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Decision regret, and other mental health outcomes, following fertility preservation in the transgender individual compared to the cisgender woman

  • Fertility Preservation
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Abstract

Purpose

This study aimed to (1) determine differences in depression, anxiety, body image, quality-of-life (QOL), and decision regret scale (DRS) scores in transgender individuals undergoing fertility preservation (FP) compared to those who decline and (2) determine if DRS score following FP varies between transgender individuals and cisgender women.

Methods

Sixteen transgender birth–assigned (BA) females and 13 BA males, undergoing FP consultation at an academic center between January 2016 and November 2019, were compared to each other and cisgender cohorts with pre-existing data: 201 women undergoing elective oocyte cryopreservation (EOC) between 2012 and 2016 and 44 women with cancer undergoing FP between 1993 and 2007. Outcomes included demographics; validated scales for depression, anxiety, body image, QOL (see below) in the trans cohort; DRS score in all three cohorts.

Results

Of 29 transgender individuals participating, 10 BA females (62%) and 12 BA males (92%) underwent FP. Beck Depression Inventory II, Hospital Anxiety and Depression Scale, Body Image Scale for Transsexuals, Satisfaction with Life Scale, Short Form Health Survey-36, and DRS scores were not significantly different between trans individuals who underwent FP and those who declined. On univariate modeling, regret was significantly lower in transpeople undergoing FP compared to those who did not (OR 0.118, p = 0.03). BA female and BA male transpatients undergoing FP reported DRS median scores 5 (mean 9) and 7.5 (mean 15), respectively, both were not significantly different from cisgender women (p = 0.97, p = 0.25) nor from each other (p = 0.43).

Conclusions

Depression, anxiety, body image, and QOL, in a group of individuals presenting for FP consultation, appear similar between transpeople undergoing FP and not, while regret is significantly lower in those choosing FP. FP is an option for transgender individuals without significant differences in regret compared to cisgender women.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author, VS.

References

  1. Ethics Committee of the American Society for Reproductive Medicine. Access to fertility services by transgender persons: an Ethics Committee opinion. Fertility and Sterility. 2015. Retrieved January 5, 2020, from https://www.fertstert.org/article/S0015-0282(15)01867-1/fulltext.

  2. Sundaram V, Mok-Lin E. Fertility preservation for the transgender individual. Curr Obstet Gynecol Rep. 2020;9(3):129–37. https://doi.org/10.1007/s13669-020-00291-z.

    Article  Google Scholar 

  3. Wallace SA, Blough KL, Kondapalli LA. Fertility preservation in the transgender patient: expanding oncofertility care beyond cancer. Gynecol Endocrinol. 2014;30(12):868–71. https://doi.org/10.3109/09513590.2014.920005.

    Article  PubMed  Google Scholar 

  4. Mattawanon N, Spencer JB, Schirmer DA, Tangpricha V. Fertility preservation options in transgender people: a review. Rev Endocr Metab Disord. 2018;19(3):231–42. https://doi.org/10.1007/s11154-018-9462-3.

    Article  PubMed  Google Scholar 

  5. Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, Version 7. Int J Transgenderism. 2012;13(4):165–232. https://doi.org/10.1080/15532739.2011.700873.

    Article  Google Scholar 

  6. Baker KE, Wilson LM, Sharma R, Dukhanin V, McArthur K, Robinson KA. Hormone therapy, mental health, and quality of life among transgender people: a systematic review. J Endocr Soc. 2021;5(4):bvab011. https://doi.org/10.1210/jendso/bvab011.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Murad MH, Elamin MB, Garcia MZ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf). 2010;72(2):214–31. https://doi.org/10.1111/j.1365-2265.2009.03625.x.

    Article  PubMed  Google Scholar 

  8. White Hughto JM, Reisner SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health. 2016;1(1):21–31. https://doi.org/10.1089/trgh.2015.0008.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Nobili A, Glazebrook C, Arcelus J. Quality of life of treatment-seeking transgender adults: a systematic review and meta-analysis. Rev Endocr Metab Disord. 2018;19(3):199–220. https://doi.org/10.1007/s11154-018-9459-y.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bustos VP, Bustos SS, Mascaro A, et al. Regret after gender-affirmation surgery: a systematic review and meta-analysis of prevalence. Plast Reconstr Surg - Glob Open. 2021;9(3):e3477. https://doi.org/10.1097/GOX.0000000000003477.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Wernick JA, Busa S, Matouk K, Nicholson J, Janssen A. A systematic review of the psychological benefits of gender-affirming surgery. Urol Clin North Am. 2019;46(4):475–86. https://doi.org/10.1016/j.ucl.2019.07.002.

    Article  PubMed  Google Scholar 

  12. van de Grift TC, Elaut E, Cerwenka SC, Cohen-Kettenis PT, Kreukels BPC. Surgical satisfaction, quality of life, and their association after gender-affirming surgery: a follow-up study. J Sex Marital Ther. 2018;44(2):138–48. https://doi.org/10.1080/0092623X.2017.1326190.

    Article  PubMed  Google Scholar 

  13. Barone M, Cogliandro A, Di Stefano N, Tambone V, Persichetti P. A systematic review of patient-reported outcome measures following transsexual surgery. Aesthetic Plast Surg. 2017;41(3):700–13. https://doi.org/10.1007/s00266-017-0812-4.

    Article  CAS  PubMed  Google Scholar 

  14. Pfafflin F. Regrets after sex reassignment surgery. J Psychol Hum Sex. 1993;5(4):69–85. https://doi.org/10.1300/J056v05n04_05.

    Article  Google Scholar 

  15. Letourneau JM, Ebbel EE, Katz PP, et al. Pre-treatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer. 2012;118(6):1710. https://doi.org/10.1002/cncr.26459.

    Article  PubMed  Google Scholar 

  16. Greenwood EA, Pasch LA, Hastie J, Cedars MI, Huddleston HG. To freeze or not to freeze: decision regret and satisfaction following elective oocyte cryopreservation. Fertil Steril. 2018;109(6):1097-1104.e1. https://doi.org/10.1016/j.fertnstert.2018.02.127.

    Article  PubMed  Google Scholar 

  17. Armuand G, Dhejne C, Olofsson JI, Rodriguez-Wallberg KA. Transgender men’s experiences of fertility preservation: a qualitative study. Hum Reprod. 2017;32(2):383–90. https://doi.org/10.1093/humrep/dew323.

    Article  CAS  PubMed  Google Scholar 

  18. Vyas N, Douglas CR, Mann C, Weimer AK, Quinn MM. Access, barriers, and decisional regret in pursuit of fertility preservation among transgender and gender-diverse individuals. Fertil Steril. 2021;115(4):1029–34. https://doi.org/10.1016/j.fertnstert.2020.09.007.

    Article  PubMed  Google Scholar 

  19. Wideman TH, Sullivan MJL, Inada S, et al. Beck Depression Inventory (BDI). In: Gellman MD, Turner JR, eds. Encyclopedia of behavioral medicine. Springer New York; 2013:178–179. https://doi.org/10.1007/978-1-4419-1005-9_441.

  20. Beck AT, Steer RA, Ball R, Ranieri WF. Comparison of Beck Depression Inventories-IA and-II in psychiatric outpatients. J Pers Assess. 1996;67(3):588–97. https://doi.org/10.1207/s15327752jpa6703_13.

    Article  CAS  PubMed  Google Scholar 

  21. Stern AF. The hospital anxiety and depression scale. Occup Med. 2014;64(5):393–4. https://doi.org/10.1093/occmed/kqu024.

    Article  Google Scholar 

  22. Rishi P, Rishi E, Maitray A, Agarwal A, Nair S, Gopalakrishnan S. Hospital anxiety and depression scale assessment of 100 patients before and after using low vision care: a prospective study in a tertiary eye-care setting. Indian J Ophthalmol. 2017;65(11):1203. https://doi.org/10.4103/ijo.IJO_436_17.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Lindgren TW, Pauly IB. A body image scale for evaluating transsexuals. Arch Sex Behav. 1975;4(6):639–56. https://doi.org/10.1007/BF01544272.

    Article  CAS  PubMed  Google Scholar 

  24. van de Grift TC, Kreukels BPC, Elfering L, et al. Body image in transmen: multidimensional measurement and the effects of mastectomy. J Sex Med. 2016;13(11):1778–86. https://doi.org/10.1016/j.jsxm.2016.09.003.

    Article  PubMed  Google Scholar 

  25. Diener E, Emmons RA, Larsen RJ, Griffin S. The Satisfaction With Life Scale. J Pers Assess. 1985;49(1):71–5. https://doi.org/10.1207/s15327752jpa4901_13.

    Article  CAS  PubMed  Google Scholar 

  26. López-Ortega M, Torres-Castro S, Rosas-Carrasco O. Psychometric properties of the Satisfaction with Life Scale (SWLS): secondary analysis of the Mexican Health and Aging Study. Health Qual Life Outcomes. 2016;14(1):170. https://doi.org/10.1186/s12955-016-0573-9.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Laucis NC, Hays RD, Bhattacharyya T. Scoring the SF-36 in orthopaedics: a brief guide. J Bone Jt Surg. 2015;97(19):1628–34. https://doi.org/10.2106/JBJS.O.00030.

    Article  Google Scholar 

  28. RAND Medical Outcomes Study. 36-Item Short Form Survey (SF-36). Rand Corporation. n.d. Retrieved January 5, 2020, from https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form.html.

  29. Foster Skewis L, Bretherton I, Leemaqz SY, Zajac JD, Cheung AS. Short-term effects of gender-affirming hormone therapy on dysphoria and quality of life in transgender individuals: a prospective controlled study. Front Endocrinol. 2021;12:717766. https://doi.org/10.3389/fendo.2021.717766.

    Article  Google Scholar 

  30. Gorin-Lazard A, Baumstarck K, Boyer L, et al. Is hormonal therapy associated with better quality of life in transsexuals? A cross-sectional study. J Sex Med. 2012;9(2):531–41. https://doi.org/10.1111/j.1743-6109.2011.02564.x.

    Article  PubMed  Google Scholar 

  31. Colton Meier SL, Fitzgerald KM, Pardo ST, Babcock J. The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals. J Gay Lesbian Ment Health. 2011;15(3):281–99. https://doi.org/10.1080/19359705.2011.581195.

    Article  Google Scholar 

  32. Gooren LJ, Sungkaew T, Giltay EJ. Exploration of functional health, mental well-being and cross-sex hormone use in a sample of Thai male-to-female transgendered persons (kathoeys). Asian J Androl. 2013;15(2):280–5. https://doi.org/10.1038/aja.2012.139.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Brehaut JC, O’Connor AM, Wood TJ, et al. Validation of a decision regret scale. Med Decis Making. 2003;23(4):281–92. https://doi.org/10.1177/0272989X03256005.

    Article  PubMed  Google Scholar 

  34. ClinCalc. Sample Size Calculator. Clincalc.com. 2019. Retrieved April 2, 2018, from https://clincalc.com/stats/samplesize.aspx.

  35. Wierckx K, Van Caenegem E, Pennings G, et al. Reproductive wish in transsexual men. Hum Reprod. 2012;27(2):483–7. https://doi.org/10.1093/humrep/der406.

    Article  PubMed  Google Scholar 

  36. Chen D, Simons L, Johnson EK, Lockart BA, Finlayson C. Fertility preservation for transgender adolescents. J Adolesc Health. 2017;61(1):120–3. https://doi.org/10.1016/j.jadohealth.2017.01.022.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Adeleye AJ, Cedars MI, Smith J, Mok-Lin E. Ovarian stimulation for fertility preservation or family building in a cohort of transgender men. J Assist Reprod Genet. 2019;36(10):2155–61. https://doi.org/10.1007/s10815-019-01558-y.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Leung A, Sakkas D, Pang S, Thornton K, Resetkova N. Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine. Fertil Steril. 2019;112(5):858–65. https://doi.org/10.1016/j.fertnstert.2019.07.014.

    Article  CAS  PubMed  Google Scholar 

  39. Adeleye A, Reid GM, Au YH, Smith JAMESF, Mok-Lin E. Quality of life after fertility preservation among transgender people. Fertil Steril. 2019;112(3):e358. https://doi.org/10.1016/j.fertnstert.2019.07.1028.

    Article  Google Scholar 

  40. Daar J, Benward J, Collins L, et al. Planned oocyte cryopreservation for women seeking to preserve future reproductive potential: an Ethics Committee opinion. Fertil Steril. 2018;110(6):1022–8. https://doi.org/10.1016/j.fertnstert.2018.08.027.

    Article  Google Scholar 

  41. Moravek MB, Kinnear HM, George J, et al. Impact of exogenous testosterone on reproduction in transgender men. Endocrinology. 2020;161(3):bqaa014. https://doi.org/10.1210/endocr/bqaa014.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Becerra Pérez MM, Menear M, Brehaut JC, Légaré F. Extent and predictors of decision regret about health care decisions: a systematic review. Med Decis Making. 2016;36(6):777–90. https://doi.org/10.1177/0272989X16636113.

    Article  PubMed  Google Scholar 

  43. Joseph-Williams N, Edwards A, Elwyn G. The importance and complexity of regret in the measurement of ‘good’ decisions: a systematic review and a content analysis of existing assessment instruments: systematic review of regret instruments. Health Expect. 2011;14(1):59–83. https://doi.org/10.1111/j.1369-7625.2010.00621.x.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Florida Institute for Reproductive Medicine, 836 Prudential Dr, Suite 902, Jacksonville, FL, 32207, USA

    Viji Sundaram

  2. University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA

    Brett Stark, Eleni Jaswa & Evelyn Mok-Lin

  3. University of Utah, 675 Arapeen Way, Salt Lake City, UT, 84108, USA

    Joseph Letourneau

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Correspondence to Viji Sundaram.

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Sundaram, V., Stark, B., Jaswa, E. et al. Decision regret, and other mental health outcomes, following fertility preservation in the transgender individual compared to the cisgender woman. J Assist Reprod Genet 41, 1077–1085 (2024). https://doi.org/10.1007/s10815-023-03013-5

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