Predictors of De-Transitioning After Gender Confirmation Surgery: A Secondary Analysis of the United States Transgender Survey
Andrew Marano, MD, Wendy Castillo, PhD, Leslie Cohen, MD.
Columbia/Cornell, New York, NY, USA.
BACKGROUND: De-transitioning is a rare outcome following gender confirmation surgery. It nonetheless remains an important consideration, as failure to foresee regret can have irreversible consequences for patients. The United States Transgender Survey (USTS) was conducted by the National Center for Transgender Equality (NCTE) in 2015 and details the experiences of nearly 28,000 transgender individuals in the United States. The purpose of this study is to analyze the USTS data to determine characteristics of individuals who have de-transitioned after undergoing gender confirmation surgery.
METHODS: A secondary analysis of the USTS was performed, including participants who indicated having undergone a transition-related surgical procedure. The primary outcome of interest was de-transitioning, based on participants’ answer to the question “Have you ever de-transitioned?” Independent variables were prospectively selected to create a theoretical model to predict de-transitioning. In addition to demographic data, predictors included living full time in gender, nonbinary status, marital status, family support, psychosocial well-being, experiences of abuse from a partner, and negative experiences in the workplace. Descriptive statistics were analyzed using a chi-square test and the theoretical model was analyzed using multivariate logistic regression.
RESULTS: 8,129 participants underwent a transition-related surgical procedure, of which 704 indicated having de-transitioned. The likelihood of de-transitioning was significantly lower in the surgery group (8.7% vs. 17.0%, p=0.00), and was also significantly lower for each individual surgical procedure. On multivariate logistic regression, there was no association between race, area of residence, or income and de-transitioning. De-transitioning was associated with assigned male at birth (OR 2.4, p=0.00), increasing age (OR 1.02, p=0.001), not living full time in gender (OR 0.28, p=0.00), nonbinary status (OR 2.47, p=0.00), single/divorced/widowed status (OR 1.33, p=0.022), unsupportive family (OR 1.84, p=0.00), psychosocial distress (OR 1.04, p=0.00), history of domestic abuse (OR 1.73, p=0.00), and adverse workplace experiences (OR 1.90, p=0.00).
CONCLUSIONS: The results of this study suggest that a lack of support in the home and/or workplace are associated with de-transitioning after gender confirmation surgery. This suggests that the quality of the social support system, rather than misdiagnosis or mistaken identity, may be a predictor for post operative de-transitioning.
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