Transgender Psychiatrist Reviews: Regret after Gender Affirming Surgery Compared to Other Surgeries
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- Опубліковано 27 вер 2024
- Hi! I'm Dr. Jamie (she/they). I'm a medical doctor, psychiatrist, WPATH GEI SOC8 certified member, and gender researcher who specializes in gender affirming care.
In this video, I review the article - A systematic review of patient regret after surgery- A common phenomenon in many specialties but rare within gender-affirmation surgery (see link to citation below), which shows the very low regret rate of gender affirming surgeries compared to other procedures and major life decisions.
#transgender #genderaffirmingcare #genderaffirmingsurgery #gendertransition #psychiatry #wpath #healthcare #nonbinary
References:
Thornton SM, Edalatpour A, Gast KM. A systematic review of patient regret after surgery- A common phenomenon in many specialties but rare within gender-affirmation surgery. Am J Surg. 2024 Aug;234:68-73. doi: 10.1016/j.amjsurg.2024.04.021. Epub 2024 Apr 24. PMID: 38688814.
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Disclaimer: These videos are not meant to be considered medical advice. If you have questions about your gender identity or any topic discussed on this channel, I recommend seeking a qualified medical or mental health professional
If you need a gender affirming provider, the World Professional Association of Transgender Health (WPATH) has a provider directory search. www.wpath.org/...
At the risk of giving my attention to the outcomes that seem salient to me, I think it's amazing that we've shifted to a model of affirmative care; that interest in GRS has absolutely soared; but that regret rates remain below that of the rates of regret of different forms of cosmetic surgery; elective surgeries; and significant life decisions.
I think this shows that the instincts of the concern trolls are off base. Perhaps they need to look inside themselves to understand what makes them uncomfortable about people choosing to seek care to improve their own lives
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Thank you for this very thoughtful comment. I think it deserves the pin. :-)
Great video!
I've been following this for years. The lack of accurate coverage of the real data in mass media is pathetic.
Thank you for this, Dr. Jamie! Having it on your channel is great. Would love to see you as an expert guest on the big media channels. LGBTQIA+ folks are being scapegoated for all sorts of things that have nothing to do with who they truly are.
LGBTQIA+ does NOT mean sexually perverse weirdos. It means people. People who are different. Time to celebrate our differences instead of fearing them!!!
I agree with you 100%. LGBTQIA+ people are just different kinds of people. We have the same love, needs, joys, and sorrows as anyone else. All we want is to live, and thrive, and be ourselves. I don't think that is so much for us to ask. 🏳⚧
To the extent there are "sexually perverse weirdos" involved, they are among the antis, the bigots. I've been repeatedly struck by how much of the rejection is based on hangups about sex. For example, they see a cis couple holding hands, they think little of it, maybe even think it's sweet. They see a, say, gay couple holding hands, they flash on "how they DO IT."
No, of course I'm not saying that's universal. But I am saying that discomfort with human sexuality is a significant driving force behind anti-LGBTQIA+ bias.
Agree 100%
@@DrJamieTalks My reply to aprilsofia to which I believe this was a response has been deleted by the almighty YT censoring algorithm. As usual, with no explanation and no way to find out why.
So let me see if I can get this part through: To the extent there are "sexually perverse weirdos" involved, they are found among those who deny LGBTQIA+ rights. A second sentence in a separate comment.
@@DrJamieTalks Second sentence: Hangups about sex are a driving force behind denial of LGBTQIA+ rights. Thus ends the RD version of my comment.
Interesting. Regret rates for GRS and detransitioners are the two big bugaboos used to delegitimize trans care. When we learn more about these things, it is clear how senseless they are in casting aspersion on trans care. Sadly, no matter what we say or prove it is too often ignored by leaders who think being trans is some kind of perversion. We must keep standing up for ourselves for it to ever change.
Thanks Dr. Jamie for the video. It is important
You're welcome! Those of us in the medical field need to help disseminate this information.
Great to see you standing up again (on video).
Haha! Ironically, standing is a little more comfortable than sitting unless it is in my recliner. Life is truly an adventure. :-)
Nice to see you back up and around and on your feet..
@@briannataylor3734 Thanks! 😊 The body is truly remarkable. I feel a little more like my true self everyday.
That Amsterdam gender clinic from the Wiepjes study is the one I went to. A fellow nonbinary friend went there too. Just five years ago their assessor at the clinic told them to choose between being either a man or a woman. It really is that recent. Not the 90's, the late 2010's.
The clinic had a policy disallowing top surgery without testosterone, which was only changed in 2019. I'd wanted to apply there in 2015, but gave up after finding out about that policy, so I only applied in 2019.
My friend also didn't want testosterone. They applied much earlier than me. They were held back from getting top surgery for a literal decade.
So I can definitely imagine someone taking testosterone that they don't want, just because they so desperately need top surgery, and then regretting the testosterone. Strict binary criteria can be a factor in causing regret.
The thing about the Amsterdam clinic having very strict criteria to get access to care is true. Maybe it does prevent some people from doing things they regret (idk), but maybe it causes people to feel they need to fit perfectly into the other binary box, and makes them go further than they actually wanted to go.
(and maybe a ton of people who can't get access to care the legal way DIY instead. Oh wait that's not a maybe, I personally know those people, and statistics on Dutch trans people DIY'ing are dismal and getting worse by the year. Way to safeguard trans people's health, Amsterdam VUmc, good flippin' job)
Basically, I don't think having strict criteria would necessarily reduce regret rates.
I haven't yet met a Dutch trans person who doesn't hate the Amsterdam Vumc clinic, and I've met quite a few. The strict criteria are the reason. That should say something about the 'benefits' of strict criteria.
@@ryn2844 Thanks for your comment. I was thinking of you when I saw that study and hoped you would comment. The newer studies clearly show that there is no increased regret with the informed consent model. Therefore, the strict criteria/gatekeeping in the Amsterdam clinic is unwarranted and likely harmful in that it fails to treat a large number of people who experience gender incongruent and would likely benefit from gender affirming surgery.
@@DrJamieTalks Definitely harmful. Before 2015, trans people had to be sterilized before they'd be allowed to change their gender on ID, and the VUmc was the only place that could get you permission to have your gender marker changed. Having correct ID is obviously important for a ton of things, so a lot of trans people got sterilized when they didn't want that. Especially for trans men, medical transition very often doesn't naturally include being sterilized. A lot of trans people regret now not being able to have kids. The Dutch government apologized for this policy this year and gave out compensation for those affected, but like, too little too late.
To clarify, the policy was specifically that you had to be unable to have children. I've had people be confused and think that it was about having to have had SRS, but no, it was specifically about sterilization. (and the VUmc also usually wouldn't give you permission to change your gender marker without SRS, but that's another matter, and that's still the case, hasn't changed.)
4 years ago (2020) a trans guy friend of mine who also went to the VUmc was told that he couldn't get testosterone because he still wanted to be pregnant someday, so while the sterilization policy was already gone by that time, that doesn't mean the people who work there stopped having the idea that you couldn't be trans *and* have kids, you had to choose one or the other. He is on T now. Things are very slowly heading in the right direction.
So yeah you know, if you want to talk about preventing regret... maybe ending those kinds of policies is a good place to start.
Great points! I feel sad for your friend and all those who suffered as a result of these cruel policies.
I find some of these stats shocking. I had no idea the regret rates for most of these things were so high! The numbers seem to conflict with what I see around me.
The regret rate for gas even is higher than I would have thought, but you listed some pretty good reasons why that might be.
I have had four surgeries in my life, and I regret none of them; all, gas included were necessary for my health.
I also have two step children who bring me nothing but contentment and joy, even as adults now. My marriage to their mother has morphed into a treasured companionable primary relationship post transition, a sturdy old oak, around which saplings freely grow in the rays of light that shine through the foliage. How do people come to regret any love found in life, it's so rare and so beautiful?
I wonder if maybe more information is needed by some, and perhaps a few weeks cooling off period as well before implementing some kinds of informed consent decisions?
Thanks for your comment. I'm so happy you are surrounded by love. 💕
Regret is a complex outcome. The waiting periods incorporated into the WPATH Standards of Care help many people decide whether or not GAS is right for them and likely decrease regret.
Regret may also mean different things to different people. It is also the product of many other intrinsic and extrinsic variables. Given the complexity involved, I think providers do a good job at mitigating regret.
If I had gone through life without having GAS, therein would lie my regret. I'm so pleased to have had it. Having had it has got rid of that nagging "do it" voice in my head that really underpins all of my transition.
The only thing that still eats away at me a bit is my voice - probably the only reason I ever get misgendered now - and perhaps working on my voice would help mitigate the remaining minority stress I suffer from. I know what I need to do, and I know how to do it, and furthermore, I know how to produce a strong, solid, female-sounding voice through having sung so much over the years; I did not transition to sound weak or mild-mannered. I've said in the past that I don't intend to do anything with it, but I might well just change my mind about that. In some respects, voice is the hardest part of transition for those who choose to do it, probably because it requires so much practice - and also, for me, I don't have a clear goal for what my voice would sound like. When I'm out, taking to strangers, I tend to raise the pitch of my voice and that has served me fairly well up to now, but I think making it a little more "witchy" at the same time (or "pharyngeal" or "twangy" - or simply just bright as opposed to mellow) will do the job.
Voice also eats at me a bit, especially when I get misgendered on the phone. 😭 Like you, I also feel like I know what I need to do. Work. Work. Work. 💕🏳️⚧️😊
@@DrJamieTalks The phone is what gets me too. How I think singing will help in my case is trying to sound a little like a musical theatre diva, many characters in that genre have very brassy, brash, even bratty voices - a bit "Ruby Wax," if you will. People talk about raising the larynx, but it's far easier not to think about it in that way but to instead try to imitate voices like these. In my case, transvoicelessons was helpful in explaining the concept but didn't really get me where I needed to go. There's a singing teacher who is a cis man as far as I know named Dan Callaway on yt who has an impressive range of sounds within his vocal compass and I'm trying to map the skills learnt from singing to talking.
Having said all this, I class myself as an advanced amateur singer, and some of the stuff I can do now I couldn't do before I started having lessons which I've done for three or four years, so perhaps this advice would only really work for people like me.
I have wondered before - reminded of it by this - what the reaction would be to a proposal that couples who want to get married have to go through a period of psychotherapy to examine the etiology of their emotions before being approved.
@@whoviating This is a good point. Or imagine if any elective surgical procedure required a period of psychotherapy! It might lead to a condition known as cisexual panic 🫨 🤣
Was a good video, I wish we could get it on the eleven o'clock news. Show the population how they are gaslighting them to believe a lie.
Thank you! I'll do my best to counter the disinformation out there.
A common argument that I see among transphobes on this subject is that people secretly regret transitioning en masse but are just too embarrassed to say anything about it, but this really makes no sense when you consider other types of embarrassing surgeries that people get. People are constantly told that they will regret various cosmetic surgeries, only to come out later and agree with the fact that they did indeed regret it. If trans people genuinely were embarrassed to receive these surgeries, then surely we should at least see a higher percentage than we currently do see.
Another experience that I have as a trans man is transphobes constantly telling me that I am going to regret transitioning any time now, but they have been saying this to me for years. Still no regrets, except for me not being able to transition even sooner than I did.
That argument is so preposterous given that all these studies assessing satisfaction and regret are anonymous. So what is there to be embarrassed about? Transphobes have no data only bull 💩
I come from the engineering world and when a project is inthe cooncept stage pro and cons arepresented to the client. I feel any service provide should be obligated to make clients aware of these.
When my egg cracked I remember the first time Iwent to my GP to begin the care i needed on my journey, I was suprised by what they didnt know. So as a client what did I do I went to Dr google.
I am starting on the GRS path this month, and really do hope there will be a discussion in regards to pro and cons.
Just if we lived in a world where medical innovation moved as fast automotive innovation.
Nice to see you back in fighting form DrJamie
Your hair is looking gorgeous🤩 have you thought of a bit of a body wave.
🥰🤗
Within the medical community there remains variability in the level of understanding of gender affirming care and transgender people in general. I remember when I went to my GP, he was kind, open-minded, and woefully ignorant. That said, he did what any other good doctor would do when he doesn't know something, he referred me to the right resources.
My experience with my surgical team has been resoundingly positive. Kaiser makes you do a class about the procedure before you ever meet with the surgeon. Pros, cons, and potential side effects are discussed. This should be expected and I anticipate your surgeon will be open to discussion.
@DrJamieTalks ill keep you in the loop.
Regret seems to have a cascade effect on people. I definitely regret some of the decisions that I have made over the years. Indecision could have proven to be even worse of an overall outcome than doing what felt right at the time. It seems only fair to look back and ask yourself what you might have done in a different way. Though, dwelling on the matter is hardly helpful. Surgery is a big deal to begin with. If it is considered to be lifesaving by the patient and their care team, then it is very likely the right course of action. Most people would be less successful in their recoveries without a healthy amount of support. Then, if the outcome was not entirely what they hoped or expected, they might even second guess the decision. Overall, I regret more of my decisions to wait or do nothing than anything else.
Thanks for your comment. I'm putting together a video on post-surgical depression "blues" which ties into this a little. Like you, I regret my inaction more than any action. For me, my inaction had a lot to do with a lack of knowledge and fear of social stigma. I didn't realize how miserable I was in my inaction until I started doing something about it. Truly, the best choice I ever made in my life.
Did I hear you correct, Do you identify as non-binary ?
Some identity labels i identify with include transgender, transwoman, non-binary, and genderqueer.
I always thought we are non-binary to a point
@@Chloedawnknauer Today, I would say I identify mostly as a trans-woman. 😊💕🏳️⚧️
❤❤❤❤❤❤❤❤🧚🥇
Holy fill in the blank! You're doing a vid standing! Out, um, standing! Clearly, things are going well.
😄😂🤣 Yes, I’m standing! 💕🏳️⚧️🥳
Such a significant population sample in the study, and interesting that part of that regret is outcome of the aesthetics. It really highlights that that support that we have moving forward in our transition to our true self WORKS and works incredibly well.
It is such a shame that the naysayers will disavow such a study when the results speak for themselves.
Thank you again for such wonderful content. And great to see you back on your feet after surgery!!
You're so welcome! There are a lot of great studies out there. I'm going to do my best to share the data. :-)
@DrJamieTalks I hope you won't mind but I have just started a UA-cam channel documenting my journey. Would I be Allright if I posted about this video? Positive and asking people to come and watch.
Of course!
Dr. Jamie, would it be true that following the WPATH protocol would reduce the number of people who regret these surgeries? It seems to me that there is a lot of “noise” about the stringency of WPATH. That, in turn, feeds the frenzy of the anti trans movement who think that anyone can decide to be trans one day and given hormones the next.
Thanks for this thoughtful question.
There is a significant amount of disinformation out there about WPATH. The Standards of Care require a 6 month period of hormones and/or period of assessment before any gender affirming surgeries are recommended. It often takes much longer given the various criteria and administrative hoops a patient must jump through to get a letter(s) and be scheduled for surgery. It is also commonly misunderstood that affirmation negates assessment. A gender affirming provider evaluates each person for gender dysphoria/incongruence and does their best to address any co-occurring mental health concerns. It is true that the Standards of Care have removed some requirements such as the 'real life test' as these requirements approached gender identity from a very binary viewpoint and acted mostly as a cruel hazing period for most trans people. Most of the noise is from people who simply don't want trans people to be visible. I think those of us who work in the space just need to keep speaking up.
@@DrJamieTalks as I remember, it was quite some time before my friend qualified for the surgery. Too bad most people have nevertheless heard of the standards of care under WPATH.
I've heard many insurances don't cover FFS or electrolysis because they say they're considered "cosmetic" procedures and are unnecessary. It's really ridiculous because those two options are so important for many people, especially trans women and transfemme people.
@@absurditydeprofundis585 I agree 100% - Kaiser covers both. Electrolysis alone can cost thousands of dollars. If insurance companies and governments would simply follow professional society guidance, these procedures would be covered and not considered cosmetic. This would improve wellbeing and quality of life and decrease long term costs.
I personally believe that cosmetic surgeries, along with healthcare in general, should be publicly-funded if their doctors and therapists agree that receiving a particular surgery will be meaningfully beneficial for one's mental health. Whether gender-affirming or not, I think that mental health is worth investing into as a society, even if sometimes that involves cosmetic procedures.
@@albedougnut I agree. I think many procedures can be 'gender affirming' for people who aren't trans. For example, hair removal in women should be covered regardless of the condition. There are many other examples. All should be covered.
It's ironic that my government in Ontario Canada will fund srs but not electrolysis or a trachea shave.
I think for trans women these procedures are increasingly becoming a personal safety concern, rather than merely a source of discomfort, especially when we travel.
Things have changed. I can recall back in my first year uni days, a male foreign student in my class getting covered for plastic surgery for a bent nose, who then returned to his home country afterwards.
Some abuses have to be checked, but it's completely unreasonable to call electrolysis merely cosmetic. No cis woman, hirsute or otherwise develops a rough stubble that has to be shaved three times a day to be remotely presentable for any number of critically important moments that occur in everyday life.
I agree 100% Electrolysis, laser hair removal, facial feminization surgery (including tracheal shave), and voice therapy (and voice surgery) should be covered.
De-transitioning is a great way to attract media attention!
@@Fritillaria_transgenteri I’d rather be lost to history than have my words elevated by people who hate me.
Thank you! You provide such helpful and interesting information. I look forward to each of your posts🫶🏾🌻🦋
@@davefisher1840 Thanks! I look forward to each of your comments. 💕
I'm not stupid I know the majority of the videos proporting to gas as regretful are highly misleading and disingenuous but still it scares me... I'm wondering if it really is the best step forward for myself but ever since starting hrt my dysphoria surrounding my genitalia is just getting worse and worse day to day life is fine but this issue is always in the back of my head. What do yall think? A part of me worries I only want it for sexual reasons so sometimes it frustrates me to even think about it... idk just a t girl but beyond that a human that doesn't wanna live with regrets.
Well, I definitely don't think you're stupid for having concerns about such a life changing surgery. It sounds like you still have some unpacking to do. Do you have a gender affirming therapist? Sometimes, it is helpful to talk it out with a professional.
I can't offer medical advice, but I can share my experience. When I began transitioning, I just wanted an orchiectomy. I was sure about that. Like you, hormones began to open some doors for me. It was like finding rooms in a house that I didn't know existed. It was exciting and scary all at once. As I continued to explore, through medical, social, and legal transition, my transition goals also shifted. This is when I began to consider bottom surgery. The process being what it is, I had a lot of time to consider pros and cons, and eventually I decided that this was the logical next step in my gender journey. At the time of my surgery, I had no fears of regret, and today (a little over a month out from surgery), I'm happy and my dysphoria has improved.
My advice (not medical). Don't let anyone tell you what is right for you. Only you can decide that for yourself. It's natural to have concerns/fears before major life decisions like elective surgery. Take your time to make the most informed decision you can to meet your life goals. 💕