Controversy is swirling over a new study on the impacts of surgically removing breasts from biologically female patients as young as 13 who have been struggling with gender-related distress.
The Chicago study, published on Sept. 26 in the distinguished peer-reviewed medical journal JAMA (The Journal of the American Medical Association) Pediatrics, reported that such surgeries have low complication rates and result in improved quality of life for young females with “chest dysphoria,” or disquiet over unwanted breast development, three months after the procedure.
The study adds another spark to the widespread conflagration over the use of puberty-blocking drugs, cross-sex hormones, and surgeries for youths who believe they are transgender or “nonbinary”—neither solely male nor solely female.
Because this study, said to be the first of its kind, gauged results for a relatively small number of patients after a short time period, it's unknown whether longer-term, larger studies would report a similar result.
Some physicians said they were appalled to learn about the use of teens in such a study, even though parental consent was required for participants younger than 18.
A 'Terrifying' or Helpful Resource?
Dr. Greg Marchand, a board-certified physician and director of a major research institute in Arizona, wrote a news release calling the JAMA article “the most terrifying study I have ever read.”
Marchand, who emphasized that he is not involved with the Chicago study and has no issues with adults making similar surgical decisions, told The Epoch Times by email on Sept. 28: “Personally, I'm so disgusted by the actions of these surgeons that I truly believe the children that took part in this study are better described as victims than patients."
Of the other view, advocates of “gender-affirming care” say the Chicago study supports their contentions that such procedures are beneficial to a person’s overall well-being and should not be denied based on age or gender.
One of the doctors who participated in the study, Dr. Sumanas Jordan, a plastic surgeon and director of the Northwestern Medicine Gender Pathways Program, said in a statement: “Our hope is that this study will now be used as a resource for teens, young adults, and for families who want to learn more about surgical transition options.”Addressing 'Gender Dysphoria'
A growing number of youth—mostly biological females—are claiming transgender or nonbinary status. Some experts believe this is a fad resulting from what is recognized can happen: social contagion. Others say it is a function of more young people feeling comfortable with "coming out" about their transgender self-perception, amid increasing societal acceptance of “nonconforming” gender identities.
Up to 9 percent of adolescents and young adults in one urban school district identified as "transgender or nonbinary" in a 2021 study, the Chicago study noted. For many years, similar surveys of adult males and females estimated transgender people made up a tiny fraction of the population—lower than 1 percent.Some transgender-identifying people experience gnawing dissatisfaction with their bodies and can be diagnosed with a condition known as "gender dysphoria" among mental health professionals. Simply put, it's persistent discomfort and distress with one's gender.
The Chicago researchers, led by Dr. Mona Ascha of Northwestern University Feinberg School of Medicine, recruited several dozen patients during preoperative consultations at three medical centers: Northwestern Memorial Hospital, The University of Illinois, and the Ann & Robert H. Lurie Children’s Hospital.
The study noted that gender-dysphoric females who feel uncomfortable about their breasts often flatten their breasts with binders in an attempt to “relieve gender dysphoria, improve social acceptance, and reduce misgendering.” But the binders can cause skin irritation, pain, and shortness of breath. Rather than deal with those issues, most chest-dysphoric sufferers prefer breast removal, according to prior research.
One study of 30 adult biological females showed they "experienced near or total resolution of chest dysphoria, lack of surgical regret, and improved quality of life and functioning," the Chicago researchers said, noting that similar studies on adolescents and young adults are lacking.
How the Chicago Study Was Done
The Chicago study followed 36 patients between the ages of 13 and 24 as they underwent double mastectomies, also called “top surgery.” Parental consent was obtained for minors. The surgeries occurred between December 2019 and April 2021.
When questioned three months after their operation, the surgical patients—compared to a similar number of nonsurgical patients in a "control group"—reported “statistically significant improvement in chest dysphoria, gender congruence, and body image,” the study said.
The three-month time frame “was chosen as a period beyond immediate postsurgical pain and euphoria while remaining in proximity to the study intervention,” it said.
“To our knowledge, this is the first and only prospective matched cohort study evaluating top surgery in youth to date,” the authors wrote.
They acknowledged that more research is needed “to guide evidence-based practices” for treating youthful gender dysphoria, especially in light of an increasing number of proposals “to criminalize gender-affirming health care for minors.”
International Concern for Minors
Several nations and many U.S. states have already either introduced or approved laws to restrict, regulate, or outlaw medications or surgeries aimed at addressing minors' gender dysphoria. One group of U.S. lawmakers recently proposed a nationwide ban.
In addition, concerns have been raised about the hefty profits that pharmaceutical companies, doctors, and medical facilities stand to gain from procedures that can have lifelong implications for young people who lack the brain development and maturity to make such decisions.
The safeguard of parental consent for minors is negated, some say, because parents have reported feeling pressured to acquiesce under the threat that the child would commit suicide without the prescribed medications or procedures.
The first U.S. law banning "gender transition procedures," approved last year in Arkansas, has been on hold pending a civil trial set for Oct. 17—viewed as a national litmus test for such measures. The American Civil Liberties Union (ACLU) filed suit against Arkansas on behalf of four children, their families, and two doctors.
A proponent of the Arkansas law, an Ohio psychiatrist who started a gender clinic in 1974 and has issued opinions in several transgender-related court cases nationally and internationally, Dr. Stephen Levine, points out that some proponents of medical intervention for teens make "sweeping and purportedly scientific assertions that are supported by almost no peer-reviewed articles or studies."
In a statement filed in the Arkansas case, Levine notes a growing online community of adult and late teen “detransitioners.” These are people who express regret over social and medical "transitioning" to the opposite gender, and seek to revert to their “natal gender"—their biological sex.
Because gender dysphoria can cause young people to self-harm, attempt suicide, or express suicidal thoughts over their recognized condition of gender dysphoria, advocates say they consider medical intervention "life-saving" and "medically necessary."
However, Levine said current evidence suggests that surgeries may fail to ameliorate the suicide rate among the transgender population in the long term.
"Large gaps exist in the medical community’s knowledge regarding the long-term effects of sex reassignment surgery and other gender identity disorder treatments in relation to their positive or negative correlation to suicidal ideation, attempts, and completion. What is known, however, is not encouraging," he wrote in a court filing.
A Swedish study tracked patients who underwent "sex-reassignment surgery," a series of operations to change outward appearance of genitalia and other characteristics, for 30 years. The result: the surgical group committed suicide at a rate 19 times greater than those in the control group.
Supporters of Surgeries Speak Out
Chase Strangio, a primary lawyer for the ACLU in its lawsuit against Arkansas, drew tens of thousands of likes when he wrote a Twitter response to recent news coverage about mastectomies for teens: “I had top surgery 13 years ago. There is not a day that goes by that I don’t think about how it was the best thing I have ever done for my survival.”
Strangio also added that he regretted having knee surgery, and he lamented that recent media reports don’t seem to discuss those types of surgical regrets.
Instead, news reports have highlighted detransitioners who regret undergoing "gender-affirming" surgeries, Strangio said, adding that judgments are being made by people who lack understanding.
He denounced media coverage of these issues as mostly “salacious pieces that tap into an existential fear about the complexity of sexed bodies.”
Hunter Martin, a participant in the Chicago study, underwent breast removal surgery two years ago at age 16. Martin was quoted in a Northwestern Medical news release expressing gratitude for counseling, supportive parents, and the surgery.
“I feel like I’ve finally been able to experience life for what it is," Martin said in the release.
