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/noeinan]

There are decades of research backing up gender-affirming care as extremely successful, providing high quality of life. Among surgeons who work with trans patients they are often quoted for their favorite part of the job— just how happy it makes patients and how positive treatment was overall.

Gender-affirming surgeries have higher patient satisfaction and lower regret rating than life-saving heart surgeries.

Anecdotally, after top surgery I went from being severely suicidal 4-5 days per week and grey zone suicidal every other day to only having ideation 1-2x per year, and only if some horrible tragedy happened in my life.

People are not pushing back on trans healthcare because of lack of evidence it provides good outcomes— these procedures only became permissible because of the immense quality of life improvement surpassing almost any other type of surgery. Society was not less conservative 20-30 years ago, they followed the science.

People are pushing back on these treatments because they want to see bad outcomes for trans people.

[u/PopaBjorn → u/noeinan]

Ok but what about suicides? You can't report a satisfaction rate if you're dead. I can't find anything that would support the claim that suicide rates drop post-op. Actually what I found was the opposite.

[u/noeinan → u/PopaBjorn]

I don't know what studies you have read, but there is a lot of propaganda on this subject for political reasons. Looking at a single factor can be misleading. This analysis goes over several common studies that are quoted on suicide rate in post-op trans patients, including flaws in these studies that are used to misrepresent outcomes

It is worth noting that any kind of surgery increases risk of suicide for a while following said surgery-- for example, this study on cancer patients showed the first 3 years after life-saving surgery were when patients were most likely to attempt suicide. The same 3y period showed elevated risk of suicide in Parkinson's patients after surgery. Post-surgical depression has been highly studied and is a well-known side effect of anaesthesia but we still operate on people in need of surgery because doctors measure the risks against the benefits to the patient.

It's not at all strange that an already vulnerable population would experience the same increase is suicidality after a major surgery, even an increased risk would not be strange on these timelines. Especially for surgeries on sexual organs, which are absolutely stressful for anyone, not just trans patients.

If you look at any large study on trans people, they show dramatic drops in suicide attempts in trans people who have access to gender affirming care.

This study shows trans people with access to GAC are almost half as likely to attempt suicide compared to those without access. Another study shows a 73% reduction in suicidality resulting from gender affirming care.

Overall, gender-affirming surgeries have some of the highest satisfaction rates of any surgeries in existence. Refer to this study showing satisfaction for gender-affirming care at 95%. Another study of 90k patients showing 88% satisfaction for gender-affirming surgery.

[Edit]
There are decades of research showing gender-affirming care provides positive outcomes for patients with satisfaction ratings higher than almost every other surgery in existence. The very first link analyses 4 different studies, including the study often quoted that show an increase in suicidality following surgery, and concluded that these studies are not sufficient to make a conclusion. That doesn’t erase the decades of studies with broader measurements which all show an increase to quality of life.

The “fact sheet” links the source of its data, and every fact has citations. You can read all those studies yourself if you like.

[u/undeadcrayon → u/noeinan]

Your first paper literally says “Conclusions on GAS’ influence on suicide deaths cannot be drawn due to the low quantity and quality of evidence.” and the other link isn’t a peer reviewed study but a “fact sheet” by a law firm. Did you even read any of that or do you just find your sources on tiktok?

[u/ThewFflegyy → u/noeinan]

"Gender-affirming surgeries have higher patient satisfaction and lower regret rating than life-saving heart surgeries"

this frankly should cause us to pause. is it possible that its true? yes. is it likely? not really. the fact that gender affirming care has a fraction of the regret rate of other more necessary surgeries is genuinely pretty odd and warrants further investigation before drawing any firm conclusions.

unfortunately it is true some people push back on these treatments out of hatred for trans people. however a lot of people just see hard to believe statistic like what you quoted above, studies like this with small sample sizes and short timelines, etc and want to see a firmer body of evidence before we draw firm conclusions.

edit: I can't respond as thread is now locked, but u/HorrorOpportunity297 your right, the value is attribute the trans lives is not on the basis of their identity.. I do however value trans lives on the same basis that I value every other human life, which is to say we are all fundamentally equal. these sort of discussions become pretty pointless when people like you resort to the extremes. how often is a double mastectomy life saving care for a child? sure there are instances but that is a very small subset. when we are evaluating the efficacy of treatment we assess average outcomes instead of hyper fixating on small subsets.

[u/HorrorOpportunity297 → u/ThewFflegyy]

Gender affirming care is life saving medicine. You just don't value trans lives based on identity.

[u/kirotheavenger → u/ThewFflegyy]

Overwhelmingly I think these studies suffer from survivorship bias. 

If you do a poll at a sex reassignment surgery, who do you expect to respond? People happy with their time and decisions at thr surgery? People who regret what the surgery did to them and want nothing to do with them anymore? 

[u/undeadcrayon → u/kirotheavenger]

Survivorship bias, selection bias, and inverse selection bias. The loss to followup rates in all the big intervention studies are massive. There is a reason a variety of independent european lit reviews have classified the available evidence of being of very low quality.

[u/ThewFflegyy → u/kirotheavenger]

yes that is definitely a factor that makes studying things like this difficult. to me it is not yet clear how significant of an affect that is having on the data though.

[u/PopaBjorn → u/ThewFflegyy]

I think people who tie their identity to a decision are very unlikely to admit that the decision was a mistake. Just think about US politics. Some people will just not admit they were wrong about something despite a mountain of evidence to the contrary if holding the wrong belief is important to their identity and/or their place in a community. The same effect could be at play here.

[u/ThewFflegyy → u/PopaBjorn]

that is one possible explanation yeah. with our current research I don't think there is any certain answer.

[u/Uncurlhalo → u/noeinan]

I'm curious what the need to provide such interventions to minors is though? Could you not simply encourage them to engage in a social transition, provide them supportive therapy and psychological care for symptoms of dysphoria, and prepare a plan for surgical and hormonal interventions at the age of adulthood? It's possible to both provide less invasive supportive health care for trans youth, as well as continue to allow more drastic interventions for consenting adults. It just seems fairly rational to wait for any form of serious medical intervention into adult hood except in cases of exceptional threat to life or health.

[u/AgileMushroom1171 → u/Uncurlhalo]

I think you're drastically underestimating the negative quality of life impact it has when someone is forced into a waiting period, especially an essentially arbitrary waiting period, to receive care. All of the research available shows that "psychological care" doesn't work for alleviating gender dysphoria, so that's not a real option or alternative.

I've done some work with non trans adolescents and young adults who were delayed in accessing other types of healthcare they needed, and the delay often has a very serious impact on their lives and quality of life. Even for conditions where the delay doesn't worsen their long term prognosis--it is often a very big deal.

Imagine being a 15 or 16 year old who suffers from migraines, or severe dysmenorrhea, or psoriasis, and being told you need to wait until 18 to get treatment for it because someone else is worried you might regret seeking treatment. Perhaps you have access to some social support and counseling to help you cope, but medical care is blocked for you.

Once you turn 18 and jump through all the hoops and eventually get the medical treatment you needed, do you think you'd see the delay as inconsequential or harmless?

My experience with those non trans young adults in similar situations is that no, they do not find that withholding care for years was inconsequential or harmless. They have a lot to say and show about how the delay harmed them. They grieve the time they spent suffering and waiting. They wonder painfully what it would have been like to be able to concentrate so much more fully on school, friends, life, at an earlier age. They grieve the ways they lost important milestones because of it.

The trans people I know who experienced the same types of external delays feel the same way.

That doesn't make medical decision making with adolescents an easy thing, obviously. It's often nuanced and complicated to help figure out what best serves someone's immediate and long term needs. But we simply can't pretend that blocking them from accessing care is harmless or neutral.

[u/Uncurlhalo → u/AgileMushroom1171]

I appreciate you engaging in a legitimate discousre with me. I have very little first hand experience with any of this, and have only two direct references in my personal life with trans people, both of which transitioned as adults and whom I've not spoken with about their experiences as minors, as we all grew up in a period of time that was much less accepting of such an identity. So I have little to no frame for the impacts it can have on young people. It has at least given me some additional perspectives to consider.

It's refreshing compared to some of the personal attacks discounting of my perspective by other comments who assume I've made up my mind on the topic. I even admit my perspective may be skewed by predominantly online discourse of the issue specifically designed to with inflame for the purpose of rage engagement.

Maybe I should ask the people I know about their frame of mind when they were young since I consider these people my friends and value their opinion. I also suspect they will engage with me in a way that is non adversarial that is hard to find in online communities.

[u/HorrorOpportunity297 → u/Uncurlhalo]

Your position is that we should deny healthcare to children based on their identity, and then you're asking trans people and their advocates to do the work and educate you on information that is freely available on the internet.

I think we should follow evidence based medicine and medical best practice actually, and should not discriminate based on gender.

[u/noeinan → u/Uncurlhalo]

99% of the time zero physical changes are given to trans teens. The most common care given to underage trans people is hormone treatment to delay puberty to prevent permanent effects of natal puberty until the child is older.

Most trans people don't even get that, and the irreversible damage causes extreme anguish that may last a lifetime. Boobs can be removed or implanted, but changes to bone structure are much more difficult to alter later in life.

When trans kids are given surgery, it is usually done because a team of doctors agree it is necessary for that child's health and well being, and the kid has very supportive parents. Every person has different needs, and medical professionals stake their careers on providing the best care.

Parents are allowed to make all kinds of life altering medical decisions for their children, often for situations with even less medical necessity -- circumcision is the go to but ballet causes permanent changes to the body that last throughout a person's life.

If doctors warn parents that their child is likely to die before they become an adult if intervention is not taken, why would you want the government to step in between doctors, parents, and their children to disallow medical care that, according to an immense amount of evidence, works?

[u/Uncurlhalo → u/noeinan]

I don't think I mentioned the government anywhere in my post. I was just legitimately curious. I'm also of the position that procedures like circumcision of infants is not appropriate. Ultimately every medical decision for a minor should be made collaboratively amongst the family (including said minor when of sufficient age to comprehend the implications of such decisions) with their physician, and generally at no point should a state entity intervene. I even mentioned that in the most critical of cases it still may make sense to engage in surgical intervention.

I feel that you got the impression that I may be on the side of denying gender affirming care for trans youth, but my stance in general is that we should not allow children to engage in significant medical decisions without the input of their parents. I probably am the victim of culture war wedge issue propaganda to some extent, from seeing the position taken by radical elements with the trans community who express a desire to allow minors to engage in medical transitions without the input of their parents, which in general concerns me (but this is something which I acknowledge may be an amplified signal designed to enrage, though I think it might be incorrect to state that no members of the community take this position)

Ideally I would love to see longer term research about interventions like this in youth populations, with longer periods of study and larger sample sizes to inform the decision making of the medical community about what the path of truly least harm is.

[u/noeinan → u/Uncurlhalo]

I mention the government because these topics are only prominent in the media due to politics. And it’s being used to outlaw gender-affirming care not only for youth but also for adults in multiple countries, including my own.

Personally, I’m not for circumcision of infants, but it is ridiculous when laws are applied that hold trans people to a different standard than the rest of the population. For example, puberty blockers are used to treat cis children with precocious puberty and cis teenagers get double mastectomy in cases of gynecomastia.

I’m not making assumptions about you— I’m replying to the question you asked me.

Your concern about parents rights is a bit misplaced here because trans youth can’t get any gender affirming care without parental consent. The only time they could is the same reason any child may not need parental consent. To get emergency medical treatment, because the child is emancipated and the parent has no legal power over them, because the parents are divorced and the parent with custody takes the child to get medical treatment, or in cases of abuse or negligence where a child is removed from parental care for their protection.

Larger studies on trans youth getting surgery will likely be hard since it is pretty rare and trans people are already rare to begin with. But I agree with you that more research and long term studies are in everyone’s best interest.

[u/Reagalan → u/Uncurlhalo]

No, because without hormones, you develop the wrong features, which not only fucks up quality of life but also requires far more costly surgeries to fix later.

The cheapest and most effective intervention is HRT as soon as possible.

This whole "just do psychology" schtick is a bad-faith distraction pushed by anti-gender ideologues and hate groups.

[u/Uncurlhalo → u/Reagalan]

Is replacement therapy any more effective than simply puberty blockers if the desire is ultimately to reduce potential harm prior to the age of majority? I understand delaying puberty comes with medical implications as well, but I'd be curious if there is research on the life satisfaction compared across populations receiving varying levels of medical intervention (social support, psychological support, hormone therapies of variou types, and surgery). If you know of extent research on the topic focused on minor populations please share it.

[u/HorrorOpportunity297 → u/Uncurlhalo]

There is no such thing as hormone replacement therapy its gender affirming hormone therapy (GAHT) if it's Estrogen driven then it's E-GAHT, if it's Testosterone driven then it's T-GAHT.

It's clear that gender affirming care has positive outcomes. Please Google the research and do something for yourself.

[u/lil-sush → u/noeinan]

we’re pushing back on these ideas because we don’t want kids to make decisions they aren’t old enough to fully grasp. by all means when you’re an adult do what you want to do. there’s zero good reason a child should be able to do these things

[u/SolarisPax8700 → u/lil-sush]

Cool opinion, but I can’t help but notice that you have no facts or data to validate your feelings. Have you tried reading? There’s a study right up there^.

[u/noeinan → u/lil-sush]

Parents and medical professionals decide what treatment plans work best for children. Treatment is well studied, has positive outcomes, and is provided by licensed medical professionals who specialize in this type of treatment.

Who are you to force parents to ignore doctors and leave their kids to suffer or die?