Transgender and non-binary teens and young adults – who experience anxiety and depression more often than others – often experience less mental stress after breast removal surgery, according to a study published Monday by Northwestern Medicine.
This is a discovery that comes as many states try to ban gender-confirmation surgeries for people under the age of 18, and hospitals, including those in Chicago, are criticized and sometimes threatened for the care they provide to transgender, non-binary and non-binary people. gender-incompatible children.
“Our findings show that the best surgery (breast removal) benefits these teens and young adults,” said Dr. Sumanas Jordan, lead author of the study, which was published in the peer-reviewed journal JAMA Pediatrics. “It’s very important to be able to have evidence and to treat it based not on policy, but based on science and medicine.”
The authors of the study compared two groups of patients aged 14 to 24 at three Chicago hospitals: one group of 36 patients who opted for so-called upper surgery, and a control group of 34 patients who sought gender-confirmed care but did not undergo surgery. Over time, participants questioned and found that three months after the operations, patients who underwent upper surgery experienced significantly less chest dysphoria, which is a stress related to breast development, than before surgery, while patients in the control group experienced more or less of this. the same level of chest dysphoria every three months before.
Patients who underwent surgery also experienced less dissatisfaction with their body image and greater gender compatibility, meaning that people feel that their appearance matches their gender identity.
Jordan called the reduction in chest dysphoria “quite dramatic.” Thoracic dysphoria has been linked to higher levels of anxiety and depression. Research suggests that transgender and non-binary adolescents are more likely to struggle with depression and anxiety than cisgender adolescents. Nearly 51% of female and male adolescents polled in a 2018 study published in the journal Pediatrics attempted suic*de.
“Puberty is a rather turbulent time, but untreated additional thoracic dysphoria and gender dysphoria do a lot of harm in my opinion,” said Jordan, who is an assistant professor of plastic surgery at Northwestern University Feinberg School of Director of Medicine and Systems for Gender Pathways at Gender Pathways. Northwestern.
Critics of gender-confirmation surgery in adolescents say they are too young to make irreversible decisions about their body. Last year, Arkansas became the first state to ban gender-confirmed treatment and surgery for those under the age of 18, although courts temporarily blocked the enforcement of the law. A dozen other states have enacted similar laws since then, according to the Kaiser Family Foundation.
In February, Texas Governor Greg Abbott instructed the state agency to investigate “s*x reassignment procedures,” including top surgery, for child abuse while being performed on minors.
In Illinois, in 2019, half a dozen Republican lawmakers, including governor candidate Darren Bailey, sponsored a bill that aimed to make gender reassignment operations and other therapies illegal for people under the age of 18. The bill did not go far.
“The procedure is irreversible,” said Tom Morrison’s representative R-Palatine, who was the main sponsor of the bill. “There are all kinds of practices in which we prohibit minors from participating because they are unable to fully consent or obtain informed consent, or have the maturity to understand what decisions they make throughout their lives.”
Gender-confirmed care doctors emphasize, however, that no one disregards the decision to perform such an operation on a teenager.
Hospitals require parental consent from those under the age of 18 in Illinois who undergo the best surgery, and patients must fully understand the operation, its risks and benefits, and be considered mature enough to make a decision, said Dr. s*x confirmation operation at Rush. University Medical Center. Schechter is the co-author of the chapter on surgery in the latest standards of care of the World Trade Association for Transgender Health, which aligns with gender development programs in hospitals.
That said, not every transgender or non-binary teenager wants or should have surgery. Some teens may be treated with dr*gs that can delay puberty or hormones. Others may not need or want medical intervention at all. The operation follows a careful evaluation by a team of doctors and discussions over time with parents and patients, he said.
“This is a very, very deliberate decision and it is a decision between parents, the person seeking surgery, the surgeon and the multidisciplinary team, mental health professional, pediatrician,” said Schechter. “It is taken very, very seriously, including when we intervene.”
He said it is rare for surgery to be performed in adolescents under the age of 16, but doctors consider patients on an individual basis. Other previous studies have also shown that the best surgeries performed on adolescents and young adults are safe and effective, said Schechter, who was not involved in the Northwestern study.
Jordan, lead author of the new study, said there was no point in delaying the best surgeries for all teens up to the age of 18.
“If you have had any other medical condition where you said,” I am not going to treat your diabetes or high blood pressure until you are 18 “or” I will hold off treating you for years, “it is not ethical to withhold care for that long. Jordan said.
She said she had seen parents who were initially opposed to surgery changed their minds when they “realized they were either healed or lost.”
Jordan and other researchers plan to continue observing the teens and young adults in the study to see how they are doing in the long term.
One of these patients, Hunter Martin, is about two years after his most important surgery and said it was still one of the best decisions he made.
Martin was 16 when he underwent surgery. It took years to get to this point, he said.
Martin knew he wanted the best surgery when he was 12 years old. In his freshman year of high school, Martin told everyone that he went Hunter and used the pronouns he / he.
He wore a chest compression garment all this time, but it was not a perfect solution. His back ached and his clothes made it difficult for Hunter to sing, one of his passions in life.
He was in his last year of high school when he had surgery. He clearly remembers the moment he opened his eyes after surgery, while the nurse was adjusting his bandages.
“As soon as I woke up, I felt an intense feeling of relief,” he said.
That feeling only got worse over time, he said. He feels more present in his body and appreciates things like being able to put on a T-shirt and walk out the door.
“Every moment that I realize and recognize that this is something I am doing now that I would not be able to do if I did not have access to this surgery is another moment of relief, euphoria,” said Martin.
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