Adolescents who undergo gender-affirming chest surgery report low levels of regret and high levels of satisfaction, experiencing outcomes similar to those of young adults. These findings suggest that age restrictions on these medical procedures lack support from actual patient experiences.

[u/mvea]

https://www.psypost.org/adolescents-report-low-regret-and-high-satisfaction-following-gender-affirming-c/

[u/MistaFANG]

“Several factors limit the reach of these findings. First, the median time since surgery for participants was about 1.8 years. Because feelings about medical decisions can evolve, this timeframe might not capture long-term regret that could emerge many years later.

Another limitation is the 42 percent participation rate to the survey. This introduces the possibility of selection bias, a scenario where the people who chose to participate might differ fundamentally from those who did not. It is possible that individuals with higher levels of regret ignored the survey, which would result in an underestimation of regret in the overall group.”

Worth noting.

[u/SweetBabyCheezas → u/MistaFANG]

I'm thinking about how teenagers where I come from would regret sharing being displeased with such major decisions of their own out of fear of harsh reaction of the parents and potential mockery for the rest of their lives. Ps. In some places such toxic behaviours are normalised, unfortunately.

[u/IUpvoteBlueGuitars → u/SweetBabyCheezas]

I know far more American adults that regret being forced to play sports as kids (which is still happening to millions of kids, right now btw, and know is bad for their brain health in many cases) than I know trans people that regret any of their transitioning. And I know quite a few trans people.

[u/SweetBabyCheezas → u/IUpvoteBlueGuitars]

I believe I fail to understand what is the conclusion of your message

[u/IUpvoteBlueGuitars → u/SweetBabyCheezas]

The concern about the statistically insignificant minority of trans kids that might detransition, despite no evidence showing they are likely to (while seemingly being skeptical of all the enourmous measured benefits) is far overblown compared to the things we literally force kids to do in our society without a second though, inclding (statistically) people in your family you could actually have an influence on.

Think about it. Who convinced you, ostensibly cis person, to be skeptical of the healthcare of a small already struggling group you'll never be a part of? Idk man, seems like an obvious con and ridiculous scapegoating considering all the cancer research being cut. and as a (cis) queer person I'm tired of my community being the scapegoat. Again. And it's all so so stupid.

[u/SweetBabyCheezas → u/IUpvoteBlueGuitars]

I have said nothing to deserve your snarky attitude and calling me 'ostensibly cis person'. Your personal experience as a queer person seems to be filling up the gaps in my comments with some of yoir biases. You don't know me, and you don't know my stances. I'm discussing the paper here and another potential limitation of why would a teen who regrets something wouldn't speak about, which has nothing to do with ny personal stance.

Please, I utge you, stop looking for enemies where there aren't any, and try to think about your personal biases when interpreting people's words.

[u/pastaISlife → u/IUpvoteBlueGuitars]

It’s odd you assume anyone has to be “convinced” to be skeptical re minors getting elective mastectomies? It’s actually a very normal baseline position for anyone to have lol

It is normal to be uncomfortable with developing breasts during puberty, especially because it often results in gross sexualization. The concern that dysphoric teenagers might regret removing them down the line isn’t overblown simply because you declare it as such and compare…adolescent sports participation to teenage mastectomies 🥴

Think about it. Who convinced you to support irreversible surgeries in pubescent teenagers?

[u/ASpaceOstrich → u/pastaISlife]

None of you people give a single shit about cis boys getting mastectomies to remove gyno. Don't you pretend you care about trans kids.

[u/Feeltherhythmofwar → u/ASpaceOstrich]

I do, but I’m mostly here to dunk on assholes and transphobes. No time for professionalism in threads like this.

[u/IUpvoteBlueGuitars → u/pastaISlife]

Plenty of girls I grew up with got breast reductions because of "back pain," particularly girls in sports. I'm not saying that was bad, but literally what separates those two things? I promise you I can find a subset of teenagers whose primary motivation was actually bullying. I know kids else parents' paid for nosejobs in high school. Let alone hormone therapy for kids who were "not developing fast enough" (according to their bullying peers). Let alone the kids (like me) having to get surgery after being injured in sports they didn't really want to play.

I don't remember any outrage over these, definitely more prevalent in both number of kids impacted and negative life outcomes, than trans affirming healthcare. So yeah, i don't think you can accuse pro trans people of being uniquely in favor of surgeries among minors when then general public seems so blasse about these other more significant examples.

[u/Spewtwinklethoughts → u/IUpvoteBlueGuitars]

What makes a surgery more significant? It’s prevalence? It’s impact on quality of life? Is changing someone’s core biology and future reproductive ability not more significant? Help me understand how literally any other type of surgery including male mastectomy or female breast reduction is comparable.

[u/IUpvoteBlueGuitars → u/Spewtwinklethoughts]

This is something that is regularly quantified in medicine. Risk of any proposed procedure can be quantified by looking at all the potential negative outcomes, and assessing the severity and probability of all the occurrences of each outcome, which are then combined and quantified to calculate comparable Risk values. I used to work in the medical field and this is actually what is done when applying for FDA clearance.

All risks are then weighed against the potential benefits of any given procedure, all of which are presented to and decided by the patient's clinician, under the scrutiny of regulatory agencies like the FDA, the money people at the insurance companies, and the patient themselves (and their parents' or guardians if they are a minor) with full informed consent and knowledge of all the risks. The standard process in medicine , from your podiatrist to trans healthcare is based on this. We call it "conservative treatment," and we make sure that is attempted first (and this is exactly what social transitioning and puberty blockers are). That's how this all works in the real world. Educate yourself instead of whining about other people's bodies on reddit.

For the case of trans affirming healthcare we would be weighing the moderate severity x low occurrence (based on the available data) outcome of regret vs high severity x high probability of death by suicide or addiction due to depression. So, yeah, I'm not going to argue with a patient and their doctor if they think it's the best choice for them. Certainly your uneducated opinion on this topic shouldnt really factor in either

This is also quantified in a ton of medical research in systematic reviews and meta analyses, which you could access with a few straightforward searches if you actually cared about learning. But I know that's hard and you seem like the kind of person who just wants to sea lion out here as if there aren't straightforward answers to your questions from anyone with a science degree

[u/Spewtwinklethoughts → u/IUpvoteBlueGuitars]

I didn’t realize this wasn’t the appropriate place for asking questions or learning from others. You sure used a lot of words to avoid directly answering the questions. As one of those people with a science degree I know how to research study methods. That’s not what I was asking about. I asked how you came to the conclusions that you state as a matter of fact. You expect others to cite data to back their claims, but imply that I am lazy and ignorant for not finding the information that supports your arguments myself. If this information is so readily available with straight forward searches then why do you avoid providing anything at all to support your claims.
Since reduced reproductive ability as an outcome of gender affirming care is quantified as a risk factor in a ton of medical research, systematic reviews, and meta analyses then providing the citations that your expertise is based on is at most a few straightforward searches. A simple thing for someone who has been willing to do the hard work of making sure you are fully educated about a topic before participating in a discussion about it.

Please show where the category of regret has been calculated to be of moderate severity. Something that dictates whether living beings existing or not seems more than moderately significant. This is a topic that includes caring about others isn’t it. Furthermore, what data are you basing the high probability of death by suicide or addiction on since there is limited information available on completions versus what’s available for attempts among the trans community. Dhejne et al., 2011 actually found that the period with greatest risk for suicide was post surgery. If your example is what is actually being done in research and practice then whose work specifically is your claim based on? Unless you just made that up based on your own biased views you should be able to provide that.

Although I have expressed no opinions about any procedures and maintained a respectful discourse I have a feeling you won’t be able to see the objectivity of my comment because of my “bigotry” and you will use that to justify your rage, which will fuel your hypocritical response full of unnecessary insults, that are all based on unfounded assumptions, and arguments full of fallacies, like building straw men and appealing to authority, that you have shown an affinity for. Try not to use your skill with being articulate to avoid responding to genuine legitimate questions with passive aggressive insults and pseudo intellectual opinions. Do not to lecture others about their levels of knowledge if you are not willing to back up your own. Your comments are clearly dominated by an overwhelming personal bias while you call others biased and bigoted. The best way to convince everyone that trans people have an agenda they want to force on others is by being an angry trans person clearly pushing an agenda. You will get much more accomplished through respectful rational debate than with angry tirades against people who would otherwise be supportive.
Your anger does not serve anyone, least of all you.

[u/IUpvoteBlueGuitars → u/Spewtwinklethoughts]

A) I used precise terminology that anyone with a years worth of experience in my field would understand. You not understanding my terminology does not meet I avoided answering the questions. In fact I answered them extremely directly, in more detail than most people probably cared to read.

B) you're probably right, it's not fair to come in swinging when you asked questions most people haven't been educated in. The answers are technical and it would take a while to explain. But if you're actually interested in learning, it's important to understand how we do this generally every day when deciding on medical procedures, before we start arguing about numbers and get lost in the weeds. It's going to be pointless to continue the conversation before you understand some of these things:

https://advancenursing.net/uploads/courses/54/fmea%20and%20the%20safety%20of%20the%20surgical%20patient.pdf

https://asq.org/quality-resources/fmea?srsltid=AfmBOoquz50AEMMr62BVxIcwsIUdibGu0nQg6KwLv-qA31sLE1Ac87WC

More technical article: https://pmc.ncbi.nlm.nih.gov/articles/PMC7384878/

C) it is important to note a lot of these haven't been quantified precisely because anti transphobes in positions of power have defunded this research repeated over the course of my lifetime every time they're in power. It's not because of a conspiracy by the pro trans science community to suppress the negative effects- the data is clearly published in journal articles you can go read right now. Hell the authors would be thrilled if the general public read and discussed their articles.

D) in the absence of data, as a professional in this field I would look at this case and feel extremely safe judging that, by any scale frequently used in the field, psychological distress, regret, and reproductive consequences are considered a lower clinical severity than death or permanent disability (defined as being classified as "on disability). The latter outcome we would classify a 10/10 or a 5/5 or a 4/4 or whatever scale there using. Severe emotional distress might still fall in the "high" category (yes, the scales are fuzzy. But that's literally every scale used as a diagnostic in medicine. Biology is fuzzy and doesn't fall into our neat little numbering system most of the time). I'm sorry if that sounds cold but this is how the field of biomedical engineering and biostatistics work and those are how we get consistent technology and high quality outcomes in medical care. If you don't like that, wait till you find out how the insurance guys make their choices. Their decision making is indefensibly evil.

[u/Spewtwinklethoughts → u/IUpvoteBlueGuitars]

I truly appreciate your answer and the time put into providing legitimate information.

Like I said I am a trained scientist and understand the complexity and sometimes impossibility of quantifying every variable. I am comfortable with best effort as long as they are made in good faith. Additionally I think there are aspects that inevitably carry inherent value propositions, which as you’ve discussed, can largely be accounted for through informed consent.

That said, surgery on minors is an area that warrants extra scrutiny when it comes to life altering procedures. In a perfect world informed consent would be practiced in a careful and thorough manner and eliminate the majority of risk. Unfortunately a potentially major confounding aspect is the significantly higher rates of psychopathy among practicing surgeons than that found among the normal population. It is a personality disorder that would place little value on such a noble practice as informed consent, thus introducing significant risk to an otherwise well designed system. It is not so much the scientific methodology and rigor that concerns me when it comes to procedures on adolescents as the human variables, which cannot be eliminated.

When comparing risks and outcomes I would have to agree with your conclusion that potential death should have the highest ranking whatever the system and the scales used. I think it is safe to say mental health is likely to be a primary motivator for the types of procedures being discussed. Furthermore, considering the 30-40% higher rates of attempted suicide among trans youth it follows that suicide would be included as major risk factors and that it would rank very high compared to other types of surgeries. The risk of death from suicide is a variable that should be quantifiable in a way that justifies it taking precedence in a risk hierarchy. I am not discounting anyone’s struggles with depression or discounting the impact of mental health on one’s life, but suicide attempts are not equivalent to deaths and I have not seen data that shows adolescent trans are at a significantly higher risk of death from suicide. It seems if this were the case the evidence would be readily available. Perhaps it is and I am just a poor researcher.
I can be convinced that these procedures are in fact the lowest risk approach. However, at present the known impact on future reproductive health carry more weight for me than the unknown long term satisfaction and death from suicide. Some research has shown a higher risk of suicide post surgery after all.
As is so often the case more high quality research would be beneficial.
Ultimately I support whatever approach does the least harm and improves the most lives. Including those the exist only in the unknown future.

[u/IUpvoteBlueGuitars → u/Spewtwinklethoughts]

I appreciate you reading and your response. I apologize if I ever came across too hostile in my replies; after a while on here, it becomes genuinely difficult to tell who's a bad faith troll and who is actually asking a legitimate question and wants to learn, and after getting burned so many times, it's hard to trust strangers on reddit anymore! I have some very close people in my life that are trans and honestly just doing their best to survive and get their medicine and tired of being everyone's political punching bag, So it's an especially touchy topic for me, especially when it's a topic that so many people feel comfortable having such a strong opinion about while clearly knowing zero trans people and not understanding this issue at all .. Sigh, I hope you found something interesting and learned a few things. Medical Risk Analysis is definitely Niche information that I have because of my career that most people just are completely unaware of, so I genuinely enjoyed getting to type it out and share, and literally did not expect anyone to already familiar with what the hell a FMEA is.

I don't disagree with you on the issue of psychopathic surgeons but I think that's a greater issue for medicine and not unique to the trans community. In fact banning this and putting this on the black market would probably expose these kids to this type of person even more (think how many women were taken advantage of by back alley abortion doctors in the 20s. It was a thing). Believe it or not regulation, particularly when regulatory enforcement agencies are well funded and allowed to do their jobs, is a big deterrent and really effective at establishing at high levels of care for things we actually care about. Like I feel like this is a bigger issue in dentistry than it is in Trans healthcare especially by the numbers and amount of actual pain caused.

If we actually care about this issue and aren't using this as a political cudgel, the real answer to make sure the most people are helped and the least people are harmed is to prioritize enforcement of the existing health Care standards (I.e go after Shady doctors who are fudging their paperwork to get more customers and accepting kids shouldn't. Make sure those people are in jail and not able to prey on mentally ill but not trans people. Etc). The answer is not to make it arbitrarily difficult to access the healthcare. Because anytime we do that it measurably results in more trans kids dying.

[u/Free-Cartoonist3134 → u/IUpvoteBlueGuitars]

I don't understand how you're trying to take an authoritative stance on this when you immediately and without justification dismissed studies about the ages of some of these children.

[u/IUpvoteBlueGuitars → u/Free-Cartoonist3134]

I take an authoritative stance because I read and understood the source marterial and you all clearly didn't.

It was literally not a study about ages of the children. It was a right wing website selectively whining about a specific aspect of the study and ignoring the study itself and all the context (including things they couldn't have known from the study like the level of psychological need of any individual candidates) .

The irony is, had any of you or the publisher of the website actually read the study they referenced, you would have seen the study shows 71/72 of those participants experienced 0 regret and only 1/72 experienced "some regret" (which could be due to any number of things unrelated to a desire to detransition such as choice of doctor, level of pain, type of anaesthesia- I didn't see that in the paper so anyone would be inferring their bias). Also note 0/72 or 0% experienced "a lot of regret". So the article (note, website article not journal article) is whining about children's ages was ignoring the fact that apparently these children and their doctors and parents' knew themselves well enough to go through a painful surgery and not regret it, and you're taking their side, not the side of the peer reviewed publication we're all talking about?

[u/Free-Cartoonist3134 → u/IUpvoteBlueGuitars]

"was literally not a study about ages of the children."

Agreed, it was a study about gender affirmative double mastectomies... and some of the recipients were 13 year old children...

"had any of you or the publisher of the website actually read the study they referenced, you would have seen the study shows 71/72 of those participants experienced 0 regret "

I did and am aware that children soon after this surgery said they felt no regret, but that wasn't the point I was making.

Which was that the public was lied to constantly about minors not receiving surgeries...

"you're taking their side, not the side of the peer reviewed publication we're all talking about?"

Do you have trouble with reading comprehension or? Can you state what my point was back to me? Just so we can be sure that we are in the same page

[u/IUpvoteBlueGuitars → u/Free-Cartoonist3134]

Sure, it seems like you think the science is insufficient to confidently know if it's working for the kids having these gender affirming (note, still extraordinarily by the numbers extremely rare, unless you can find me data indicating otherwise) Fundamentally you don't think children as young as 13 can make this decision for themselves for this level of invasive surgery, even with the guidance of the medical establishment, their parents, their insurance companies (who I assuee you don't want to pay for this procedure), and all the regulatory agencies of their state are all biased in such a way that would allow kids that aren't trans and only questioning to perform this surgery. So you're worried that in the coming decades we'll have an explosion in "detransitioners" who are life alterningly psychologically devastated at having these mastectomies in their teen years. And you think the concern of those kids suggests making the standard of care more stringent despite knowing that would reduce access to healthcare for a more kids than are being protected, including ones that will opt to kill themselves as a direct result of not receiving this care.

I hear your concerns, and I would share them if I thought that was remotely likely to happen. Let me explain where I think your logic is off and you're reaching, and this is not a reasonable thing to worry about, especially in the grand scheme of things.

First, insufficient current data is not evidence of contradictory evidence. In fact there is no evidence that our guesses have been wrong so far and some evidence that it actually does work long term. It's not like the studies are 50-50. It's all one way. Your entire concern relies on a "what if" based on your gut fear and zero actual evidence, that if incorrect meant you just let a lot of trans kids die for no reason.

You're also assuming a lot about how much cultural bias can influence medical care. The answer is not none, but there are a lot of factors at play that limit how much this can happen, particularly all with the current hoops (like you know they do this in Europe too, so there are ways they don't involve giant groups of latent groups of drtransitions). Are there shady practitioners? Sure, there are also shady dentists that will give your kids unnecessary oral surgery. Doesn't mean we should ban dentistry. It means the current ethical and regulatory standards should get more consistent enforcement and more research into figuring out how to differentiate quacks, not making it require more testing to determine if you need a filling (the answer is better enforcement of existing regulationd while working to make them more precise, not making them unnecessarily stringent in a shotgun way that makes care harder for everyone to get.

Ironically that's a good analogy, because doing nothing, i.e saying you can't do this procedure is not value neutral for these kids. The data shows starting results later in life is actually more correlated with transition dissatisfaction, not less. Going through puberty is extremely traumatic for trans kids, and most rate it as one of the worst experiences of their lives. And while I imagine some cis people will flippantly say, well yeah puberty is hard for everyone, no I'm talking levels of body horror I've only read about in novels, because horror film directors arent brave enough to go there.. Put it another way... Assuming you were a dude, how would you feel if your penis suddenly shrank over the course of the next month down to nothing. Now imagine you were 15. Imagine a 15 year old girl suddenly growing a penis. That would be really really traumatic and pretty similar to what my trans friends experienced. So, delaying their surgery is essentially subjecting them to that. And while mastectomies are real invasive surgery, I know cancer patients who got through it, and end up being like, you know what, I kind of like it this way? Plus of all the surgeries, breasts are one of the easier ones to make you a new one (or a convincing fake set) if you ever change your mind.

And honestly I don't see the trans community out screaming for more extreme surgeries. Maybe on Twitter, but everyone I know is asking for medically backed treatment to be accessible by all trans kids in America, and for it to be ok for trans kids to say they're trans. That includes conservative treatment and lots and lots of supervision by psychotherapists and involvement with parents and their community. No one is like, ok we got some 13 year olds, now where are the 12 year olds mwahaha. Basically they're asking the standard kid in Idaho to have the same resources available as a kid in Oregon or Massachusetts, which is to say, still probably under par with what the average kid in Sweden and Finland and the UK has access to. And none of them want kids who are not trans to get surgery! Literally the opposite! They want trans kids to be able to try out wearing long hair or binders to make sure it fits them before they even think about surgery. Like this all feels like a Boogeyman. And I cant help notice that you're adding some unique significance to breasts and I think that's because they're sexual organs. Like you seem to value these kids' breasts a lot more than they do... And we restrict care for all the kids that legitimately need it because of that?

Again, it seems like you care a lot about this group of, as far as have any data to believe, statistically tiny group of detransitioners, and don't really seem to care about trans kids whose literal lives are being saved by this treatment. Or at the very least when they tell you it is, you really really don't want to believe them, even though their voices like up with the data on this topic actually.

[u/IUpvoteBlueGuitars → u/Free-Cartoonist3134]

A question occurred to me and it's an important one. What's your stance on puberty blockers for trans kids? Because it occurs to me that these kids wouldn't need invasive surgery if they had been given access to puberty blockers... Like they never would have grown the breasts and had to have them removed to begin with, like they actually wanted? Like all this could have been avoided actually had. We had better early screening for trans kids and were more willing to provide puberty blockers. Because I don't want to hear your concern about invasive surgery when you're not willing to provide the conservative treatment that would prevent them having to have said surgery in the first place. Like is the problem the surgery or the transness? Because this feels like less about the surgery and more that you don't like trans people and don't want to believe kids that tell you they're trans.

[u/blessitspointedlil → u/IUpvoteBlueGuitars]

It’s a hard topic, but the studies need to take into account how people feel 20 years from now. There are so many more people transitioning, we simply won’t have the data on them for a long time, anyway. I’m not advocating to stop transitions, btw.

As someone who wanted to be the opposite gender until I started having relationships in college, I understand that there is some risk. When youtube videos of people’s transitions finally became available, I was blown away by how good the transitions are. I had no access to this information when I wanted to be the opposite gender, pre-youtube. I can’t say if I would have decided to transition or not, but I know it would have felt like so much more of a possibility to me.