and S.S.B.), who reviewed titles and abstracts and selected those of relevance to the research question.
The first step was conducted by 2 screeners (V.P.B.
22 The study selection was performed in a 2-stage screening process. Search results were exported from the database into XML format and then uploaded to Covidence. ( See Supplemental Digital Content 1, which displays the search strategy.) The actual strategy listing all search terms used and how they are combined is available in Supplemental Digital Content 1. Controlled vocabulary supplemented with keywords was used to search for studies of de-transition and regret in adult patients who underwent gender confirmation surgery. The search strategy was designed and conducted by an experienced librarian, with input from the study’s principal investigator. 21 The databases included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. 20įollowing the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a comprehensive research of several databases from each database’s inception to May 11, 2020, for studies in both English and Spanish languages, was conducted. Therefore, the aim of this study was to evaluate the prevalence of regret and assess associated factors in TGNB patients 13-years-old or older who underwent GAS. In the present study, we hypothesized that the prevalence of regret is less than the last estimation by Pfafflin in 1993, due to improvements in standard of care, patient selection, surgical techniques, and gender confirmation care. Special attention should be paid in identifying and recognizing the prevalence and factors associated with regret. 20 Both regret and de-transition may add an important burden of physical, social, and mental distress, which raises concerns about the appropriateness and effectiveness of these procedures in selected patients. 5, 13– 19 However, despite this, there is a minor population that experiences regret, occasionally leading to de-transition surgeries. Significant improvement in the quality of life, body image/satisfaction, and overall psychiatric functioning in patients who underwent GAS has been well documented. In the United States, from 2017 to 2018, the number of GAS increased to 15.3%. 1, 9 The number of GAS has consistently increased during the last years. 5, 10 These interventions should be addressed by a multidisciplinary team, including psychiatrists, psychologists, endocrinologists, physical therapists, and surgeons. 5, 8– 10 Gender-affirmation surgeries (GAS) aim to align the patients’ appearance with their gender identity and help achieve personal comfort with one-self, which will help decrease psychological distress. Gender-affirmation care plays an important role in tackling gender dysphoria. 6 Despite advocacy to promote and increase awareness of the human rights of transgender and gender non-binary (TGNB) individuals, discrimination continue to afflict the daily life of these individuals. 4, 5 Approximately 0.6% of adults in the United States identify themselves as transgenders. 1– 3 This population has increased risk of psychiatric conditions, including depression, substance abuse disorders, self-injury, and suicide, compared with cis-gender individuals. Discordance or misalignment between gender identity and sex assigned at birth can translate into disproportionate discomfort, configuring the definition of gender dysphoria.
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