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Comment by superchroma | Hacker News Reader

Don't more people regret knee replacement surgeries than people who regret transitioning, by an order of magnitude?

At least hormone induced changes are fairly reversible. Can't exactly cook up a new knee.

> At least hormone induced changes are fairly reversible.

The article talks about youth transitioning. Can't hormone treatment during the early years have lasting, permanent effects?

Children with hormonal diseases (like precocious puberty) have to take puberty blockers and they have no lasting effect. They just stop the onset of secondary sex characteristics until a more appropriate age. (remember: those hormones control all sorts of changes, including sometimes-painful growth spurts)

> They just stop the onset of secondary sex characteristics until a more appropriate age.

At which point if they still did take puberty blockers at this more appropriate (critical?) age, wouldn't there be permanent effects?

Transitioning as a child is a series of steps. It starts with social transitioning below age 10. Puberty blockers from around 10 to 15. Hormone treatments from 15 onward. Some opt to continue to top/bottom surgery, usually after the age of 17 (with a parent's consent if under 18).

And no. Puberty blockers are well understood (been using for over 50 years), and their use restricted to timeframes where it won't impact the child's development.

If I was a transgender child in this day and age I would do hormones in secret rather than have to go through this abusive process.

Just so I understand, you're making the claim that you can put a child on puberty blockers / hormone treatments from age 10 to 17, and then you can take them off of it and they will resume their sex-at-birth biological development the same as their peers who didn't have hormone treatment, with no permanent effects? Is that right?

If it's just puberty blockers, as I claim in the previous comment, correct. Which is to say, up to the age of 15, there are no permanent changes. From 15 - the point where they start hormone therapy, that's anywhere between 5-10 years into the overall treatment - there are more permanent changes. The two are distinct phases in their transition.

But nothing really life altering. Will the child end up looking different if they de-transition after taking hormones, yes. More breast tissue if they took E, and more muscle definition if they took T. However, these are also body developments that can also happen without human intervention.

I didn't mean to misrepresent your post. It looks like throughout this thread, my original question became distorted from a larger scope to just puberty blockers taken at an early age.

Anyway, aside from effects on bone density, I did find this:

> One of the disadvantages in adolescent girls who have been treated with GnRH analogues at an early age is the possibility of insufficient skin for penile inversion vaginoplasty. > How Young Is Too Young: Ethical Concerns in Genital Surgery of the Transgender MTF Adolescent

I could be misunderstanding this, but it sounds like there could be lasting effects on penis growth. Wouldn't that make sense, since your body would be getting estrogen during a time where it'd normally be developing in a way where it'd otherwise would be receiving testosterone?

Double check those bone density results, because new research shows they're present before treatment with puberty blockers starts. Some theories are that some children have reduced access to sporting activity.

The penis growth effect has been a solved issue for a long time, dr powers talks about using testosterone gel on the genitals.

Puberty blockers have a long use in children. Unlike a lot of paediatric medications puberty blockers are licensed for use in children, and are used for their licensed use (blocking puberty), albeit for a different population (gender incongruent children with strong trans indicators, instead of children with precocious puberty).

This - being licensed in children, and being used mostly in line with the license - is better than many paediatric meds.

We have a lot of research about use in precocious puberty - they meds are mostly harmless. We don't have a huge amount of research in trans children, but that's for exactly the same reason we don't have research in a bunch of different meds for children.

There's some crazy stat, that 98% of kids put on puberty blockers continue to cross-sex hormones. Which clearly tell you, whatever the puberty blockers are for, its not temporary and its not 'time to think'...

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4...

According to the Cass Review, even social transition isn't a neutral act but should be considered an active intervention, which could lock in what may be a temporary phase of identity development, and make it more difficult for the patient to accept their body as it is.

https://cass.independent-review.uk/wp-content/uploads/2022/0...

The Cass Review has also said that children should have easier access to cross sex hormones - they're considering removing the requirement for children to have spent time on puberty blockers before moving onto CSH.

The Cass review supports transition.

The alternative explanation is that it was almost impossible for trans children to access healthcare in the UK and the only people making their way through the pipeline of GP to GIC to hormone centre were those who were undeniably trans.

Do you not believe that 5-8 years is enough time for a child to think about whether they want their bodies to look like how their minds already feel?

Its also enough time for them to accept their body the way it is. Yet that doesn't appear to be what ever happens, why?

Prior estimates were 90% would desist..

https://www.frontiersin.org/articles/10.3389/fpsyt.2021.6327...

> Can't hormone treatment during the early years have lasting, permanent effects?

It can, although the GP's assertion that this is more reversible than knee surgery is probably still true.

That sounds unlikely, what and from where are the regret rate numbers you are comparing?

A cursory search reveals one study suggesting 30% continue to experience chronic pain and 1 in 5 regret knee replacement.

https://www.aarp.org/health/conditions-treatments/info-2018/...

Not great numbers, but sample sizes and study integrity, as with the data on gender affirming care, is the killer.

Thanks for the info. What rates for gender-affirming care are you comparing this to though?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503911/

Between 1% and 8%, depending on how detransition is defined. This article found 6.9% (12/175, 6 clearly detransitioning and 6 ambiguous) at one clinic, including anyone who sought and received care over a certain interval.

That is interesting but the same study also says that 21.7% of this cohort disengaged from the clinic. So the rate could be even higher, depending on if they stopped treatment entirely or changed to another service provider.

“Disengaged” here means that they did not make it through the assessment/pre-screening process and did not receive treatment, which is not what is meant by “detransition” or what is commonly understood as contributing to “regret rate”.

When an elderly person rejects knee replacement prior to surgery e.g., because they’ve learned the risks, they’re also not counted in the regret rate for knee replacement.

EDIT: Those that disengaged did not complete treatment, therefore they cannot regret completing treatment. Perhaps they regret starting treatment and perhaps they don’t; either way, that’s not the same thing as detransition. I can’t read their minds to figure out why they disengaged, and neither can anyone else.

If I'm reading this correctly, this included disengagement prior to surgery but after hormonal treatment. So it could be that some in this group regretted the hormonal treatment so chose not to continue with the surgical intervention?

The data there is not good. There are studies that claim it is low. They focus on surgery a lot. There are not many trans people (relative to the general population) and not many studies on them. There is not sufficient granularity between:

- trans people who only take hormones,

- who do that and have top surgery,

- who are castrated and,

- who have top and bottom surgery

Personally, I think bottom surgery is not quite there and is definitely a medical frontier and free-for-all. Hormones and top surgery are fairly reversible via application of more money, exercise and time.

Based on that, I am forced to fall back to first principles, and feel that given that the risk of lasting damage is low on some procedures, that those procedures which give perfectly acceptable and also potentially reversible results are reasonable to offer in this way.

There is a big difference in what would be an objectively determined need (a knee replacement) versus something that is very subjective (wanting to be another gender). There is no quantifiable measurement for determining gender. (Speaking specifically for minors.)

Did you know that most gender affirming surgeries for minors are breast enlargements and reductions for cis girls (born as a girl, not transitioning)?

If someone wants a knee surgery because they want to continue their hobby of endurance running, but does not need the surgery for an otherwise normal life, does that surgery count as an objective or subjective need?

They are less reversible the younger you are.

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