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

• समीक्षा में 14 देशों के 7,928 सर्जरी मरीज़ों को कवर करने वाले 27 अध्ययन शामिल थे; 67% की पुरुष-से-महिला और 33% की महिला-से-पुरुष सर्जरी हुई, और केवल एक मरीज़ नॉन-बाइनरी दर्ज था।
• कुल मिलाकर, लगभग 1% मरीज़ों को सर्जरी पर पछतावा हुआ (संभवतः 1% से कम और 2% के बीच), लेकिन अध्ययनों के बीच परिणाम बहुत भिन्न थे; कुल 77 लोगों ने पछतावा बताया।
• पछतावा महिला-से-पुरुष सर्जरी और स्तन निकालने के बाद 1% से कम, पुरुष-से-महिला सर्जरी के बाद 1%, और योनि बनाने की सर्जरी के बाद 2% था।
• पछतावे के सबसे आम कारण नई लैंगिक भूमिका में परिवार और समाज द्वारा स्वीकार किए जाने में कठिनाई थे, उसके बाद खराब सर्जिकल या शारीरिक परिणाम।
• लगभग सभी अध्ययनों ने खुद बनाए प्रश्न या साक्षात्कार इस्तेमाल किए, अधिकांश को खराब या ठीक-ठाक गुणवत्ता का आँका गया, और अनुवर्ती 1 साल से कम से 9 साल तक चला।
• इसके संकेत थे कि कम पछतावे वाले अध्ययनों के प्रकाशित होने की संभावना अधिक थी; इसके लिए समायोजन ने अनुमान 1% से घटाकर 0.5% कर दिया।
• 2022 के सुधार ने लेखकों द्वारा समीक्षा दोबारा चलाने के बाद तालिकाएँ और आकृतियाँ ठीक कीं, और प्रकाशित पत्रों (एक्सपोसिटो-कैम्पोस और डी'एंजेलो 2021; ब्यूली 2022) ने विधियों और निष्कर्षों को चुनौती दी।

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.