In a Viewpoint article published on December 27, 2023, in JAMA Surgery, three researchers from Johns Hopkins are calling on the medical community to reject a widespread but scientifically unsupported assumption that many transgender and gender diverse (TGD) individuals who undergo gender-affirming surgery (GAS) later regret their decision to undergo such procedures.
The researchers are:
- Harry Barbee, Ph.D., Assistant Professor and Interdisciplinary Social Scientist at the Johns Hopkins Bloomberg School of Public Health
- Bashar Hassan, MD, Postdoctoral Fellow in Plastic and Reconstructive Surgery at the Johns Hopkins Center for Transgender and Gender Expansive Health (CTH) and the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center
- Fan Liang, MD, Medical Director at CTH and Assistant Professor of Plastic and Reconstructive Surgery at the Johns Hopkins University School of Medicine
In their article, the three report on the results of a retrospective review of the limited number of evidence-based studies addressing regret after GAS. They also describe how research, healthcare, and public policy can be guided by the use of scientific data to properly define postoperative regret—currently estimated to be very low—to meet the healthcare needs of diverse population groups.
Key findings of their review of the current medical literature on regret after GAS include:
- Less than 1% of TGD individuals who receive GAS report regret, which appears to be significantly lower than the rate of surgical regret among cisgender individuals.
- Differences in post-GAS regret between TGD and cisgender individuals may be related to the reasons each group has for the surgery (e.g., gender affirmation vs. cancer treatment).
- This decrease in regret may also be attributed to the careful implementation of existing evidence-based, multidisciplinary guidelines and care standards for TGD individuals, such as requiring a well-documented history of gender dysphoria (the feeling of mismatch between biological sex and gender identity).
- Precise assessment of patient satisfaction and regret after GAS remains a considerable challenge.
To improve the assessment and understanding of regret after GAS, the researchers recommend:
- Use of Gender-Q, a promising specific and comprehensive patient-reported outcome measure currently undergoing international field tests and validations.
- Evaluating regret after GAS no sooner than one year post-operation to mitigate any biases.
- Incorporating baseline assessments of factors that may influence regret, such as age, race, education level, and quality of life.
- A more nuanced examination of regret after GAS could uncover ways to enhance public policy and, consequently, the long-term health of the TGD-identifying population.
Barbee, H., et al. (2023). Postoperatives Bedauern bei Transgender- und geschlechtsdiversen Empfängern einer geschlechtsbejahenden Operation. JAMA-Chirurgie. doi.org/10.1001/jamasurg.2023.6052.