Trans regret? Research casts doubt on stories about sex reassignment surgery

You’ll often hear lawmakers, activists, and commentators argue that many transgender people regret their decision to undergo sex reassignment surgery, a belief that is fueling a wave of laws restricting access to gender-affirming healthcare.

Gender-affirming healthcare can include surgical procedures such as facial reconstruction, lower back surgery. “superior” and genital surgery or “below”.

But in an article we recently published in JAMA Surgery, we cast doubt on the idea that transgender people often regret sex reassignment surgery.

Data suggests that less than 1% of transgender people who undergo sex reassignment surgery regret it. This proportion is even more staggering when compared to 14.4% of the general population regretting the same surgery.

For example, studies have found that between 5% and 14% of all women who undergo a mastectomy to reduce their risk of developing breast cancer say they regret doing so. however, Less than 1% of transgender men who undergo the same procedure say they regret it.

The statistics are based on reviews of existing studies that examined regret in 7,928 transgender people who received gender reassignment surgeries. Although some of this previous research has been criticized for overlooking the fact that regret can sometimes take years to develop, it is consistent with a growing number of studies showing positive health outcomes among transgender people receiving gender-affirming care.

Why is access to sex reassignment surgery important?

About 1.6 million people in the United States identify as transgender. Although only 25% of these people have undergone gender reassignment surgeries, these procedures have become more common. From 2016 to 2020, approximately 48,000 trans people in the United States received sex reassignment surgeries.

These procedures offer transgender people the opportunity to align their physical bodies with their gender identity, which can have a positive impact on their mental health. Research shows that access to sex reassignment surgery can reduce levels of depression, anxiety and suicidal ideation among transgender people.

Mental health benefits may explain lower levels of regret. Transgender people have much higher rates of mental health problems than cisgender people, or those whose gender identity matches their birth sex. This is mostly because transgender people have a hard time living authentically without discrimination, harassment and violence.

Sex reassignment surgery usually involves undergoing a series of tests: a waiting period, hormone therapy, and learning about the potential risks and benefits of the procedures. Although most surgeries are reserved for adults, leading guidelines recommend that patients be at least 15 years old.

This meticulous process that trans people go through before undergoing surgery may also explain the lower levels of regret.

Additionally, many cisgender people undergo surgeries that, in their ideal world, they would not receive. But they do so to avoid health problems.

For example, a cisgender woman who undergoes a mastectomy to prevent breast cancer may regret the decision if she doesn’t like her new look. Conversely, a transgender male who undergoes the same procedure is more likely to be satisfied with a masculine-looking chest.

Research and improve public policies

It is important to note that this research is not conclusive. Opinions about surgical procedures can change over time, and patients may feel very differently about their results eight years after the procedure than they do one year after the procedure.

However, the consensus among experts, including experts from the American Medical Association, is that sex reassignment surgery can improve the health of transgender people and should not be banned.

US states such as Oklahoma and North Dakota have ignored this consensus and restricted access to these procedures. In response, 12 states have designated themselves “sanctuaries” for gender-supportive care.

Although our statistics on surgical regrets may change as researchers learn more, they are the best data healthcare professionals have. And public policies based on the best available data are those that can improve people’s lives the most.