외과의 설문, 성별 수술 후회를 0.2~0.3%로 제시 - 응답률 30%와 외과의의 기억에 근거

대화를 이끌며: 성별 확정 수술 후 후회의 유형과 관련 병인

Authors: Sasha Karan Narayan, Rayisa Hontscharuk, Sara Danker, Jess Guerriero, Angela Carter, Gaines Blasdel, Rachel Bluebond-Langner, Randi Ettner, Asa Radix, Loren Schechter, Jens Urs Berli
Journal: Annals of Translational Medicine
Year: 2021
Source: https://doi.org/10.21037/atm-20-6204

Summary

Gender surgeons who attended WPATH and USPATH conferences (meetings of trans health professionals) were asked how many patients they had seen who regretted surgery or wanted it reversed. Fewer than a third replied. Together they recalled 62 such patients out of an estimated 18,000 to 27,000 they had operated on, so the authors put regret at 0.2–0.3%. Where reasons were known, the most common was a change in gender identity or a wrong diagnosis, then family or social rejection, then relationship problems. The authors suggest sorting regret into three types: 'true gender-related', 'social' and 'medical'. This grouping is useful for discussion. But the regret figure cannot be trusted: it depends on surgeons' memory, on regretful patients going back to a surgeon, and on numbers from a self-selected minority who answered.

Key findings

초청된 외과의 154명 중 46명(30%)이 답했습니다. 대부분 미국(67%) 또는 유럽(22%)에서 일했고 65%는 10년 넘게 진료했습니다.
이들은 트랜스 환자 18,125~27,325명을 수술했다고 추정했고 수술을 후회하거나 되돌리기를 요청한 환자 62명을 기억했으며, 이는 약 0.2~0.3%입니다.
외과의의 57%가 후회하는 환자를 적어도 한 명 봤습니다. 62건 중 45건(73%)은 생식기 수술이었고 13건(21%)은 가슴 또는 유방 수술이었습니다.
이유가 알려진 경우(환자 46명) 42%는 성 정체성의 변화나 잘못된 진단, 15%는 가족 또는 사회의 거부, 11%는 관계 문제와 관련이 있었습니다.
저자들은 되돌림 요청을 ‘진정한 성별 관련’ 후회(42%), ‘사회적’ 후회(37%), ‘의학적’ 후회(8%)로 분류했습니다. 이 환자들의 24%는 수술 후 합병증이 있었습니다.
외과의의 91%는 되돌리는 수술 전에 새로운 정신 건강 평가를 요구하겠다고 했고, 88%는 다음 WPATH 지침이 되돌리는 수술을 다루기를 원했습니다.
저자들은 설문이 어떤 것이 얼마나 흔한지 알아내기에 적합하지 않으며 과거 연구에 대한 자신들의 검토가 체계적이지 않았음을 인정합니다.

Abstract

Background: A rare, but consequential, risk of gender affirming surgery (GAS) is post-operative regret resulting in a request for surgical reversal. Studies on regret and surgical reversal are scarce, and there is no standard terminology regarding either etiology and/or classification of the various forms of regret. This study includes a survey of surgeons' experience with patient regret and requests for reversal surgery, a literature review on the topic of regret, and expert, consensus opinion designed to establish a classification system for the etiology and types of regret experienced by some patients.

Methods: This anonymous survey was sent to the 154 surgeons who registered for the 2016 World Professional Association for Transgender Health (WPATH) conference and the 2017 USPATH conference. Responses were analyzed using descriptive statistics. A MeSH search of the gender-affirming outcomes literature was performed on PubMed for relevant studies pertaining to regret. Original research and review studies that were thought to discuss regret were included for full text review.

Results: The literature is inconsistent regarding etiology and classification of regret following GAS. Of the 154 surgeons queried, 30% responded to our survey. Cumulatively, these respondents treated between 18,125 and 27,325 individuals. Fifty-seven percent of surgeons encountered at least one patient who expressed regret, with a total of 62 patients expressing regret (0.2-0.3%). Etiologies of regret were varied and classified as either: (I) true gender-related regret (42%), (II) social regret (37%), and (III) medical regret (8%). The surgeons' experience with patient regret and request for reversal was consistent with the existing literature.

Conclusions: In this study, regret following GAS was rare and was consistent with the existing literature. Regret can be classified as true gender-related regret, social regret and medical regret resulting from complications, function, pre-intervention decision making. Guidelines in transgender health should offer preventive strategies as well as treatment recommendations, should a patient experience regret. Future studies and scientific discourse are encouraged on this important topic.

Conclusion

In this study, regret following GAS was rare and was consistent with the existing literature. Regret can be classified as true gender-related regret, social regret and medical regret resulting from complications, function, pre-intervention decision making. Guidelines in transgender health should offer preventive strategies as well as treatment recommendations, should a patient experience regret. Future studies and scientific discourse are encouraged on this important topic.

Methodological limitations

Numbers don't match up: The regret count includes patients who had surgery with any surgeon, but the total patients figure is only the replying surgeons' own patients. So the result is not a true rate. Cohn (2023) called the method hard to interpret.
Few surgeons replied: Only 30% answered. Surgeons who rarely see regret may have been more or less likely to reply, and the experience of the rest is unknown.
Many regretful patients never return: Many people with regret, or who detransition, never go back to their surgeon or gender clinic. Littman (2021) found only 24% told their clinicians. So the survey probably undercounts regret.
Based on memory and rough ranges: Patient numbers and regret cases were recalled from memory and given as ranges, which were added up to get 18,125 to 27,325.
Regret not defined, follow-up unknown: The survey deliberately left 'regret' undefined. Surgeons did not routinely ask about regret, and how long they kept track of patients is unknown.
Narrow view: Only breast and genital surgery were covered, and only surgeons were asked. Mental health clinicians and hormone doctors, who may hear about regret first, were not surveyed.
Informal review of past studies: The authors admit their review was not systematic and may have picked studies selectively. It mostly repeats older low-regret figures that had their own dropout problems (for example Wiepjes 2018, which lost track of 36% of patients).
Untested categories: The 'true', 'social' and 'medical' regret types come from expert opinion and have not been tested to see if they work reliably.
Authors' roles: Several authors hold leadership roles in WPATH or on its guideline committee, and most are surgeons or clinicians who provide these treatments. These roles are unpaid and disclosed, but they matter for how the low-regret conclusion is presented.
Possible double counting: The authors note that a patient may have seen more than one of the surgeons who replied, which could inflate the count.

detrans.ai

Summary

Key findings

Abstract

Conclusion