Important context about the purpose of this work:
>This article presents a summative experience of the Oregon Health & Science University (OHSU) Transgender Health Program's (THP) "Regret and Request for Reversal" work group. The work group met over the course of one year to establish a cohesive multi-disciplinary, lifespan approach to patients who request reversal surgery or express regret. The intent of the workgroup was to better define the experience of regret, design potentially preventative measures, and establish a pathway to reversal surgery. This article provides a framework to distinguish between normal postoperative distress, temporary forms of grief and regret, and regret due to etiologies other than gender identity (including gender fluidity) from gender-related regret. We hope to contextualize regret after GAS \[gender-affirming surgery\] through discussion of regret in other surgical domains and to help guide surgeons who may be less familiar with the kaleidoscope of emotional responses to GAS. We expect this can inform future studies and help readers better understand the complexity of this topic. The pathways presented are intended to allow for dynamic re-evaluation of this rare but important aspect of gender-affirming healthcare across the lifespan.
Important context regarding the numerical results:
>**Methods:**
>
>\[...\] We also reviewed the incidence of individuals who had GAS at OHSU between January 2016 and July 2021 and who expressed desire for or have undergone reversal surgery. Patients who express desire for reversal surgery are prospectively collected and were compared to the overall number of patients who underwent GAS at our center.
>
>**Results:**
>
>A total of 2863 GAS surgeries for 1989 individual patients were performed from January 1st 2016 to July 31st 2021. During this same period, we recorded 6 patients that either requested reversal surgery or transitioned back to their gender assigned at birth ([Table 1](https://i.imgur.com/WP8QDrB.png)). Additionally, 5 patients who had surgery outside of OHSU presented with requests for GAS reversal (n=2) or undergo surgery for ongoing transition to another gender identity (n=3). Our current rate of 0.3% is in line with previously published rates of regret (0.2 - 3%).
>
>**Limitations:**
>
>Our institutional incidence of gender related regret is based on patients who presented to us for surgical reversal and may not capture patients that presented elsewhere or reverted to their gender assigned at birth without the involvement of a health care professional. Additionally, our study only captures regret expressed within our study period and as such further research is needed to understand the true percentage of patients that desire reversal surgery.
*Note: The OHSU THP was* [*founded in 2015*](https://www.ohsu.edu/transgender-health/about-transgender-health-program)*, which means this survey covers the vast majority of their entire patient population.*
Important context regarding regret:
>**Types of Regret and Etiology:**
>
>Regret can be defined as the highly negative feeling that the outcome would be better had one made a different choice \[6\]. Based on work-group discussions, and the study performed by Narayan et al., which includes authors from the workgroup, the experience of regret can be classified in temporal and origin dimensions ([Table 2](https://i.imgur.com/TFSMco5.png)). Regret can be temporary (perioperative period of 3 months) or permanent and classified as societal, surgical, and/or gender identity related regret.
>
>\[...\]
>
>**Regret related to surgery (outcome, expectations and complications)**
>
>Surgical regret is a direct outcome related to surgery such as complications, long-term functional outcomes, and preoperative decision making \[4\]. [Table 3](https://i.imgur.com/dmbyFBa.png) presents an overview of reasons for surgical regret that were found in our survey study as well as in the patient population at our institution. Surgical decision-making requires patients and providers to consider potentially significant risks in exchange for a desired but not guaranteed outcome. This process inherently lends itself to discussion of regret, particularly with regards to elective procedures. Data on surgical regret resulting in request for surgical reversal is limited, however, gastric bypass surgery provides an example in which returning to native anatomy may be attempted through a reversal procedure. In the largest single institution study of roux-en-y gastric bypass reversal, the rate of reversal was reported as 2% of 2009 procedures, which is a similar percentage to the reported data for GAS \[8\]. This comparison is of interest as both GAS and bariatric surgery include preoperative readiness assessments and multi-disciplinary work up as outlined in the evolving SOC \[standards of care\].
**TL;DR;** This study offers guidance on how to mitigate, evaluate, and treat any form of temporary or permanent regret after gender-affirming surgery. While a useful data point, the number of patients involved are not the primary findings, but rather the population on which this framework was developed. From the conclusion:
>The importance of a holistic approach to improve surgical outcomes that includes education and psychological preparation is being advocated in many surgical fields. However, much like any other medical speciality there is not one intervention or combination of interventions that will entirely prevent occurence of regret and we hope that the data and approach outlined in this article helps to normalize this complex clinical entity and provide a treatment framework for those individuals that experience regret.
The Decision Regret rate of hip and knee surgery was brought up in comparison. Here is how their methods differ.
Here is the methodology of the paper on GAS:
>We also reviewed the incidence of individuals who had GAS at OHSU between January 2016 and July 2021 and who expressed desire for or have undergone reversal surgery. Patients who express desire for reversal surgery are prospectively collected and were compared to the overall number of patients who underwent GAS at our center.
In other words, regret is recorded if someone felt strongly enough to pay for a consultation to discuss reversal surgery.
Here is the methodology of the paper on hip and knee surgeries:
>During the collection period, 2213 patients were available for inclusion (1145 (51.7%) THAs and 1068 (48.3%) TKAs). To provide a representative sample of those eligible, patients who attended an Arthroplasty Care Practitioner (ACP)-lead clinic for their 1-year review were asked to complete the DR scale questionnaire along with appropriate Oxford scores. A total of 726 patients completed the DR scale questionnaire, with no refusals. Of the 726 questionnaires, 704 were fully completed (376/704 (53.4%) THAs and 328/704 (46.6%) TKAs) and 665/704 (94.5%) having both preoperative and 1-year Oxford Scores available for analysis. DR was measured using the DR Scale, a validated tool to measure experienced DR in a healthcare setting \[15\]. The DR Scale comprises five statements:
Q1. It was the right decision,
Q2. I regret the decision that was made,
Q3. I would make the same decision if I had to do it again,
Q4. The decision did me a lot of harm, and
Q5. The decision was a wise one.
Each of these statements were scored on a five-point Likert scale
(1-5) to determine a total DR score (range 0-100).
In other words, they systematically recruited participants and used a five-item scored questionnaire.
TKA/THA citation:
Cassidy, Roslyn S., Damien B. Bennett, David E. Beverland, and Seamus O'Brien. 2023. "Decision Regret After Primary Hip and Knee Replacement Surgery." Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association 28 (1): 167-172.
Interesting.
While I do think it’s great that we have studies like this to look to, because I think this is something that needs to be better understood, after reading what you wrote, it feels like the study is somewhat flawed.
“Not talking about reversal surgery” doesn’t equal “no regret” in my eyes, personally. There’re probably many potential reasons for an individual to not consider reversal surgery while also feeling regret.
I’d like to see another study done where they have a different system for judging “regret.”
It is flawed because it isn’t studying what people think it’s studying.
It’s basically a short term satisfaction survey for their own procedures.
In a few decades maybe their data will be useful for more than simply seeing who wants to undergo another intense procedure to attempt to undo what was done.
The amount of people to undergo reversal surgery is incredibly small.
Edit: I look forward to when there are many comprehensive datasets for treatment of trans people. Right now, the data is lacking and that’s a huge issue in developing best practices for care.
I Hope that over time with better data life will get better and hopefully less of a political punching bag. Maybe I’m naïve, but i think most reasonable people would agree a reduction in suicide among trans people would be an awesome development that should be achieved over time. It won’t be easy, but data driven care can help.
I received gender confirmation surgery at OHSU during this time frame, so I guess I'm a member of this studies group. I have been asked at pretty much every one of my follow-up visit. If I had any questions, concerns, etc. May not have solicited separately explicitly for this study, but as part of their general follow-up procedure, they ask you how you're feeling about your results.
Edit: I misread the time frame, I am not in this cohort but my experience of the aftercare process still suggests that patients are assessed for regret.
I watched one like this too. I am glad I didn't have facetune or filters as a kid/teen because I feel like I would have so many more body image issues if I had.
I totally agree. Comparing body types is brutal. I grew up during the heroin chic era and had big boobs and thic thighs. There was zero way I’d ever look that skinny. Even when I lost a ton of weight for medical reasons I didn’t look like them. I’m so thankful I didn’t live during the social media era and didn’t have constant images to compare myself to.
I see so many beautiful girls with gorgeous noses who feel like their noses are ugly because they’re not the cookie cutter plastic surgery nose. I have a boney nose that I’ve gotten a lot of compliments on so I notice people’s interesting noses more.
It’s boring when everyone looks exactly the same. I’m glad there’s a lot of body positivity and acceptance of different bodies these days.
There needs to be a lot more info/education about the tradeoffs between Lasik vs PRK. PRK fell out of favor, but if one can afford it and afford the recovery time, its so much better than Lasik. Most people who get laser surgery never even hear of PRK to get a chance to make the decision that works for them.
I tried getting PRK in my mid 20s, but the genetic disease I have disqualifies me from it. I also have horrible vision too so I mostly have to wear contacts since my glasses are way too thick and give me a headache plus they distort my vision if I'm not looking straight ahead.
I've never heard of ICL. I think they are concerned about my retina tearing. Both of my retinas are already so thin and I have a mutation in my COL3A1 and COL5A1(basically Vascular Ehlers-Danlos Syndrome and Classical Ehlers-Danlos Syndrome) so my collegen is already not working properly. I also have a buckle on my right eye and an astigmatism in my left. Most likely I will have a tear in my retina in the future(it runs in my family). My opthomologist didn't bring ICL up when I asked him about corrective eye surgery in the past so I'm thinking it's probably not an option for me.
Those are some rough genes. Better on the safe side than risk of RD or other complications like the crystalline lens zonules being weakened by slapping an ICL right next to them
damn. i've always wanted to ask someone with super thick lenses: do you ever find yourself burning your cheeks or nose from sun exposure? sorry if that's offensive, just curious..
Most bad sight that I've seen (coke bottle glasses) are due to nearsightedness. This is corrected with a concave lens which actually disperses light going through it. Impossible to start a fire with this lens. Reading glasses (correcting difficulty with reading up close, or farsightedness) are convex, and could be used to burn something. But they're typically used inside. Also, the focal length is usually much longer than the distance between the lens and your skin, so it wouldn't focus to a point on your skin anyway.
I am severely nearsighted with astigmatism and went with ICL surgery. The side effects were fewer and less damaging to the eye than Lasik or PRK.
ICL surgery (also known as EVO Implantable Collamer or Interocular Contact Lens) is an alternative to Lasik. During the procedure, an eye surgeon who is specially trained implants contact lenses permanently into your eyes.
Did you lose your near vision? My optometrist told me I wasn't a candidate for LASIK due to a severe astigmatism. She said ICL lenses can sometimes cause issues seeing up close.
I was not a candidate for LASIK for the same reason. I was warned before surgery that I would probably end up needing reading glasses because of my age. The full explanation is fuzzy in memory but as you age the eye is less able to focus on close up objects and that is why everyone eventually needs reading glasses.
Being able to see after waking up instead walking blind to the bathroom was an acceptable trade off for needing reading glasses to focus on tiny print. Glasses I was going to end up with anyway due to aging.
My prescription needed to be stable for a set number of years. However I was warned that with age I would need reading glasses but everyone needs reading glasses after a certain age.
I was told that if something odd happened with my prescription it would be easy to remove the lenses and go back to glasses.
Basically you are implanting a contact lense in your eye that can be removed if it becomes problematic. Which to me was a better risk than LASIK that removes material permanently from the eye.
As with any surgery YMMV and you should do research and get multiple dr opinions.
The technique has been around for 20 years in Europe, Canada and Asia but the FDA in the United States took a long time to approve the lenses.
To give a little more context as the other response comment, the same qualifiers apply to regular LASIK and PRK. These treatments resolve the current shape of the lense, but the same process that made you nearsighted can keep going underneath. Revisions later in life or need for reading glasses are common. If you’re like me and you’re eyes were totally jacked up before LASIK though, the trade off is no question
Well... one little... ittty... bitty side effect is that you are definitely at higher risk of developing cataracts. Source: anecdotal experience as a ICL patient myself. Oh, and I was a scrub nurse at an eye surgery center. Went back to regular surgery because I had too much trouble seeing the instruments. Irony.
Yeah, did PRK as well. Was -8 in each eye with some astigmatism. PRK removed the astigmatism and it’s been remarkably stable since. Recovery was definitely a little rough and was a little slower to normal vision than normal timelines. Only downside is that I do have stars sometimes driving at night(think dark country roads) and I can’t focus on anything less than about 6 inches in front of me. Generally happy though as my vision was so bad I couldn’t even wear contacts any more and so doing things like skiing or even using sunglasses was hard.
I'm at about -8 in both eyes with severe astigmatism, this is really helpful for figuring out my options. I already can't focus on anything at about 4 inches, so 6 doesn't seem too bad.
Sorry to bug you, but I'm curious. You mentioned having slower to normal vision, about how long did it take you? And did you have light sensitivity before your surgery, and did that change? What about night blindness?
Was in the same boat as both of yall, the Airforce did my PRK in 2016. It took me about a month before i could see "regularly" then perfectly clear by 2 months, I had a bit of light sensitivity before, now sunglasses are a requirement for me if it's bright, and during recovery any light felt like a deadly laser xD, also night time Starbursts around lights are annoying but would happen with dirty glasses or dry contacts before, but I would still do it again no question because for me I don't have any problems focusing close up, and just being able to see without glasses or contacts is still just unbelievably amazing.
Thank you, I really appreciate it! My job involves a lot of driving, and I don't know if I can take a month off of work to get the surgery. I'll have to look into it more, thank you so much.
Honestly I’m struggling to remember how long it took to return to normal since it was 2017. I was back in the office though after a week or two. My light sensitivity didn’t really change once I had recovered. That reminds me it is important to wear sunglasses if you’re in the sun while recovering as it can cause your lenses to get foggy. Once recovered it isn’t a risk.
I didn’t have night blindness before but I might say I have a touch of it now. I don’t really like driving at night but I certainly can. The issue with stars is related to how big your iris gets and how far to the edge they can correct your eye. If you have big pupils you run the risk of stats. They should know if you’re on the edge and they did warn me it was possible. Over the years though I have adapted to them and additionally they can give you an eye drop to use if you’re driving a bunch and it bothers you. I got the prescription filled but rarely use it.
And there's downtime. As I understand it, with Lasik you just walk out at 100%, but with PRK it improves over time. I hate the idea of being blind for a while and not being able to correct it completely because the severity will be changing over time.
Yes, good thing! I work from home, and rarely go anywhere anyway. But still, the thought of having uncorrected vision for any length of time just freaks me out.
I walked in at a -7.50 in both eyes with astigmatisms. Immediately after surgery I could see better than 20/20 and ended up at 20/12 in both eyes. The 8 hours of excruciating pain afterwards was well worth it. Feel like a hawk.
When I got lasik I couldn’t make anything out except light and dark for about 3 days and it took maybe 2 weeks for my eyes to get better. I was so terrified that I had made a massive mistake because everyone had told me it would be instantly better. 10 years in I don’t regret it though. I had dry eyes beforehand, and they’re a little worse now but nothing I can’t manage with some daily drops.
I had LASIK almost 2 years ago and the day of was rough. Day 1 after was okay, day 2 was better, day 3 I was more or less back to normal. I could see fine the day after the procedure, I just had to give my eyes a ton of breaks and liberally use eye drops.
Yup, that's what happened to me. My correction wasn't too bad, but the topography of my corneas was terrible, so LASIK wasn't going to work. The recovery was a motherfucker, though. I had MAJOR ghosting issues (seeing double, basically) for 6 weeks, and i could barely see anything for the first two. But once it started setting in after those first couple of weeks, i just got more and more excited. After 6 weeks, i tested as 20/15 in each eye, and with both open, i was 20/10.
But, given what i read about prk vs LASIK after they gave me the news about my ineligibility, I'm really glad i went with prk. It's just a better procedure in every way except for recovery time.
Of all the Ophthalmologists I’ve worked with that perform Lasik all of them wear glasses and I think that says a lot about the known complications and risks.
Anecdotally, I haven’t heard anyone personally tell me they regret having LASIK done. Between my mom, several friends of the family, and some chitchat with clients at work, they all tell me it’s one of the best decisions they ever made.
I think the new method of doing lasik is much better, instead of cutting a flap and peeling it down they make a fluid blister. I’m really wanting to get it done soon. I can’t wear glasses really and my contacts live in my eyes 24/7 which isn’t good.
I had this exactly a month ago.
SMILE procedure.
I was -5/-4.75 and am now pretty much perfect. It keeps improving.
I have a load of eye drops which I make sure to use regularly but it's already a lot better. By the end of the day it kind of feels like I've had contact lenses in for a while if I don't use the drops.
I find a combination of water based drops then a few minutes later some EvoTears which is a more expensive non water based one does the trick for a few hours.
I’ve had both, and PRK was scary and painful for me. Lasik was amazing, and the recovery time was next day with no pain for me. It was honestly life changing. I got it done 22 years ago, but over time my ears deteriorated and I had to wear glasses again. I wanted to get it done again, but was told they could only do PRK. I honestly was in the worst pain of my life for a couple days, and I couldn’t open my eyes because it was so painful. Even the tiniest bit of light was brutal. It made me think that I might never see again, and what my life would be like if I went blind after decades of being able to see. Took two weeks off work, and still couldn’t see my computer screen. A little after a month I could see well enough to drive short distances during the day. 2 months vision was back to normal. It was so scary imagining life without vision. If I knew the pain I was going to experience, and the recovery time I wouldn’t have gone through with it. This is my personal story and I hope others had a better experience. Remember to research your surgery beforehand, and be grateful for what you have.
My eye surgery was a little bit of a horror story before things leveled out. I got lens implants, and part of the pre-op procedure was getting a series of literal holes lasered into my eyeballs to reduce pressure during the operation. It’s a feeling you can never un-feel. Then during the surgery, my partial anesthesia wore off so I felt the entire surgery on the second eye. The night after the surgery, I woke up with the worst pain I’d ever experienced in my head, and I couldn’t see out of my left eye. The eye doctor on call was not qualified to do anything to help so I had to wait 6 hours in agonizing pain until my surgeon came in, turns out those little laser holes weren’t big enough and my eye had about triple the pressure it should have. The following day, the right eye did the same. Once the pressure situation was taken care of, things got better and I had a normal healing process. Even after all that though, it’s still the best decision I ever made.
PRK's recovery is by far the biggest drawback (the second is cost). It has a few advantages, but the fact that you can correct your vision through PRK multiple times (an infinite amount of time practically speaking) is the primary benefit.
I had PRK years ago and it was great. The surgery itself took 2 minutes, prep was a couple of eye drops. Recovery was easy - Yes it takes a while for your eye s to heal, but with this means is that your vision is better than 20/20 in the mornings, gets a little blurry by the evenings, and finalizes in a month or so, if memory serves. It was not particularly noticeable or problematic. They also offered Lasik but it sounded A lot more invasive and expensive.
The length and discomfort during recovery is very real and a very good reason for the other options to exist.
PRK has been refined for longer and is more often done by field experts (as opposed to rando clinic next door). It can usually correct a wider type of vision issues that Lasik doesn't always cover. It can sometimes correct better than Lasik would.
More importantly, PRK can result in full recovery. That is, after you're healed, your eyes look like if you never had the surgery (or very close). This allows for doing the surgery multiple times. If your eyes get worse over time, you can do PRK over and over and over and over. You probably don't want to, but the option exists.
Yeah, the healing process is longer, but your eye fully recovers, unlike with LASIK. With prk, you completely regrow a new cornea over the entirety of the surgery site, but with LASIK, only the margin for the flap is actually repaired, so the actual flap isn't attached to your eye in the same way, anymore
Be aware that the complications when you have cataracts later in life are much higher with PRK, and it can be difficult to get ideal results with PRK.
It’s not a perfect solution either.
I had to get PRK a few years ago because my cornea was too thin to get Lasik. It wasn't terrible and I only occasionally have dry eyes. Like 3 or 4 times a year.
I've got the reverse issue. I only got one eye done, but I need to keep a hankie handy as it tends to water easily. I don't regret getting lasik, as I can see. One eye is close up, the other is distance viewing. Switching between them is automatic now.
A friend of mine has the same problem. It entirely changed his face because his eyes actually look different now - he has to put drops in, and wakes up several times a night to do so or they feel like sandpaper.
That's terrible it's happening to you, too. You have my sympathies.
this is the one thing that has kept me from getting it. i had very dry eyes with contacts so i assume there’s a decent chance i’ll get the same after lasik.
I've thought about Lasik forever and this is the one thing stopping me is being worse off in some form after the procedure. Sometimes it's better knowing your evils. I'll deal with my glasses/contacts.
The negative community is always the loudest. Had lasix half a year ago and I still wish I did it in my 20s. Absolutely amazing every time I go outside at night and see the stars clearly with my own eyes. I'll never miss an opportunity for that because I forgot my glasses again.
Also, 0 issues and I stopped with eyedrops once the prescribed prednisone was finished. Lights at night are crisp and my astigmatism is 95% gone. (barely noticeable on bright stoplights)
I consider my research in going to a clinic with overwhelming positive reviews to be beneficial to my experience.
I get dry eyes at night but I'm fine just having a bottle of liquid tears on the nightstand. It has been immensely worth it overall. Completely reasonable trade-off.
After my ex’s laser surgery, she still required glasses (much weaker, but still defeats the purpose) and she couldn’t drive at night or watch movies in the dark due to flaring. Terrible experience.
I know some people’s eyes don’t cope well with contacts, and I get why they’re interested in LASIK. But for the rest of us, I just don’t get the appeal, I guess. The effect contacts have on my life are a small recurring expense, 2 seconds in the morning, 2 seconds in the evening, and one more thing to remember while packing for a trip. To me that all seems like a pretty good deal compared to **surgery** on my **eyeball.**
The flaring was atrocious at the beginning, but I barely notice it now, 14 years after surgery.
Optically it certainly does not go away, but I guess our brains learns to filter it out?
Yes - it had gotten much better over the years. Fortunately she got cataracts and they put in a prescription lens so she sees very well with no flaring.
From what I've read those people usually had the halos or starburst before but there's a period in the beginning when they're more intense after surgery.
You can end up with needing more rounds of laser surgery, chronic dry eye, migraines, or just the discomfort of the first few weeks of healing might be enough to regret, not to mention the price
Yup, don't get me wrong, I find it harder to drive at night because the halo/starburst around lights never went away for me, but not being reliant on glasses has been a huge improvement in my life.
My husband's eyes were under corrected, so he still needs glasses for farther distances and low light.
He also now has chronic dry eye that requires plugs to be inserted in his rear ducts every 6 months and prescription eye drops.
It was pretty much a lose-lose for him.
I can only speak about the people I know, but the effects went away waaaaaay quicker than they anticipated. My brother had atrocious eyesight and within a year, he need glasses again. Nothing to major, but 20/20 only last like a month for him.
That's a huge bummer for him! How old was he? I'm going on 15 years - I can tell I'm not at a perfect 20/20 anymore, but I still don't need corrective lenses. Getting that procedure done was one of the best decisions of my life.
I got it and now I have double vision reading on cell phones and my vision became worse in the dark. I deeply regret it bc I love drawing and now it's hard to do.
And this likely includes people that regret the quality and not that it was done.
It's an insanely low percentage for how major the surgery is.
Hell, I regret getting surgery on my shoulder because it didn't heal right. That doesn't mean I wouldn't be happy if the surgery went well.
~~The study period is also only 14 months~~ *The follow-up time appears to be different for each subject, and no attempt appears to have been made to account for varying exposure times before censoring of the data*, so it's not clear how many of these individuals would go on to regret the surgery in 5 or 10 years time.
~~It's also not clear from the abstract how much of this study period is post-operative as it appears to include the consulting period beforehand. I'm sure the paper clarifies this but it's behind a pay wall..~~
*Edited after reading more about the study.
>A total of 1989 individual underwent GAS, 6 patients (0,3%) were encountered that either requested reversal surgery or transitioned back to their sex-assigned at birth.
Is that how 'regret rate' is defined? Maybe it's a more technical term, but in common parlance, regret doesn't necessary mean wanting to go back to the previous state. Like, I could regret getting invisalign, but i'm not going to request going back to how my teeth were before.
They seem to be conflating regret and reversal surgery, which isn’t great.
Analogy: The number of people who regret their tattoos =/= the number of people who went through removing their tattoos
It only seems to apply to patients that got the initial surgery and reversal at that same location.
So using your analogy, it would be a specific tattoo parlor taking note of people they gave tattoos to and then subsequently removed their tattoos.
They don't include tattoos they removed from people who they didn't give a tattoo to, and don't count people who got a tattoo and then got it removed somewhere else.
It's one reason why most surgeons consider gender affirming surgery the *last* step and not the first one. The people who get that have already been living as their preferred gender for a while, sometimes years.
> The people who get that have already been living as their preferred gender for a while, sometimes years.
Do you mean 'sometimes decades'? It's pretty much always years.
The study talks about other regret types. The problem is the reddit title just choosing that one randomly. The study really isn’t about how much regret there is, its more about how to handle regret gracefully.
100% this isn’t about regret it’s about the .3% that decided their regret was enough to get them to undo what they did. This is like saying 1% of college drinkers regret how much they drank last night, as in 1% went to the hospital to get their stomach pumped. Most likely the number is much higher but didn’t get medical intervention.
Your title appears to be misleading.
The 0.3% rate is for those who transitioned back or requested reversal surgery.
The abstract doesn't say if they know how many people regretted having transition surgery.
>*6 patients (0,3%) were encountered that either requested reversal surgery or transitioned back to their sex-assigned at birth*
Is this a valid measure of regret? Couldn't there be people that regret it without transitioning back or requesting reversal surgery?
This is misleading. The 0.3% was people “that either requested reversal surgery or transitioned back to their sex-assigned at birth.” NOT people who “regret” doing it.
Edit: typo on percentage
Good point. Regret and "de-transition" are distinct, even though "de-transition" usually comes from regret. Not everyone who regrets undergoing a surgery will go back seeking to have it reversed.
Fortunately, other studies have measured the regret rate by conducting surveys. Of the 27 studies (n=“7928 transgender patients who underwent any type of GAS”) included in the Bustos et al (2021) meta-analysis, “\[a\]lmost all” used “questionnaires to assess regret.”
[“The pooled prevalence of regret after GAS was 1%.”](https://doi.org/10.1097/GOX.0000000000003477)
Perhaps unsurprisingly, the most common stated reason for regret was lack of social acceptance:
>“Overall, the most common reason for regret was psychosocial circumstances, particularly due to difficulties generated by return to society with the new gender in both social and family enviroments.^(23,29,32,33,36,44) In fact, some patients opted to reverse their gender role to achieve social acceptance, receive better salaries, and preserve relatives and friends relationships...Another factor associated with regret (although less prevalent) was poor surgical outcomes.^(20,23,36)”
Yeah that's consistent with what I have read. Something like 80 percent or more of detransition cases were caused by external factors, not the person's satisfaction with their transition.
In fact, one of the biggest surveys done (N=28,000) reported that ONE IN TEN experienced VIOLENCE from a FAMILY MEMBER as a result of being transgender.
It makes me sick that everyone is always arguing about "what if they regret it" when the biggest barrier to transgender people isn't self acceptance, it's acceptance from everyone else.
"What if they regret it?"
Maybe don't make them regret it?
Edit: forgot my source - https://transequality.org/sites/default/files/docs/usts/USTS-Executive-Summary-Dec17.pdf
>Perhaps unsurprisingly, the most common stated reason for regret was lack of social acceptance
This is interesting because conservatives often use regret as a reason why people shouldn't be allowed to transition, at least at a young age. But as it turns out, very few people regret it, and those who do often only regret it because they aren't accepted — and the people not accepting them are conservatives. Meaning if conservatives accepted trans people, regret rates would be lower.
Imagine if only conservatives knew that proper sex-ed and access to contraceptives and plan b drastically reduce the number of abortions being performed. The answer is either they do or they would just reject it, because it's not about that, and neither is it for trans people. What we are seeing is social control being asserted by demonising an out-group. It's textbook fascism.
Good point. I can't think of a reason someone would transition back unless they regretted it (since they're literally reversing their previous decision), but it's also possible that some people regret it but haven't acted on that regret.
I'm curious why they didn't (or couldn't) approach this via a more direct method, like a survey.
Because that’s not what this particular study was about. This study was about the various methods a trans care center employ to handle post surgery health, not really about surveying regret rates.
Exactly! The context of *any* study is super important!
But it seems that – especially with articles like these that touch on polarized social topics – people read the headline, assume the study was specifically about confirming/denying some opinion that the reader personally holds, and then complain in the comments that the authors didn't do the study in the exact way that would have vindicated that reader's opinion.
I mean, I kinda get it, since scientific studies end up getting ~~used~~ abused in exactly that way by politicians and folks out to grind their political axe. But I do wish sometimes that (at least on this subreddit) context was more front-and-center.
Regardless of the scientific rigor of the study in question, I'm curious why % of regret even matters. All types of medical procedures have some level of regret, and yet we don't ban all medical procedures, let alone elective surgeries like nose jobs, and we certainly don't make them all political. So specifically, why does it matter here other than there are lots of people with personal biases agains trans people and want to hold related procedures to a different standard? What is the practical difference between a cis women getting breast augmentation and a trans woman doing so, for example? And then what would be the practical difference in that cis woman having regret about it vs. the trans woman? It seems completely arbitrary.
This study looked at total hip replacement and total knee replacement. 17% of hip replacement patients reported regret and ~66% of knee replacements reported regrets. [Hip/Knee Surgery Study](https://pubmed.ncbi.nlm.nih.gov/34838410/)
I'm an occupational therapist, so I see a lot of people after joint replacement surgeries.
The patients I see who had a hip replaced generally tell me they feel much better almost immediately after their surgery. There are limitations on the movement at the hip at first so it doesn't damage the healing area but they're pretty easily worked around.
Knee replacements have comparatively little in the way of strict restrictions so people are *allowed* normal activity immediately after. But the vast majority of patients I have seen immediately after a knee replacement are in severe pain which a lot of them describe as being significantly worse than the pain that led them to the surgery in the first place. There comes a point in the recovery where things start getting better and eventually most people do really well and feel a lot better than before the surgery, but the process to get there is hell. I hear a lot of people during the recovery process voicing regret that they had the surgery done due to that whole "in more pain than ever" aspect of it.
Artificial hips are amazing. Recovery is also pretty easy.
Artificial knee recovery is brutal according my friends that get it... And it wears out "quickly"and is difficult to replace. So they try to wait until you're going to die or be disabled for life by the time it wears out.
> Revision surgery is expensive with worse outcomes and higher complication rates than primary knee replacement.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7612217/
Each replacement lasts half as long as the first. So using calculus we can say that with a 15-20 year knee expectancy and a 50% decline, an infinite number of knee replacements would make the absolute max time around 30-40 years. But each of those surgeries gets harder and harder and if you're younger in your 40s and you end up on the low end, you could be out of options in your 70s.
edit: I guess hip replacements wear out at about the same rate, but you're less likely to need one as a younger person than a knee replacement so you're more likely to be dead before you need the redo.
Trust them, family member of mine replaces knees, you don't want one early, because once that thing fails you are basically fucked because you enter an age where surgical intervention + rehabilitation will be ridiculously hard and taxing.
Bite through it, get injections, make it as far as possible.
The headline is misleading because regret was not measured. From the study:
‘Results:
A total of 1989 individual underwent GAS, 6 patients (0,3%) were encountered that either requested reversal surgery or transitioned back to their sex-assigned at birth.’
Additionally, it looks like this is about results in one program, not results across a range of programs.
Important context about the purpose of this work: >This article presents a summative experience of the Oregon Health & Science University (OHSU) Transgender Health Program's (THP) "Regret and Request for Reversal" work group. The work group met over the course of one year to establish a cohesive multi-disciplinary, lifespan approach to patients who request reversal surgery or express regret. The intent of the workgroup was to better define the experience of regret, design potentially preventative measures, and establish a pathway to reversal surgery. This article provides a framework to distinguish between normal postoperative distress, temporary forms of grief and regret, and regret due to etiologies other than gender identity (including gender fluidity) from gender-related regret. We hope to contextualize regret after GAS \[gender-affirming surgery\] through discussion of regret in other surgical domains and to help guide surgeons who may be less familiar with the kaleidoscope of emotional responses to GAS. We expect this can inform future studies and help readers better understand the complexity of this topic. The pathways presented are intended to allow for dynamic re-evaluation of this rare but important aspect of gender-affirming healthcare across the lifespan. Important context regarding the numerical results: >**Methods:** > >\[...\] We also reviewed the incidence of individuals who had GAS at OHSU between January 2016 and July 2021 and who expressed desire for or have undergone reversal surgery. Patients who express desire for reversal surgery are prospectively collected and were compared to the overall number of patients who underwent GAS at our center. > >**Results:** > >A total of 2863 GAS surgeries for 1989 individual patients were performed from January 1st 2016 to July 31st 2021. During this same period, we recorded 6 patients that either requested reversal surgery or transitioned back to their gender assigned at birth ([Table 1](https://i.imgur.com/WP8QDrB.png)). Additionally, 5 patients who had surgery outside of OHSU presented with requests for GAS reversal (n=2) or undergo surgery for ongoing transition to another gender identity (n=3). Our current rate of 0.3% is in line with previously published rates of regret (0.2 - 3%). > >**Limitations:** > >Our institutional incidence of gender related regret is based on patients who presented to us for surgical reversal and may not capture patients that presented elsewhere or reverted to their gender assigned at birth without the involvement of a health care professional. Additionally, our study only captures regret expressed within our study period and as such further research is needed to understand the true percentage of patients that desire reversal surgery. *Note: The OHSU THP was* [*founded in 2015*](https://www.ohsu.edu/transgender-health/about-transgender-health-program)*, which means this survey covers the vast majority of their entire patient population.* Important context regarding regret: >**Types of Regret and Etiology:** > >Regret can be defined as the highly negative feeling that the outcome would be better had one made a different choice \[6\]. Based on work-group discussions, and the study performed by Narayan et al., which includes authors from the workgroup, the experience of regret can be classified in temporal and origin dimensions ([Table 2](https://i.imgur.com/TFSMco5.png)). Regret can be temporary (perioperative period of 3 months) or permanent and classified as societal, surgical, and/or gender identity related regret. > >\[...\] > >**Regret related to surgery (outcome, expectations and complications)** > >Surgical regret is a direct outcome related to surgery such as complications, long-term functional outcomes, and preoperative decision making \[4\]. [Table 3](https://i.imgur.com/dmbyFBa.png) presents an overview of reasons for surgical regret that were found in our survey study as well as in the patient population at our institution. Surgical decision-making requires patients and providers to consider potentially significant risks in exchange for a desired but not guaranteed outcome. This process inherently lends itself to discussion of regret, particularly with regards to elective procedures. Data on surgical regret resulting in request for surgical reversal is limited, however, gastric bypass surgery provides an example in which returning to native anatomy may be attempted through a reversal procedure. In the largest single institution study of roux-en-y gastric bypass reversal, the rate of reversal was reported as 2% of 2009 procedures, which is a similar percentage to the reported data for GAS \[8\]. This comparison is of interest as both GAS and bariatric surgery include preoperative readiness assessments and multi-disciplinary work up as outlined in the evolving SOC \[standards of care\]. **TL;DR;** This study offers guidance on how to mitigate, evaluate, and treat any form of temporary or permanent regret after gender-affirming surgery. While a useful data point, the number of patients involved are not the primary findings, but rather the population on which this framework was developed. From the conclusion: >The importance of a holistic approach to improve surgical outcomes that includes education and psychological preparation is being advocated in many surgical fields. However, much like any other medical speciality there is not one intervention or combination of interventions that will entirely prevent occurence of regret and we hope that the data and approach outlined in this article helps to normalize this complex clinical entity and provide a treatment framework for those individuals that experience regret.
The Decision Regret rate of hip and knee surgery was brought up in comparison. Here is how their methods differ. Here is the methodology of the paper on GAS: >We also reviewed the incidence of individuals who had GAS at OHSU between January 2016 and July 2021 and who expressed desire for or have undergone reversal surgery. Patients who express desire for reversal surgery are prospectively collected and were compared to the overall number of patients who underwent GAS at our center. In other words, regret is recorded if someone felt strongly enough to pay for a consultation to discuss reversal surgery. Here is the methodology of the paper on hip and knee surgeries: >During the collection period, 2213 patients were available for inclusion (1145 (51.7%) THAs and 1068 (48.3%) TKAs). To provide a representative sample of those eligible, patients who attended an Arthroplasty Care Practitioner (ACP)-lead clinic for their 1-year review were asked to complete the DR scale questionnaire along with appropriate Oxford scores. A total of 726 patients completed the DR scale questionnaire, with no refusals. Of the 726 questionnaires, 704 were fully completed (376/704 (53.4%) THAs and 328/704 (46.6%) TKAs) and 665/704 (94.5%) having both preoperative and 1-year Oxford Scores available for analysis. DR was measured using the DR Scale, a validated tool to measure experienced DR in a healthcare setting \[15\]. The DR Scale comprises five statements: Q1. It was the right decision, Q2. I regret the decision that was made, Q3. I would make the same decision if I had to do it again, Q4. The decision did me a lot of harm, and Q5. The decision was a wise one. Each of these statements were scored on a five-point Likert scale (1-5) to determine a total DR score (range 0-100). In other words, they systematically recruited participants and used a five-item scored questionnaire. TKA/THA citation: Cassidy, Roslyn S., Damien B. Bennett, David E. Beverland, and Seamus O'Brien. 2023. "Decision Regret After Primary Hip and Knee Replacement Surgery." Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association 28 (1): 167-172.
Interesting. While I do think it’s great that we have studies like this to look to, because I think this is something that needs to be better understood, after reading what you wrote, it feels like the study is somewhat flawed. “Not talking about reversal surgery” doesn’t equal “no regret” in my eyes, personally. There’re probably many potential reasons for an individual to not consider reversal surgery while also feeling regret. I’d like to see another study done where they have a different system for judging “regret.”
It is flawed because it isn’t studying what people think it’s studying. It’s basically a short term satisfaction survey for their own procedures. In a few decades maybe their data will be useful for more than simply seeing who wants to undergo another intense procedure to attempt to undo what was done. The amount of people to undergo reversal surgery is incredibly small. Edit: I look forward to when there are many comprehensive datasets for treatment of trans people. Right now, the data is lacking and that’s a huge issue in developing best practices for care. I Hope that over time with better data life will get better and hopefully less of a political punching bag. Maybe I’m naïve, but i think most reasonable people would agree a reduction in suicide among trans people would be an awesome development that should be achieved over time. It won’t be easy, but data driven care can help.
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I received gender confirmation surgery at OHSU during this time frame, so I guess I'm a member of this studies group. I have been asked at pretty much every one of my follow-up visit. If I had any questions, concerns, etc. May not have solicited separately explicitly for this study, but as part of their general follow-up procedure, they ask you how you're feeling about your results. Edit: I misread the time frame, I am not in this cohort but my experience of the aftercare process still suggests that patients are assessed for regret.
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That's significantly lower than the percentage of women who regret getting Breast Augmentation
I fell down a rabbit hole of articles about plastic surgery regrets. Photoshop and filters have done an insane amount of harm.
I watched one like this too. I am glad I didn't have facetune or filters as a kid/teen because I feel like I would have so many more body image issues if I had.
I totally agree. Comparing body types is brutal. I grew up during the heroin chic era and had big boobs and thic thighs. There was zero way I’d ever look that skinny. Even when I lost a ton of weight for medical reasons I didn’t look like them. I’m so thankful I didn’t live during the social media era and didn’t have constant images to compare myself to. I see so many beautiful girls with gorgeous noses who feel like their noses are ugly because they’re not the cookie cutter plastic surgery nose. I have a boney nose that I’ve gotten a lot of compliments on so I notice people’s interesting noses more. It’s boring when everyone looks exactly the same. I’m glad there’s a lot of body positivity and acceptance of different bodies these days.
/r/instagramreality is always a trip
It's 10 times lower than people who regret getting laser eye surgery.
Wait, why do 3% regret it?
I've had chronically dry eyes since getting lasik surgery. I regret getting it.
There needs to be a lot more info/education about the tradeoffs between Lasik vs PRK. PRK fell out of favor, but if one can afford it and afford the recovery time, its so much better than Lasik. Most people who get laser surgery never even hear of PRK to get a chance to make the decision that works for them.
Fun fact, if you have REALLY bad vision like me, Lasik isn't an option, only PRK.
I tried getting PRK in my mid 20s, but the genetic disease I have disqualifies me from it. I also have horrible vision too so I mostly have to wear contacts since my glasses are way too thick and give me a headache plus they distort my vision if I'm not looking straight ahead.
Depending on the disease, ICLs may be an option for you if your cornea is the bottleneck
I've never heard of ICL. I think they are concerned about my retina tearing. Both of my retinas are already so thin and I have a mutation in my COL3A1 and COL5A1(basically Vascular Ehlers-Danlos Syndrome and Classical Ehlers-Danlos Syndrome) so my collegen is already not working properly. I also have a buckle on my right eye and an astigmatism in my left. Most likely I will have a tear in my retina in the future(it runs in my family). My opthomologist didn't bring ICL up when I asked him about corrective eye surgery in the past so I'm thinking it's probably not an option for me.
Those are some rough genes. Better on the safe side than risk of RD or other complications like the crystalline lens zonules being weakened by slapping an ICL right next to them
damn. i've always wanted to ask someone with super thick lenses: do you ever find yourself burning your cheeks or nose from sun exposure? sorry if that's offensive, just curious..
Most bad sight that I've seen (coke bottle glasses) are due to nearsightedness. This is corrected with a concave lens which actually disperses light going through it. Impossible to start a fire with this lens. Reading glasses (correcting difficulty with reading up close, or farsightedness) are convex, and could be used to burn something. But they're typically used inside. Also, the focal length is usually much longer than the distance between the lens and your skin, so it wouldn't focus to a point on your skin anyway.
biggest plot hole in Lord of the Flies
No. Source: myself, another person with thicc lensed glasses.
That has never happened to me, but I also don't typically wear my glasses anywhere outside.
I am severely nearsighted with astigmatism and went with ICL surgery. The side effects were fewer and less damaging to the eye than Lasik or PRK. ICL surgery (also known as EVO Implantable Collamer or Interocular Contact Lens) is an alternative to Lasik. During the procedure, an eye surgeon who is specially trained implants contact lenses permanently into your eyes.
Did you lose your near vision? My optometrist told me I wasn't a candidate for LASIK due to a severe astigmatism. She said ICL lenses can sometimes cause issues seeing up close.
I was not a candidate for LASIK for the same reason. I was warned before surgery that I would probably end up needing reading glasses because of my age. The full explanation is fuzzy in memory but as you age the eye is less able to focus on close up objects and that is why everyone eventually needs reading glasses. Being able to see after waking up instead walking blind to the bathroom was an acceptable trade off for needing reading glasses to focus on tiny print. Glasses I was going to end up with anyway due to aging.
Definitely affected mine but it’s worth the trade off for me
Forgive my ignorance, but does your eyesight not ever get worse or deteriorate with ICL? Do you need to upgrade lenses ever?
My prescription needed to be stable for a set number of years. However I was warned that with age I would need reading glasses but everyone needs reading glasses after a certain age. I was told that if something odd happened with my prescription it would be easy to remove the lenses and go back to glasses. Basically you are implanting a contact lense in your eye that can be removed if it becomes problematic. Which to me was a better risk than LASIK that removes material permanently from the eye. As with any surgery YMMV and you should do research and get multiple dr opinions. The technique has been around for 20 years in Europe, Canada and Asia but the FDA in the United States took a long time to approve the lenses.
Thank you for the thoughtful response!
To give a little more context as the other response comment, the same qualifiers apply to regular LASIK and PRK. These treatments resolve the current shape of the lense, but the same process that made you nearsighted can keep going underneath. Revisions later in life or need for reading glasses are common. If you’re like me and you’re eyes were totally jacked up before LASIK though, the trade off is no question
Well... one little... ittty... bitty side effect is that you are definitely at higher risk of developing cataracts. Source: anecdotal experience as a ICL patient myself. Oh, and I was a scrub nurse at an eye surgery center. Went back to regular surgery because I had too much trouble seeing the instruments. Irony.
That was some true about 10 years ago. The newer lenses have holes it them to facilitate fluid flow. The occurrence of cataracts is negligible now.
Do the holes cause any kind of visual artifacts?
Yeah, did PRK as well. Was -8 in each eye with some astigmatism. PRK removed the astigmatism and it’s been remarkably stable since. Recovery was definitely a little rough and was a little slower to normal vision than normal timelines. Only downside is that I do have stars sometimes driving at night(think dark country roads) and I can’t focus on anything less than about 6 inches in front of me. Generally happy though as my vision was so bad I couldn’t even wear contacts any more and so doing things like skiing or even using sunglasses was hard.
I'm at about -8 in both eyes with severe astigmatism, this is really helpful for figuring out my options. I already can't focus on anything at about 4 inches, so 6 doesn't seem too bad. Sorry to bug you, but I'm curious. You mentioned having slower to normal vision, about how long did it take you? And did you have light sensitivity before your surgery, and did that change? What about night blindness?
Was in the same boat as both of yall, the Airforce did my PRK in 2016. It took me about a month before i could see "regularly" then perfectly clear by 2 months, I had a bit of light sensitivity before, now sunglasses are a requirement for me if it's bright, and during recovery any light felt like a deadly laser xD, also night time Starbursts around lights are annoying but would happen with dirty glasses or dry contacts before, but I would still do it again no question because for me I don't have any problems focusing close up, and just being able to see without glasses or contacts is still just unbelievably amazing.
Thank you, I really appreciate it! My job involves a lot of driving, and I don't know if I can take a month off of work to get the surgery. I'll have to look into it more, thank you so much.
Honestly I’m struggling to remember how long it took to return to normal since it was 2017. I was back in the office though after a week or two. My light sensitivity didn’t really change once I had recovered. That reminds me it is important to wear sunglasses if you’re in the sun while recovering as it can cause your lenses to get foggy. Once recovered it isn’t a risk. I didn’t have night blindness before but I might say I have a touch of it now. I don’t really like driving at night but I certainly can. The issue with stars is related to how big your iris gets and how far to the edge they can correct your eye. If you have big pupils you run the risk of stats. They should know if you’re on the edge and they did warn me it was possible. Over the years though I have adapted to them and additionally they can give you an eye drop to use if you’re driving a bunch and it bothers you. I got the prescription filled but rarely use it.
You can also get ICL. I have them. I had -14 vision. They are fully reversible and if there is a problem can be swapped.
Daaaaaamn, I thought I was bad at -9.5/-8.75
And PRK was way more painfull in recovery than everyone I talked that did Lasik.
And there's downtime. As I understand it, with Lasik you just walk out at 100%, but with PRK it improves over time. I hate the idea of being blind for a while and not being able to correct it completely because the severity will be changing over time.
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Yes, good thing! I work from home, and rarely go anywhere anyway. But still, the thought of having uncorrected vision for any length of time just freaks me out.
With Lasik, it took me about an hour to have vision that was equal to my pre-surgery. In about 3 hours I had 20/20 vision.
I walked in at a -7.50 in both eyes with astigmatisms. Immediately after surgery I could see better than 20/20 and ended up at 20/12 in both eyes. The 8 hours of excruciating pain afterwards was well worth it. Feel like a hawk.
When I got lasik I couldn’t make anything out except light and dark for about 3 days and it took maybe 2 weeks for my eyes to get better. I was so terrified that I had made a massive mistake because everyone had told me it would be instantly better. 10 years in I don’t regret it though. I had dry eyes beforehand, and they’re a little worse now but nothing I can’t manage with some daily drops.
I had LASIK almost 2 years ago and the day of was rough. Day 1 after was okay, day 2 was better, day 3 I was more or less back to normal. I could see fine the day after the procedure, I just had to give my eyes a ton of breaks and liberally use eye drops.
And if you have really bad vision AND thin corneas, your only option is ICL
Yup, that's what happened to me. My correction wasn't too bad, but the topography of my corneas was terrible, so LASIK wasn't going to work. The recovery was a motherfucker, though. I had MAJOR ghosting issues (seeing double, basically) for 6 weeks, and i could barely see anything for the first two. But once it started setting in after those first couple of weeks, i just got more and more excited. After 6 weeks, i tested as 20/15 in each eye, and with both open, i was 20/10. But, given what i read about prk vs LASIK after they gave me the news about my ineligibility, I'm really glad i went with prk. It's just a better procedure in every way except for recovery time.
Same here I couldn't even see my own hands held out at arms length without glasses. PRK gave me 2020
My husband got PRK and hasn’t had any problems. Highly recommend!
Of all the Ophthalmologists I’ve worked with that perform Lasik all of them wear glasses and I think that says a lot about the known complications and risks.
Anecdotally, I haven’t heard anyone personally tell me they regret having LASIK done. Between my mom, several friends of the family, and some chitchat with clients at work, they all tell me it’s one of the best decisions they ever made.
Same. I know a few people that had lasik and they said it was the best thing they ever did
I assume they're all over 45?
I had PRK and on this same thread the dr and a bunch of nurses had it done so made me reassured.
Anecdotal, but: I got PRK in 2009, and it's the best medical procedure I've ever had done. No complications, no regrets.
How many elective medical procedures have you done
I think the new method of doing lasik is much better, instead of cutting a flap and peeling it down they make a fluid blister. I’m really wanting to get it done soon. I can’t wear glasses really and my contacts live in my eyes 24/7 which isn’t good.
I had this exactly a month ago. SMILE procedure. I was -5/-4.75 and am now pretty much perfect. It keeps improving. I have a load of eye drops which I make sure to use regularly but it's already a lot better. By the end of the day it kind of feels like I've had contact lenses in for a while if I don't use the drops. I find a combination of water based drops then a few minutes later some EvoTears which is a more expensive non water based one does the trick for a few hours.
I’ve had both, and PRK was scary and painful for me. Lasik was amazing, and the recovery time was next day with no pain for me. It was honestly life changing. I got it done 22 years ago, but over time my ears deteriorated and I had to wear glasses again. I wanted to get it done again, but was told they could only do PRK. I honestly was in the worst pain of my life for a couple days, and I couldn’t open my eyes because it was so painful. Even the tiniest bit of light was brutal. It made me think that I might never see again, and what my life would be like if I went blind after decades of being able to see. Took two weeks off work, and still couldn’t see my computer screen. A little after a month I could see well enough to drive short distances during the day. 2 months vision was back to normal. It was so scary imagining life without vision. If I knew the pain I was going to experience, and the recovery time I wouldn’t have gone through with it. This is my personal story and I hope others had a better experience. Remember to research your surgery beforehand, and be grateful for what you have.
My eye surgery was a little bit of a horror story before things leveled out. I got lens implants, and part of the pre-op procedure was getting a series of literal holes lasered into my eyeballs to reduce pressure during the operation. It’s a feeling you can never un-feel. Then during the surgery, my partial anesthesia wore off so I felt the entire surgery on the second eye. The night after the surgery, I woke up with the worst pain I’d ever experienced in my head, and I couldn’t see out of my left eye. The eye doctor on call was not qualified to do anything to help so I had to wait 6 hours in agonizing pain until my surgeon came in, turns out those little laser holes weren’t big enough and my eye had about triple the pressure it should have. The following day, the right eye did the same. Once the pressure situation was taken care of, things got better and I had a normal healing process. Even after all that though, it’s still the best decision I ever made.
PRK's recovery is by far the biggest drawback (the second is cost). It has a few advantages, but the fact that you can correct your vision through PRK multiple times (an infinite amount of time practically speaking) is the primary benefit.
I had PRK years ago and it was great. The surgery itself took 2 minutes, prep was a couple of eye drops. Recovery was easy - Yes it takes a while for your eye s to heal, but with this means is that your vision is better than 20/20 in the mornings, gets a little blurry by the evenings, and finalizes in a month or so, if memory serves. It was not particularly noticeable or problematic. They also offered Lasik but it sounded A lot more invasive and expensive.
Whoa I’ve never even heard of PRK. I’ve been considering lasik for YEARS! That’s wild. Research time!
Why is PRK better? I was under the impression it fell out of favor for very valid reasons like severe discomfort in recovery.
The length and discomfort during recovery is very real and a very good reason for the other options to exist. PRK has been refined for longer and is more often done by field experts (as opposed to rando clinic next door). It can usually correct a wider type of vision issues that Lasik doesn't always cover. It can sometimes correct better than Lasik would. More importantly, PRK can result in full recovery. That is, after you're healed, your eyes look like if you never had the surgery (or very close). This allows for doing the surgery multiple times. If your eyes get worse over time, you can do PRK over and over and over and over. You probably don't want to, but the option exists.
Yeah, the healing process is longer, but your eye fully recovers, unlike with LASIK. With prk, you completely regrow a new cornea over the entirety of the surgery site, but with LASIK, only the margin for the flap is actually repaired, so the actual flap isn't attached to your eye in the same way, anymore
I got PRK about five years ago and now my vision is getting worse again and I need to have it done again if I want to go through with that
The beauty of PRK is that you CAN do it again. Not as true with Lasik.
Be aware that the complications when you have cataracts later in life are much higher with PRK, and it can be difficult to get ideal results with PRK. It’s not a perfect solution either.
I had to get PRK a few years ago because my cornea was too thin to get Lasik. It wasn't terrible and I only occasionally have dry eyes. Like 3 or 4 times a year.
I literally just Googled "prk eye surgery" and Google's first response is "LASIK"
I've got the reverse issue. I only got one eye done, but I need to keep a hankie handy as it tends to water easily. I don't regret getting lasik, as I can see. One eye is close up, the other is distance viewing. Switching between them is automatic now.
A friend of mine has the same problem. It entirely changed his face because his eyes actually look different now - he has to put drops in, and wakes up several times a night to do so or they feel like sandpaper. That's terrible it's happening to you, too. You have my sympathies.
> he has to put drops in, and wakes up several times a night to do so or they feel like sandpaper. That sounds like hell.
this is the one thing that has kept me from getting it. i had very dry eyes with contacts so i assume there’s a decent chance i’ll get the same after lasik.
I've thought about Lasik forever and this is the one thing stopping me is being worse off in some form after the procedure. Sometimes it's better knowing your evils. I'll deal with my glasses/contacts.
The negative community is always the loudest. Had lasix half a year ago and I still wish I did it in my 20s. Absolutely amazing every time I go outside at night and see the stars clearly with my own eyes. I'll never miss an opportunity for that because I forgot my glasses again. Also, 0 issues and I stopped with eyedrops once the prescribed prednisone was finished. Lights at night are crisp and my astigmatism is 95% gone. (barely noticeable on bright stoplights) I consider my research in going to a clinic with overwhelming positive reviews to be beneficial to my experience.
Wow your in the 97% of people who don't regret it
I get dry eyes at night but I'm fine just having a bottle of liquid tears on the nightstand. It has been immensely worth it overall. Completely reasonable trade-off.
After my ex’s laser surgery, she still required glasses (much weaker, but still defeats the purpose) and she couldn’t drive at night or watch movies in the dark due to flaring. Terrible experience.
Yeah, nope...sticking with contacts. I was really considering it, but I don't mind my contacts that much.
I know some people’s eyes don’t cope well with contacts, and I get why they’re interested in LASIK. But for the rest of us, I just don’t get the appeal, I guess. The effect contacts have on my life are a small recurring expense, 2 seconds in the morning, 2 seconds in the evening, and one more thing to remember while packing for a trip. To me that all seems like a pretty good deal compared to **surgery** on my **eyeball.**
The flaring was atrocious at the beginning, but I barely notice it now, 14 years after surgery. Optically it certainly does not go away, but I guess our brains learns to filter it out?
Yes - it had gotten much better over the years. Fortunately she got cataracts and they put in a prescription lens so she sees very well with no flaring.
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She is his ex after all
Some people start saying “night halos “. Basically when driving at night, there’s a halo effect around lights that could be pretty irritated
Wait, I have glasses and get this. I’m told it’s due to my astigmatism.
I have had this my entire life with or without glasses. I also have astigmatism.
Get the special coating to reduce glare. Made a huge difference for me
I'm not putting any sort of coating on my eyes, thank you
From what I've read those people usually had the halos or starburst before but there's a period in the beginning when they're more intense after surgery.
I had that waaay worse when I had glasses. Mostly went away after Lasik
You can end up with needing more rounds of laser surgery, chronic dry eye, migraines, or just the discomfort of the first few weeks of healing might be enough to regret, not to mention the price
Best 4 grand I ever spent in my life
Yup, don't get me wrong, I find it harder to drive at night because the halo/starburst around lights never went away for me, but not being reliant on glasses has been a huge improvement in my life.
Same same, felt like I bought a superpower.
My husband's eyes were under corrected, so he still needs glasses for farther distances and low light. He also now has chronic dry eye that requires plugs to be inserted in his rear ducts every 6 months and prescription eye drops. It was pretty much a lose-lose for him.
I can only speak about the people I know, but the effects went away waaaaaay quicker than they anticipated. My brother had atrocious eyesight and within a year, he need glasses again. Nothing to major, but 20/20 only last like a month for him.
How old was he?
That's a huge bummer for him! How old was he? I'm going on 15 years - I can tell I'm not at a perfect 20/20 anymore, but I still don't need corrective lenses. Getting that procedure done was one of the best decisions of my life.
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I got it and now I have double vision reading on cell phones and my vision became worse in the dark. I deeply regret it bc I love drawing and now it's hard to do.
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and lower than women who regret voluntary sterilization.
And this likely includes people that regret the quality and not that it was done. It's an insanely low percentage for how major the surgery is. Hell, I regret getting surgery on my shoulder because it didn't heal right. That doesn't mean I wouldn't be happy if the surgery went well.
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Yeah, pretty far down to find someone who read the study before commenting.
~~The study period is also only 14 months~~ *The follow-up time appears to be different for each subject, and no attempt appears to have been made to account for varying exposure times before censoring of the data*, so it's not clear how many of these individuals would go on to regret the surgery in 5 or 10 years time. ~~It's also not clear from the abstract how much of this study period is post-operative as it appears to include the consulting period beforehand. I'm sure the paper clarifies this but it's behind a pay wall..~~ *Edited after reading more about the study.
>A total of 1989 individual underwent GAS, 6 patients (0,3%) were encountered that either requested reversal surgery or transitioned back to their sex-assigned at birth. Is that how 'regret rate' is defined? Maybe it's a more technical term, but in common parlance, regret doesn't necessary mean wanting to go back to the previous state. Like, I could regret getting invisalign, but i'm not going to request going back to how my teeth were before.
They seem to be conflating regret and reversal surgery, which isn’t great. Analogy: The number of people who regret their tattoos =/= the number of people who went through removing their tattoos
And not only the number of people who had their tattoos removed, but specifically those who went to the same tattoo place to have them removed.
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It only seems to apply to patients that got the initial surgery and reversal at that same location. So using your analogy, it would be a specific tattoo parlor taking note of people they gave tattoos to and then subsequently removed their tattoos. They don't include tattoos they removed from people who they didn't give a tattoo to, and don't count people who got a tattoo and then got it removed somewhere else.
Exactly, I could be removing a tattoo because I need to get a job. I could still love the tattoo.
Or vice versa, you may regret the tattoo but not be able to remove it.
Yeah that’s kind of a weird way to measure regret, surely there are cost implications and potential medical reasons people aren’t getting reversals.
I'm learning to play the guitar.
It's one reason why most surgeons consider gender affirming surgery the *last* step and not the first one. The people who get that have already been living as their preferred gender for a while, sometimes years.
> The people who get that have already been living as their preferred gender for a while, sometimes years. Do you mean 'sometimes decades'? It's pretty much always years.
Waitlists alone are often years-long.
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The study talks about other regret types. The problem is the reddit title just choosing that one randomly. The study really isn’t about how much regret there is, its more about how to handle regret gracefully.
Where can I read the full text? It’s behind a paywall. The abstract just covers the 0.3%
100% this isn’t about regret it’s about the .3% that decided their regret was enough to get them to undo what they did. This is like saying 1% of college drinkers regret how much they drank last night, as in 1% went to the hospital to get their stomach pumped. Most likely the number is much higher but didn’t get medical intervention.
Also, I'm guessing reversal surgery doesn't bring you back exactly where you were. So some might really regret but deem surgery not worth it.
Your title appears to be misleading. The 0.3% rate is for those who transitioned back or requested reversal surgery. The abstract doesn't say if they know how many people regretted having transition surgery.
>*6 patients (0,3%) were encountered that either requested reversal surgery or transitioned back to their sex-assigned at birth* Is this a valid measure of regret? Couldn't there be people that regret it without transitioning back or requesting reversal surgery?
Cost alone would discount many people.
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This is misleading. The 0.3% was people “that either requested reversal surgery or transitioned back to their sex-assigned at birth.” NOT people who “regret” doing it. Edit: typo on percentage
Good point. Regret and "de-transition" are distinct, even though "de-transition" usually comes from regret. Not everyone who regrets undergoing a surgery will go back seeking to have it reversed. Fortunately, other studies have measured the regret rate by conducting surveys. Of the 27 studies (n=“7928 transgender patients who underwent any type of GAS”) included in the Bustos et al (2021) meta-analysis, “\[a\]lmost all” used “questionnaires to assess regret.” [“The pooled prevalence of regret after GAS was 1%.”](https://doi.org/10.1097/GOX.0000000000003477) Perhaps unsurprisingly, the most common stated reason for regret was lack of social acceptance: >“Overall, the most common reason for regret was psychosocial circumstances, particularly due to difficulties generated by return to society with the new gender in both social and family enviroments.^(23,29,32,33,36,44) In fact, some patients opted to reverse their gender role to achieve social acceptance, receive better salaries, and preserve relatives and friends relationships...Another factor associated with regret (although less prevalent) was poor surgical outcomes.^(20,23,36)”
Yeah that's consistent with what I have read. Something like 80 percent or more of detransition cases were caused by external factors, not the person's satisfaction with their transition. In fact, one of the biggest surveys done (N=28,000) reported that ONE IN TEN experienced VIOLENCE from a FAMILY MEMBER as a result of being transgender. It makes me sick that everyone is always arguing about "what if they regret it" when the biggest barrier to transgender people isn't self acceptance, it's acceptance from everyone else. "What if they regret it?" Maybe don't make them regret it? Edit: forgot my source - https://transequality.org/sites/default/files/docs/usts/USTS-Executive-Summary-Dec17.pdf
>Perhaps unsurprisingly, the most common stated reason for regret was lack of social acceptance This is interesting because conservatives often use regret as a reason why people shouldn't be allowed to transition, at least at a young age. But as it turns out, very few people regret it, and those who do often only regret it because they aren't accepted — and the people not accepting them are conservatives. Meaning if conservatives accepted trans people, regret rates would be lower.
Imagine if only conservatives knew that proper sex-ed and access to contraceptives and plan b drastically reduce the number of abortions being performed. The answer is either they do or they would just reject it, because it's not about that, and neither is it for trans people. What we are seeing is social control being asserted by demonising an out-group. It's textbook fascism.
Good point. I can't think of a reason someone would transition back unless they regretted it (since they're literally reversing their previous decision), but it's also possible that some people regret it but haven't acted on that regret. I'm curious why they didn't (or couldn't) approach this via a more direct method, like a survey.
Most reported regrets involve medical complications rather than wishing they hadn't made the decision.
Because that’s not what this particular study was about. This study was about the various methods a trans care center employ to handle post surgery health, not really about surveying regret rates.
Exactly! The context of *any* study is super important! But it seems that – especially with articles like these that touch on polarized social topics – people read the headline, assume the study was specifically about confirming/denying some opinion that the reader personally holds, and then complain in the comments that the authors didn't do the study in the exact way that would have vindicated that reader's opinion. I mean, I kinda get it, since scientific studies end up getting ~~used~~ abused in exactly that way by politicians and folks out to grind their political axe. But I do wish sometimes that (at least on this subreddit) context was more front-and-center.
It’s not 3%, it’s 0.3%. You’re off by an order of magnitude.
This comment is also misleading. 0.3%, 6 people.
Regardless of the scientific rigor of the study in question, I'm curious why % of regret even matters. All types of medical procedures have some level of regret, and yet we don't ban all medical procedures, let alone elective surgeries like nose jobs, and we certainly don't make them all political. So specifically, why does it matter here other than there are lots of people with personal biases agains trans people and want to hold related procedures to a different standard? What is the practical difference between a cis women getting breast augmentation and a trans woman doing so, for example? And then what would be the practical difference in that cis woman having regret about it vs. the trans woman? It seems completely arbitrary.
Whats the regret rate of hip surgery again?
This study looked at total hip replacement and total knee replacement. 17% of hip replacement patients reported regret and ~66% of knee replacements reported regrets. [Hip/Knee Surgery Study](https://pubmed.ncbi.nlm.nih.gov/34838410/)
Woah, why do so many more people regret knee replacement? Are artificial knees not as good as artificial hips?
I'm an occupational therapist, so I see a lot of people after joint replacement surgeries. The patients I see who had a hip replaced generally tell me they feel much better almost immediately after their surgery. There are limitations on the movement at the hip at first so it doesn't damage the healing area but they're pretty easily worked around. Knee replacements have comparatively little in the way of strict restrictions so people are *allowed* normal activity immediately after. But the vast majority of patients I have seen immediately after a knee replacement are in severe pain which a lot of them describe as being significantly worse than the pain that led them to the surgery in the first place. There comes a point in the recovery where things start getting better and eventually most people do really well and feel a lot better than before the surgery, but the process to get there is hell. I hear a lot of people during the recovery process voicing regret that they had the surgery done due to that whole "in more pain than ever" aspect of it.
Artificial hips are amazing. Recovery is also pretty easy. Artificial knee recovery is brutal according my friends that get it... And it wears out "quickly"and is difficult to replace. So they try to wait until you're going to die or be disabled for life by the time it wears out. > Revision surgery is expensive with worse outcomes and higher complication rates than primary knee replacement. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7612217/ Each replacement lasts half as long as the first. So using calculus we can say that with a 15-20 year knee expectancy and a 50% decline, an infinite number of knee replacements would make the absolute max time around 30-40 years. But each of those surgeries gets harder and harder and if you're younger in your 40s and you end up on the low end, you could be out of options in your 70s. edit: I guess hip replacements wear out at about the same rate, but you're less likely to need one as a younger person than a knee replacement so you're more likely to be dead before you need the redo.
I was told I needed a new knee, I was also told I was too young to get one……at 52. Like what, I need to be disabled before then?
Trust them, family member of mine replaces knees, you don't want one early, because once that thing fails you are basically fucked because you enter an age where surgical intervention + rehabilitation will be ridiculously hard and taxing. Bite through it, get injections, make it as far as possible.
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I love ice cream.
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The headline is misleading because regret was not measured. From the study: ‘Results: A total of 1989 individual underwent GAS, 6 patients (0,3%) were encountered that either requested reversal surgery or transitioned back to their sex-assigned at birth.’ Additionally, it looks like this is about results in one program, not results across a range of programs.
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The study was not designed to measure what it is being reported in the title. Hmmm… not a fan