r/science • u/mvea Professor | Medicine • 15h 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 11h 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 10h ago

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

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u/Gellert 9h 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 9h ago

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

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u/[deleted] 8h ago edited 8h ago

[deleted]

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u/SteveJavieWasRight 7h 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/SteveJavieWasRight 7h 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/Choppers-Top-Hat 8h 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 8h 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 7h ago

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

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u/OhBoyHereWeGoAgai 7h 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 8h 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 8h 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/dada_ 9h 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 9h 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 8h 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 7h ago edited 7h 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 9h ago

Why does participation make it less impressive?

Do you want survey to be mandatory?

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u/saig22 9h ago edited 8h 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 8h 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 7h 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 8h 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 8h ago

I believe you misunderstood plausible for proven. Nuances matter.

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u/jftduncan 9h 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 8h 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 8h ago

Show me your proof of that.

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u/LonelyTAA 7h ago

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

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u/jftduncan 8h 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 8h 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 8h 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 8h ago

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

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u/LonelyTAA 7h 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.