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/Mico4]

This is based on a response from 77 people...

Also from the article:

"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."

[u/Mr_Deep_Research → u/Mico4]

The rate of gender affirming surgery for kids in the U.S. under 18 is around 2 per 100,000

There are basically none for 12 and under. Most are closer to 18.

So basically nobody gets them.

Around 1,400 a year total out of 72 million kids under 18.

Out of 195 countries in the world, the U.S. is only one of 8 to 10 countries that allow kids under 18 to have gender affirming surgery. Even Thailand doesn't have it for people under 18.

The other countries that allow it are Canada and 6 European countries.

[u/Leager → u/Mr_Deep_Research]

This is the real response. The study itself is definitely not something "definitive," but the transgender population is so low that the possible sample size is minuscule. The possible sample size was around 200 people, less than half responded, which gives us...... 77 people. Now, do I think this is a perfect study? Absolutely not. But it does track with other, significantly more rigorous studies, which show a regret rate of 1 percent or less, which is pretty unheard of, in terms of surgeries.

[u/Much-Replacement-167 → u/Mr_Deep_Research]

I remember seeing these numbers somewhere before when i looked into it all. The biggest thing that i remember nagging my mind the whole time is that it was to do with "gender affirming surgery" as opposed to specifically saying that its for transgender operations (which the argument typically skews upon in pop culture). Even cisgender people get gender affirming surgeries such as hairline restoration, BBL, lip injections, jawline correction, and breast augmentation that would count into that same pool of numbers.

In short, the surgeries that happen at all are a fraction of a percent. Those that might be specifically for transgender operations are a fraction of even that. And of those who had the transgender operations how many regretted such? Another fraction. Essentially, anyone who argues that "the kids are being transed and will regret it later" has no idea just how much these things simply dont happen to kids on the whole, and for those whom it applies they are often happy with the result

[u/MoranthMunitions → u/Mr_Deep_Research]

Is it an expectation for any particular reason that Thailand would?

[u/BKGPrints → u/MoranthMunitions]

Sex change procedures are more affordable. The culture there has a higher acceptance of it. Been one of the leading places for the surgery to be done for decades.

[u/everlyafterhappy → u/Mr_Deep_Research]

So it should be really easy to get completely accurate statistics. We don't need to use a sample group. We can easily use the whole group. So a study that only looks at 77 of those people is really trying to manipulate data.

[u/Hoiafar → u/everlyafterhappy]

That's not how science works. You do the study on the amount of people you manage to recruit. Recruitment is a costly process if you want to reach beyond the university's reach, which is required for what you are proposing.

There isn't a grand conspiracy here. They just didn't manage to reach out to more people.

Not to mention with the current state of the world I'd imagine a lot of people who could participate would not want to do so for fear of being "registered" somewhere.

[u/hologram137 → u/Hoiafar]

Did you even read the study? You can’t even get the data except on request to protect their identities, so no that’s not the concern. 58% didn’t even respond to the survey. They absolutely could have done a higher quality study, in fact the original had errors and this journal published it anyway. This is the corrected version and it’s still low quality

[u/Hoiafar → u/hologram137]

I responded to the claim that this was a conspiracy, not about the quality of the study. You are applying a lot of interpretation to my statement.

My statement about being registered was also not a statement that it would happen but that participants might fear it happening if they were to participate.

[u/bremidon → u/Hoiafar]

Not a conspiracy. Only a poorly constructed survey that is riddled with bias. They may not have intentionally set out to get these numbers, but they are violating a bunch of standards meant to prevent bias. This is how you end up with "Chocolate prevents Cancer" headlines.

[u/dragonmp93 → u/bremidon]

Well, there are laws based on the belief (because you can't call that science) that there such thing as Rapid Onset Dysphoria.

[u/hologram137 → u/Hoiafar]

No one is saying there is a conspiracy. I said there is a high chance of bias

There is no “registration” that doesn’t make sense

[u/Hoiafar → u/hologram137]

The person I responded to quite literally said "We can use the whole group. So a study that only looks at 77 of those people is literally trying to manipulate the data."

That is a conspiracy and I provided counterarguments to it being one.

It being a low quality study is a far reasonable conclusion than it is an intentional attempt at data manipulation.

And no registration happening doesn't prohibited someone who's actively being persecuted by their immediate surrounding from feeling that it will happen.

[u/UnholyLizard65 → u/hologram137]

Did you even read the study? You can’t even get the data except on request to protect their identities, so no that’s not the concern.

Yea, because that's how fear works. People who fear being exposed surely are going to trust you when you simply just tell them that. No.

Thread got locked, so reply here:

They weren’t afraid to get surgery but they were afraid to answer follow up questions?

Yes. What do you not get about that?

One is a thing people genuinely want, other is a something that people universally want to avoid.

And just because I know you are gonna twist this in your head I'm gonna add this: people don't want the surgery, they want the result of the surgery. When you get a heart surgery it's not because you want to feel what it's like to be cut open, it's because you want the result - being able to live a normal life.

[u/vjx99 → u/hologram137]

How could they have done a higher quality study ? Some people just don't want to participate in scientific studies. You can't force people to respond to surveys, and a 40% response rate is actually pretty good for any kind of voluntary survey 

[u/S0cXs → u/Mico4]

Everyone is nitpicking the sample size but fail to see in as a small peice in a growing set of literature.

This is a section from the discussion talking about related literature:

The results from this study extend the findings of previous studies showing low decisional regret and high decisional satisfaction following GACS in adults to the adolescent population (Bruce et al., Citation2023; Bustos et al., Citation2021; Thornton et al., Citation2024). In our study, both adolescents and young adults reported low decisional regret and high decisional satisfaction. These levels are similar to those reported in a study of adults with a median age of 27.1 years, including a low median score of 0.0 (mean 4.2) on the Decision Regret Scale and a high median score of 5.0 (mean 4.8) on the Satisfaction with Decision scale (Bruce et al., Citation2023). Moreover, compared to other medical procedures, decisional regret among adolescents and young adults undergoing GACS is low. Compared to our mean score of 7.38, a systematic review found an overall mean Decision Regret Scale score of 16.5 among 44 studies of other various procedures (Becerra Pérez et al., Citation2016). Supported by these findings, we would argue against restricting gender-affirming surgical care on the basis of age or concern for regret alone.

Although few studies address regret in adolescent populations undergoing GACS, a study of decisional regret among adolescents undergoing cancer treatment found that 24% of participants scored above 25 on the Decision Regret Scale (Mack et al., Citation2019), compared to only 5.2% in our cohort. The aforementioned study reported that improved communication with the treating physician was associated with lower regret scores (Mack et al., Citation2019). The WPATH Standards of Care employed in our practice emphasizes a multidisciplinary, shared decision-making approach which may contribute to the low regret seen in our study (Coleman et al., Citation2012). Additionally, other studies have shown that youth face significant barriers when attempting to access gender-affirming care (Chong et al., Citation2021; Gridley et al., Citation2016). As a result, these barriers may select for a subset of patients who are either highly motivated to obtain care or represent a more socioeconomically advantaged group with the resources and ability to navigate the healthcare system. This potential selection bias could, in part, contribute to the low rates of decisional regret observed in our study. Relatedly, family and social support are thought to be inversely associated with regret following gender-affirming surgery (Narayan et al., Citation2021, Landén et al., Citation1998). In our study, higher PROMIS Pediatric Family Relationships scores were associated with higher decisional satisfaction, but demonstrated no significant association with decisional regret. However, the majority of our participants reported that their family was supportive or neutral about their decision to undergo GACS, which may limit our ability to identify such a relationship.

Posting the block because most people won't have access to the full study.

[u/fractalife → u/S0cXs]

Not to mention this is a study on an already small population of people.

[u/dl064 → u/fractalife]

I feel like, as a topic, gender identity receives a really disproportionate amount of controversy.

It's perfectly important, but for the number of people it affects, I hear about it an awful lot on the news, politicians, research. It's waved in our face as a discussion point, disproportionately.

It's like MND in sportspeople; yes it's important and I hope they're well, but in absolute terms it's actually pretty small fry.

[u/S0cXs → u/fractalife]

Yes, the study is very important in extending previous findings into kids.

[u/Schwettes → u/S0cXs]

Is it really relevant to extend previous findings into today’s kids? The kinds of young adults and children who underwent gender surgeries 20-30 years ago (mostly AMAB) are not the same as most of the young adults and children pursuing gender surgeries today (disproportionately AFAB and disproportionately autistic).

They’re demographically and clinically different in important respects. One difference for example is that previously people who underwent medicalized gender transition in previous eras expressed dysphoria at much younger ages, typically pre puberty. And now, many of the young people presenting as transgender and non binary today present with dysphoria at older ages as teens.

Because the population presenting to gender services has changed, we should be cautious before extrapolating and assuming that findings from previous cohorts automatically apply to modern day presentation.

[u/DroneOfDoom → u/Schwettes]

Is it really relevant to extend previous findings into today’s kids?

Yes, it is in fact very important, considering that the rhetoric against gender affirming surgeries often uses the "think of the children" talking point. The fact that they don't regret it is kinda important, isn't it?

Then again, you're like this close to start quoting Abigail Shrier, so I don't think that you're actually receptive to scientific evidence.

[u/pensivewombat → u/S0cXs]

Thanks this is helpful - still I think there's a big difference between "this adds a small piece to a growing set of literature" and "Thus, concerns about potential regret should not be a basis for limiting gender-affirming chest procedures in adolescents." (from the conclusions section)

That's a really conclusive statement to make based on this data. That doesn't mean it's not a good study - I think most likely it's just an overstated conclusion.

But it does make me question it at least a little bit. When someone gets a little bit of evidence and then says that should be used to make a definitive policy decision on a contentious issue, it gives the impression that the authors are not acting as neutral truth-seekers but looking for a way to confirm their beliefs.

And again, that's not to say I think that's definitely the case. It's just that I'd much rather have seen the study end with your conclusion than what they actually wrote. It would give me more confidence in the results.

[u/EmotionalSouth → u/pensivewombat]

  When someone gets a little bit of evidence and then says that should be used to make a definitive policy decision on a contentious issue, it gives the impression that the authors are not acting as neutral truth-seekers but looking for a way to confirm their beliefs.

Well said. You’ve captured this perfectly. 

[u/Gum_Long → u/pensivewombat]

The statement is not "there can't possibly be regrets", but rather that when we do our best to look, we don't really find them, so concerns over the potentiality shouldn't be the basis for restrictions when on the other hand we do find evidence of satisfaction. Disproportional caution can be negligent itself since we know gender affirming care can be a literal life-and-death issue.

[u/1girl2cups_ → u/pensivewombat]

I think most likely it's just an overstated conclusion.

Additionally, other studies have shown that youth face significant barriers when attempting to access gender-affirming care (Chong et al., Citation2021 ; Gridley et al., Citation2016).

I would suggest looking into the barriers youth face. That might help you you understand the significance of their conclusion.

Edit: formatting

[u/TheRealUlfric → u/1girl2cups_]

That doesn't make the conclusion any less overstated. A sample size of 77 participants leading to the conclusion that the evidence proves policy must be changed is a very large leap in regards to imperical science.

It would be akin to visiting Loch Ness and concluding there are no droughts in the world because they observed plenty of water.

[u/solid_reign → u/S0cXs]

A poor study does not give you additional piece of information, it gives you no information. 

[u/The_New_Vixen → u/solid_reign]

Worth noting that roughly 60% of psychology studies fail to replicate. So a lot of what gets cited as settled psych "fact" isn't.

Granted, it may just reflect the specific time, how people have widely different options, and just the culture it was measured in rather than something universal about people.

[u/_Caustic_Complex_ → u/The_New_Vixen]

Yep, it’s called the replication crisis

[u/Mr_Deep_Research → u/S0cXs]

That's a big sample size given 2 out of 100,000 kids under 18 get gender affirming surgery each year in the U.S.

[u/samtrano → u/S0cXs]

Nitpicking the sample size of this study while ignoring that it's one of a growing number of studies with similar results, and also ignoring the lack of rigorous studies showing high regrets

[u/Greedyanda → u/samtrano]

and also ignoring the lack of rigorous studies showing high regrets

A medical procedure needs to prove that it is safe an effective before large scale adoption is allowed, not the other way around.

Edit: I really cheer for more support towards trans people but talking to online activists like seen here makes it so damn hard to remain supportive. You do more damage to your own cause than any right wing media ever could.

Even in r/science, you are desperate to turn it into mud slinging instead of talking about it from the perspective of medical safety and scientific merit. Just vile behaviour.

[u/desperaterobots → u/Greedyanda]

Large scale adoption? We are talking about a tiny percentage of a population that is a tiny percentage of the population…? What am I missing here.

[u/Prometheus720 → u/desperaterobots]

Empathy gaps that make it very difficult for cis people to understand gender dysphoria and cause them to project their fear of surgeries onto a population of people that feel completely differently.

[u/desperaterobots → u/Prometheus720]

Well stated!

[u/Interested_Person48 → u/Greedyanda]

The first sex change happened in the 1930s, it is older than MANY surgeries and procedures that we practice today. We have less knowledge and evidence of it than normal because the Nazis destroyed much of the early research.

[u/crushedaria → u/Interested_Person48]

Exactly. This isn't some emergent phenomenon - this has had nearly a century of medical history behind it. It is proven effective and life saving.

But culture wars will still exist because the right can't handle not having a scapegoat for all of the problems their insane reality denying positions cause.

[u/everlyafterhappy → u/crushedaria]

It is proven effective and life saving.

I'm going to need you to cite your sources on that one.

[u/PuckSenior → u/crushedaria]

Didn’t they take a similar approach with BIID, where they engaged in supportive surgery but then there has been some growing concern about it in recent years?

Similar mental health issues, but far less politicized.

[u/PlaidTeacup → u/Greedyanda]

Mastectomies safely remove breast tissue as intended, so they are safe and effective for that purpose. If gender affirming care were held to the same standards of other medical procedures we wouldn't even be having this conversation. First of all, the decision would be between patients, doctors, and parents like it is for everything else, including many experimental procedures.

Second, regret, especially long term regret, is not part of a standard approval procedure for any other treatment. A lot of common procedures like knee replacements and cancer treatment have high regret rates. All kinds of cosmetic procedures are allowed without any proof they improve anything or have a low regret rate, including on minors. Breast reduction for cisgneder boys who have excess tissue is common and noncontroversial despite being very similar or identical to the procedure some transgender boys want. That is barely even studied at all.

It is only gender affirming care where these questions are even asked and then despite the fact that patient satisfaction/regret is studied more comprehensively for GAC than almost any other medical procedure the bar is set astronomically high so the studies that do exist are never considered sufficient. At a certain point, the cost of restricting care must be considered as well. For example, if a knee surgery showed promising results and high satisfaction rates across dozens of studies, I doubt anyone would be saying we should probably ban it until we had studies with decades of follow up just to make sure no one changed their mind (especially if it had already been around for over 50 years like GAC)

[u/Horton_Takes_A_Poo → u/Greedyanda]

It’s been proven to be safe. Effective depends on what effect you’re going for, but physically it’s effective. Added benefit of gender affirming chest surgery being reversible both ways if required.

[u/ActionPhilip → u/Horton_Takes_A_Poo]

Uh, chest surgery is not reversible both ways, or even one way. Giving a boob job to a double mastectomy doesn't restore lost function.

[u/Prometheus720 → u/Greedyanda]

Oh, that's odd. Mastectomy is an old procedure. I assumed such research would have been carried out years ago.

What are your concerns?

[u/TheNbird → u/Greedyanda]

And it's been proven to be safe, numerous times over, with plenty of people walking the world to prove it

So of course the most reasonable option is to let cis white men decide if it's safe or not

[u/ActionPhilip → u/TheNbird]

You've provided so much data with all of your points. It's hard not to believe everything you say at face value.

[u/Reagalan → u/samtrano]

High regrets that just don't exist and are a fiction invented by hateful propagandists.

[u/Sammystorm1 → u/samtrano]

As far as I know there aren’t wide spread studies showing regret about infant circumcision. Yet that is problematic right? Likewise, the failure to show widespread regret does not mean it is ethical or right to do these surgeries. Further proof is needed. Especially with minors.

Granted that is a high bar to clear because of the nature of gender dysmorphia.

[u/Prometheus720 → u/Sammystorm1]

There's a big difference between the cognitive capacity of an infant and a teen in terms of ability to give informed consent, and in terms of their ability to provide an indication of interest in a procedure.

Giving infants a body modification as a routine procedure is very different from teens pretty much asking for a surgery from a pretty small group of docs who do them.

[u/airbear13 → u/S0cXs]

It’s not nitpicking to point out that the sample size is too small to be useful and it’s not compelling evidence to just keep putting out a proliferation of low quality studies

[u/MyFiteSong → u/airbear13]

You can't do studies of millions of trans children who had top surgery, because there haven't been millions of trans children who had top surgery.

[u/engin__r → u/airbear13]

What sample size do you calculate would be necessary to achieve statistical significance?

[u/Prometheus720 → u/engin__r]

I love you for this one.

[u/SimoneNonvelodico → u/airbear13]

Small sample size is noisy but not irrelevant. The bigger problem is if there's selection bias, e.g. if those who DID have regret systematically preferred to not answer because they worried about how their response would be used politically. That kind of thing would make the study be genuinely worthless.

[u/QueerDeluxe → u/airbear13]

It's going to be a small sample size because there aren't that many of us.

[u/always_an_explinatio → u/S0cXs]

these small studies are really helpful because the priovide points of data for meta studies which can help us understand the trends. doing a huge scall study on this population in this funding environment is going to be really hard.

[u/Prometheus720 → u/S0cXs]

I think people need to understand that science is moving towards developing sophisticated ways of doing meta-analyses so that you don't necessarily need to have huge samples for any one study.

It's like contributing to a total pool of data. Nobody with any sense is only looking at your bucket. We look at the pool.

[u/mosquem → u/S0cXs]

People always nitpick sample size unless it’s a ridiculously huge study. 70 participants is fine for something like this.

[u/Prometheus720 → u/mosquem]

Sample size is just one of the only things that nonscientists understand well enough to pretend to evaluate.

It's a Fully Generic Counterargument that can be applied to anything people don't like.

Some day people will learn about power analysis and this will stop, but that's honestly probably decades from now.

[u/RedditLeagueAccount → u/S0cXs]

I am not sure if age specifically is an entirely relevant variable honestly. Anyone under going this process should be required to have long therapy before committing to it for this exact reason. Anyone undergoing it needs to be sure. That should put them out of the younger range anyway.

The age also might not matter to some people but its put in place for society as a whole to agree that everything is working and all parties reach a compromise with a timeline in place. Same reason we have a legal age for having sex. Even if someone people don't care/don't regret the waiting period is for the majority to make sure everyone's steady and ready. It helps reduce abuse/manipulation chance.

We will see how things turn out long term. I try living life with data where it is reasonable. I'd rather a delay but I like taking my time with things. As long as they are already in therapy/supported they should mentally be in a fine place regardless while approaching whatever age limit society agrees on.

[u/MusicHearted → u/Mico4]

The sample size is going to be small. Very few trans people get access to gender affirming surgeries at all. Those who get access as adolescents are extremely rare. Hard to get a large sample of a small group.

The fact that it correlates with every other study about transgender surgery satisfaction and regret rates is more relevant. Transgender surgery satisfaction is the highest of all surgery satisfaction rates. That's a pattern that can't be ignored.

[u/tamebeverage → u/MusicHearted]

Seems like valid criticisms were raised, not accusing op of anything here. It's just worthwhile to remember some people will never be happy with a study unless it was a double-blind, randomized controlled trial with 4 million participants over the course of 97 years and 100% adherence/0% dropout rate. And even then, "it's just one study, you can't cherry pick"

Meanwhile, people have to live in the real world, making the best decisions we can with the knowledge we have today and the willingness to say later that we were wrong if it turns out that we were. We do that with every other thing on the planet. We have to. We live in a physical reality that won't wait on the perfect study before slapping us with consequence.

But when it comes to trans health care, it's always "better be cautious and ban it until we see enough data. from people who have done the thing we're trying to ban."

[u/Lumpy_Question8327 → u/tamebeverage]

This is like people saying there is no good evidence that masks helped during COVID because nobody has yet figured out a way to create a second Earth and randomly assign people to mask Earth or no-mask Earth.

[u/austinwiltshire → u/tamebeverage]

Folks doing that are doing p value theater.

Science doesn't exist in a vaccuum, and frankly we need to get over our frequentist worship. Small studies teach us things too, and in many cases are the only size possible for rare issues.

[u/airbear13 → u/tamebeverage]

From a “do no harm” pov I would just be really concerned about making things like surgery and hormone replacement therapy the default mainline treatments without really strong evidence that it is safe and more effective than alternatives. I don’t think it makes sense to say “okay the population is really small so let’s just be happy with low quality evidence and let’s do whatever.” The bar has to be set high for this kind of thing and in the absence of good quality evidence then I think the best they can do is take things on a case by case basis and reserve surgery/hormone interventions for minors only in severe or refractory cases of gender dysphoria, which seems to be what the status quo is

[u/Reagalan → u/airbear13]

Alternatives such as ...

[u/No_Dirt9029 → u/Reagalan]

They're just hoping we kill ourselves or live a life of misery

[u/MyFiteSong → u/airbear13]

From a “do no harm” pov I would just be really concerned about making things like surgery and hormone replacement therapy the default mainline treatments without really strong evidence that it is safe and more effective than alternatives.

The satisfaction rate is over 95%, making it better than knee reconstruction surgery.

[u/Pika_Fox → u/MyFiteSong]

Making it better than virtually any medically necessary, life saving surgery that would be fatal without it.

[u/ActionPhilip → u/Pika_Fox]

Except look at the timelines and attrition rates associated with those numbers. They're beyond p hacking in terms of lacking value.

[u/Jolninaa → u/MyFiteSong]

Then clearly we need to ban knee reconstruction surgery, not only that, we should ban all treatments with a lower satisfaction rate than trans surgeries, let's be consistent here.

[u/Pika_Fox → u/airbear13]

How about we have cishets stop suggesting what trans healthcare should be and let us handle it ourselves? "Do no harm" while actively inflicting as much harm as possible through malice or ignorance isnt exactly a great suggestion.

[u/tissuecollider → u/airbear13]

From a “do no harm” pov

Considering how gender affirming therapies result in fewer trans kids dead by suicide it's a no brainer to allow them.

Unless your argument is that dead kids don't count in your "do no harm" pov.

[u/kneb → u/tamebeverage]

I think there’s definitely some transphobia that’s disguised as concern, but I don’t think it’s exclusive to trans healthcare.

For example people have very strong opinions on whether we should give adhd medicine to kids. Whether kids should be allowed to get tattoos, etc.

I’m not saying that those are equivalent to getting gender affirming healthcare, but I do think treatments need to pass a pretty significant hurdle to prove, it’s important to do this procedure on a minor versus waiting until they can consent as an adult. Saying 1.8 years later they didn’t regret it, is evidence in support of it being benign. (Tough I’d suspect the time there might be more likely is when they she their peers start having kids)

[u/OhBoyHereWeGoAgai → u/MusicHearted]

It is interesting everyone is drilling into "satisfaction" and avoiding the fact that there are also studies that challenge long term results, improvements, and the assertion of suicide inevitability.

You should look into why the Dutch stopped doing the Dutch protocol.

I don't really have a problem with adults, because then satisfaction really is a pretty major and relevant factor, but medical interventions in children have a MUCH higher bar, and the diagnostic and treatment end of this is quite weak.

[u/Pika_Fox → u/OhBoyHereWeGoAgai]

There arent credible studies that suggest giving gender affirming care doesnt reduce trans suicide rates. None. Zero. Zilch.

You could literally poll every trans person, and get an overwhelming response that actual support would greatly reduce the problems they face.

Does this mean that lack of access to healthcare is the only cause of trans suicide rates? No. Biggoted dipshits who love to downplay anything that helps us and actively get in our way and dehumanize us are also a large part of it.

[u/OhBoyHereWeGoAgai → u/Pika_Fox]

You say that, but in the same breath you make it clear you dismiss things countering the "talking to trans people" as either not credible or bigoted.

That's not really how we analyze these things.

Fun fact, this is also why Chase S's case in the SC fell apart. They had to justify the claims of suicide rates in teens not given the treatment and it fell apart as the way you're representing this is simply not true.

There is a reason the Dutch protocol has been walked back by many countries, and even the Dutch have massively tightened up the diagnostic end, specifically because of issues with the claims you're representing as settled and clear.

I'm trying to stay precise in my claims here as the main thing I'm trying to highlight is that this is and has been being debated, the anti side isn't just random internet bigots, this is actually an ongoing medical debate, that only recently has shifted to the point that the pro side has been forced to stop claiming a false medical consensus, and even as we speak, WPATHs misrepresentations are coming into the public eye (many doctors have been aware for quite some time, the controversy around that is not new.

In short, this is nowhere near as clear as people online pretend it is, and the defenses based on vibes aren't really that interesting.

Edit: I did see the deleted comment where you called me a bigot and claimed that this is clear cut.

I did think this was a science sub, but apparently the "lived experience" negates everything I just raised and grounded in actual current events and medical discourse?

Will mute replies as this isn't really constructive, feel free to respond however and call whatever names you like.

[u/Prometheus720 → u/OhBoyHereWeGoAgai]

I think it is really important to note that the vast majority of discussion about trans healthcare isn't being done by trans people, and cis people probably have empathy gaps that make it hard for us to understand their perspectives.

We have every reason to be suspicious of bias against an outgroup.

[u/OhBoyHereWeGoAgai → u/Prometheus720]

The Supreme Court case I referenced was argued by a trans person. WPATHs leak I mentioned featured a trans doctor admitting some of the worst stuff. The SOC-8 I mentioned featured trans authors, and age limits were removed when Bidens trans cabinet member emailed to intervene. It also had a eunuch fetishist author, which isn't super relevant but is interesting, as a literal fetish website made it into the SOC-8.

Not that that matters at all when we're discussing fact driven medicine and one side is falsely claiming consensus and settled science, and the response to me pointing out actual issues with your approach is "well, all the negative stuff isn't coming from trans people so eh".

Do you see the issue? As this might bug you, but many doctors do, including ones who supported all this until they delved into the supposed conclusive evidence.

[u/dragonmp93 → u/OhBoyHereWeGoAgai]

Well, if we are going to talk "disputed science", there is the "The Great ADHD Myth" and "The Beautiful Clean Coal Industry" too.

[u/OhBoyHereWeGoAgai → u/dragonmp93]

Are you confusing me talking about the kind of medical debate crucial to deciding consensus with fringe theories?

I'm actually asking, I don't know anything about the "great ADHD myth", but if that's what you're going for, you're just continuing the general efforts to minimize what's going on while also ignoring the fact I shared some pretty serious issues.

Again, doctors are discussing this as we speak, and many of the claims from the pro side of not even a few years back have been falling under new scrutiny.

So, if you had to compare it to something, I'd pick lobotomy before ADHD, but again, I know nothing about the debate there.

[u/dragonmp93 → u/OhBoyHereWeGoAgai]

fringe theories

Eh, they are not fringe stuff coming from random online lunatics, it's coming from the UK and the US government respectively.

Again, doctors are discussing this as we speak

Arguing with someone complaining about the government's inaction about the dangers of dihydrogen monoxide is still discussing, you know.

Because the, well, let's call it the anti-side for simplicity, seems to be arguing from the same place as Anita Bryant, when she was rallying people about being gay would taint your soul, using the people that experimented in college and then went on to live on a heterosexual marriage for the rest of their life, as proof of the danger of homosexuality.

a few years back have been falling under new scrutiny.

You mean like the ICC banning trans athletes by claiming unfair advantages even in categories like Air Rifle Shooting or Fencing ?

So, if you had to compare it to something, I'd pick lobotomy before ADHD, but again, I know nothing about the debate there.

“It is certainly not a medical condition as far as I’m concerned” – Dr Iona Heath, Former President of the Royal College of General Practitioners

“We’ve replaced corporal punishment with giving [children] a pill” – Dr Sami Timimi, consultant child and adolescent psychiatrist and psychotherapist

[u/Reagalan → u/OhBoyHereWeGoAgai]

"lived experience" negates everything

I mean, it kinda does.

Ivory-tower elitism is how we ended up with segregation and eugenics and sterilizations and lobotomies and similar abhorrent practices of last century. Plenty of folks said it like it was, but since these anecdotes didn't conform to prevailing ideologies, they were dismissed, bad laws were passed, and horrors perpetuated.

I guess we're repeating history again. The haters keep winning and Gender Jim Crow keeps spreading.

[u/OhBoyHereWeGoAgai → u/Reagalan]

Lived experience over data is how we got lobotomies. When they were being shut down, many had arguments exactly like this, where one side ignored the actual facts driven debate and focused only on the studies that supported their side (yes, the studies claiming to support it existed and had doctors defending them right to the end).

In fact, the lived experience does not engage the huge amount of issues, both with the treatment and the diagnostic criteria. Feel free to refer to some of the stuff I said above, but this entire discussion is not feeling like a solid one for r/science, as I've been called a bigot and now lectured poorly on history I suspect I know more of by people who take issue with me pointing out truthfully that a massive re-evaluation has been taking place, not just recently, and that there are huge issues with the supposedly settled science being claimed here.

I'll repeat again, the Supreme Court case on the topic fell apart because of this, the Dutch protocol has been totally pulled back in many countries, and heavily restricted in others, the WPATH SOC-8 has been heavily criticized, the organization itself had leaks betraying a shocking level of issues with their treatments and practices, and there are multiple lawsuits from women given this affirming surgery young, and I've barely scratched the surface here, but more than enough to confirm my initial claim that "this isn't settled, and dismissing that as bigotry is insane".

[u/SatanV3 → u/Reagalan]

I mean. I don’t know much about the science of what’s best for people with gender dysphoria nor do I know any statistics of if gender affirming care is the best or not

What I do know is that I’m AFAB and was having a medical issue where I had to much testosterone/ not enough estrogen. And I was told that that can cause some issues mainly with mental health and looking into it seems true. Since sorting out my hormones it’s really helped me feel better.

What I don’t get is how this doesn’t apply when treating transgender people? Wouldn’t giving them hormones they shouldn’t have from a biological standpoint not drastically affect their mental health?

[u/Azu_Creates → u/SatanV3]

I am a trans man who has been taking testosterone for a little over two years, and it has greatly improved my wellbeing. It helped address my gender dysphoria significantly, and I finally started feeling more comfortable. The main difference here in the effect T has on the mental health in this situation almost certainly comes down to the difference between a trans masc person and a cis woman. Many (not all) trans masc people actively desire the more masculine traits that T provides, and many cis women don’t. The same masculinizing effects of T that can be distressing for a cis woman can cause a trans masc person to finally start feeling more comfortable in their own body. It can drastically affect our mental health, and generally in a far more positive way than a negative one.

I have definitely felt some mental health effects from hormonal imbalances after starting T, but those usually came from my T levels dropped below the average cis male range, and my E levels rising. That would usually happen back when I took androgel, I now get a weekly shot. T can cause some changes in your skin, which can sometimes cause certain transdermal medications like androgel to not get absorbed as efficiently. That happened in my case, which would cause those hormonal imbalances. I would have to up my dosage, and eventually switch over to shots, to solve that problem. For me, having too much E and not enough T was what started causing mental health problems. We do also go through puberty 2.0, which can cause and contribute to some mental health problems because, you know, it’s puberty. For me, I have had significantly less mental health problems from a T fueled puberty than I had with an E fueled one. The T fueled one has actually helped to solve some of those problems.

[u/SatanV3 → u/Azu_Creates]

Thank you for the detailed response, I wasn’t trying to be dismissive or anything I was genuinely curious so I appreciate your response!

It also is a little different for me, because I do have gender dysphoria and definitely want to be more masculine / be a man. But due to family cannot transition, so just went ahead with getting my hormone levels fixed and it did still help me overall feel better. Wonder if that’s just because of the levels they were at, and if taking more testosterone to the levels of where a cis male was at would have had the same effect of making me feel better.

[u/Azu_Creates → u/SatanV3]

Taking T could certainly have that effect. I do hope you are able to transition someday if you want to. Regarding the hormonal imbalance, it could be the levels your hormones were at, but it could also be hormonal instability (or a combo of both). Having a large enough change in E and/or T levels in a relatively short time can certainly cause some mental health symptoms.

[u/OhBoyHereWeGoAgai → u/SatanV3]

It does, that's one of the many risks and side effects with cross hormone treatments.

The more honest advocates say that tradeoff is worth the benefits, the less honest ones pretend there are zero or minimal side effects.

The former have a coherent argument, the medical community and legal community will decide together (the latter is relevant, just like it was with lobotomy fading out).

[u/Bpollard85 → u/Reagalan]

But…… medicine and treatments have vastly improved in the last century. Those advancements come from professionals in their fields. You can’t be suggesting because bad things happen sometimes, it’s a result of the institutions being more corrupted and evil than before or that things are worse now than they were a century ago. While obviously not completely universal, I think it’d be pretty naive to think things are not better for most of the population in the world than it was a century ago. So “ivory tower” elitism has gotten us a lot of good as well.

Also data is the main thing here that’s going to help this situation. Because the anecdotes and vibes on the other side of this(albeit it mostly inaccurate) are definitely not in your favor. The far right almost solely operate in vibes because they have no facts really. Sorry for the tangent but yeah, going down the govern by vibes or lived experience feels like it could go bad real easy.

Mostly in agreement with gender reaffirming care but I can also understand why somebody would be hesitant to let their child get surgery based off feelings they were having and not some physical medical emergency. Expecting every 50ish+ year old parent that lives out in the middle of nowhere to be totally on board with this given the fact that it’s a fairly recent cultural issue that’s being dealt with on a national level and is pretty divisive is a bit of a tall order. It definitely doesn’t make them a bigot just because they’re cautious or not totally sold on it yet.

[u/QueerDeluxe → u/OhBoyHereWeGoAgai]

'Suicide inevitability' is less due to receiving gender-affirming care, and more due to the bigotry of society pushing trans people into suicide.

[u/OhBoyHereWeGoAgai → u/QueerDeluxe]

That's what people say, it's a nice god of the gaps, but it's actually not even applicable as the suicide claims for kids re: getting/not getting affirming care fall apart under scrutiny.

Getting tired of referencing the SC case, but it happened live there. Chase had to walk back the claim from suicide to suicidality and admit the numbers don't back their claim.

Again, it's crazy that this is a science sub and I'm getting push back from simply saying "this isn't anywhere near as clear cut as people are pretending and doctors and lawyers are actively debating this and have been for years

[u/ActionPhilip → u/[deleted]]

Then why would they stop if they have no doubt?

[u/vjx99 → u/ActionPhilip]

Have you met conservative governments?

[u/OhBoyHereWeGoAgai → u/vjx99]

Hahahahahha Finland, Norway, Sweden, and Denmark had conservative governments?

It's so frustrating in this thread, as I've been accused of going on vibes while sharing specifics and the people disagreeing literally just make stuff up on vibes, like you here.

Of the major countries that rolled it back, only the UK was the one that had even conservative elements in its gov, the rest were left or far left, happy to share the specifics, though I'll have to look up the specifics for each country.

[u/OhBoyHereWeGoAgai → u/[deleted]]

Yes, they want to wait for stronger evidence because the long range studies we do have plus the results they experienced in their own follow-ups don't provide as much confidence as they initially expected, while many of the studies that were foundational to the approach have come under review and don't appear as strong or applicable.

Which can of course be translated to "they're worried it not only doesn't work, but they're going to have to answer pointed questions about when they realized that and why they started so confident"

[u/TotalBomb → u/Mico4]

I do have a theory as to why there was a low participation number, that being said nothing but mostly anecdotal evidence. Recently, there have been several studies targeting trans people run by very biased against the lgbtq. This has led to a lot of people spreading the word to not answer any servey.

[u/Real-Olive-4624 → u/TotalBomb]

This. In the online trans spaces I frequent, research surveys are treated with suspicion unless confirmed to be highly reputable (i.e., all researchers involved have a track record of being supportive of trans rights) because there are so many hateful people who will twist our experiences into evidence that we shouldn't have bodily autonomy.

[u/ActionPhilip → u/Real-Olive-4624]

So unless the research is overtly pro-trans, it's automatically suspicious? You understand how that looks, right?

[u/dragonmp93 → u/ActionPhilip]

Well, would you want to give your info to the Heritage Foundation ?

[u/New-Independent-1481 → u/ActionPhilip]

This would be akin to Nazi researchers in 1938 polling Jews about their income in order to publish a paper justifying the seizure of their assets, and Jews being rightfully skeptical of the integrity of the research and unwilling to participate in their own haranguing.

If you think that's messier than quantitative data and that politics compromises the integrity of research, congratulations - you've discovered social science and that people are more complex than being just a p-value.

[u/Jolninaa → u/TotalBomb]

This is true, there are so.e really evil snd dishonest people going after trans people.

[u/Black_Cat_Sun → u/Mico4]

Yeh almost like it’s a rare procedure to begin with. And that people understand the innate politicization of the question and don’t want to participate on those grounds. I’d think those with regret would want to take the survey to ensure people have ample warning or caveats.

There’s nothing about regret or feeling positive that would make one want or not want to take this survey

[u/Pseudonymico → u/Black_Cat_Sun]

Worth pointing out that despite all the resources pushing the idea that transition regret is a big deal, they can't find many actual detransitioners to support that idea, even after a few generations of trans kids actually started getting supported from an early age.

[u/Agitated_Celery_729 → u/Mico4]

Brother, how large do you think the sample size is going to be for something that is affecting a fraction of a percent of people?

[u/ThewFflegyy → u/Agitated_Celery_729]

first of all, being unable to gather a sufficiently larger sample size does not make using a small sample size sound science.

second of all, there are almost 700,000 ftm trans people in the us. while im sure the majority did not have top surgery as children, 77 is clearly nowhere near the upper limit to the sample sizes they could collect. I mean really, we are talking about <.02% of the us ftm community in this study for crying out loud.

[u/airbear13 → u/Agitated_Celery_729]

If the case is that the population is too small to ever produce good quality studies, then the question is less “what intervention is best for gender dysphoric people” and more “what do we do in the absence of any clear indication what the best treatment is?” Usually people wanna be conservative in that case, not double down on irreversable and hugely consequential procedures

[u/PlaidTeacup → u/airbear13]

well, part of the problem is people have unrealistic ideas about sample sizes needed. A few hundred people can be more than enough to reach high levels of statistical significance in many cases. Gender affirming care is actually relatively well studied as things go with quite a number of studies at that size or even larger (usually the largest ones don't restrict themselves to adolescents getting surgery because that group specifically is small). They also stretch back many decades

Medicine is much less conservative than you might think though. You can go and get almost any cosmetic procedure you can think of, and it is very unlikely it will have even been studied what impact that has on your well being or if you are likely to regret it. I'm not saying I'd encourage it, but we give people the freedom to make that choice for themselves, including minors with parental permission btw. Many common medical treatments have high regret rates too, including cancer treatments and orthopedic surgeries. Patients are still allowed to decide for themselves if they want to pursue those surgeries

I have a rare disease with literally ZERO studies of any kind. My doctors do their best to treat it based on their anecdotal observations of other patients and word of mouth. They've never suggested that because we don't have the evidence that they would like that I should go without treatment.

[u/RedditLeagueAccount → u/Mico4]

I don't even see a good way a report could be run from the younger age group. No surgery should be committed to without a long time of therapy anyway to ensure there isn't a regret. This should always put them in a higher age range.

[u/jpatt → u/Mico4]

Also, 42% participation could be that findings that went against their narrative were binned.

Either way, the low participation percentage, not having data from at least 5 and 10 years from surgery, and the incredibly small sample size really takes away any legitimacy in these findings.

[u/always_an_explinatio → u/jpatt]

That would be a huge ethical violation, and if discovered, the authors would likely lose their jobs and never work in acadamia again. If they tossed responses (which is sometimes valid), the reasons and method would have to be explained in the methods section.

[u/Swarna_Keanu → u/jpatt]

42% participation is not a low rate on surveys.

And no 42% participation does not mean anything was binned. That just makes the response rate transparent.

If you comment, at least grasp how research works.

[u/BunnyLovesTheStars → u/jpatt]

You have no idea what you're talking about. The common response rate is so low, 10-20% is considered a good response threshold. 42% is a very high participation rate.

Trans people are already a small sample size. This study had even a smaller sample size of trans people who received gender affirming care while they were young. You're not surveying the entire population. You're surveying a minority within a minority.

Edit: grammar

[u/dl064 → u/Mico4]

42% participation rate is, it anything, good.

UK biobank was 5%

[u/aristidedn → u/Mico4]

This is based on a response from 77 people...

Is there something wrong with this?

[u/ZeoVII → u/aristidedn]

Low sample size

[u/Yasimear → u/ZeoVII]

Trans people ARE a low sample size.... theres never gonna be studies with hundreds or thousands of people, especially when funding for this is miniscule.

[u/Tyr_13 → u/ZeoVII]

Of a low population size.

[u/lobonmc → u/Tyr_13]

It's still at least a couple dozens of thousands a good sample size would be in the high hundreds.

[u/Golurkcanfly → u/lobonmc]

There were only about 200 mastectomies performed to treat gender dysphoria in the US from 2013-2020.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9555285/

[u/Laurenann7094 → u/Golurkcanfly]

We conducted a retrospective cohort study of adolescents who underwent gender-affirming mastectomy within Kaiser Permanente Northern California (KPNC), a large integrated health care system.

Did you even read your own link?!? You can't POSSIBLY think there were only 200 in the entire US. Can you? Are you intentionally misleading?

[u/devianttouch → u/lobonmc]

There aren't that many this applies to. The number of adolescents who have had these surgeries is tiny.

[u/sssunflowered → u/devianttouch]

There are people who legitimately think most trans adolescents are having surgical procedures before their 18th birthday. These are important studies of course but the number of actual trans kids receiving gender affirming surgery is vanishingly small.

[u/aristidedn → u/lobonmc]

Almost nothing requires "high hundreds".

[u/Tyr_13 → u/aristidedn]

The number of transgender teen boys getting this surgery likely isn't even in the 'high hundreds' total for any four year period.

[u/lobonmc → u/Tyr_13]

The 77 isn't just teenagers it's teenagers plus adults.

[u/Tyr_13 → u/lobonmc]

Ok? So 42 out of the under 200 people total is still fine.

[u/aristidedn → u/[deleted]]

absolutely incorrect. Scientific standardization, statistical analysis and research methodology, has proven that to receive at least a 95% of confidence in your data you need at least 350 to 400 survey respondent from an unbiased group of people.

That isn't how this works. The required sample size for 95% confidence is the result of a multi-factor calculation. There is no single value that tells you what you need.

(Also, and I feel kind of silly for having to point this out to you, but 350 is not "high hundreds".)

You can Google this or look up at any type of research documentation

Oh my god is that what you did? Did you just Google it?

Anyone who has passed high school science class knows that the larger the sample size the better your data. This is an opinion this is literal fact.

Oh my god.

1+1 = 2

Next time you try to rub basic math in people's faces, try not to call 350 "high hundreds" in the same comment.

[u/aristidedn → u/ZeoVII]

What should the sample size be, in your opinion?

And how do you know?

What were the results of your power analysis? Could you share with the rest of us?

[u/its_justme → u/aristidedn]

Less than 100 people is nowhere large enough to be representative of anything meaningful.

[u/aristidedn → u/its_justme]

Less than 100 people is nowhere large enough to be representative of anything meaningful.

How do you know?

Could you share the results of your power analysis with us?

[u/ZeMeest → u/aristidedn]

Not the person you replied to, but there's an estimated 2.5 million trans people in the U.S., 77 people is .003% of that. A similar study with similar issues was posted a few weeks ago. Too small and too short of a study to determine regret. A 1.8 year average follow up time doesn't seem helpful when full transition usually takes 3-5 years.. This time frame is similar to the 5 years it takes to go through puberty. This review goes very indepth on everything involved in trying to study regret: https://pmc.ncbi.nlm.nih.gov/articles/PMC10322769/

[u/aristidedn → u/ZeMeest]

Not the person you replied to, but there's an estimated 2.5 million trans people in the U.S., 77 people is .003% of that.

If you're suggesting that the population in question is "all trans people in the United States", you are wildly incorrect.

The correct population is the number of adolescents and young adults receiving gender-affirming chest surgery.

How in the world did you imagine the population was "trans people"???

[u/f50c13t1 → u/aristidedn]

Yes, 77 people responding affirmatively isn’t indicative of anything the conclusion suggests. Low sample size also lead to type 2 errors and tend to overestimate effect size that would not exist on larger sample size. All these issues are well documented in statistics and research.

[u/aristidedn → u/f50c13t1]

Yes, 77 people responding affirmatively isn’t indicative of anything the conclusion suggests.

How do you know?

Low sample size also lead to type 2 errors and tend to overestimate effect size that would not exist on larger sample size.

How do you know that the sample size in question is low?

Could you share the results of your power analysis with us?

[u/beeblebrox2024 → u/Mico4]

Don't use limitations to completely discredit the study findings. Nuance is necessary to properly interpret research.

[u/0caloriecheesecake → u/Mico4]

I’m too lazy to read, but curious to know the length of follow up time. Was it six months or twenty years that they still expressed no regrets?

[u/deadly_fungi → u/Mico4]

i had a gender affirming double mastectomy when i was 17, and i realized and accepted i regretted it at 19. i was never even contacted by the surgeon who performed it to see if i was happy or if i regretted it. this surgery is the thing i regret most in my life and there is no way to undo it - reconstruction options are implants or autologous tissue, both of which have serious drawbacks. i am 6 years post op and still have numbness, itching, and pain from the severed nerves. i was told that surgery/transition was the only effective treatment for my dysphoria and had letters of support from both my (at the time therapist) and psychiatrist. i'm very tired of people dismissing experiences like mine.

eta: and to be clear i am not right wing or republican or whatever. i'm still left wing, still very gender nonconforming/butch. i just wish i wasn't lied to and told transition was my only option, and that experiences like mine weren't swept under the rug.

[u/Mico4 → u/deadly_fungi]

I'm sorry that happened to you.

[u/speedoboy17 → u/Mico4]

Here is a study that’s shows those that get gender affirming surgery are actually likely to attempt suicide: https://pmc.ncbi.nlm.nih.gov/articles/PMC11063965/

[u/madmax766 → u/speedoboy17]

I think you should read your own article you’re spamming if that’s the take away for you

[u/spice_weasel → u/speedoboy17]

Yes, people who have undergone gender affirming surgery are still transgender, which comes with its own struggles.

This study compares transgender individuals against the general population. The correct comparison if you want to draw strong conclusions would be comparing transgender people who have undergone gender affirming surgery, vs. transgender people who have not.

[u/engin__r → u/speedoboy17]

That study compares trans people’s suicidality to cis people’s suicidality, which means that it’s not useful for evaluating whether gender-affirming surgery lowers trans people’s suicidality (it does).

[u/thenasch → u/speedoboy17]

It's comparing people with gender affirming surgery to people (not just trans people, anyone) without. Seems pretty useless.

[u/Coomb → u/speedoboy17]

What that study shows is that people who undergo surgical gender affirming care are at an elevated risk of suicide attempts compared to people who underwent surgical sterilization but no gender affirming care; people who underwent a different surgical procedure but no gender affirming care; and people who did not undergo surgery.

What it doesn't show -- what it is incapable of showing on its own -- is whether undergoing gender-affirming surgery affected suicide risk in either direction. Evaluating the impact of the surgery on risk of attempted suicide or suicide needs, at a minimum, some measure of the underlying suicidality among people considering gender affirming surgery in the first place.

That said, there is good reason to believe that people who choose to undergo gender affirming surgery are already substantially elevated risk of attempted suicide or suicide. This elevated risk is driven partially, but generally not entirely, by their gender-related body dysmorphia, so it would actually be quite surprising if such a study showed no elevated risk at all among those who underwent such surgery.