clinical guidelines and texts, we describe four modes in which Gender Dysphoria is ordered. These modes of ordering illustrate that Gender Dysphoria is not one, but multiple. We illustrate how in the mode of isolating, Gender Dysphoria is something which is carefully isolated from mental disorders, while in the modes doing the future and narrating, Gender Dysphoria is done as a continuous and predictable object of care. Such orderings of Gender Dysphoria potentially conflict with a fourth mode of ordering: the doing of diversity in transgender health care. The study’s findings provide empirical insights into how transgender health care is currently done in The Netherlands and provide a foundation on which ethical debates on what good transgender health care should entail.

中文翻译：

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进行和取消跨性别医疗保健：临床实践中“性别不安”的排序

正如《精神障碍诊断和统计手册》第五版所述，正式的性别不安分类是报销荷兰性别肯定医疗保健和跨性别心理保健的先决条件。性别不安及其概念先驱一直是不断变化的目标：由于医学内外的研究、政策、护理实践和行动主义而变化。这就提出了一个问题：性别不安到底是什么。为了阐明这个问题，我们求助于在临床实践中使用这一概念来得出诊断和治疗指征的人：从事性别肯定医疗保健和跨性别心理保健工作的心理健康专业人员。使用物质符号学方法，我们反思性别不安在临床实践中是如何进行的。基于对 17 名临床医生的基于实践的访谈的分析以及对临床指南和文本的检查，我们描述了性别不安的四种排序模式。这些排序模式表明，性别不安不是一种，而是多种。我们说明了在隔离模式中，性别不安是如何与精神障碍仔细隔离的，而在未来和叙述模式中，性别不安是作为一个连续的、可预测的护理对象来完成的。性别不安的这种排序可能与第四种排序模式相冲突：跨性别医疗保健的多样性。该研究的结果为荷兰目前如何进行跨性别医疗保健提供了实证见解，并为关于良好的跨性别医疗保健应包含哪些内容的伦理辩论提供了基础。