Johns Hopkins researchers find little regret after gender confirmation surgery

In a Viewpoint article published on December 27, 2023, at JAMA Surgerythree Johns Hopkins researchers are urging the medical community to reject a widely held but scientifically unsupported belief that many transgender and gender variant (TGD) people who undergo gender confirmation surgery (GAS) later regret their decision to undergo it in such operations.

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 researcher 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 Johns Hopkins University School of Medicine

In their article, the three report findings from a retrospective look at the limited number of evidence-based studies addressing grief after GAS. They also describe how research, health care, and public policy can be guided by using scientific data to properly define postoperative regret. currently believed to be too low -? to address the health needs of diverse populations.

Among the findings from our review of the medical literature available to date on grief after GAS are:

• Less than 1% of people with TGD who receive GAS report regret, which seems dramatically lower than the rates of regret for surgery among people who are cisgender.
• Differences in post-GAS regret between individuals who are TGD and those who are cisgender may be related to each group’s reasons for undergoing the surgery (for example, gender realignment versus cancer treatment).
• This reduction in regret may also be due to the careful application of existing evidence-based, interdisciplinary guidelines and standards of care for those with TGD, such as requiring a well-documented history of gender dysphoria (feelings of mismatch between biological sex and gender identity).
• Accurate assessment of patient satisfaction and regret after GAS remains a major challenge.

To improve the assessment and understanding of post-GAS repentance, the researchers recommend:

• Using the Gender-Q, a promising specific and comprehensive patient-reported outcome measure currently undergoing international field testing and validation.
• Assessment of repentance after GAS no earlier than one year after surgery to overcome any biases.
• Incorporating key assessments of factors that may influence sadness, such as age, race, education level, and quality of life.
• More nuanced research on post-GAS grief could reveal opportunities to improve public policy and, consequently, the long-term health of the population identified as TGD.