Study says transgender youth feel less distress after surgery
Transgender and nonbinary teens and young adults — who experience anxiety and depression at higher rates than others — often feel less mental distress after surgery to remove their breasts, according to a study out of Northwestern Medicine published Monday.
It’s a finding that comes as a number of states are attempting to ban gender-confirming surgery for people younger than 18, and as hospitals, including in Chicago, have been criticized, and sometimes threatened, for the care they provide to transgender, nonbinary and gender-nonconforming children.
“Our findings are that top surgery [ to remove the breasts] benefits these teenagers and young adults,” said Dr. Sumanas Jordan, lead author of the study, which was published in the peer-reviewed journal JAMA Pediatrics. “It is so important to be able to have evidence and treat them not based on politics but based on science and medicine.”
The study’s authors compared two groups of patients ages 14 to 24 across three Chicago hospitals: one group of 36 patients who chose to undergo so-called top surgery and a control group of 34 patients who sought out gender-confirming care but did not undergo surgery. They questioned participants over time, and found that three months after the surgeries, the patients who had top surgery experienced significantly less chest dysphoria, which is distress related to development of the breasts, than they had before the surgeries, while patients in the control group experienced about the same levels of chest dysphoria as they had three months earlier.
Patients who underwent surgery also experienced less
body image dissatisfaction and more gender congruence, which is when people feel that their appearance matches their gender identity.
Dr. Jordan called the decrease in feelings of dysphoria “pretty dramatic.” Chest dysphoriahas been associated with higher levels of anxiety and depression. Research suggests that transgender and nonbinary youth struggle with depression and anxiety at higher rates than cisgender teens.Nearly 51% of female-tomale adolescents surveyed as part of a study published in 2018 in the journal Pediatrics had attempted suicide.
“Adolescence is a pretty turbulent time, but to have that burden of that extra chest dysphoria and gender dysphoria that’s untreated, I think does a lot of harm,” said Dr. Jordan, system director for the Gender Pathways Program at Northwestern.
Critics of gender-confirming surgery for teens say they are too young to make irreversible decisions about their bodies. Last year, Arkansas became the first state to ban gender- confirming treatments and surgery for people under 18, though courts have temporarily blocked that law. Over a dozen other states have introduced similar legislation, according to the Kaiser Family Foundation.
In February, Texas Gov. Greg Abbott directed a state agency to investigate “gendertransitioning procedures,” including top surgeries, as child abuse when performed on minors.
In Illinois in 2019, half a dozen Republican lawmakers sponsored a bill that aimed to make gender-confirmation surgeries and other treatments illegal for people under age 18. The bill didn’t go far.
Doctors involved with gender-confirming care, however, stress that no one takes the decision to perform such a surgery on a teen lightly.
Hospitals require parental consent for anyone under 18 in Illinois having top surgery, and patients must fully understand the surgery, its risks and benefits and be deemed mature enough to make a decision, said Dr. Loren Schechter, director of gender confirmation surgery at Rush University Medical Center. Dr. Schechter is a co-lead author of the surgery chapter in the most recent standards of care from the World Professional Association for Transgender Health, which hospitals follow.
Not every transgender or nonbinary teen wants to or should have surgery, he said. Some teens might be treated with medication that can delay puberty or hormones. Others might not need or want medical intervention at all. Surgery happens after a thorough assessment by a team of doctors and discussions with parents and patients, he said.
“This is a very, very considered decision, and it’s a decision between parents, the individual seeking surgery, the surgeon and the multidisciplinary team, the mental health professional, the pediatrician,” Dr. Schechter said. “It’s taken very, very seriously, and that includes the times at which we perform the intervention.”
It’s uncommon for the surgery to be performed on teens under 16, but doctors consider patients on a case-by-case basis, he said. Other studies have also shown that top surgeries performed on teens and young adults are safe and effective, said Dr. Schechter, who was not involved with the Northwestern study.
“If you had any other medical conditions where you said, ‘I’m not going to treat your diabetes or high blood pressure until you’re 18′ or ‘I’m going to hold off on treating you for years,’ it’s not ethical to withhold care for that long,” Dr. Jordan said.
She said she’s seen parents who were initially against the surgery change their minds when “they realize it’s either treat them or lose them.”
One of the patients in the study, Hunter Martin, is about two years out from his top surgery, and said it continues to be one of the best decisions he’s made.
Mr. Martin was 16 when he underwent top surgery. It took years to get to that point, he said.
“As soon as I woke up, I just had this intense feeling of relief wash over me,” he said.
That feeling has only intensified over time, he said. He feels more present in his body, and appreciates things like being able to throw on a T-shirt and walk out the door.
“Every moment that I realize and recognize this is something I’m doing now that I couldn’t have done if I didn’t have access to this surgery is another moment of relief, of euphoria,” Mr. Martin said.