Adolescents Report Low Regret and High Satisfaction After Gender-Affirming Chest Surgery

Researchers Maya Younoszai, Caleb Haley, Cole V. Roblee and colleagues published a cross-sectional study in the *International Journal of Transgender Health* that compared postoperative experiences of adolescents (under 18) with those of young adults (18-26). Participants were patients who received chest surgery at a pediatric hospital between January 2018 and April 2023 and were at least one year post-operation. Surveys were returned by 77 of 183 eligible patients (42 % response rate), including 42 adolescents and 35 young adults.

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In recent years several U.S. states have introduced bills to restrict gender-affirming care for minors, often citing concerns that teenagers might later regret irreversible procedures. The new data provide patient-reported outcomes that directly address those policy arguments.

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Using the Decision Regret Scale (0–100, higher = more regret) and the Satisfaction with Decision scale (1–5, higher = greater satisfaction), the study found a median regret score of 0 for both age groups and a median satisfaction score of 5, the highest possible rating. Statistical analysis showed no significant difference between adolescents and young adults on either measure. A family-support questionnaire revealed a positive correlation between perceived family support and satisfaction, though the link to regret was not statistically significant. Five participants reported higher regret scores or mismatched regret-satisfaction responses; qualitative follow-up indicated dissatisfaction with aesthetic outcomes (e.g., keloids, uneven contours) rather than true gender-related regret. None expressed a desire to revert to their sex assigned at birth.

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The median follow-up time was about 1.8 years, which may not capture long-term shifts in sentiment. The 42 % participation rate raises the possibility of selection bias, as individuals with higher regret might have opted out. Additionally, the sample was predominantly white, male-identified, and testosterone-using, limiting generalizability. Social pressures surrounding the politicized nature of gender-affirming care could also influence respondents’ willingness to report dissatisfaction.

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The authors note that their findings align with earlier research on older patients, suggesting that adolescents process chest-surgery decisions comparably to adults. If regret remains low and satisfaction high, the empirical basis for age-based bans on gender-affirming chest surgery may be weakened, providing clinicians and policymakers with patient-centered evidence for future legislative deliberations.

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