Study finds adolescents report high satisfaction, low regret after gender-affirming chest surgery

A study published in the International Journal of Transgender Health has found that adolescents who undergo gender-affirming chest surgery report satisfaction levels and regret scores nearly identical to those of young adults who have the same procedure. The research, conducted by Maya Younoszai, Caleb Haley, Cole V. Roblee, and colleagues, directly addresses a central argument made by policymakers who have pushed to restrict youth access to these surgeries: the concern that teenagers will later regret irreversible physical changes.

Gender-affirming chest surgery typically involves removal of breast tissue to create a flat chest contour. Until this study, most data on patient satisfaction and regret following the procedure came from adult populations. The researchers designed a cross-sectional study to compare outcomes between patients who had surgery before age 18 and those who waited until young adulthood. They surveyed patients who received chest surgeries at a pediatric hospital between January 2018 and April 2023, requiring that participants be at least one year post-operation. Of 183 eligible patients, 77 completed surveys: 42 who had surgery as adolescents and 35 who had surgery between ages 18 and 26.

The findings were striking in their uniformity. Using the Decision Regret Scale, which scores regret from zero to 100, both the adolescent and young adult groups had a median regret score of exactly zero. On the Satisfaction with Decision scale, which ranges from one to five, both groups achieved the highest possible median score of five. The differences between age groups were not statistically significant. The researchers also measured family support and found a positive correlation with surgical satisfaction, though family support did not significantly predict regret levels.

Among the 77 participants, five reported higher regret scores or a mismatch between regret and satisfaction measures. When researchers examined their written responses and conducted interviews, a pattern emerged: these patients expressed dissatisfaction with specific aesthetic outcomes—issues like keloids or uneven chest contours—rather than regret about the transition itself. None reported what clinicians call true gender-related regret, meaning a desire to return to their sex assigned at birth. Even these five patients stated that the surgery had improved their overall quality of life, allowing them to stop wearing restrictive chest binders and feel more confident in social interactions and clothing choices.

The study also tracked 13 participants whose gender identity shifted after surgery. Someone might have identified as a transgender man at the time of operation but later identified as nonbinary. Their regret and satisfaction scores did not differ from the rest of the group. Before surgery, all patients underwent psychological evaluations by both a surgeon and a mental health provider. For patients under 18, all legal guardians had to consent; if any guardian was unsupportive, the surgery was not performed.

The researchers acknowledge several limitations that shape how the findings should be interpreted. The median time since surgery was approximately 1.8 years, a relatively short window that may not capture regret emerging years later. The 42 percent survey response rate raises the possibility of selection bias—people with higher regret might have declined to participate, potentially underestimating dissatisfaction in the overall population. Additionally, because gender-affirming care has become a highly politicized issue, some participants might have minimized their dissatisfaction in surveys, fearing that expressed regret could be used to restrict healthcare access for themselves or others.

Most participants in the study were white, identified as male, and had a history of testosterone use. A notable finding was that high percentages of patients had documented diagnoses of depression and anxiety prior to surgery, yet the group experienced very low complication rates. The researchers note that despite these limitations, their data align with earlier studies of older patients, suggesting that adolescents appear to process their surgical decisions with outcomes comparable to young adults. The question of what happens over decades remains open.