Researchers and clinicians with the Society for Evidence Based Gender Medicine claimed a recent study that found a near-0% regret rate for so-called "gender-affirming" mastectomies was "untrustworthy and not applicable."
Last week, a study published in the JAMA Network, "Long-Term Regret and Satisfaction With Decisions Following Gender-Affirming Mastectomy," reported that individuals reported high satisfaction levels regarding their decision to undergo double mastectomies.
SEGM released a critical analysis of the report this week, noting that "the study suffers from serious methodological limitations."
"The study authors lauded the 'overwhelmingly low levels of regret following gender-affirming surgery,' and framed their findings as in conflict with the 'increasing legislative interest in regulating gender-affirming surgery,' referring to current legislative attempts to restrict or ban 'gender-affirming' procedures for minors," SEGM stated.
SEGM contended that the study failed to evaluate "long-term" satisfaction since patients were surveyed an average of 3.6 years after surgery, despite its endpoints spanning over 30 years.
"Further, only a small proportion (25%) of the study participants were followed longer than 5 years. Such follow-up cannot be considered long-term," the analysis explained.
Participants averaged 27 years old, and no one under 18 was eligible to participate in the study. Therefore, the group of researchers argued that the study did not apply to the debate regarding bans on children receiving gender mutilating surgeries.
"The results also suffer from low applicability to the central issue the study and the invited commentary sought to address, which was whether legislative attempts to regulate 'gender-affirming' surgeries are warranted in minors," SEGM added.
The study also had a high non-participation rate, which SEGM claimed "threatens the validity of the results," noting that 41% of eligible patients did not participate.
"To mitigate the non-response bias from over 40% of the eligible participants, the study authors analyzed medical records of the 'nonparticipants' at the same institution for the presence of mastectomy 'reversal' procedures. Finding no such 'reversals,' the authors concluded that regret rates among non-participants was similarly nearly zero. However, this assumption is fundamentally flawed," the analysis added.
SEGMA explained that unsatisfied patients were "unlikely" to return to the same clinic that performed the mastectomy. The researchers noted that masculinizing mastectomies are not considered "reversible" since surgical techniques differ from mastectomy surgeries for women with breast cancer. Additionally, insurance companies often cover the cost of "gender-affirming" surgeries but not reversals.
"The only intellectually honest commentary is that we do not have good knowledge of the likely rates of detransition and regret following chest masculinization mastectomy, nor do we know how many people experience regret but remain transitioned. There is an urgent need for quality research in this area," SEGMA reported.
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