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39 % af transmænd og ikke-binære rapporterede fortrydelse over fertilitetsvalg efter fjernelse af reproduktive organer

Valg af fertilitetsbevarelse og beslutningsfortrydelse efter kønsbekræftende operation hos transmænd eller kønsligt ikke-binære personer

SpørgeskemaundersøgelserDetransition & fortrydelseKirurgi
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 af 112 transmænd og ikke-binære (51 %), der fik fjernet deres reproduktive organer på University of North Carolina i 2014 til 2023, besvarede undersøgelsen, omkring 2,5 år efter operationen i gennemsnit.
  • På et afprøvet spørgeskema om fortrydelse havde 39 % fortrydelse over de fertilitetsvalg, de traf før operationen: 23 % mild og 16 % moderat til svær (scorer op til 85 ud af 100).
  • Medicinske journaler viste, at alle var blevet givet rådgivning om fertilitet, men kun 30 % huskede, at de var blevet informeret om fertilitet eller måder at stifte familie på.
  • Journalerne viste, at 97 % var blevet tilbudt en fertilitetsspecialist, men kun 3 personer (5,5 %) sagde ja, og ingen gik videre til at nedfryse æg eller embryoner.
  • Den mest almindelige grund til at sige nej var ikke at ønske børn på det tidspunkt (68 %), efterfulgt af planer om adoption, bekymring for at stoppe testosteron og frygt for, at graviditet ville forværre kønslidelse.
  • Fortrydelsen var meget højere hos dem, der følte, at rådgivningen om effekter på fertiliteten var dårlig (en typisk score på 50 mod 0), og noget højere hos dem, der følte, at rådgivningen om fertilitetsmuligheder var dårlig (12,5 mod 0).
  • Flere personer vurderede det som vigtigt at få børn eller en familie i fremtiden på tidspunktet for undersøgelsen end før operationen, hvilket tyder på, at holdninger kan ændre sig efter operationen.

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.)