Studies examining transgender women and men show that the overwhelming majority are very happy with the results they obtain from gender confirmation surgery. According to a data analysis of 27 studies involving 7900 patients by the JAMA, more than 99% were satisfied with their gender affirming surgeries. Despite this, socially conservative politicians, media figures, and anti-transgender activists often claim that there are high incidents of unsatisfactory surgical outcomes. Let’s dig into the real data and step away from the reactionary dogma.
What is Gender Affirming Surgery?
Gender affirming surgery is an umbrella term that refers to an array of surgical procedures that help to bring a person’s physical characteristics in line with their gender identity. These surgeries are a part of gender-affirming care, but do not fully define it. Gender affirming care is any form of treatment or therapy that allows transgender and nonbinary individuals to live authentically and experience relief from gender dysphoria. Gender affirming surgery includes various procedures that are selected to meet the unique needs of each individual.
Examples of gender affirming surgery include:
- Chest masculinization (top surgery)
- Metoidioplasty or phalloplasty (construction of a penis)
- Breast augmentation
- Vaginoplasty (construction of a vagina)
- Facial feminization surgery
- Body contouring
- Voice modification
Any procedure used to treat gender dysphoria can be categorized as gender affirming.
These procedures are not considered to be cosmetic according to reputable medical professionals. Instead, they lead to significant improvements in self-esteem, mental health, and quality of life. People who receive this kind of gender affirming care experience lower rates of depression, anxiety, and gender dysphoria. They also report a higher quality of life.
Who Gets Gender Affirming Surgery?
Gender affirming surgery is sometimes called transgender surgery or gender reassignment surgery. While transgender and nonbinary folks certainly seek out these treatments, this isn’t limited to them. Cisgender people also seek out surgical options to affirm their gender identity. For example, a cisgender man might choose to have surgery to remove excess breast tissue to achieve a more masculine appearance. A cisgender woman might pursue a breast augmentation so that her body matches her vision of femininity.
Despite this, most of the negative rhetoric around gender affirming surgery is not very balanced. Most of it focuses solely on transgender patients. While this article focuses on transgender patient outcomes, it’s important to understand the underlying motives behind exaggerating postoperative regret.
How Gender Confirmation Surgery Helps Gender Identity
Transgender patients seek out gender affirming surgery because these procedures play a key role in supporting their sense of self. When a person’s physical characteristics don’t align with their gender identity, some surgeries can provide immense relief. When that disconnect is so great for transgender individuals that it causes harm, this is gender dysphoria. This is something that is diagnosed in clinical settings, and explored in depth in gender dysphoria studies.
Medical professionals can offer treatments like surgical gender transition to help affirm their client’s gender identity to reduce psychological distress and achieve positive mental health outcomes. There is significant gender affirming outcomes literature that proves out the high levels of transgender patient satisfaction after initial gender affirming surgery or other initial gender affirming procedures. That’s because these surgeries work to relieve the distress and pain of gender dysphoria.
While it was historically called gender identity disorder, modern understanding and vocabulary has evolved. Now medical professionals and others embrace associated definitions – gender fluidity, gender dysphoria, etc. These terms reflect a focus on inclusivity and affirmation in the discipline of transgender health. Despite these positive changes, the transgender community rightfully fears societal stigma and lack of access to care. This demonstrates the importance of transgender equality in healthcare.
What is Regret in a Medical Context?
First, it’s important to understand what post-op regret means in clinical and research contexts. It is an emotional or psychological response that involves the patient regretting their decision to undergo a surgical procedure. This regret is often linked to a broader sense of identity or circumstances. A patient may report post surgical regret if they:
- Find that the surgical outcome did not match their expectations
- Don’t receive adequate preoperative counseling
- Struggle with external factors such as lack of family support or social stigma
These might include patients seeking reversal surgery because outcomes don’t align with their gender identity or expressing that the results did not lead to them achieving life goals they associated with their results.
Surgical complications or dissatisfaction with some outcomes are not considered to be surgical regret. For example, a patient may dislike the scars on their chest after top surgery or struggle with chronic genital pain after bottom surgical complications. These may be problematic for the patient, but would not be called post operative regret.
In research, patient reported outcomes are often categorized to make the data clearer. For example a gender dysphoria study tracking patients after breast and genital procedures may include categories of:
- Satisfaction without complications
- Satisfaction with complications
- Regret without complications
- Regret with complications
This can increase understanding of the results and provide those using the research with important context.
What Are Stats For Gender Affirming Surgery?
Transgender surgery which includes reconstructive surgery and may be idiomatically called sex reassignment surgery has high satisfaction rates and negligible regret rates. Individuals who seek such treatment to address gender dysphoria these results allow them to achieve a stronger sense of gender identity and better mental wellbeing.
Satisfaction Rates For Gender Affirming Surgery For TGNC Patients Surgically Treated
Overall satisfaction rates after sex reassignment surgeries are quite high. The study linked at the top of this article also revealed that 90% of patients had improved mental wellness after surgery. Additionally Plastic And Reconstructive Surgery published a meta-analysis in 2020 that found 94-98% of transgender patients were happy with outcomes of phalloplasty and vaginoplasty.
Patients were also happy with their top surgery results including both mastectomy and chest reconstructive surgery. Here the satisfaction rates were 94 to 100%. Additionally, a study from the American Society of Plastic Surgeons reported that 98% of trans men were either satisfied or very satisfied with the results of their top surgery.
Surgical Regret Rates
it’s important to acknowledge regret when it happens to patients with gender dysphoria. Overall, this is at less than 1%. However, more people regret bottom surgeries than top surgeries. This is particularly true for phalloplasty where regret rates can be as high as 5%. Vaginoplasty regret rates were still reported as less than 1%.
In a long-term follow up study, from 2018, there were only 2% of patients seeking surgical reversal out of 600 who were tracked. Regret was attributed to social and psychological pressures more than dissatisfaction with surgical outcomes.
Post Surgery Quality of Life
What about patients’ reported satisfaction after they have had genital surgery or other procedures. Here’s the pertinent data.
Mental Health Improvements
There was a study published in The Lancet in 2018 that found that transgender patients experienced a 42% reduction in depression and a 44% reduction in suicidal ideation.
Further, a 2020 study in Transgender Health revealed that gender-affirming surgery decreased suicidal ideation in transgender women by 61% and by 72% in transgender men.
Finally, a 2016 study that was published in The Journal of Sexual Medicine found that gender-affirming surgery helped relieve gender dysphoria. 80% of patients reported experiencing significantly less gender-related distress.
Sexual Outcomes
How did patients report on sexual function after surgery?
Researchers and clinicians have identified postoperative sexual function as a key priority for many patients and something to consider when measuring outcomes. After a vaginoplasty 80 to 90% of patients report being satisfied with their sexual function. Though others may experience some initial complications that improve over time.
The results of phalloplasty are known to be less predictable. Because of this, it is expected that more patients will have identified poor sexual function as an outcome. Studies show that higher rates of patients who receive phalloplasty surgery report impaired postoperative sexual function. Despite this, they report significant improvement in their quality of life overall.
Factors That Contribute to Regret or Satisfaction
There are several factors that contribute to feelings of regret and satisfaction after gender confirmation surgeries including sex reassignment surgery. There is a complex mixture of psychological, medical, and social elements that influence these outcomes. It’s important to understand these to ensure better outcomes and decrease post-op regret.
Factors Leading to Patient Satisfaction
Ideally, all patients are happy with the outcomes of their surgical procedures. All medical professionals should want to increase satisfaction rates while reducing the number of patients who pursue surgical reversal procedures. So, let’s take a look at the factors that contribute to better rates of post-op satisfaction.
A Comprehensive Preoperative Assessment
Providers must conduct a proper preoperative patient assessment for all prospective patients. This should include a full evaluation of the patient’s expressed gender identity, what that means to them, and a mental wellness assessment. These evaluations can ensure that patients are in a place to be able to handle the impacts of surgery, and ensure that treatment after the procedure meets their needs.
Provide Patients With Education And Counseling
People considering surgery deserve thorough patient education pertaining to the benefits, potential risks, and limitations of surgery. This creates space for managed expectations. Counseling should be provided by comprehensive teams who can educate patients about their options and what outcomes will look like for them.
Use Top-Rated Surgical Techniques
There have been significant advances in plastic surgery involving gender confirming procedures. These combined with the use of advanced surgical techniques can lead to better functional and aesthetic outcomes. This is extraordinarily important in genital surgical procedures where both appearance and sexual function are critical.
Prioritize Results That Are Consistent With The Patient’s Stated Gender Identity
Patients are happiest when outcomes align with their previously expressed identity and personal transition goals. Providers must take time to understand not just what the patient’s gender identity is, but what that means to them. Two transgender patients may identify as masculine, but have very different ideas on how they want that masculinity expressed through their appearance.
Factors That Contribute to Regret
Yes, regret rates are low, but they shouldn’t be dismissed as unimportant. Each patient who experiences regret after sex reassignment surgery or other procedures may be traumatized. Some may face additional trauma and expense to undergo reversal surgery. Others simply have to live with results that don’t align with their previously expressed gender identity. Everyone should want to actively decrease postoperative regret.
Failure to Prepare Patients And Providing Inadequate Counseling
Patients who receive incomplete or inaccurate counseling are more likely to feel regret. Often, they are not fully prepared for what they will experience post-op. These mismatches between outcomes and expectations lead to greater dissatisfaction.
Social And Psychological Pressures
Not all regret stems from failed surgeries or lack of understanding on the part of the patient. Often it comes from external factors. However, outcomes could still be improved if providers identified poor family support systems or recognized how social stigma could be a factor.
These things should not be dismissed or underestimated. Often, when patients request surgical reversal procedures, lack of support and pressure are the strongest factors. Of the few people who detransition medically or socially, the most common causes were family pressures, difficulty of maintaining transitioning, harassment, and struggles to maintain employment.
Medical Issues
Initial surgical complications that include impaired sexual function or chronic pain can lead to regret. This can be mitigated with proper preoperative diagnosis and management of risk factors.
Mental Health Issues
Poorly managed or untreated issues with a patient’s mental wellness before surgery can predict future postoperative regret.
Minimizing Patient Regret And Increasing Satisfaction
The World Professional Association For Transgender Health (WPATH) works to promote evidence-based care that centers the needs of the patient with a goal of better outcomes. This might include emphasizing alternatives such as encouraging patients to undergo hormonal therapy prior to choosing surgery as an option. Patients deserve collaborative teams of professionals who understand their needs and expectations.
The medical community can actively improve transgender health, support every patient’s medical transition process, and promote transgender equality by addressing the issues that lead to regret.
How to Effectively Address Misinformation
Anti-transgender sentiments often fuel misinformation about surgeries intended to affirm gender. These views are often obscured by claims of being concerned for patient welfare. These claims exaggerate regret rates or portray patients as lacking informed consent. Not only do these statements not align with scientific evidence, they perpetuate harmful stereotypes about transgender people. The World Professional Association For Transgender Health provides evidence-based guidelines that include comprehensive mental and physical health evaluations, appropriate preoperative diagnosis, and patient education as part of the process of medical transition.
Contextualizing Regret Rates
The vast majority of patients express satisfaction with their previous gender-affirming surgery. When there is regret, that is most often attributed to lack of social support, changes in personal circumstances, and stigma – not unhappiness with the surgery itself. It’s important to provide that context in these discussions, particularly when the rhetorical goals of the other party are to dismiss or marginalize transgender people. When discussions of regret arise, it is much better to address empirical and theoretical considerations than to amplify unfounded fears or hateful rhetoric.
Addressing Anti-Transgender Rhetoric And Misinformation
Some people who have sought surgical reversal procedures are unfairly used as examples in anti-transgender rhetoric. They are portrayed as evidence of widespread negligence or harm in transgender healthcare. In reality, there is only a miniscule number of people requesting reversal surgery. Further, many who do pursue secondary surgical consultations or other procedures do so to refine outcomes to better match their gender identity – not because they regret their initial gender affirming procedure.
The claims that medical transition procedures are being performed on individuals who lack the capacity to understand or give consent are particularly misleading. These assertions conveniently ignore rigorous standards and protocols in place for medical transition that include mental health evaluations and in-depth assessments by teams of professionals. These protect individuals and ensure they are making informed decisions.
These safeguards ensure that individuals are making informed, deliberate decisions about their care.
Reversal Procedures
For the small number of patients who choose reversal procedures, care is provided with competency, respect, and compassion. Providers who are involved with performing surgical reversal procedures take time to review the patient’s surgical transition history and partner with mental health colleagues to address the factors that led to the request. It’s important to understand the differences between cases where the patient wants to detransition and where patients pursued procedures consistent with their gender identity.
The Role of Education in Combating Misinformation
Public health education campaigns are necessary to counteract harmful rhetoric. By providing accurate data about regret rates and informing people of the individualized, multi-step process of transition, healthcare professionals can help to dispel prevailing myths. However, this process is challenging as people often tie their dogmatic beliefs on this topic with deeply held religious and cultural views. Many reject facts and evidence. However, education and information are still the best weapons against harmful misinformation.
It’s also important to hold those spreading misinformation accountable. This means exposing their motivations and ideologies while relentlessly countering them with data. For example, correcting people who refuse to differentiate between regret and a desire to pursue additional procedures. Patients seeking surgery increases when access to competent care improves. This is a positive, not a reason to spread fear or misinformation.
The Positive Impacts of Surgical Interventions For Trans People
Surgical procedures that are tailored to bring a person’s physical traits in alignment with their identity can have a transformative impact on their emotional well-being, physical health, and social life. The World Professional Association for Transgender Health affirms that these interventions can greatly help to relieve the stress associated with gender dysphoria. Surgery helps trans people lead authentic, fulfilling lives.
Psychological And Emotional Benefits
When a person experiences incongruence between their identity and physical traits they may feel a deep sense of distress. Surgical interventions, including those that involved genital surgery have proved to reduce anxiety, depression, isolation, and suicidal thoughts. Patients who have these procedures report increased confidence and feeling more authentic. These benefits ripple across many facets of their lives. These outcomes demonstrate stability and psychological relief experienced after surgery.
Social And Behavioral Benefits
The positive impacts of surgeries don’t just affect the individual. Patient postoperative behaviors often change in a positive way with the individual feeling more confident and better able to engage in community, social, and professional activities. This can be attributed with better alignment between physical and social presentation that reduces the risk of misgendering or stigma. Post-surgery, individuals may experience more acceptance and feel better about themselves.
Physical Well-being and Long-Term Satisfaction
Many trans people experience physical dysphoria and these surgeries can relieve that for them, especially those that have procedures involving their genitals. When they experience improved physical comfort and functionality, they also experience a better quality of life. Studies have shown that people who have these procedures experience high rates of physical and emotional well-being in the long-run. Even those who are not completely satisfied with their appearance and sexual function still credit surgery to overall improvement of life.
Importance of Post Operative Care
Post operative care should focus on a desire to achieve optimal results for patients. Healthcare providers and patients should be able to look at outcomes objectively. When a patient decides to seek a secondary surgical consultation, that should be seen as part of the continuum of care and a positive step towards achieving transition goals. This should not be seen as failure or regret.
Even the rare cases of patients pursuing surgical reversal should be seen as part of the individualized approach to these procedures. It’s important to know that reversals or adjustments are not evidence that a person is no longer transgender, that they were misled, or that they don’t view their overall transition as positive.
Final: Implications For Policymakers And Medical Professionals
While it is wonderful that surgical interventions are available, there are significant implications for medical professionals and policy makers. Healthcare providers must stay on top of best practices, such as those provided by WPATH to provide the best care. They must also educate themselves about the communities they serve to provide services that are culturally competent. Psychologists, counselors, and others who specialize in mental wellness must be included in patient care teams to provide holistic care.
People who make policies are ethically obligated to take action that serves the needs of their constituents. This includes focusing on equitable access to healthcare, respect for autonomy, and fostering inclusive policies – all while rejecting false and fear mongering rhetoric. When evidence based practices are pursued, both groups can help patients achieve positive outcomes.
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