AuroraSaab
Squire
I'm not sure that a review of 55 articles in the USA that indicate outcomes is the slam dunk you think it is. It's a bit of a distraction anyway. The biggest concern is with offering surgery to young people, so you would need to differentiate that group (say 16 to 25) from older people who might have a very different outlook (see Caitlin Jenner for example).
The 'study' isn't new material. It's a narrative review of old research. A few points:
1. The author is a gender reassignment surgeon who is currently being sued by a patient for performing a mastectomy without informed consent. So a clear conflict of interest and hardly an unbiased reviewer.
https://eu.jsonline.com/story/news/...-over-gender-affirming-surgeries/71437329007/
2. The studies being reviewed were not graded for quality. All studies were given the same weight and taken at face value despite many being criticised as being of low quality. It does not meet the criteria for a 'systematic' review; it's a narrative one.
This is different from Cass where studies were independently graded and more weight given to high quality research.
3. The reason some of the studies are poor quality are things like having a very narrow definition of regret and detransition (eg the Bustos review). Another cited was a survey with only a 30% response rate of WPATH-affiliated (ie gender association) surgeons, taking at face value their self-reports about how many patients regretted their procedures. This is open to bias and ignores that detransitioners and regreters may not go back to the doctors who harmed them.
Another issue is that most studies cited on regret/detransitioning are short term, eg 5 years or under. IIRC Cass found that the average time before detransition was 7 years so we need to be looking at 10 years later not 2 or 5.
Importantly, as I Cowden pointed out, the cohort for many of these studies are male adults who transitioned late on - often after years of persisting in their gender identity. They are less likely to regret surgery. This is very different from those who now make up most gender clinic patients, which is children and young people.
Further, this overview only looks at surgical regret. There will be others who have desisted/detransitioned from either meds or their social transition who will never appear in such studies because they simply dropped off the radar of their clinics.
In short, research is limited, most studies are poor and few clinics do follow ups - the Tavistock did zero follow up in 30 years.
Reviews like this show exactly why the evidence for gender medicine needs to be far more rigorously examined. Which is exactly what Hilary Cass did and found it lacking.
Last edited: