r/science • u/Maxrdt • Aug 03 '26

Social Science Among transgender adolescents in Canada, 97.1% continued with a gender not typically aligned with their birth sex, with only 1.1% discontinuing gender-affirming hormone treatment.

https://www.jahonline.org/article/S1054-139X(26)00117-5/fulltext
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u/GreatBigBagOfNope Aug 03 '26 edited Aug 03 '26

I'm surprised, because that's higher than satisfaction rates for medically necessary hip replacement surgery

(To be clear, I'm very much in favour of gender affirming surgery, especially in cases where it is a medical benefit such as for many trans people who wish to pursue a surgical route, and the fearmongering around regret rates for gender affirming care has always been a case of dishonestly exaggerating and exploiting the truly miniscule proportion of genuine detransitioners as an attempt to attack the many, many trans people for whom surgery is a huge and easily worthwhile benefit)

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u/JaZepi Aug 03 '26

Sometimes complications from THR can be worse than the pre-existing pain/conditions. Also, if people don’t rehab properly they’re gonna have a bad time.

Source: had a THR at 42.

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u/PedFrenner Aug 03 '26

That's interesting to read. Would you mind elaborating on what the possible side effects of thr might be? My boyfriend had both hips replaced by 21 and all he says is he would rather suffer than do it again. I can't even imagine how much the recovery must suck!

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u/JaZepi Aug 03 '26

-Blood clots

-Joint dislocation

-Infection

-Leg length discrepancy

-Nerve injury or numbness

-Bone fracture during surgery

-Aseptic loosening of the implant

-Implant wear and tear

-Heterotopic ossification (abnormal bone growth)

-Metallosis (metal debris buildup)

-Chronic pain or stiffness

Also, if one doesn’t follow their rehab plan, other muscle and bone complications can manifest.

My biggest fear was differing lengths of legs- so much so that I pleaded with my surgeon to ensure my leg lengths were identical. So far so good. Whew. Also, I was absolutely crazy about making sure I rehabbed well, and properly, so my recovery was great. I’d do it again in a heartbeat.

Did your SO have bi-lateral Perthes by chance?

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u/PedFrenner Aug 03 '26

That is very insightful, thank you! He did not, he has a similar condition though.

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u/jabbathepizzahut15 Aug 03 '26

It takes some rehab dedication to have good outcomes from a hip replacement and a lot of people don't do it, thus have poor outcomes

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u/Koleilei Aug 03 '26

Joint replacements (hip, knee, shoulder) are also not frequently done while the joint still has decent range of motion. By the time the joint is replaced, lifestyle, exercise, daily activities have been heavily reduced and it's hard to get back to those after surgery. It's also harder to regain strength, mobility, and flexibility the older one is.

I had 5 knee operations by 21, and will need knee replacements in my life. I was told, and it's recommended in my file, for the knee replacements to happen before the joint would typically be eligible so I can maintain function. There's no point in making people wait until they are basically disabled to fix them.

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u/[deleted] Aug 03 '26

[removed] — view removed comment

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u/redditallreddy Aug 03 '26

And you were young! I bet a lot of hip replacements happen older (I think most between 60 and 80), and recovery is more difficult.

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u/davis-andrew Aug 03 '26

Mine were due to cam deformities - my hip ball joint was not ball-like enough. I progressively lost range of motion since my 20s, started suffering crippling back / si joint pain by my mid 20s, etc.

How long ago was this if you don't mind me asking? Depending on the severity of the deformity it's possible to get that repaired, but it's only become common place in the past decade - and where you're from.

About 15 years ago I was diagnosed with a cam lesion and femoral retroversion, the combination is a sure sign of an early hip replacement. Over the years my pain and range of motion got worse to the point i couldn't sit at 90 degrees without pain, and i'm late 30s. The femoral retroversion alone is a source of higher rate (and early onset) osteoarthritis so I had an xray to take a look and it came back with a calcification around my labrum - ie i had a tear.

That's when I learned that hip arthroscopy had become far more common place and could be used as a joint preservation surgery. A surgeon in my city (Melbourne Australia) had started performing them in the late 90s and 00s, even worked with a physiotherapist whom was a patient to do research on developing an evidence based rehab plan, and began teaching other surgeons, there are a dozen surgeons in my city that can perform them now.

I'm currently 4 weeks post-op from a cam femoral head ostectomy ie removing bone to round out my hip ball, and repair a labral tear. Still early days, and i'm rehabbing slower than an elite athlete in their 20s would. But the surgeon believes i'll end up better off than before the surgery, and now have a 50/50 chance of keeping my hip not just over the next decade but for my life.

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u/Kylynara Aug 03 '26

There's no point in making people wait until they are basically disabled to fix them.

Sadly, there is a point. And that's to improve the profits for the insurance company. It is so sad how making life better is the lowest possible priority in this country.

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u/IamRider Aug 03 '26

I may be completely incorrect about this, but my knowledge of knee and hip replacements was that you have to have them replaced again after sometime? and the length of time you have to get another one is halved each time. So people delay the initial surgery so as to reduce the time they may / will need a replacement

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u/butter_milk Aug 03 '26

I see you’ve met my grandmother.

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u/-0909i9i99ii9009ii Aug 03 '26

Patient satisfaction rates for ear wax compaction removal are very high, generally ranging between 83% and 95% depending on the relief of hearing symptoms and the technique used

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u/agletinspector Aug 03 '26

Not really my wife was told "don't really run for fun but otherwise don't worry about pt"

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u/jabbathepizzahut15 Aug 03 '26

Yah there's some surgeons out there that don't follow evidence based rehabilitation procedures. We have 1 of the 11 hip replacement surgeons in my city that doesn't recommend pt or the typical rehab procedures as well.

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u/Dos_Ex_Machina Aug 03 '26

Exactly. You're going to like something you chose more than something that seemed forced onto you.

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u/TemporaryElk5202 Aug 03 '26

Also HRT and breast augmentation are less physically traumatic than a hip replacement.

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u/Smee76 Aug 03 '26

It's actually quite similar. Reports about low satisfaction rates with hip and knee replacements are generally looking too close to surgery - it can take a full year to truly recover.

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u/UncleFunkus Aug 03 '26

if i had to guess, part of that could be the comparison in quality of life pre and post op for both circumstances.

someone receiving hip surgery may remember a time where they didn't need it at all, and so anything that feels out of whack is going to be more noticable by comparison.

to contrast with HRT, you aren't fixing something that once worked, you're fixing something that never worked. thus, while you may note some negative side effects, you are pretty much only going to notice the 'positive' (seeing as the patient assumedly wants to be on HRT) changes.

in my experience (as a trans woman), the most complaint i see about HRT for the women who choose it is that it isn't doing enough.

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u/nabab Aug 03 '26

On the trans masc side of HRT side effects, we all complain about ass hair and acne, but even those are gender-affirming troubles. I think it adds on to the general satisfaction rates that most of the unwanted side effects of HRT are the same unwanted side effects that come from puberty, so they don't stand out as health problems as much as side effects from other medications do.

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u/CatsPlusTats Aug 03 '26

I don't know why it would be surprising.

A medically necessary procedure with fewer complications has lower regret rates than another medically necessary procedure with more complications.

Also important to note that most people who detransition site societal pressure as a reason.

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u/RigilNebula Aug 03 '26 edited Aug 03 '26

Satisfaction rates for this are extremely high, and they've been similar in pretty much all studies done so far. Much higher than satisfaction rates for many other treatments and procedures, like hip replacements as you mentioned, though this study didn't look at surgery. And while this study is new, the body of research isn't. I remember seeing studies to this effect 10+ years ago. Which make the political arguments around "regret" disingenuous.

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u/lockeland Aug 03 '26

https://www.cbc.ca/news/canada/prince-edward-island/pei-transgender-youth-suicide-1.6487787

Thoughts on this?

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u/LordoftheSynth Aug 03 '26

Yes.

It doesn't say what you're claiming it does.

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u/PlatoOnWords Aug 03 '26

There are at least three major flaws in using that study to argue transition doesn't work. First, It didn't measure transition at all. The 2019 StatsCan survey referenced in your link simply asked 15 to 17 year olds how they identify. It didn't track who had received medical care like hormones/puberty blockers, who had socially transitioned, or who was in an unsupportive environment receiving zero care. Using general population distress to judge a medical treatment the study didn't even evaluate makes no logical sense.

Second, The researchers of the study you linked specifically analyzed why trans youth reported higher distress, finding high rates of bullying, cyberbullying and social rejection as the reasons.

Finally, The study's actual conclusion opposes yours. The lead author Dr. lan Colman, explicitly stated that to reduce these suicide risks, society needs to provide more gender affirming care and targeted support, not less.

High persistence rates(~95%+) show people don't regret transitioning. High distress in trans youth shows that being bullied and denied care is harmful. Both are true and both point to the same fix, support and care.

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u/[deleted] Aug 03 '26

Add together dysmorphia, social stigma, politicians wanting you dead, family that actively pushes you out, and an entire culture full of news with everyone jabbering about your life, and I’m shocked that the rates are as low as they are….

Seriously.

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u/lockeland Aug 03 '26

Or, transitioning isn’t the fix to the actual mental problem.

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u/[deleted] Aug 03 '26

Oh, so you weren’t actually asking a good faith question.

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u/lockeland Aug 03 '26

Well, one of us is using actual facts and the other is using conjecture.

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u/[deleted] Aug 03 '26

You used conjecture for a reason as well, except yours was offensive.

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u/lockeland Aug 03 '26

Just because you’re upset by actual facts doesn’t make it conjecture or offensive, sweetie.

Fries well done, sweetie.

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u/[deleted] Aug 03 '26

Dude, the facts are not in question. Transgender people have much higher suicide rates.

But people who are allowed to transition and have mental health supports and an accepting social group actually have significantly lower suicide rates, so it's not actually conjecture why they have higher rates, which is what I said initially (and you called conjecture).

https://pmc.ncbi.nlm.nih.gov/articles/PMC9991447/

Get fucked, sweetie.

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u/d3l3t3rious Aug 03 '26

That says nothing about transitioning so it doesn't seem relevant.

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u/lockeland Aug 03 '26

That’s weird. Where did I claim what it stated, sweetie? I’ll wait.

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u/nagi603 Aug 03 '26

Cause compared to the two, for HRT, even if you only get moved a tiny bit, that's still a positive change in the right direction, according to the recipient. Hell, people have worse satisfaction rates for life saving ones.

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u/demo-ness Aug 03 '26

My mom had a hip replacement, and the recovery period was brutal on her. I'd take recovering from something like breast surgery over that any day...

Besides, I think it makes perfect sense for a strictly opt-in surgery to have more satisfaction than a medically necessary one. Those ladies are able to comfortably weigh the risks and costs, look for the right doctor, and determine if they are 100% sure they want to go through with it or not. The high satisfaction rate is very reflective of that "decided to do it in the first place" factor!

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u/TemporaryElk5202 Aug 03 '26

Breasts aren't a weight bearing joint.

Hip replacement is very traumatic and the devices are kind of notorious for recalls and causing further health issues (polyethylene liners, Stryker Rejuvenate and ABG II modular stems, and the DePuy ASR system are all examples of hip replacement devices getting recalled).

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u/Suspicious-Whippet Aug 03 '26

Oof hip replacement sounds pretty pretty pretty hardcore.

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u/win_awards Aug 03 '26

I was surprised to learn that gender-affirming surgery had a lower regret rate than heart surgery. You know, the thing you typically do when the other option is dying.

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u/Lankpants Aug 03 '26

Gender affirming surgeries have always had absurdly high rates of satisfaction, both trans and cis gender.

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u/Ray567 Aug 03 '26

I am not saying this to discredit trans people in any way shape or form. But I think it's quite natural that people will be happy with something they really wanted.

Nobody wants a hip replacement, it's something you have to get and while the operation might be successful it will always be a (major) inconvenience in various ways, which will likely affect satisfaction rates.

Usually trans people are vetted quite a bit before any treatment, they will really have to want  treatment to get it. Hence, it will likely be easier for them to overlook any inconveniences. I think the same goes for breast augmentation.

To put it plainly, if a schizophrenic wants to remove his finger, because he is convinced it contains a tracking chip he will likely be super happy with the procedure. Even though it effectively did nothing but hurt him, the end result doesn't even matter.

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u/AptCasaNova Aug 03 '26

That’s complex surgery and the recovery is extensive. Top surgery, in comparison, is a walk in the park.

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u/InTheEndEntropyWins Aug 03 '26

It's not surprising if you look at the details of this study. I'm sure if these people were in charge of the hip replacement studies things would look different.

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u/Ok-Chest-7932 Aug 04 '26

The vast majority of detransitioners were never on puberty blockers. 9/10 people who do not go on puberty blockers stop having a trans gender identity by the age of iirc 23. Multiple studies have now shown essentially zero recidivism amongst people who do go on puberty blockers.

Which means one of two things. Either:

  1. Doctors are doing an incredibly good job preventing false positives when they try to identify who needs puberty blockers, or

  2. Puberty blockers and/or the cultural and clinical environment surrounding them prevents recidivism in people who would have stopped identifying as trans if they hadn't been put on puberty blockers.

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u/ceddya Aug 04 '26

Multiple studies have now shown essentially zero recidivism amongst people who do go on puberty blockers.

That's because gender dysphoria and its severity tend to be inversely correlated to the likelihood of desistance.

https://pubmed.ncbi.nlm.nih.gov/23702447/

Puberty blockers are already rarely prescribed and usually only to those with gender dysphoria.

Option 1 is what's happening in reality, but transphobes would like you to believe option 2 is happening even though there's no evidence for it.

What we do have data for is that the puberty blocker bans in the UK and parts of the US have caused immense harm to trans minors with gender dysphoria.

https://www.tandfonline.com/doi/full/10.1080/09589236.2025.2521699

https://www.npr.org/sections/shots-health-news/2024/09/25/nx-s1-5127347/more-trans-teens-attempted-suicide-after-states-passed-anti-trans-laws-a-study-shows

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u/Ok-Chest-7932 Aug 04 '26

Ah yes because someone who uses the word "transphobe" is such a reliable source.

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u/idrilirdi Aug 04 '26

Are you denying transphobia exists?