Summary

This review combined 27 studies of nearly 8,000 people who had gender surgery and estimated that about 1% regretted it. The authors concluded regret is extremely rare and credited better screening of patients. The 1% figure is now widely quoted. But the authors themselves say the evidence underneath is weak: most studies were rated poor or fair, almost none used tested ways of measuring regret, and results varied a lot between studies. Critics point out that people were often followed for only one or two years, while regret typically shows up after about eight years. Many people were lost track of (36% in the largest study), and some numbers were copied wrongly. Most people studied were adults treated under older, stricter rules. The 1% is best seen as a minimum drawn from incomplete data, not a reliable regret rate for today's patients.

Key findings

• این مرور 27 مطالعه با 7,928 بیمار جراحی از 14 کشور را شامل شد؛ 67% جراحی مرد به زن و 33% زن به مرد داشتند و فقط یک بیمار به‌عنوان غیرباینری ثبت شده بود.
• در مجموع حدود 1% از بیماران از جراحی پشیمان بودند (احتمالاً بین کمتر از 1% تا 2%)، اما نتایج بین مطالعات بسیار متفاوت بود؛ مجموعاً 77 نفر پشیمانی گزارش کردند.
• پشیمانی پس از جراحی زن به مرد و برداشتن پستان کمتر از 1%، پس از جراحی مرد به زن 1%، و پس از جراحی ساخت واژن 2% بود.
• رایج‌ترین دلایل پشیمانی، مشکل در پذیرفته شدن توسط خانواده و جامعه در نقش جنسیتی جدید بود، و پس از آن نتایج ضعیف جراحی یا جسمی.
• تقریباً همهٔ مطالعات پرسش‌ها یا مصاحبه‌های خودساخته به کار بردند، بیشتر آن‌ها ضعیف یا متوسط ارزیابی شدند و پیگیری از کمتر از 1 سال تا 9 سال بود.
• نشانه‌هایی بود که مطالعات با پشیمانی کم احتمال بیشتری برای انتشار داشتند؛ تعدیل برای این، برآورد را از 1% به 0.5% کاهش داد.
• اصلاحیهٔ 2022 جدول‌ها و شکل‌ها را پس از اجرای دوبارهٔ مرور توسط نویسندگان اصلاح کرد، و نامه‌های منتشرشده (اکسپوسیتو-کامپوس و دانجلو 2021؛ بیولی 2022) روش‌ها و نتیجه‌گیری‌ها را به چالش کشیدند.

Abstract

Background: There is an unknown percentage of transgender and gender non-confirming individuals who undergo gender-affirmation surgeries (GAS) that experiences regret. Regret could lead to physical and mental morbidity and questions the appropriateness of these procedures in selected patients. The aim of this study was to evaluate the prevalence of regret in transgender individuals who underwent GAS and evaluate associated factors.

Methods: A systematic review of several databases was conducted. Random-effects meta-analysis, meta-regression, and subgroup and sensitivity analyses were performed.

Results: A total of 27 studies, pooling 7928 transgender patients who underwent any type of GAS, were included. The pooled prevalence of regret after GAS was 1% (95% CI <1%-2%). Overall, 33% underwent transmasculine procedures and 67% transfemenine procedures. The prevalence of regret among patients undergoing transmasculine and transfemenine surgeries was <1% (IC <1%-<1%) and 1% (CI <1%-2%), respectively. A total of 77 patients regretted having had GAS. Twenty-eight had minor and 34 had major regret based on Pfäfflin's regret classification. The majority had clear regret based on Kuiper and Cohen-Kettenis classification.

Conclusions: Based on this review, there is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population.

Conclusion

Based on this review, there is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population.