Researchers Ask Why Regret is So Rare for Trans Patients, What Can Be Learned
Dr. Harry Barbee answered our questions about the direction of research into trans patients’ post-surgical regret, and how other areas of medicine might benefit from understanding the unusually low rates of regret for these procedures.
by Mira Lazine
A viewpoint article that appeared in the journal JAMA Surgery titled “Postoperative Regret Among Transgender and Gender-Diverse Recipients of Gender-Affirming Surgery” asks an intriguing question: Why is regret so much lower for trans surgical patients compared to others? The piece, of a type where the authors draw on prior literature to express an argument was co-authored by Dr. Harry Barbee, Dr. Bashar Hassan, and Dr. Fan Liang suggests that there is much that can be learned from gender-affirming procedures in other areas of medicine where regret is higher.
The focus of the article is on postoperative regret rates for patients who received some type of gender affirming surgery. The viewpoint draws on a prior study on the topic, a meta analysis of over 7,000 patients that found a strikingly low regret rate - less than 1% postoperative regret for both transmasculine individuals and for transfeminine people. Barbee et al. contrast this with the average regret rate for most surgeries, which they state is around 14.4%. The average regret after surgery is exponentially higher than anything you see for gender affirming care!
“Researchers are currently working to improve their understanding of regret among patients who receive gender-affirming surgeries, and they still have much to learn about the extent to which rates of regret for gender-affirming surgeries are lower than others,” Barbee explained over email. Barbee is an Assistant Professor in the Bloomberg School of Public Health at Johns Hopkins University and is queer & nonbinary, using they/them pronouns. “Nevertheless, the available data that we have on this topic suggests that rates of regret for gender-affirming surgeries may be lower than those of other surgical procedures. “
The article goes on to compare regret rates for the same procedure, breast removal, between cisgender women and transmasculine people. What they find is illuminating - transmasc people have a miniscule regret rate for mastectomies, whereas cis women have a much higher rate, closer to 13%.
The authors present two different hypotheses for why regret would be so low among this population. One explanation is that trans people go into these procedures highly informed and highly motivated to receive them, whereas cis people receiving them tend to be much more in the dark and much less eager.
“Achieving this goal through surgery may lead patients to think more positively about their procedure than patients who, for example, seek a surgical procedure to prevent potentially negative health outcomes like cancer,“ said Barbee
The other explanation comes down to education. Trans people are more likely to learn more about the procedures they’re receiving, leading to a realistic understanding of the risks and benefits, whereas cis people may not have the same depth of knowledge or spend as much time considering the risks and benefits.
The authors also discuss some of the limitations of these studies, such as a need for better measures and more focus on potential confounding factors that could help to explain some of the differences observed.
One mainstream myth, pushed by anti-trans activists, has been that trans people are rushed into surgery or other irreversible treatments lightly, and without a fully informed consent process. Another is that physicians who provide this care don’t consider the risk of regret or the stories of detransitioners when deciding on best practices. This is, flatly, false, as this article demonstrates. There are plenty of discussions of regret rates and how to improve transgender care - if anything, it’s one of the only things that gets consistently focused on in transgender healthcare. The narrative that trans people, academics, and medical professionals don’t care about any of this is blatantly incorrect, and this article helps to showcase that.
“Researchers should continue to study rates of regret and satisfaction among individuals who access gender-affirming surgeries. However, just as clinical guidelines for gender-affirming care change and improve as better evidence becomes available, public policy that regulates access to gender-affirming care should also be based on available evidence,” Barbee wrote.
Research into regret rates are important because they refute misleading narratives around trans care, and because they help us better understand what avenues of medical care work for trans people, and what doesn’t.
Dr. Barbee outlines it this way: “Studying various dimensions of postoperative regret and satisfaction can help healthcare practitioners identify ways to improve patient education such that patients can make the most well-informed decisions about pursuing gender-affirming surgical procedures.“
The authors end the article with a brief discussion on the need for better public policy. Much of the newer policy has not been evidence-based, which can severely harm trans people seeking this care out. We’ve seen this play out with bans on youth care in numerous states, and with onerous restrictions on adult treatment in states like Florida and, soon-to-be, Ohio.
This article showcases not only some of the science on regret rates, but a reason as to why policymakers should be listening to academics, medical professionals, and the LGBTQ community on the best practices for handling those who are transitioning. Otherwise, we’re putting lives at stake and hurting so many people along the way. As Barbee writes, “Much of the public policies that prohibit transgender people from accessing gender-affirming care are not based on scientific consensus and often have the potential to cause more harm than good.”
Mira Lazine is a freelance journalist covering transgender issues, politics, and science. She can be found on Twitter, Mastodon, and BlueSky, @MiraLazine