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생식기관 제거 후 트랜스 남성과 논바이너리 사람의 39%가 생식력 선택에 대해 후회를 보고

트랜스젠더 남성 또는 성별 논바이너리 사람의 성별 확정 수술 후 생식력 보존 선택과 결정 후회

설문 조사역전환과 후회수술
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

  • 2014~2023년 노스캐롤라이나대학교에서 생식 기관을 제거한 트랜스 남성과 논바이너리 사람 112명 중 57명(51%)이 수술 평균 약 2.5년 후 설문에 답했습니다.
  • 검증된 후회 설문에서 39%가 수술 전에 한 생식 능력 선택에 후회가 있었습니다. 경미 23%, 중등도에서 심각 16%였습니다(최대 100점 만점에 85점).
  • 의료 기록에는 모두가 생식 능력에 대한 조언을 받았다고 나와 있었지만, 생식 능력이나 가족을 이루는 방법에 대해 들은 것을 기억하는 사람은 30%뿐이었습니다.
  • 기록에 따르면 97%가 생식 능력 전문의를 제안받았지만 받아들인 사람은 3명(5.5%)뿐이었고, 난자나 배아를 냉동한 사람은 없었습니다.
  • 거절의 가장 흔한 이유는 당시 아이를 원하지 않아서(68%)였고, 그다음이 입양 계획, 테스토스테론을 중단하는 것에 대한 걱정, 임신이 성별 불쾌감을 악화시킬까 하는 두려움이었습니다.
  • 생식 능력에 대한 영향에 관한 조언이 부실했다고 느낀 사람에서 후회가 훨씬 높았고(전형적 점수 50 대 0), 생식 능력 선택지에 관한 조언이 부실했다고 느낀 사람에서도 다소 높았습니다(12.5 대 0).
  • 설문 시점에 미래에 아이나 가족을 갖는 것을 중요하다고 평가한 사람이 수술 전보다 더 많았으며, 이는 수술 후에 생각이 바뀔 수 있음을 시사합니다.

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.)