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39 % transmiehistä ja ei-binäärisistä katui hedelmällisyysvalintojaan lisääntymiselinten poiston jälkeen

Hedelmällisyyden säilyttämisen valinnat ja päätösten katumus sukupuolen vahvistamisleikkauksen jälkeen transmiehillä tai ei-binäärisillä

KyselytutkimuksetDetransitio & katumusLeikkaushoidot
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

  • 112 transmiehestä ja muunsukupuolisesta 57 (51 %), joiden lisääntymiselimet poistettiin University of North Carolinassa vuosina 2014–2023, vastasi kyselyyn keskimäärin noin 2,5 vuotta leikkauksen jälkeen.
  • Testatulla katumuskyselyllä 39 %:lla oli katumusta ennen leikkausta tekemistään hedelmällisyysvalinnoista: 23 % lievää ja 16 % kohtalaista tai vakavaa (pisteet jopa 85 sadasta).
  • Sairauskertomukset osoittivat, että jokaiselle annettiin hedelmällisyysneuvontaa, mutta vain 30 % muisti kuulleensa hedelmällisyydestä tai tavoista perustaa perhe.
  • Tiedot osoittivat, että 97 %:lle tarjottiin hedelmällisyysasiantuntijaa, mutta vain 3 ihmistä (5,5 %) hyväksyi, eikä kukaan jatkanut munasolujen tai alkioiden pakastamiseen.
  • Yleisin syy kieltäytymiseen oli, ettei halunnut lapsia tuolloin (68 %), sen jälkeen suunnitelmat adoptoida, huoli testosteronin lopettamisesta ja pelko raskauden pahentavan sukupuoliahdistusta.
  • Katumus oli paljon suurempaa niillä, jotka kokivat neuvonnan hedelmällisyysvaikutuksista huonoksi (tyypillinen pistemäärä 50 vs. 0), ja jonkin verran suurempaa niillä, jotka kokivat neuvonnan hedelmällisyysvaihtoehdoista huonoksi (12,5 vs. 0).
  • Useampi ihminen piti lasten tai perheen saamista tulevaisuudessa tärkeänä kyselyhetkellä kuin ennen leikkausta, mikä viittaa siihen, että näkemykset voivat muuttua leikkauksen jälkeen.

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.)