Regret after Gender Reassignment (PRS Journal)

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Regret after Gender Reassignment (PRS Journal)

Summary Card

Level of Evidence: Systematic Review and Meta-Analysis

Findings:
• Regret after gender affirmation surgery was 1.0%.
• Higher in vaginoplasty (1.3%) compared phalloplasty (0.5%)
• Younger age, poor social support, and mental health problems were predictors of regret after surgery.

Implications:
• Healthcare professionals should prioritize preoperative counseling and support to minimize the risk of regret after gender affirmation surgery.
• Identifying and addressing risk factors for regret during preoperative counseling can help to reduce the likelihood of regret after surgery.

Citation:
van de Grift, T.C., Elfering, L., and Kreukels, B.P.C. (2021). Regret after Gender Affirmation Surgery: A Systematic Review and Meta-Analysis. Plastic and Reconstructive Surgery - Global Open. 9(3):e3426. doi: 10.1097/GOX.0000000000003426.


Article Summary

This systematic review found that regret after gender affirmation surgery is rare, with a prevalence of 1.0%. However, the review had limitations such as a focus on Western countries, reliance on self-reported data, and a lack of examination of long-term outcomes

Background


Key Point

Gender affirmation surgery is a crucial aspect of transgender healthcare that can significantly improve quality of life, but there is a potential risk of regret that needs to be considered and addressed by healthcare professionals.

Gender affirmation surgery is a significant step for transgender individuals seeking to transition physically to align their body with their gender identity. Although the majority of transgender individuals report improved quality of life and satisfaction with gender affirmation surgery, some may experience regret after surgery. The authors conducted this study to investigate the prevalence and predictors of regret after gender affirmation surgery.

Methods


Key Point

The study utilized a systematic review of existing literature to investigate the prevalence and predictors of regret after gender affirmation surgery.

The authors conducted a systematic review of 29 studies published between 2004 and 2019, including a total of 15,784 transgender individuals who underwent gender affirmation surgery.

The review aimed to examine the prevalence and predictors of regret after surgery, including factors such as age, social support, mental health problems, and surgical procedure.

Results


Key Point

The overall prevalence of regret after gender affirmation surgery was found to be low, at 1.0%. 

The meta-analysis found that the overall prevalence of regret after gender affirmation surgery was 1.0%. The prevalence of regret was higher among individuals who underwent vaginoplasty (1.3%) compared to those who underwent phalloplasty (0.5%).

The review also found that younger age, poor social support, and mental health problems were predictors of regret after surgery.

Discussion

The study's findings indicate that regret after gender affirmation surgery is rare, with an overall prevalence of 1.0%. The authors highlight the importance of preoperative counseling and support to minimize the risk of regret. The study's findings suggest that younger age, poor social support, and mental health problems may increase the risk of regret after surgery. The authors recommend that healthcare professionals work to identify and address these risk factors during preoperative counseling to minimize the risk of regret after gender affirmation surgery.


Article Discussion


Key Point

Healthcare professionals can improve clinical practice by prioritizing preoperative counseling and support, identifying and addressing risk factors for regret, and staying up-to-date on the latest research and guidelines related to gender affirmation surgery. Limitations of the study include the Western-centric focus, reliance on self-reported data, and lack of examination of long-term outcomes


Three Learning Points:

  1. Regret after gender affirmation surgery is rare, with an overall prevalence of 1.0%.
  2. Vaginoplasty is associated with a slightly higher prevalence of regret (1.3%) compared to phalloplasty (0.5%).
  3. Younger age, poor social support, and mental health problems are predictors of regret after surgery.

Three Limitations:

  1. The study's focus on Western countries may limit its generalizability to other regions.
  2. Self-reported data used in the review may be subject to social desirability bias.
  3. The review did not examine long-term outcomes, differentiate between regret related to surgical outcomes versus other factors, account for variations in definitions and criteria, consider non-English language studies, assess the impact of surgeon experience and skill, or evaluate the role of postoperative care and support.

Three Further Reading Recommendations:

  1. American Society of Plastic Surgeons. Gender Affirming Surgery. Accessed April 15, 2023. https://www.plasticsurgery.org/reconstructive-procedures/gender-affirming-surgery.
  2. James SE, Herman JL, Rankin S, et al. The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality; 2016.
  3. WPATH. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. Seventh Version. WPATH; 2011.

Three Ways to Improve Clinical Practice:

  1. Healthcare professionals should prioritize preoperative counseling and support to minimize the risk of regret after gender affirmation surgery.
  2. Identify and address risk factors for regret, such as younger age, poor social support, and mental health problems, during preoperative counseling.
  3. Stay up-to-date on the latest research and guidelines related to gender affirmation surgery to ensure the best possible care for transgender patients.


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