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Il 39% di uomini trans e persone non binarie ha rimpianto le scelte di fertilità dopo l'asportazione degli organi

Scelte di preservazione della fertilità e rimpianto decisionale dopo la chirurgia di affermazione di genere in uomini transgender o persone di genere non binario

SondaggiDetransizione e rimpiantoChirurgia
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 delle 112 persone tra uomini trans e non binari (51%) che avevano subito l'asportazione degli organi riproduttivi alla University of North Carolina nel 2014–2023 hanno risposto al sondaggio, in media circa 2,5 anni dopo l'intervento.
  • In un questionario sul rimpianto validato, il 39% aveva rimpianto per le scelte sulla fertilità fatte prima dell'intervento: 23% lieve e 16% da moderato a grave (punteggi fino a 85 su 100).
  • Le cartelle mediche mostravano che a ogni persona era stata data una consulenza sulla fertilità, ma solo il 30% ricordava che le fossero stati illustrati la fertilità o i modi per avere una famiglia.
  • Le cartelle mostravano che al 97% era stato offerto uno specialista della fertilità, ma solo 3 persone (5,5%) hanno accettato, e nessuna è poi passata a congelare ovociti o embrioni.
  • Il motivo più comune per dire di no era non volere figli in quel momento (68%), seguito da piani di adozione, preoccupazione per l'interruzione del testosterone e timore che la gravidanza peggiorasse il disagio di genere.
  • Il rimpianto era molto più alto in chi riteneva scarsa la consulenza sugli effetti sulla fertilità (punteggio tipico di 50 contro 0), e un po' più alto in chi riteneva scarsa la consulenza sulle opzioni di fertilità (12,5 contro 0).
  • Più persone al momento del sondaggio ritenevano importante avere figli o una famiglia in futuro rispetto a prima dell'intervento, il che suggerisce che le opinioni possano cambiare dopo l'intervento.

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.)