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39% dos homens trans e pessoas não binárias relataram arrependimento sobre fertilidade após retirar órgãos reprodutivos

Escolhas de preservação da fertilidade e arrependimento decisório após cirurgia de afirmação de gênero em homens transgênero ou pessoas de gênero não binário

PesquisasDetransição e arrependimentoCirurgia
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 de 112 homens trans e pessoas não binárias (51%) que retiraram seus órgãos reprodutivos na Universidade da Carolina do Norte em 2014 a 2023 responderam à pesquisa, cerca de 2,5 anos após a cirurgia em média.
  • Em um questionário de arrependimento testado, 39% tinham arrependimento quanto às escolhas de fertilidade feitas antes da cirurgia: 23% leve e 16% moderado a grave (pontuações de até 85 em 100).
  • Os prontuários mostraram que toda pessoa recebeu orientação sobre fertilidade, mas apenas 30% se lembravam de ter sido informadas sobre fertilidade ou formas de ter uma família.
  • Os registros mostraram que 97% receberam oferta de um especialista em fertilidade, mas apenas 3 pessoas (5,5%) aceitaram, e nenhuma chegou a congelar óvulos ou embriões.
  • O motivo mais comum para dizer não foi não querer filhos na época (68%), seguido de planos de adotar, preocupação em parar a testosterona e medo de que a gravidez piorasse o sofrimento de gênero.
  • O arrependimento foi muito maior em quem achou que a orientação sobre os efeitos na fertilidade foi ruim (pontuação típica de 50 contra 0), e um pouco maior em quem achou ruim a orientação sobre as opções de fertilidade (12,5 contra 0).
  • Mais pessoas avaliaram como importante ter filhos ou uma família no futuro no momento da pesquisa do que antes da cirurgia, sugerindo que as opiniões podem mudar depois da cirurgia.

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.)