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39% dintre bărbații trans și persoanele non-binare au regretat alegerile despre fertilitate după îndepărtarea organelor

Alegerile privind păstrarea fertilității și regretul decizional după chirurgia de afirmare a genului la bărbați transgender sau persoane non-binare

SondajeDetranziție și regreteChirurgie
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 din 112 bărbați trans și persoane non-binare (51%) cărora li s-au îndepărtat organele reproductive la Universitatea din Carolina de Nord în 2014–2023 au răspuns la sondaj, în medie la aproximativ 2,5 ani după operație.
  • Pe un chestionar testat de regret, 39% aveau regret privind alegerile de fertilitate făcute înainte de operație: 23% ușor și 16% moderat până la sever (scoruri până la 85 din 100).
  • Dosarele medicale au arătat că fiecărei persoane i s-a dat sfat privind fertilitatea, dar doar 30% își aminteau că li s-a vorbit despre fertilitate sau despre modalități de a avea o familie.
  • Dosarele au arătat că 97% au primit oferta unui specialist în fertilitate, dar doar 3 persoane (5,5%) au acceptat și niciuna nu și-a congelat ulterior ovule sau embrioni.
  • Cel mai frecvent motiv pentru un refuz a fost că nu voiau copii la acel moment (68%), urmat de planuri de adopție, grija față de oprirea testosteronului și teama că sarcina ar agrava suferința legată de gen.
  • Regretul a fost mult mai mare la persoanele care au simțit că sfatul despre efectele asupra fertilității a fost slab (un scor tipic de 50 față de 0) și ceva mai mare la cei care au simțit că sfatul despre opțiunile de fertilitate a fost slab (12,5 față de 0).
  • Mai multe persoane au considerat important să aibă copii sau o familie în viitor la momentul sondajului decât înainte de operație, ceea ce sugerează că opiniile se pot schimba după operație.

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.)