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메타분석, 성별 수술 후 후회 1% 보고 - 그러나 포함된 연구는 추적이 짧고 이탈이 심했음

성별 확정 수술 후 후회: 체계적 문헌고찰 및 유병률 메타분석

체계적 및 증거 검토역전환과 후회수술
Authors
Valeria P. Bustos, Samyd S. Bustos, Andres Mascaro, Gabriel Del Corral, Antonio J. Forte, Pedro Ciudad, Esther A. Kim, Howard N. Langstein, Oscar J. Manrique
Journal
Plastic and Reconstructive Surgery Global Open
Year
2021
Source
https://doi.org/10.1097/GOX.0000000000003477

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

  • 검토는 14개국의 수술 환자 7,928명에 대한 연구 27건을 포함했습니다. 67%가 남성에서 여성으로, 33%가 여성에서 남성으로의 수술이었고, 논바이너리로 기록된 환자는 한 명뿐이었습니다.
  • 합치면 환자의 약 1%가 수술을 후회했지만(아마 1% 미만에서 2% 사이), 연구마다 결과가 크게 달랐고, 후회를 보고한 사람은 모두 77명이었습니다.
  • 후회는 여성에서 남성으로의 수술과 유방 제거 후에는 1% 미만, 남성에서 여성으로의 수술 후에는 1%, 질을 만드는 수술 후에는 2%였습니다.
  • 후회의 가장 흔한 이유는 새로운 성별 역할에서 가족과 사회에 받아들여지기 어려운 것이었고, 그 다음이 수술이나 신체 결과가 좋지 않은 것이었습니다.
  • 거의 모든 연구가 직접 만든 질문이나 인터뷰를 사용했고, 대부분 미흡하거나 보통 품질로 평가되었으며, 추적은 1년 미만에서 9년까지였습니다.
  • 후회가 낮은 연구가 발표될 가능성이 더 높다는 징후가 있었으며, 이를 보정하면 추정치가 1%에서 0.5%로 낮아졌습니다.
  • 2022년 정정은 저자들이 검토를 다시 돌린 뒤 표와 그림을 바로잡았고, 게재된 서신들(Expósito-Campos와 D'Angelo 2021; Bewley 2022)은 방법과 결론에 이의를 제기했습니다.

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.