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39 % trans moških in nebinarnih oseb je po odstranitvi reproduktivnih organov poročalo o obžalovanju glede plodnosti

Izbire ohranitve plodnosti in odločitveno obžalovanje po spolno potrditveni operaciji pri transspolnih moških ali nebinarnih osebah

AnketeDetransicija & obžalovanjeOperacije
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 od 112 trans moških in nebinarnih oseb (51 %), ki so imele reproduktivne organe odstranjene na University of North Carolina v letih 2014 do 2023, je odgovorilo na anketo, v povprečju približno 2,5 leta po operaciji.
  • Na preizkušenem vprašalniku o obžalovanju je 39 % imelo obžalovanje glede odločitev o plodnosti, sprejetih pred operacijo: 23 % blago in 16 % zmerno do hudo (ocene do 85 od 100).
  • Zdravstveni zapisi so pokazali, da je vsaka oseba dobila nasvet o plodnosti, a se je le 30 % spomnilo, da so jim povedali o plodnosti ali načinih ustvarjanja družine.
  • Zapisi so pokazali, da je bil 97 % ponujen specialist za plodnost, a so sprejeli le 3 osebe (5,5 %), nobena pa ni nadaljevala z zamrznitvijo jajčec ali zarodkov.
  • Najpogostejši razlog za zavrnitev je bilo, da takrat niso želeli otrok (68 %), sledili so načrti za posvojitev, skrb zaradi prenehanja testosterona in strah, da bi nosečnost poslabšala spolno stisko.
  • Obžalovanje je bilo precej večje pri osebah, ki so menile, da je bil nasvet o učinkih na plodnost slab (tipična ocena 50 proti 0), in nekoliko večje pri tistih, ki so menile, da je bil nasvet o možnostih plodnosti slab (12,5 proti 0).
  • Več oseb je ob anketi ocenilo, da je imeti otroke ali družino v prihodnosti pomembno, kot pred operacijo, kar nakazuje, da se pogledi po operaciji lahko spremenijo.

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.)