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39 % des hommes trans et personnes non binaires regrettent leurs choix de fertilité après ablation des organes

Choix de préservation de la fertilité et regret décisionnel après une chirurgie d'affirmation de genre chez des hommes transgenres ou des personnes non binaires

EnquêtesDétransition & regretChirurgie
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 des 112 hommes trans et personnes non binaires (51 %) ayant subi l'ablation de leurs organes reproducteurs à l'université de Caroline du Nord en 2014-2023 ont répondu à l'enquête, environ 2,5 ans après la chirurgie en moyenne.
  • Sur un questionnaire de regret validé, 39 % avaient un regret quant aux choix de fertilité faits avant la chirurgie : 23 % léger et 16 % modéré à sévère (scores jusqu'à 85 sur 100).
  • Les dossiers médicaux montraient que chaque personne avait reçu des conseils sur la fertilité, mais seuls 30 % se souvenaient qu'on leur avait parlé de fertilité ou de façons de fonder une famille.
  • Les dossiers montraient que 97 % s'étaient vu proposer un spécialiste de la fertilité, mais seules 3 personnes (5,5 %) ont accepté, et aucune n'a ensuite congelé d'ovocytes ou d'embryons.
  • La raison la plus courante du refus était de ne pas vouloir d'enfants à ce moment-là (68 %), suivie de projets d'adoption, de la crainte d'arrêter la testostérone et de la peur qu'une grossesse aggrave la détresse de genre.
  • Le regret était bien plus élevé chez ceux qui trouvaient médiocres les conseils sur les effets sur la fertilité (un score typique de 50 contre 0), et un peu plus élevé chez ceux qui trouvaient médiocres les conseils sur les options de fertilité (12,5 contre 0).
  • Plus de personnes jugeaient important d'avoir des enfants ou une famille à l'avenir au moment de l'enquête qu'avant la chirurgie, ce qui suggère que les points de vue peuvent changer après la chirurgie.

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.)