39 % trans mužů a nebinárních lidí uvedlo lítost nad volbami ohledně plodnosti po odstranění reprodukčních orgánů

Volby zachování plodnosti a rozhodovací lítost po genderově afirmativní operaci u trans mužů nebo genderově nebinárních osob

Dotazníky Detranzice & lítost Chirurgie

Authors: Austin Johnson, Asha B. McClurg, Janine Baldino, Rajeshree Das, Erin T. Carey
Journal: F&S Reports
Year: 2024
Source: https://doi.org/10.1016/j.xfre.2023.12.002

Summary

Surgeons at the University of North Carolina surveyed trans men and nonbinary people who had their womb and/or ovaries removed. They asked about regret over the fertility decisions made before surgery, not regret about the surgery itself. Of 57 people who replied, about 2.5 years after surgery, 39% had at least mild regret and 16% moderate to severe regret. Nearly everyone had turned down seeing a fertility specialist, most often because they did not want children at the time, and no one froze eggs or embryos. Records said all had been given fertility advice, but only 30% remembered it, and those who felt the advice was poor had more regret. More people rated having a family in future as important after surgery than before. With only half replying, one clinic and short follow-up, the true level of regret is uncertain and could be higher or lower.

Key findings

57 ze 112 trans mužů a nebinárních lidí (51 %), kterým byly odstraněny reprodukční orgány na University of North Carolina v letech 2014 až 2023, odpovědělo na průzkum, v průměru asi 2,5 roku po operaci.
Na ověřeném dotazníku lítosti mělo 39 % lítost ohledně rozhodnutí o plodnosti, která učinili před operací: 23 % mírnou a 16 % středně těžkou až těžkou (skóre až 85 ze 100).
Lékařské záznamy ukázaly, že každému člověku byla dána rada o plodnosti, ale jen 30 % si pamatovalo, že jim bylo řečeno o plodnosti nebo způsobech, jak mít rodinu.
Záznamy ukázaly, že 97 % bylo nabídnuto vyšetření u specialisty na plodnost, ale přijali ho jen 3 lidé (5,5 %) a žádný nepokračoval zamrazením vajíček nebo embryí.
Nejčastějším důvodem odmítnutí bylo, že v té době nechtěli děti (68 %), následovaly plány na adopci, obavy z přerušení testosteronu a strach, že těhotenství zhorší genderovou tíseň.
Lítost byla mnohem vyšší u lidí, kteří měli pocit, že rada o účincích na plodnost byla špatná (typické skóre 50 oproti 0), a o něco vyšší u těch, kdo měli pocit, že rada o možnostech plodnosti byla špatná (12,5 oproti 0).
Více lidí hodnotilo mít děti nebo rodinu v budoucnu jako důležité v době průzkumu než před operací, což naznačuje, že názory se mohou po operaci změnit.

Abstract

OBJECTIVE: To investigate the prevalence of decisional regret regarding preoperative fertility preservation choices after gender-affirming surgery or removal of reproductive organs.

DESIGN: Cross-sectional.

SETTING: University-based pratice.

PATIENTS: A total of 57 survey respondents identifying as transgender men or gender nonbinary with a history of gender-affirming surgery or removal of reproductive organs between 2014 and 2023 with the University of North Carolina Minimally Invasive Gynecology division.

INTERVENTION: Survey or questionnaire.

MAIN OUTCOME MEASURES: The prevalence and severity of decisional regret regarding preoperative fertility preservation choices were measured with the use of the validated decisional regret scale (DRS) (scored 0-100). Secondary outcomes included patient-reported barriers to pursuing reproductive endocrinology and infertility consultation and fertility preservation treatment.

RESULTS: The survey response rate was 50.9% (57/112). "Mild" to "severe" decisional regret was reported by 38.6% (n = 22) of survey respondents, with DRS scores among all respondents ranging from 0-85. Higher median DRS scores were associated with patient-reported inadequacy of preoperative fertility counseling regarding implications of surgery on future fertility or family-building (0 vs. 50) and fertility preservation options (0 vs. 12.5). No desire for future fertility at the time of fertility counseling was the most frequent reason (68.4%) for declining a referral to reproductive endocrinology and infertility for additional fertility preservation discussion.

CONCLUSIONS: Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret.

Conclusion

Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret. (Full text adds that care should include equitable access to family-building options in the context of decreasing access to gender-affirming care.)

Methodological limitations

Only half replied: Only 51% (57 of 112) answered, and those who did had more recent surgery than those who didn't (about 2 vs 4 years). So the regret figure could be too high or too low.
Short follow-up: Surgery was on average 2.5 years earlier (from 50 days to 6.7 years). Regret about fertility often appears later (up to about 10 years in studies of cancer patients), so regret is probably undercounted, as the authors admit.
Memory of past events: People were asked years later about the advice they got and their earlier feelings about children, so memories may be wrong. The big gap between advice recorded (100%) and advice remembered (30%) shows this.
Questions contradict each other: 84% said effects on fertility were discussed well enough, yet only 30% remembered getting fertility advice. This suggests problems with how the researchers' own untested questions were worded.
Small numbers: With 57 people (and 22 with any regret), the figures are imprecise, and the links found came from several simple tests that did not account for other factors.
One clinic only: Everyone came from one US university gynaecology service with a set routine for fertility advice. Results may differ where less advice is given.
Measured regret about fertility, not surgery: The questionnaire asked about regret over fertility choices, not about the surgery or transition. So the 39% figure should not be quoted as a surgery regret rate.
No before-surgery measure: Regret was measured only once, so changes in wanting children could not be tracked over time.

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Summary

Key findings

Abstract

Conclusion