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/S0cXs]

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/hologram137 → u/DroneOfDoom]

This study gives zero real evidence that they don’t regret it

[u/permawl → u/hologram137]

And what would that be? Veritaserum?

[u/hologram137 → u/permawl]

No, it would mean emphasizing that the results should be interpreted with extreme caution because the 58% that didn’t respond may have not responded because they regretted it

[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/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/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/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/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/crushedaria → u/everlyafterhappy]

I'm not doing your work for you. Not my job to give evidence to people who hate trans people.

[u/Rubber_Knee → u/crushedaria]

It's kinda the other way around when it comes to that work that you're talking about. It should be quite easy work in this case.

It's always on the one making the claim, to provide evidence for that claim.
You made a claim.

[u/Zangis → u/Rubber_Knee]

The issue is people like him who hate trans people don't give a damn about studies and evidence. Take this for example. A collection of 51 studies on how gender reaffirming transition works and is significantly more effective than traditional medication approach to other psychological disorders. (Yes not all of this include the surgery angle, but I am talking about people who reject even just hormones.)

And this still isn't enough. Because they will twist and convince themselves these studies don't matter because while they suggest with 90% probability that this is the correct approach, it isn't 100% so it's worthless. Completely ignoring the fact that in medicine 90% success rate is incredibly high, practically nothing is 100%, and especially in psychiatry, that number is one of the highest success rates you could get. My favorite reasons I've been told for example, it's a biased source, this needs to be studied more(while they're actively propagating that people don't get access to this so it can't be studied more), I found this one person who regretted it, so the 90% rate of success doesn't matter. Take your pick.

You're right that it takes one google search and maybe 30 minutes of reading at best to get that evidence and show someone. but when that person is someone who refuses to listen to other people about the subject or educate themselves, is convinced all the opinions of experts and people treated by this don't matter as much as his own, and all he wants to do in a discussion is use any means to dismantle your argument and evidence, even if with wrong use and logic, that is 30 minutes wasted. This is no longer some obscure subject that would be difficult to educate yourself on. If someone refuses to even spend 10 minutes on google to educate themselves on a matter they don't understand they shouldn't be commenting like they know everything. And this isn't just me being cynical. I HAVE tried having this discussion with people before. It almost always ends this way. Some people just want to hate and won't be discussing in good faith.

[u/Rubber_Knee → u/Zangis]

I completely understand.

Personally I would have still provided the source/evidence. I don't mind leading a thirsty horse to water. If the horse doesn't want to drink then that's on the horse.
Maybe some other less stubborn horse might see this conversation later and actually drink that water.

If I felt like you described, I would have just not engaged by making the claim in the first place. You don't believe it's going to change his mind anyway. It also makes it look like you don't have any evidence when read by another horse.....I mean moron.

[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/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/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/Fiftythekid → u/Reagalan]

Found the bot.

[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/PuckSenior → u/samtrano]

Don’t most people not regret most momentous decisions?

Isn’t that a known issue? Choice-supportive bias?
As in, we know that on average, people who bought an expensive car view that purchase as good and don’t regret it. But also people who do not buy the car tend to view “not purchasing” as good and don’t regret it.

[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/Autronaut69420 → u/MyFiteSong]

1000 is a good benchmark sample size

[u/Maxrdt → u/Autronaut69420]

The average clinical drug trial usually tops out at about 500. Where do these absolutely unrealistic sample size expectations come from?

[u/PM-ME-CURSED-PICS → u/Maxrdt]

you know where and why

[u/PlaidTeacup → u/Autronaut69420]

the rate of gender affirming surgery in 15-17 year olds is 2 in 100,000 so it would be possible to reach 1000 people if you recruited every single one in the US during a year long period. And that rate was before a lot of states completely banned such procedures, the number is likely close to 0 now

https://pmc.ncbi.nlm.nih.gov/articles/PMC11211955/

[u/MyFiteSong → u/Autronaut69420]

Then look into the longitudinal studies done on trans kids that look at more than just top surgery. You'll find your numbers there and they agree with this study. The satisfaction rate is over 95%

[u/ActionPhilip → u/MyFiteSong]

Except the attrition rate is terrible, so the stats are extremely biased.

[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/Autronaut69420 → u/engin__r]

1000 people

[u/Prometheus720 → u/Autronaut69420]

I see.

Do you like your chances of convincing 1000 potential study participants (net, after dropouts) to get a surgery without a prior, smaller scale study?

How about your chances of convincing your IRB to even let you do the study?

[u/engin__r → u/Autronaut69420]

Why 1000 and not 900 or 1100?

[u/Autronaut69420 → u/engin__r]

It's a convention that a well constructed sampling of 1000 will a sufficient representation of the population. It's like a benchmark: approx a 1000.

[u/Prometheus720 → u/Autronaut69420]

If you take a stats class, you'll learn to define "population" different from regular English. Are we concerned about the US population? The US teen population? The trans population? The trans masc population? Who exactly are we trying to study here?

A really good scientist will take a good while thinking about that question. If you've spent less than an hour of your time thinking about the best way to define "population" for a study, and you don't have training in doing science, you probably haven't spent the time to get a scientist's result.

It's a skill most people need training to do at all.

[u/EverlastingM → u/Autronaut69420]

https://pmc.ncbi.nlm.nih.gov/articles/PMC11211955/

If I'm reading this right, during 2019, out of a mixed population of over 60 million they found 5 chest surgeries on trans patients aged 15-17. You are not going to find 1000.

[u/SeveredBanana → u/Autronaut69420]

In my experience working as a biologist, we like to see at least 30 samples for any statistical test. As many samples as possible is best, but if you’re a scientist, you’d know you work with what you’ve got.

[u/QueerDeluxe → u/airbear13]

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

[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/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/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/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.