Evidence suggests that less than 1% of transgender people who undergo gender-affirming surgery report regret it. An official website of the United States Government Official websites use. gov A. The gov website belongs to an official government organization of the United States.
This is an open access article distributed under the terms of the Creative Commons Attribution-Non-Commercial-Derivatives 4.0 License (CCBY-NC-ND), where it is allowed to download and share the work as long as it is duly cited. The work cannot be modified in any way or used commercially without the permission of the magazine. Complementary digital content is available in the text. There is an unknown percentage of people who are transgender and who have not confirmed their gender identity and who undergo gender affirmation surgery (GAS) and they regret it.
Regret can cause physical and mental morbidity and calls into question the appropriateness of these procedures in selected patients. The objective of this study was to evaluate the prevalence of regret in transgender people who underwent GAS and to evaluate associated factors. A total of 27 studies were included, involving 7928 transgender patients who underwent any type of GAS. The combined prevalence of regret after GAS was 1% (95% CI).
According to this review, there is an extremely low prevalence of regret in transgender patients after GAS. We believe that this study corroborates the improvements made with respect to the GAS selection criteria. However, there is a high subjectivity in the evaluation of regret and the lack of standardized questionnaires, which highlights the importance of developing validated questionnaires in this population. Discordance or misalignment between gender identity and the sex assigned at birth can result in disproportionate distress, shaping the definition of gender dysphoria.
1—3 This population is at greater risk of suffering from psychiatric illnesses, such as depression, substance use disorders, self-harm, and suicide, compared to cisgender people, 4,5 Approximately 0.6% of adults in the United States identify themselves as transgender, 6 Despite the promotion and increased awareness of rights human transgender people and non-binary gender (TGNB) individuals, discrimination continues to affect the daily lives of these people 4.7.After selecting the articles, we evaluated the characteristics of the study. We identified the year of publication, the country in which the study was conducted, the size of the population and the number of transmale and transfemale patients with their respective average age (expressed with SD, rank or interquartile range). if it was included in the study). In addition, we extracted information about the data collection method (interviews versus questionnaires), the number of regrets after GAS, as well as the type of surgery, follow-up time and transition procedures.
We classified the type of regret based on the patient's reasons for regret if they were mentioned in the studies. The Pfäfflin and Kuiper and Cohen-Kettenis regret classifications were used (table. Our main result of interest was the prevalence of regret among transgender patients who underwent any type of gas. The secondary outcomes of interest were to discriminate the prevalence of regrets according to the type of gender transition (transfeminine and transmasculine) and the type of surgery.
In the search, a total of 74 articles were identified and 2 additional records were identified through other sources. After the first step of the selection process, 39 articles were relevant based on the information provided in their titles and abstracts. After the second step, a total of 27 articles were included in the systematic review and meta-analysis (fig. In total, the included studies grouped 7928 cases of transgender people who underwent any type of GAS.
A total of 2578 (33%) underwent transmasculine procedures, 5136 (67%) underwent transfeminine surgeries, and 1 non-binary patient underwent surgery. Table 2 lists the characteristics of the studies. Regardless of the type of surgical technique, of all the transfeminine surgeries included, 772 (39.3%) were vaginoplasty, 260 (13.3%) were clitoroplasty, 107 (5.5%) were breast augmentation, 72 (3.7%) were labiaplasty and vulvoplasty, and a small minority were facial feminization, vocal cord surgery, thyroid cartilage reduction and surgery of ovariectomy. The rest did not specify the type of surgery.
Regarding transmasculine surgeries, 297 (12.4%) were mastectomies, 61 (2.6%) were phalloplasty and 51 (2.1%) hysterectomies (tables 3 and. In general, the follow-up time from surgery to the time of evaluation of regret ranged from 0.8 to 9 years (table). Studies that differentiate the type of surgery between transmale patients Almost all studies conducted unvalidated questionnaires to evaluate regret due to the lack of standardized questionnaires available on this topic, 15, 19—33 Most questions to evaluate regret used options such as “yes”, sometimes “no” or “always”, sometimes “never” or “most likely”, perhaps, rather not” or “definitely not”.Subgroup analysis of the prevalence of regret among people with TGNB after gender-based gender confirmation surgery. Subgroup analysis of the prevalence of regret among people with TGNB after gender confirmation surgery by type of surgery.
None of the covariates analyzed affected the assessment criteria grouped in this meta-analysis. The funnel-shaped graphic shows the asymmetry between studies (fig. Egger's test yielded a P value of 0.0271, suggesting statistical significance for publication bias. The Trim & Fill method included 14 approximate studies, with a limited impact of adjusted results.
The change in effect size went from 0.010 to 0.005 without statistical significance (fig. Funnel-shaped graph of the Trim & method) Fill. Excluding studies with a sample size of less than 10 and studies with a high-risk bias, the pooled prevalence was similar to 1% (CI). The prevalence of regret in the population with TGNB after GAS was 1% (CI).
Other factors associated with regret were identified. Blanchard and others in 1989 observed a strong positive correlation between heterosexual preference and postoperative regret.32 All of the patients in this study who experienced regret were heterosexual trans men, 32 Conversely, Lawrence and others in 2003 found no such correlation and attributed their findings to increased social tolerance in North American and Western European societies, 36 Bodlund and others found that clinically evident personality disorder was a negative prognostic factor of regret in patients undergoing GAS, 48 On the other hand, Blanchard et al did not find a correlation between the patient's education, age at the time of surgery and the gender assigned at birth, 32 Regret after GAS may be due to continuous discrimination affecting the TGNB population, affecting their free expression of gender identity and, consequently, to feeling sorry for having undergone surgery, 15 Poor social and group support, late-onset gender transition, malfunctioning sexual and mental health problems are factors associated with regret, 15 Therefore, evaluating all of these possible factors before surgery and controlling them, if possible, could reduce regret rates increase even more and increase post-operative patient satisfaction. In the current study, we identified a total of 7928 cases from 14 different countries. To the best of our knowledge, this is the biggest attempt to gather information about regret rates in this population.
However, limitations, such as significant heterogeneity between studies and between the instruments used to assess regret rates, and the risk of moderate to high bias in some studies, represent a major obstacle to the generalization of the results of this study. The lack of validated questionnaires to assess regret in this population is an important limiting factor. In addition, bias can occur because patients may refrain from expressing regret for fear of being judged by the interviewer. In addition, the temporality of the feeling of regret in some patients and the variable definition of regret may underestimate the real prevalence of “true regret”.”.
According to this meta-analysis, the prevalence of regret is 1%. We believe that this reflects and corroborates the increased accuracy of patient selection criteria for GAS. Efforts should be aimed at individualizing the patient based on their objectives and at identifying risk factors for regret. Surgeons must continue to follow the current standard of care guidelines from the World Association of Transgender Health Professionals (WATH).
We consider this to be a reflection on improvements in the selection criteria for surgery. However, more studies need to be done to evaluate the types of regret, as well as their association with different types of surgical procedures. All authors have filled out the ICMJE uniform disclosure form. The authors are responsible for all aspects of the work and ensure that issues related to the accuracy or integrity of any part of the work are properly investigated and resolved.
National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894. Pfafflin examined 2000 patients who underwent gender-affirming surgery between 1961 and 1991, and revealed a regret rate of less than 1% in several studies. Special attention should be paid to identifying and recognizing the prevalence and factors associated with regret. The inclusion criteria were all articles that included patients aged 13 years or older who underwent gas treatment and who reported rates of regret or loss of the transition, and observational or interventional studies in English or Spanish. Regret after GAS may be due to the continuous discrimination affecting the population of TGNB, since it affects their free expression of gender identity and, therefore, is felt regretted having to undergo surgery.
Littman found that patients may choose not to disclose the transition to health professionals, primary care providers may not transmit information to the clinic, or patients may feel reluctant to seek support at the clinic in a survey of people in transition. Short-term mood improvements provide no credible evidence that the highly invasive medical and surgical interventions involved in gender transition guarantee a high-quality, regret-free life.
