Transgender Youth Feel Less Distress After Gender Confirmation Surgery, Northwestern Study Says

Transgender and non-binary teens and young adults, who experience anxiety and depression at higher rates than others, often feel less mental anguish after surgery to remove their breasts, according to a Northwestern Medicine study published Monday.

It’s a finding that comes as several states try to ban gender confirmation surgery for people under the age of 18, and as hospitals, even in chicagothey have been criticized, and at times threatened, for the care they provide to transgender, non-binary and gender non-conforming children.

“Our findings are that upper surgery (to remove the breasts) benefits these adolescents and young adults,” said Dr. Sumanas Jordan, lead author of the study, which was published in the peer-reviewed journal JAMA Pediatrics. “It is very important to be able to have evidence and treat them not based on politics but based on science and medicine.”

The study authors compared two groups of patients ages 14 to 24 at three Chicago hospitals: a group of 36 patients who chose to undergo so-called upper surgery and a control group of 34 patients who sought care to confirm their gender. but did not undergo surgery. They questioned the participants over time and found that three months after the surgeries, patients who had upper surgery experienced significantly less chest dysphoria, which is distress related to breast development, than before the surgeries , while patients in the control group experienced roughly the same levels of chest dysphoria as they had three months earlier.

Patients who had surgery also experienced less body image dissatisfaction and more gender congruence, which is when people feel their appearance matches their gender identity.

Jordan called the decrease in feelings of chest dysphoria “pretty dramatic.” Thoracic dysphoria has been associated with higher levels of anxiety and depression. Research suggests that transgender and non-binary youth struggle with depression and anxiety to a greater extent than cisgender teens. Nearly 51% of female-to-male teens 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 additional chest dysphoria and gender dysphoria that goes untreated, I think it does a lot of damage,” said Jordan, who is an assistant professor of plastic surgery at the Feinberg School of Medicine in Northwestern University. Director of Medicine and Systems for the Gender Pathways Program at Northwestern.

Critics of gender confirmation surgery for teenagers say they are too young to make irreversible decisions about their bodies. Last year, Arkansas became the first state to ban gender confirmation treatments and surgeries for people under 18, though courts have temporarily blocked enforcement of that law. Since then, more than a dozen other states have introduced similar legislation, according to the Kaiser Family Foundation.

In February, Texas Governor Greg Abbott ordered a state agency to investigate “gender transition procedures,” including top surgeries, as child abuse when performed on minors.

In Illinois in 2019, half a dozen Republican lawmakers, including gubernatorial candidate Darren Bailey, sponsored a bill that aimed to make gender confirmation surgeries and other treatments illegal for people under the age of 18. The bill did not go very far.

“The procedure is irreversible,” said Rep. Tom Morrison, R-Palatine, who was the main sponsor of the bill. “There are all kinds of practices that we prohibit minors from participating in because they can’t give full consent or have informed consent or have the maturity to understand the kind of lifelong decisions they’re making.”

However, doctors involved in gender confirmation care stress that no one takes the decision to perform such surgery on a teenager lightly.

Hospitals require parental consent for anyone under the age of 18 in Illinois undergoing top surgery, and patients must fully understand the surgery, its risks and benefits and be considered mature enough to make a decision, he said. Dr. Loren Schechter, director of gender confirmation surgery at Rush. University Medical Center. Schechter is co-lead author of the surgery chapter in the World Professional Association for Transgender Health’s latest standards of care, which tracks gender development programs in hospitals.

Not all transgender or non-binary teens want or should have surgery, she said. Some teens may be treated with drugs that can delay puberty or hormones. Others may not need or want medical intervention at all. The surgery is done after a thorough evaluation by a team of doctors and discussions with parents and patients over time, she said.

“This is a very, very considered decision, and it’s a decision between the parents, the person seeking the surgery, the surgeon and the multidisciplinary team, the mental health professional, the pediatrician,” Schechter said. “It is taken very, very seriously, and that includes the times when we perform the intervention.”

It’s rare for the surgery to be performed on teens younger than 16, but doctors consider patients on a case-by-case basis, he said. Previous studies have also shown that upper surgeries performed on adolescents and young adults are safe and effective, said Schechter, who was not involved in the Northwestern study.

Jordan, the lead author of the new study, said it doesn’t make sense to delay upper surgery for all teens until age 18.

“If you had any other medical condition where you said, ‘I’m not going to treat your diabetes or high blood pressure until you’re 18,’ or ‘I’m going to put off treatment for years,’ it’s unethical to deny care for that long.” Jordan said.

He said he has seen parents who were initially against the surgery change their minds when “they realize it’s either treat it or lose it.”

Jordan and other researchers plan to continue to follow the teens and young adults in the study to see how they fare long-term.

One of those patients, Hunter Martin, is about two years away from his top surgery and said it remains one of the best decisions he has ever made.

Martin was 16 years old when he underwent top surgery. It took years to get to that point, he said.

Martin knew he wanted top surgery when he was 12 years old. In freshman year of high school, Martin had told everyone that he called himself Hunter and that he used the pronouns he/he.

During all that time, he wore a chest compression garment, but it wasn’t a perfect solution. Her back hurt and the garment made it difficult for Hunter to sing, one of her passions in his life.

He was a senior in high school when he had the surgery. He clearly remembers the moment she opened her eyes after the procedure, to a nurse adjusting her bandages.

“As soon as I woke up, I had an intense sense of relief wash over me,” he said.

That feeling has only intensified over time, he said. She feels more present in her body and appreciates things like being able to throw on a t-shirt and walk out the door.

“Every moment that I realize and acknowledge that this is something that I’m doing right now that I couldn’t have done if I hadn’t had access to this surgery is another moment of relief, of euphoria,” Martin said.

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