Another Day, Another Blatantly False Piece of Academic Writing on Transition Regret

Why are papers on transition regret rife with ridiculous errors, and why do those errors occur in the first place?

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One of the most basic errors you would expect to be caught in peer-reviewed academic literature is plain data errors. They require no real expertise to catch and tend to be trivial to fix. It’s simply part of regular proof reading that any serious article of any sort should undergo.

So why are papers on transition regret rife with ridiculous errors, such as inventing thousands of people out of thin air? And why do those errors occur in the first place?

Let’s have a look at the latest in a long line of peer-reviewed garbage: “A Systematic Review of Patient Regret After Surgery- A Common Phenomenon in Many Specialties but Rare Within Gender-Affirmation Surgery” by Thornton et al.

This piece self-identifies as a systematic review, which it simply isn’t, but that’s rather technical (and, dare I say, academic) compared to the grievous errors in the paper, and will require some back-and-forth with the journal. Going over all of that in detail will take time and isn’t that interesting — although if the paper does get corrected or retracted, it’ll likely be due to such procedural issues rather than overarching problems.

While many individuals report satisfaction and improved measures of mental health after undergoing gender affirming surgery, there is a small but vocal minority who experience regret after their procedures.⁴

De-transitioning, also known as continued gender transition, has been exhaustively covered in the mainstream and conservative media and is an emerging area of study in gender affirming care.

The paper also has a rather noticeable disdain for the subject matter and a clear agenda with the goal of minimizing transition regret as a niche, “exhaustively covered” issue, championed by a “small” but unnecessarily “vocal” group.

Let’s have a look at the sources the paper cites for the rate of regret.

First up: Wiepjes et al., 2018.

A study performed in Amsterdam retrospectively examined 6,793 patients who attended a gender identity clinic in Amsterdam from 1972 to 2015 and found 0.6% and 0.3% of transwomen and transmen reported experiencing regret after gender affirming surgery, respectively. The authors noted that reasons for regret could be divided into three categories. True regret was defined as regretting having GAS. Social regret involved losing touch with loved ones or being fired from a job because of GAS. Lastly, some participants reported feeling non-binary and no longer feeling satisfied with their surgical result. Average time to experiencing regret was 130 months (more than 10 years) post-operatively.³⁰

This is simply erroneous. The authors make the claim that Wiepjes et al., 2018, measured reports of “experiencing regret after gender affirming surgery”. This is false, as the study first required hormonal detransition, the cessation of cross-sex hormone treatment and going back on your natal sex hormones, at the same clinic. Every time the authors describe this as only measuring “experienced regret” they are not being truthful.

In addition, the number who were investigated for this rather specific definition of regret was not 6,793 but 2,627. I’m not sure what the exact purpose of putting the number of people who visited the clinic, including those who never transitioned whatsoever, is but it certainly inflates the number.

You might ask yourself how it’s possible that the authors read Wiepjes et al., 2018, but did not manage to understand what was investigated, nor how many people were looked at. The most likely answer, to me at least, is that none of the authors, peer reviewers, or editors, actually read the paper.

Next up: Bustos et al., 2021. If you need a primer on this, I’ve written about it before.

In 2021, a systematic review and meta-analysis was completed which assessed 27 studies, including a total of 7,928 transgender individuals. One third of the included individuals underwent transmasculine procedures, while the remaining two thirds underwent transfeminine procedures. Of the 7,928 individuals included in the analysis, 1.0% expressed regret. The most common reason for post-operative regret was “difficulty/dissatisfaction in life with the new gender role.” Another common reason was failure of surgery to achieve their aesthetic surgical goals. The authors hypothesized that the rate of regret established by this metanalysis was lower than a previously established rate from 1993 due to increased rigor in the selection process before gender affirming surgery.

Bustos et al., 2021, pulls together all the greatest hits of gender pseudoscience: erroneous data, fraudulent methods, zero peer-review, irresponsibility (or perhaps hostility) from the journal, and more. It’s a paper where the factual error count is in the triple digits to this day.

However, after wrangling the arms of the journal editors a bit, they put out a partial correction (where they actually introduced some new errors as well as fixed a handful). The lowest possible bar you could hold the authors against in this 2024 paper is that they used that 2022 “correction.”

Of course they didn’t.

An inability to even copy and paste numbers is what we’re dealing with here. From the entire chain, authors through editors. It ties into the previous paper as well—if Thornton et al. had read Wiepjes et al., 2018, they would be entirely equipped to see through Bustos et al., which makes the exact same nonsensical mistakes they did.

I would provide an exact number instead of 7,928 here, but it’s not actually possible to do that because one of the included papers reports contradictory numbers, which Bustos et al. didn’t mention or, more likely, even notice. Another provides an estimate rather than exact figures. They also included papers which did not investigate a regret rate in the review, which is just bizarre.

Either way, out of the claimed 7,928 people, at least 3,400 were not investigated for regret in any way. As previously mentioned another 2,627 had a requirement that you had to hormonally detransition in order to count as regretful. Another didn’t measure regret at all, simply legal sex marker reversals. If you go through the papers and add up the number of people who were explicitly asked about regrets (in any way) you get around 1,300. With unknown loss to follow-up, often very short follow-up, and no uniformity to the way they were asked.

Which apparently to Thornton et al., the peer-reviewers, and the journal editors, is enough to conclusively state that we know the rate of transition regret.

Next up is Narayan et al., 2021, which was a combined survey and systematic review. See if you can spot the sleight of hand.

Another study surveyed all surgeons registered for the 2016 World Professional Association for Transgender Health and the 2017 US Professional Association for Transgender Health. Most respondents practiced in the United States and had surgically treated at least 100 transgender or gender-nonconforming patients. Of the 30% of surgeons that completed the survey, 61% respondents had treated at least one patient who experienced regret or requested reversal of a procedure. Overall, the calculated rate of regret after gender affirming surgery was 0.2%-0.3%. Of the 62 patients that respondents reported had sought reversal surgery, reasons for reversal included surgical complications, continued evolution of their gender identity, rejection or alienation from social support, and difficulty in romantic relationships.⁵

An anonymous survey of WPATH or USPATH conference attendants with 70 percent non-respondents (fairly catastrophic given the population), asking them to estimate the number of patients they’ve surgically transitioned (somewhere between 18,125 and 27,325) and how many patients they’ve “encountered” (meaning what?) who “regretted their gender transition” (open for a wide range of interpretations) is not a very serious approach.

The paper sometimes treats “regret,” “reversal request,” and “detransition” as the same thing, sometimes not. The authors (both Narayan et al. and Thornton et al.) seem very confused about what the respondents were actually talking about. Usually, when you’re confused, the right thing to do is to slow down and work it out. Not to take the decision to treat 62 patients seeking surgical reversal as “the regret rate”—which is absurd, and reveals the authors’ intellectual, or rather emotional, bias towards presenting as low a number as possible.

Next up is Bruce et al., 2023.

Recently, research from the University of Michigan demonstrated low levels of regret after gender-affirming mastectomy in a cross-sectional study. On average, respondents underwent surgery 3.6 years before the survey. The median Decision Regret Scale score was 0.0. Further, of the 139 respondents, zero requested reversal procedures.³²

The respondents certainly reported low decision regret. Of course, 3.6 year mean follow-up is less than most studies put the average time to regret at, and a 40 percent non-response rate is… an issue. It’s also exclusively following mastectomy, and that this often provides (at least) short term relief from breast-related distress seem highly plausible.

If Thornton et al. was a systematic review rather than a literature review with a (very poor) systematic search, these issues would be explored and Bruce et al. would take its rightful place as low quality evidence for potential short term benefits. Presenting it as evidence of a low regret rate, however, is ridiculous.

On a side note, Bruce et al. also cites erroneous data from Bustos et al., this time regarding follow-up times rather than sample sizes. It truly is the gift that keeps giving in terms of academic misinformation.

The final thing referenced is the 2022 USTS Early Insight report.

In February 2024, the 2022 US Transgender Survey Early Insight report was published, providing data from 92,329 binary and nonbinary transgender people. This report noted that 97% of respondents who had undergone gender-affirming surgery reported that they were “a lot more satisfied” or “a little more satisfied” with their lives.³³

This was an anonymous online survey recruiting participants via advocacy groups, and described as “a survey for trans people, by trans people.”

When Thornton et al. describe it as “92,329 binary and nonbinary transgender people” they actually get that wrong as well, as the report describes it as “38% nonbinary, 35% transgender women, 25% transgender men, and 2% crossdressers.” This may seem like nitpicking, but it actually describes the inconsistencies of the worldview that Thornton et al. champion.

Other than poking fun at them, there isn’t much more to say here. The Early Insight report doesn’t discuss regret, which is why they didn’t claim it did. Which would make it odd that they put it under the heading “Regret After Gender-Affirming Surgery” if you’re operating under the assumption that Thornton et al. are writing an academic paper, but that’s clearly not the intention.

Human writing has many purposes. The most obvious is communication, to convey thoughts and ideas to others. But we also do it for fun, or to assist ourselves, to organize our thoughts, all sorts of ways. Academic papers of this sort, however, are supposed to have a single purpose: to inform others.

When people write falsehoods, figuring out why they do so is interesting. It tells us something about them. For example, when Thornton et al. repeat erroneous data about papers, it tells us that they didn’t care. Despite using emotive language about regret, it tells us that they don’t care enough about the reality of regret to even read a six page paper (a very low bar), but they were happy to write a paper about it.

So why did they write this paper, despite not caring about the topic?

Research on regret after gender-affirming surgery poses unique challenges, as patients may fear that their regret could be weaponized against the transgender community. Those who seek to limit access to GAS often use regret as a key element in their arguments and in proposed legislation.

The aim of Thornton et al. appears to be to muddy the waters and push their own narrative, as the errors are not random but rather all go in the same direction. They are concerned with the consequences of regret, not regret itself. They simply aimed to distract people, and to breathe some new life into old misinformation, and they accomplished that.

There’s a steady stream of blatant garbage flowing through journals in this field. It’s not the replication crisis of science at large, or publication bias, and it’s not about large scale matters out of control—although structural vulnerabilities in the publishing process of journals is of course an issue.

In the end it comes down to emotionally driven choices by the individuals involved allowing falsehoods to be printed. The paper is a thinly veiled ideological document masquerading as science, but whether it highlights the complicity or just the illiteracy of the peer-reviewers and editors is yet to be determined.

*This article was originally published on JLCederblom’s blog on Medium.

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