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El 39 % de hombres trans y personas no binarias se arrepintió de sus decisiones de fertilidad tras la extirpación

Decisiones de preservación de la fertilidad y arrepentimiento de la decisión tras la cirugía de afirmación de género en hombres transgénero o personas de género no binario

EncuestasDestransición y arrepentimientoCirugía
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 de 112 hombres trans y personas no binarias (51 %) a quienes se extirparon los órganos reproductivos en la Universidad de Carolina del Norte en 2014 a 2023 respondieron a la encuesta, unos 2,5 años después de la cirugía de media.
  • En un cuestionario de arrepentimiento validado, el 39 % tenía arrepentimiento por las decisiones de fertilidad que tomó antes de la cirugía: 23 % leve y 16 % de moderado a grave (puntuaciones de hasta 85 sobre 100).
  • Los historiales médicos mostraban que a todas las personas se les dio asesoramiento sobre fertilidad, pero solo el 30 % recordaba que se le hablara de fertilidad o de formas de tener una familia.
  • Los registros mostraban que al 97 % se le ofreció un especialista en fertilidad, pero solo 3 personas (5,5 %) aceptaron, y ninguna llegó a congelar óvulos o embriones.
  • El motivo más común para decir que no fue no querer hijos en ese momento (68 %), seguido de planes de adoptar, preocupación por dejar la testosterona y miedo a que el embarazo empeorara el malestar de género.
  • El arrepentimiento era mucho mayor en quienes sentían que el asesoramiento sobre los efectos en la fertilidad había sido malo (una puntuación típica de 50 frente a 0), y algo mayor en quienes sentían que el asesoramiento sobre las opciones de fertilidad había sido malo (12,5 frente a 0).
  • Más personas valoraron como importante tener hijos o una familia en el futuro en el momento de la encuesta que antes de la cirugía, lo que sugiere que las opiniones pueden cambiar tras la cirugía.

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.)