Regret and satisfaction after adolescent gender-affirming chest surgery

Background There are increasing policy efforts to restrict gender-affirming care for youth, often citing concern for potential regret and poor evidence base. While previous studies show low decisional regret and high decisional satisfaction in adults following gender-affirming chest surgery, data are needed for individuals under the age of 18. The aim of this study was to compare decisional regret and decisional satisfaction following gender-affirming chest surgery between adolescents and young adults.Methods A cross-sectional, patient-reported outcomes study was conducted at a pediatric hospital from April to July 2024. All patients met World Professional Association for Transgender Health Standards of Care surgical criteria. Eligible individuals were at least one-year postoperative from gender-affirming chest surgery. Primary outcomes were scores on the Decision Regret Scale and the revised Satisfaction with Decision scale, two validated patient-reported outcome measures. Scores were compared between adolescent (below age 18) and young adult (between ages 18–26) cohorts.Results Of the 77 participants who completed the survey, 42 (54.5%) underwent surgery as adolescents and 35 (45.5%) as young adults. The median (IQR) Decision Regret Scale score was 0.0 (0.0-0.0), indicating low decisional regret, and did not differ between cohorts (p = 0.23). The median (IQR) Satisfaction with Decision score was 5.0 (5.0-5.0), indicating high decisional satisfaction, and did not differ between cohorts (p = 0.40).Conclusions Adolescents who underwent gender-affirming chest surgery had similarly low decisional regret and high decisional satisfaction compared to young adults. These results are also comparable to previously reported data in adult populations. Thus, concerns about potential regret should not be a basis for limiting gender-affirming chest procedures in adolescents.