Question What is the rate of regret and satisfaction with decision after 2 years or more following gender-affirming mastectomy?
Conclusions and Relevance In this cross-sectional survey study, the results of validated survey instruments indicated low rates of decisional regret and high levels of satisfaction with decision following gender-affirming mastectomy. The lack of dissatisfaction and regret impeded the ability to perform a more complex statistical analysis
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The problem I see with detransition and regret rates after 2 years is that this is too short a period to guage properly whether transitioning works and deals with issues like gender dysphoria which is a psychological problem and not a body problem.
The idea with transitioning is that by changing the body it will heal the mind which is fundementally in contradiction to how we usually deal with psychological disorders. If gender dyphoria is mental disorder then like other mental disorders such as anorexia norvosa or other body dysphorias like muscle dysmorphia are treated with psychotherapy initially.
It seems longer term studies show declining satisfaction so whether this is because no or little therapy has been provided or transitioning isn't enough to overcome the problem is yet to be determined. But certainly it seems that professionals at the forefront of Trans care are backing away from Affirmation and Transitioning as the first approach and are now advocating for therapy first.
If gender dysphoria is about body aned mind integrity, feeling authentic and real within ones self then I don't think changing the body is really going to solve this problem. The idea that we can more or less cut off body parts and rebuild them artifically seems to go against the idea of an authentic body that is integrated into the psyche.
A transwomen or man when transitioned are not really becoming the opposite sex but rather become a feminized men or masculinized women, counterfeits or impersonators of the sex with which they ‘identify. I think in the long run this must feed into gender dysphoria in that the treatment for gender dysphoria is more or less creating more gender dysphoria by creating an inauthentic body to live in and in some ways perhaps just as inauthentic as living in the opposite sex.
I would have thought that if we at least try therapy first to help a person accept who they are, perhaps overcome any psychological issues that may be causing the dysphoria such as childhood trauma that this would be the best first step. Then we can reassess to see if changing the body will also help. But to automatically assume that changing the body is the first and best step seems premature and against the normal practice for all other similar disorders.
Its a difficult and complex problem and I think theres more to learn. I know that with other disorders like anorexia and other body dysmorphias or even self image/worth problems that people can learn to live with who they are warts and all and be happy and confident by learning not to judge themselves by how they think others see them. Afterall people come in all shapes and sizes and some have lost body parts ect but still live a happy life.
