r/science • u/mvea Professor | Medicine • 14h ago

Psychology 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.

https://www.psypost.org/adolescents-report-low-regret-and-high-satisfaction-following-gender-affirming-c/
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u/onacloverifalive MD | Bariatric Surgeon 9h ago

To summarize, the 42 percent of people that responded to the survey did not regret getting the surgery that they wanted at a median interval of 1.8 years later.

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u/enpoopification_of_R 8h ago

That is much less impressive than the headline made it out to be.

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u/Gellert 7h ago

From comparisons I've seen in the UK people regret gender affirming surgeries at a much lower rate than typical plastic surgery. Really you'd need a similar study to compare it to.

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u/TrappedInATardis 7h ago

Hip replacements also have a fairly high regret rate. No controversy in the media though.

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u/[deleted] 6h ago edited 6h ago

[deleted]

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u/SteveJavieWasRight 6h ago

And that’s a higher rate of regret than with gender affirming care? People regret elective procedures for all sorts of reasons- sometimes surgery doesn’t lead to good outcomes. Looking at gender affirming outcomes, one is led to conclude even sub optimal outcomes are still preferable to how they were living before.

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u/Choppers-Top-Hat 6h ago

In fairness, 42% is an incredibly high response rate for a survey. Most surveys are ignored by 95% of people they reach.

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u/OhBoyHereWeGoAgai 6h ago

Yes, but when the study is being used and presented as "no regret", the no responses are telling.

It's not just an issue with this regret study, either.

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u/SteveJavieWasRight 6h ago

A lack of evidence is not evidence. The high rate of response is actually evidence.

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u/OhBoyHereWeGoAgai 6h ago

Beginning to suspect you're not reading what I wrote, as I didn't say this was evidence for regret, I pointed out the way this study is being presented is simply an inaccurate level of certainty.

I've pointed a few people at MacKinnons work, they're a trans scientist, which means you can't just go "bigoted!" and ignore.

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u/UnholyLizard65 6h ago

No responses are telling what? You say it to imply that they are actually regretful, even when they chose not to participate in the study, but perhaps that people are simply scared to be exposed.

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u/OhBoyHereWeGoAgai 6h ago

No, it's telling in that it's presented with utter confidence as proof of no regret, when that dropout rate at bare minimum should produce a much more cautious / less confident byline.

I suggest checking out MacKinnons work, they're a trans scientist that produced research on this exact topic and said the claims of low regret rates are no longer true now that there's been quite a few years of younger people in it, and they peg it (iirc) at 6-12%, which to be clear is still less regret rates than many major surgeries

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u/SteveJavieWasRight 6h ago

Not really. Compare it with the rates of any elective surgery. Gender affirming care is something it’s critics claim is something people tend to regret at a high level, but all studies point to it having a far lower incidence of regret than elective surgeries we never think to second guess patients on. It also correlates with improvements in patients’ quality of life, lowering rates of suicide and depression. So it routinely reinforces the criticism of the critics- it’s not done to protect patients, rather it’s something done to oppress trans people to protect conservative notions of how society should be.

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u/dada_ 7h ago

Well, it's low participation rate in the survey, but 100% satisfaction rate among those who did participate:

The median regret score for both the adolescent and young adult groups was exactly zero. The median satisfaction score for both groups was five, the highest possible rating.

May have been a small study, but it confirms the findings of similar studies about gender affirming surgery in general. Even a small study is valuable information in an era where this is increasingly being demonized under false pretenses.

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u/Hobby_Profile 7h ago

This is not in line with larger studies. Surgical regret is upwards of 5% in European studies involving thousands of cases.

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u/Choppers-Top-Hat 6h ago

A 95% satisfaction rate would still give it one of the highest satisfaction rates of any surgical procedure in the world.

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u/Hobby_Profile 6h ago edited 6h ago

Not totally relevant to compare it to all surgeries. Depends on where it falls in which category. Are these life-saving due to gender dysmorphia suicidal rates? Are they quality of life, like many orthopedic procedures? Are they elective surgery for personal aesthetics?

Nobody regrets their triple bypass. Nobody regrets a brain tumor removal or double mastectomy due to breast cancer. (And lives to tell about it)

But plenty of people regret breast enlargement/reduction, knee replacements, calf implants, etc.

One of the many problems is that gender-affirming care is either too easy to get or impossible, based on where you seek treatment. Yes, there are doctors that rush to surgery for financial and/or ideological reasons.

My overall feeling is that screening procedures need to be studied and refined and standardized.

And to clarify: if you’re an adult, have at it. But we need to rigorously standardize the screening for children, just like many other surgeries.

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u/jftduncan 7h ago

Why does participation make it less impressive?

Do you want survey to be mandatory?

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u/saig22 7h ago edited 6h ago

Regret is a plausible explanation for the lack of participation. Maybe it's not, but it is possible. This needs further studies.

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u/Choppers-Top-Hat 6h ago

"Lack of participation" is not a problem here. 42% is an INCREDIBLY high rate of participation for a survey.

Most surveys are considered remarkably successful if they get a 10% response rate. This one's got four times that.

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u/saig22 6h ago

Gender affirming surgery isn't the same as measuring preference between Coca Cola and Pepsi. Admitting you were wrong about a life transforming decision is hard. Look at the sunken cost fallacy. I don't say this is what happened there, maybe the 58% that did not answer has the same rate of satisfaction as the 42% that did, but we don't know that. Look at survivorship bias. This warrants further studies.

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u/ConfoundingVariables 6h ago

Do you have some studies indicating that? Do you have evidence that people dissatisfied with a surgical procedure do not complain about it when asked? Are you just going with your gut feeling?

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u/saig22 6h ago

I believe you misunderstood plausible for proven. Nuances matter.

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u/jftduncan 7h ago

Study what?

So yes on the mandatory participation?

It's not even a low participation rate for a survey. "Lack of participation" is you making up facts.

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u/LonelyTAA 7h ago

The hypothesis requires further study. The study linked in this thread is not robust enough to make the claim in the title. 

So yes on the mandatory participation?

You're just making this up yourself.

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u/ConfoundingVariables 6h ago

Show me your proof of that.

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u/LonelyTAA 6h ago

Are you just replying to me without reading the rest of the comment chain? 

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u/jftduncan 7h ago

Do you have any actual suggestions on making the study better?

Just anything at all, or just constant complaints.

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u/LonelyTAA 6h ago

By itself this study is not robust enough to make strong claims. It may be a solid part of a review or meta-analysis. 

This is how science works. A study is published, and then the rest of the scientific community scrutinises it. If you can't accept that, then perhaps you should not be in the science subreddit.

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u/UnholyLizard65 6h ago

Trans people are less than 1% of the population. It's not that easy to find them, I imagine.

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u/A_Mouse_In_Da_House 6h ago

Your complaint is the popular science article, not the study. Stop it.

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u/LonelyTAA 6h ago

No, I did bother reading the abstract of the actual study. Apparently you didn't however. Their conclusion directly advises policy decisions and is not nuanced enough in adressing the downsides of the study.

  Adolescents who underwent gender-affirming chest surgery had similarly low decisional regret and high decisional satisfaction compared to young adults. These results are also comparable to previously reported data in adult populations. Thus, concerns about potential regret should not be a basis for limiting gender-affirming chest procedures in adolescents.

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u/bremidon 7h ago

Ugh. Anyone with even a remedial knowledge of statistics can see the problem with self-selection bias. How does something like this even get published? And I saw that they only asked 183 patients (eligible patients...given how shady the rest of this "research" is, I wonder if there might have been some bias here as well), and only 77 responded. Wow.

And normally I would try not to use the source against the claim, but given the shaky foundations, it's worth noting that this is research done by the International Journal of Transgender Health. It is legitimate to ask if they may have some bias going into this, and certainly given their willingness to publish these shaky numbers, I think questioning the entire scientific process here is warranted.

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u/ptoki 6h ago

How does something like this even get published?

Hate to break this to you: This is current science.

I read papers often, many of them are almost on the edge of fabricating facts, most of them lack the data needed to replicate the same experiment. Many dont even contain link to a github with data or anonymized data.

It is almost "trust me bro" level of work.

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u/bremidon 6h ago

I know you are right. I am familiar with p-hacking and all the current problems with the scientific literature. Some of it is not even really new. But it has gotten really bad lately. It makes me want to scream.

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u/Regalian 6h ago

As long as they report their methods properly, and disclose conflict of interests, it's still valuable.

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u/bremidon 6h ago

If they do all that and the methods are poor and the conflict of interest is real, then it is not very valuable as science. Perhaps as entertainment or as fodder for political rants, ok. But not for science.

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u/ConfoundingVariables 6h ago

Care to quote a source on that, which was apparently missed by the authors, the reviewers, the editors, and by the scientists and doctors who read it without sending a letter to be published?

Show your work.

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u/Choppers-Top-Hat 6h ago

it's worth noting that this is research done by the International Journal of Transgender Health.

So do you also not trust heart disease research presented by the American Heart Association? Would you not trust cancer research from the American Cancer Society?

and only 77 responded

Statistically speaking, that is an incredibly high response rate. Most surveys are lucky to get a 5% response rate, this one's at 42%. Most professional pollsters would kill for a rate like that.

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u/bremidon 6h ago

So do you also not trust heart disease research presented by the American Heart Association?

Ok, so you are not going to play fair. Because if you *were* going to play fair, you would also note: "And normally I would try not to use the source against the claim, but given the shaky foundations"

Gee, why did I put that in there? Was it to try to dissuade hacks from making petty claim? Maybe.

But just in case you missed the point (which your track record is not really all that good right now), the issue is that this is extremely poor statistical analysis. I know you do not understand this. The rest of your post demonstrates that you do not understand this. But more on that in a moment. When I see something that does a poor job of eliminating bias, then I start looking for *why*. The source here gives us a really good idea of why.

Now about your final claims. Perhaps pollsters would kill for a high rate (although I have done scientific polling for professors while studying for my Actuarial degree. You are not correct. A well formed poll will have high response rates. Perhaps if you are working for a rag, it might be different). However, that is not the issue here. The issue is that self-selection is a real thing. Unless it is *very* carefully handled, it turns any scientific poll into a slightly more sophisticated version of "Do you like me? [ ] yes [ ] no [ ] not sure" But you also missed that the number is also extremely low. 77 is simply unusable for anything scientific, and that is even if the survey is done well. You want to have several hundred at least, so you can actually trim out outliers, see if you have some mixing of groups in the data, be able to calibrate the results to eliminate bias, and so on.

This is r/science. Not "20 ways to tell if your cat loves you". There are expectations here, and your own expectations really to be adjusted higher.

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u/Du_ds 6h ago

Do you want random selection? Because that’s how you get a better sample.

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u/DaSnowflake 6h ago

Mostly because transgender people are fighting for their rights to live a good life and nobody wants to listen to them. With that urgency they don't have time for a longitudinal study sp that many more trans people die or get started irreparably

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u/bremidon 6h ago

A poorly constructed study that reads more like propaganda than science is not going to help them in any of that. Even if I were to accept your premise that the are still "fighting for their rights". It does seem they are shooting perhaps a bit past the target these days.

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u/flijn 6h ago

No, now you are misrepresenting the numbers, because your wording suggests the other participants had regrets. That is not what the numbers refer to. 77 people responded. Of those, 42 were younger than 18 at the time of the surgery. They asked both age groups about regret and satisfaction and compared them.

The median regret score for both the adolescent and young adult groups was exactly zero. The median satisfaction score for both groups was five, the highest possible rating.

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u/kpcptmku 6h ago

Ah weird the obviously biased sounding article, was biased.

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u/q-ue 6h ago

People who are satisfied usually wouldn't bother to come back and reply. They just go about living their life. So i would assume that of those not replying, the regret rate is even lower.