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

• 154 名受邀外科醫師中有 46 人（30%）回覆；多數在美國（67%）或歐洲（22%）執業，65% 已執業超過 10 年。
• 他們估計自己為 18,125 至 27,325 名跨性別患者動過手術，並回憶有 62 人對手術後悔或要求逆轉，約為 0.2–0.3%。
• 57% 的外科醫師至少看過一名後悔的患者；62 例中有 45 例（73%）涉及生殖器手術，13 例（21%）涉及胸部或乳房手術。
• 在原因已知的（46 名患者）中，42% 涉及性別認同的改變或錯誤診斷，15% 是家庭或社會的拒絕，11% 是關係問題。
• 作者將逆轉要求分為「真正與性別有關」的後悔（42%）、「社會性」後悔（37%）和「醫療」後悔（8%）；這些患者中有 24% 在手術後出現併發症。
• 91% 的外科醫師會要求在逆轉手術前重新進行心理健康評估，88% 希望下一版 WPATH 指引涵蓋逆轉手術。
• 作者承認，調查不適合用來推算某件事有多常見，而且他們對過去研究的回顧並不系統。

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.