A new study was published showing that transgender people who opt for top surgery have very little regret. Conservatives are predictably outraged at the conclusion, going as far as to blame science.
I was talking about this with my partner and he said he's seen conservative complaints about a lack of randomized controlled trials (RTCs) on gender affirming care. Imagine what they'd say if someone DID try to run that... approaching a teen's parents at their pediatrician, asking if they'd like to flip a coin to see if they'll start HRT 🙄 Next let's run an RCT on abortion 🫠
When we as humans encounter information that causes our very beliefs to be rocked, and it creates a great cognitive dissonance within us, we can choose to use our faculties to look within ourselves, think critically, question those beliefs, uncover the driving narratives, inform ourselves, and adjust our beliefs, and in doing so, evolve as humans.
The scientific method is not a strong point for conservative ideology, the Idea of evolution is just beginning to catch on over there. In the world of the Conservative nothing is ever going to change... sad but true
I closely followed the Florida SB 254 hearings and administrative rulemaking meetings, and read the documents produced by the folks commissioned to write the non-peer reviewed papers to support the Florida healthcare ban, and all I could think while reading and listening to their words is that they have absolutely zero concept at all, whatsoever, of what gender dysphoria is or why we seek out gender-affirming care. (I've also read a great deal of the actual science and rebuttals from orgs like WPATH and healthcare providers, to make sure I was fully informed of both the science and the arguments against the science.) I think they want to discredit peer-reviewed science because their own "science" is NOT peer-reviewed, and they want to put it on equal footing with the peer-reviewed literature. But, like, it's more than that at the same time. They are incapable of understanding that surgery alleviates significant discomfort and distress when it is used to treat gender dysphoria, not least of all because they refuse to acknowledge that gender dysphoria is real or to try to understand how dysphoria is experienced by trans people. They fundamentally refuse to accept that we know what will make us more comfortable and happy in our own bodies better than they do. They want us to fit into their image of what they believe someone assigned female at birth should be and what they think we should WANT to be, and when we do not fit that image, they seek to control what we do with our bodies (with incredibly strong parallels with the anti-choice playbook) to prevent us from changing our bodies to be more comfortable with ourselves because they think that our chests absolutely must be used for the purpose of feeding babies (and possibly also for pleasing men). Ironically, they also oppose binding, citing the actual physical harm it can cause when done improperly or for too long, yet they don't want to let us do the thing that will stop us from binding - surgery. They will use the word of the 1-3% of people who actually regret their transitions to ban the medical care of the remaining 97-99%, and yet will not listen to the voices of the overwhelming majority of trans people who are happy and satisfied with the transition-related care we have received, or listen to our doctors or to our mental health professionals. Their entire model is based on distortions and propaganda, so it's not surprising that they want to treat the peer-reviewed science as if it is, too. I am absolutely exhausted by these people and their crusade to take away healthcare that does not impact them in any way whatsoever. (And I expect them to try to go after our private insurance coverage again next session like they tried to do in Florida with SB 254 earlier this year, FYI. So be aware of that on the horizon in next year's onslaught of anti-trans legislation.) And as this has gone from a thoughtful comment on the actual article to a rant about the broader attacks on our healthcare altogether, I think I'm going to stop here before I've written an entire essay on what the conservatives are doing here.
As someone else said, they still deny the science of climate change. I was going to go further and say it’s like they’re flat earthers. The evidence is clear but doesn’t fit their fear/hate-based narrative so they dig in.
The fact that there are people who think there are only two genders and have no understanding of how gender identity works blows my mind. Of course when these topics are removed from schools it’ll only get worse. Which is their goal.
“Science” to conservatives is just a fun word to scream loudly. You can’t force science to fit a theory, nor can you blatantly leave out all the asterisks. Sure Germany’s economy came out of the Great Depression quicker than other nations, but the data is not illustrating all those deemed inhuman who were removed from unemployment ledgers as slaves are not “unemployed”. It’s the same goose stepping pony show on science, 78 years AFTER “fascism ended”.
I am a liberal who values bodily and personal autonomy, which extends to transgender individuals. I do not think legislation is the ideal way to formulate medical practice guidelines; physicians and their professional societies have the responsibility of establishing standards of care that are in the interests of all of their patients.
Gender dysphoria is a real, rare, and poorly understood phenomenon. In order to treat the condition appropriately, quality research is greatly needed, but is lacking. This is especially of concern in regard to the growing number of minors who want to medically transition. Which is more harmful – making minors wait until age 18 or granting access to minors without question?
Unfortunately, the recently published study in JAMA by Bruce, Khouri, Bolze et al on regret after top surgery unfortunately can’t go far towards advancing a peace settlement in the current war over access, by minors, to puberty blockers, cross-sex hormones, and surgeries.
The JAMA study was not on minors, but adults: All the individuals who responded to the survey were at least 18 when they got top surgery, and the median age at the time of surgery, among respondents, was 27, nine years into adulthood.
A basic tenet of research is that study findings can’t be generalized, or applied, to a group that was different than the group studied.
You might say, okay, but there were probably individuals among the 139 respondents that had, as minors, wanted top surgery, maybe even for a very long time, but for some reason, did not get the surgery until age 18. That may be so, but unfortunately the study tells us nothing about that, beyond reporting that the median time from surgery to survey completion was 3.6 years. That does tell us that for half of the respondents, their top surgery was relatively recent – 3.6 years ago or less.
Most published studies on regret do show a very low rate of regret. However, those studies were mainly on individuals who are quite different than individuals today seeking medical transition. Today’s cohort is much younger, many more are female, and the timeline from emergence of dysphoria to the point at which they seek medical transition is much shorter.
The research to date on average amount of time until detransition or regret manifests is hampered by considerable heterogeneity – differences in terminology, definitions, and types of measures used to identify “onset” and regret or detransition. That makes it hard to draw firm conclusions that are not all over the map. One study reported a five-year average; another, eight years. And that is why there is no known way clinically to reliably “predict” who will have regret and who won’t.
The study was a missed opportunity. The researchers failed to collect (or report) the following data about respondents:
• Age first experiencing gender dysphoria
• Age wanting top surgery
• Number of years waiting for surgery
• Age at time of surgery
• Year of surgery
Another weakness of the study, was the rate of non-responders. When no data is collected on 4 out of 10 potential study participants, you have to consider how much the outcomes might have been different if they had responded, especially when there were some statistically significant differences found (based on medical records) between responders and non-responders. The latter group had lower rates of depression and anxiety and more time had passed since the surgery (4.6 years median). These interesting findings, as well as the high non-response rate, are a caution about what can be firmly concluded about the study results.
Loss-to-follow-up – the failure to track down, or engage, individuals who have medically transitioned, and learn from their experiences – is typical in the field of research on medical transition, unfortunately.
One other limitation of the study is that all participants got top surgery at one institution. That limits application of findings to US gender clinics in general. It is possible that pre-operative care is superior at that hospital, having a bearing on regret rate – something worth exploring.
All in all, while this study does offer data worth noting as now part of the scientific literature, it is not proof that medical transition is safe for minors.
The critique of the study by the Society for Evidence-Based Gender Medicine, which you link in your article, goes farther than what I have said here about the study’s limitations. It is worth reading with an open mind.
Of importance is that Sweden, known for its progressive attitudes towards LGBT rights, is now imposing strict limits on access to medical interventions for gender dysphoria in minors. The UK, Denmark, Holland, and Finland have done the same. These countries, which were way ahead of the US in advocating for medical transition, now are concerned about the harms observed and say that the research is inconclusive.
Both camps in the current controversy say that their aim is to reduce harm for any and all trans kids. I believe that there are decent folks on opposing sides really do want the best for kids. Those folks are motivated by love, not ideology, political or otherwise.
I rate my irreversible damage 5 out of 5 stars, would recommend!
They still can't accept climate change despite scientific consensus, are we really this surprised that they're blithly dismissing science again?
I was talking about this with my partner and he said he's seen conservative complaints about a lack of randomized controlled trials (RTCs) on gender affirming care. Imagine what they'd say if someone DID try to run that... approaching a teen's parents at their pediatrician, asking if they'd like to flip a coin to see if they'll start HRT 🙄 Next let's run an RCT on abortion 🫠
When we as humans encounter information that causes our very beliefs to be rocked, and it creates a great cognitive dissonance within us, we can choose to use our faculties to look within ourselves, think critically, question those beliefs, uncover the driving narratives, inform ourselves, and adjust our beliefs, and in doing so, evolve as humans.
Or not.
In the end, it won’t matter what the studies say. They don’t care. They’ll outlaw out healthcare anyway.
The scientific method is not a strong point for conservative ideology, the Idea of evolution is just beginning to catch on over there. In the world of the Conservative nothing is ever going to change... sad but true
I'm still healing from my "irreversible damage" and even with all the discomfort and chest zappies, 10/10 would absolutely do again.
I closely followed the Florida SB 254 hearings and administrative rulemaking meetings, and read the documents produced by the folks commissioned to write the non-peer reviewed papers to support the Florida healthcare ban, and all I could think while reading and listening to their words is that they have absolutely zero concept at all, whatsoever, of what gender dysphoria is or why we seek out gender-affirming care. (I've also read a great deal of the actual science and rebuttals from orgs like WPATH and healthcare providers, to make sure I was fully informed of both the science and the arguments against the science.) I think they want to discredit peer-reviewed science because their own "science" is NOT peer-reviewed, and they want to put it on equal footing with the peer-reviewed literature. But, like, it's more than that at the same time. They are incapable of understanding that surgery alleviates significant discomfort and distress when it is used to treat gender dysphoria, not least of all because they refuse to acknowledge that gender dysphoria is real or to try to understand how dysphoria is experienced by trans people. They fundamentally refuse to accept that we know what will make us more comfortable and happy in our own bodies better than they do. They want us to fit into their image of what they believe someone assigned female at birth should be and what they think we should WANT to be, and when we do not fit that image, they seek to control what we do with our bodies (with incredibly strong parallels with the anti-choice playbook) to prevent us from changing our bodies to be more comfortable with ourselves because they think that our chests absolutely must be used for the purpose of feeding babies (and possibly also for pleasing men). Ironically, they also oppose binding, citing the actual physical harm it can cause when done improperly or for too long, yet they don't want to let us do the thing that will stop us from binding - surgery. They will use the word of the 1-3% of people who actually regret their transitions to ban the medical care of the remaining 97-99%, and yet will not listen to the voices of the overwhelming majority of trans people who are happy and satisfied with the transition-related care we have received, or listen to our doctors or to our mental health professionals. Their entire model is based on distortions and propaganda, so it's not surprising that they want to treat the peer-reviewed science as if it is, too. I am absolutely exhausted by these people and their crusade to take away healthcare that does not impact them in any way whatsoever. (And I expect them to try to go after our private insurance coverage again next session like they tried to do in Florida with SB 254 earlier this year, FYI. So be aware of that on the horizon in next year's onslaught of anti-trans legislation.) And as this has gone from a thoughtful comment on the actual article to a rant about the broader attacks on our healthcare altogether, I think I'm going to stop here before I've written an entire essay on what the conservatives are doing here.
As someone else said, they still deny the science of climate change. I was going to go further and say it’s like they’re flat earthers. The evidence is clear but doesn’t fit their fear/hate-based narrative so they dig in.
The fact that there are people who think there are only two genders and have no understanding of how gender identity works blows my mind. Of course when these topics are removed from schools it’ll only get worse. Which is their goal.
Well, they still have Chloe Cole 🙄
tf are these people smoking
“Science” to conservatives is just a fun word to scream loudly. You can’t force science to fit a theory, nor can you blatantly leave out all the asterisks. Sure Germany’s economy came out of the Great Depression quicker than other nations, but the data is not illustrating all those deemed inhuman who were removed from unemployment ledgers as slaves are not “unemployed”. It’s the same goose stepping pony show on science, 78 years AFTER “fascism ended”.
I am a liberal who values bodily and personal autonomy, which extends to transgender individuals. I do not think legislation is the ideal way to formulate medical practice guidelines; physicians and their professional societies have the responsibility of establishing standards of care that are in the interests of all of their patients.
Gender dysphoria is a real, rare, and poorly understood phenomenon. In order to treat the condition appropriately, quality research is greatly needed, but is lacking. This is especially of concern in regard to the growing number of minors who want to medically transition. Which is more harmful – making minors wait until age 18 or granting access to minors without question?
Unfortunately, the recently published study in JAMA by Bruce, Khouri, Bolze et al on regret after top surgery unfortunately can’t go far towards advancing a peace settlement in the current war over access, by minors, to puberty blockers, cross-sex hormones, and surgeries.
The JAMA study was not on minors, but adults: All the individuals who responded to the survey were at least 18 when they got top surgery, and the median age at the time of surgery, among respondents, was 27, nine years into adulthood.
A basic tenet of research is that study findings can’t be generalized, or applied, to a group that was different than the group studied.
You might say, okay, but there were probably individuals among the 139 respondents that had, as minors, wanted top surgery, maybe even for a very long time, but for some reason, did not get the surgery until age 18. That may be so, but unfortunately the study tells us nothing about that, beyond reporting that the median time from surgery to survey completion was 3.6 years. That does tell us that for half of the respondents, their top surgery was relatively recent – 3.6 years ago or less.
Most published studies on regret do show a very low rate of regret. However, those studies were mainly on individuals who are quite different than individuals today seeking medical transition. Today’s cohort is much younger, many more are female, and the timeline from emergence of dysphoria to the point at which they seek medical transition is much shorter.
The research to date on average amount of time until detransition or regret manifests is hampered by considerable heterogeneity – differences in terminology, definitions, and types of measures used to identify “onset” and regret or detransition. That makes it hard to draw firm conclusions that are not all over the map. One study reported a five-year average; another, eight years. And that is why there is no known way clinically to reliably “predict” who will have regret and who won’t.
The study was a missed opportunity. The researchers failed to collect (or report) the following data about respondents:
• Age first experiencing gender dysphoria
• Age wanting top surgery
• Number of years waiting for surgery
• Age at time of surgery
• Year of surgery
Another weakness of the study, was the rate of non-responders. When no data is collected on 4 out of 10 potential study participants, you have to consider how much the outcomes might have been different if they had responded, especially when there were some statistically significant differences found (based on medical records) between responders and non-responders. The latter group had lower rates of depression and anxiety and more time had passed since the surgery (4.6 years median). These interesting findings, as well as the high non-response rate, are a caution about what can be firmly concluded about the study results.
Loss-to-follow-up – the failure to track down, or engage, individuals who have medically transitioned, and learn from their experiences – is typical in the field of research on medical transition, unfortunately.
One other limitation of the study is that all participants got top surgery at one institution. That limits application of findings to US gender clinics in general. It is possible that pre-operative care is superior at that hospital, having a bearing on regret rate – something worth exploring.
All in all, while this study does offer data worth noting as now part of the scientific literature, it is not proof that medical transition is safe for minors.
The critique of the study by the Society for Evidence-Based Gender Medicine, which you link in your article, goes farther than what I have said here about the study’s limitations. It is worth reading with an open mind.
Of importance is that Sweden, known for its progressive attitudes towards LGBT rights, is now imposing strict limits on access to medical interventions for gender dysphoria in minors. The UK, Denmark, Holland, and Finland have done the same. These countries, which were way ahead of the US in advocating for medical transition, now are concerned about the harms observed and say that the research is inconclusive.
Both camps in the current controversy say that their aim is to reduce harm for any and all trans kids. I believe that there are decent folks on opposing sides really do want the best for kids. Those folks are motivated by love, not ideology, political or otherwise.