6 ms·

Don't more people regret knee replacement surgeries than people who regret transitioning, by an order of magnitude? At least hormone induced changes are fairly

Don't more people regret knee replacement surgeries than people who regret transitioning, by an order of magnitude? At least hormone induced changes are fairly reversible. Can't exactly cook up a new knee.

trinn 3y ago
That sounds unlikely, what and from where are the regret rate numbers you are comparing?
- superchroma 3y ago
  A cursory search reveals one study suggesting 30% continue to experience chronic pain and 1 in 5 regret knee replacement. https://www.aarp.org/health/conditions-treatments/info-2018/knee-replacement-surgery-regret.html https://www.aarp.org/health/conditions-treatments/info-2018/... Not great numbers, but sample sizes and study integrity, as with the data on gender affirming care, is the killer.
  - trinn 3y ago
    Thanks for the info. What rates for gender-affirming care are you comparing this to though?
    - superchroma 3y ago
      The data there is not good. There are studies that claim it is low. They focus on surgery a lot. There are not many trans people (relative to the general population) and not many studies on them. There is not sufficient granularity between: - trans people who only take hormones, - who do that and have top surgery, - who are castrated and, - who have top and bottom surgery Personally, I think bottom surgery is not quite there and is definitely a medical frontier and free-for-all. Hormones and top surgery are fairly reversible via application of more money, exercise and time. Based on that, I am forced to fall back to first principles, and feel that given that the risk of lasting damage is low on some procedures, that those procedures which give perfectly acceptable and also potentially reversible results are reasonable to offer in this way.
      - deleted 3y ago
        [deleted]
    - throwaway626 3y ago
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503911/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503911/ Between 1% and 8%, depending on how detransition is defined. This article found 6.9% (12/175, 6 clearly detransitioning and 6 ambiguous) at one clinic, including anyone who sought and received care over a certain interval.
      - trinn 3y ago
        That is interesting but the same study also says that 21.7% of this cohort disengaged from the clinic. So the rate could be even higher, depending on if they stopped treatment entirely or changed to another service provider.
        throwaway626 3y ago
        “Disengaged” here means that they did not make it through the assessment/pre-screening process and did not receive treatment, which is not what is meant by “detransition” or what is commonly understood as contributing to “regret rate”. When an elderly person rejects knee replacement prior to surgery e.g., because they’ve learned the risks, they’re also not counted in the regret rate for knee replacement. EDIT: Those that disengaged did not complete treatment, therefore they cannot regret completing treatment. Perhaps they regret starting treatment and perhaps they don’t; either way, that’s not the same thing as detransition. I can’t read their minds to figure out why they disengaged, and neither can anyone else.
        trinn 3y ago
        If I'm reading this correctly, this included disengagement prior to surgery but after hormonal treatment. So it could be that some in this group regretted the hormonal treatment so chose not to continue with the surgical intervention?
mensetmanusman 3y ago
They are less reversible the younger you are.
bitshiftfaced 3y ago
> At least hormone induced changes are fairly reversible. The article talks about youth transitioning. Can't hormone treatment during the early years have lasting, permanent effects?
- nicoburns 3y ago
  > Can't hormone treatment during the early years have lasting, permanent effects? It can, although the GP's assertion that this is more reversible than knee surgery is probably still true.
- lowmagnet 3y ago
  Children with hormonal diseases (like precocious puberty) have to take puberty blockers and they have no lasting effect. They just stop the onset of secondary sex characteristics until a more appropriate age. (remember: those hormones control all sorts of changes, including sometimes-painful growth spurts)
  - bitshiftfaced 3y ago
    > They just stop the onset of secondary sex characteristics until a more appropriate age. At which point if they still did take puberty blockers at this more appropriate (critical?) age, wouldn't there be permanent effects?
    - falcolas 3y ago
      Transitioning as a child is a series of steps. It starts with social transitioning below age 10. Puberty blockers from around 10 to 15. Hormone treatments from 15 onward. Some opt to continue to top/bottom surgery, usually after the age of 17 (with a parent's consent if under 18). And no. Puberty blockers are well understood (been using for over 50 years), and their use restricted to timeframes where it won't impact the child's development.
      - bitshiftfaced 3y ago
brodouevencode 3y ago
There is a big difference in what would be an objectively determined need (a knee replacement) versus something that is very subjective (wanting to be another gender). There is no quantifiable measurement for determining gender. (Speaking specifically for minors.)
- eesmith 3y ago
  If someone wants a knee surgery because they want to continue their hobby of endurance running, but does not need the surgery for an otherwise normal life, does that surgery count as an objective or subjective need?
- falcolas 3y ago
  Did you know that most gender affirming surgeries for minors are breast enlargements and reductions for cis girls (born as a girl, not transitioning)?

trinn 3y ago

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

superchroma 3y ago
A cursory search reveals one study suggesting 30% continue to experience chronic pain and 1 in 5 regret knee replacement. https://www.aarp.org/health/conditions-treatments/info-2018/knee-replacement-surgery-regret.html https://www.aarp.org/health/conditions-treatments/info-2018/... Not great numbers, but sample sizes and study integrity, as with the data on gender affirming care, is the killer.
- trinn 3y ago
  Thanks for the info. What rates for gender-affirming care are you comparing this to though?
  - superchroma 3y ago
    The data there is not good. There are studies that claim it is low. They focus on surgery a lot. There are not many trans people (relative to the general population) and not many studies on them. There is not sufficient granularity between: - trans people who only take hormones, - who do that and have top surgery, - who are castrated and, - who have top and bottom surgery Personally, I think bottom surgery is not quite there and is definitely a medical frontier and free-for-all. Hormones and top surgery are fairly reversible via application of more money, exercise and time. Based on that, I am forced to fall back to first principles, and feel that given that the risk of lasting damage is low on some procedures, that those procedures which give perfectly acceptable and also potentially reversible results are reasonable to offer in this way.
    - deleted 3y ago
      [deleted]
  - throwaway626 3y ago
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503911/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503911/ Between 1% and 8%, depending on how detransition is defined. This article found 6.9% (12/175, 6 clearly detransitioning and 6 ambiguous) at one clinic, including anyone who sought and received care over a certain interval.
    - trinn 3y ago
      That is interesting but the same study also says that 21.7% of this cohort disengaged from the clinic. So the rate could be even higher, depending on if they stopped treatment entirely or changed to another service provider.
      - throwaway626 3y ago
        “Disengaged” here means that they did not make it through the assessment/pre-screening process and did not receive treatment, which is not what is meant by “detransition” or what is commonly understood as contributing to “regret rate”. When an elderly person rejects knee replacement prior to surgery e.g., because they’ve learned the risks, they’re also not counted in the regret rate for knee replacement. EDIT: Those that disengaged did not complete treatment, therefore they cannot regret completing treatment. Perhaps they regret starting treatment and perhaps they don’t; either way, that’s not the same thing as detransition. I can’t read their minds to figure out why they disengaged, and neither can anyone else.
        trinn 3y ago
        If I'm reading this correctly, this included disengagement prior to surgery but after hormonal treatment. So it could be that some in this group regretted the hormonal treatment so chose not to continue with the surgical intervention?

mensetmanusman 3y ago

They are less reversible the younger you are.

bitshiftfaced 3y ago

> At least hormone induced changes are fairly reversible. The article talks about youth transitioning. Can't hormone treatment during the early years have lasting, permanent effects?

nicoburns 3y ago
> Can't hormone treatment during the early years have lasting, permanent effects? It can, although the GP's assertion that this is more reversible than knee surgery is probably still true.
lowmagnet 3y ago
Children with hormonal diseases (like precocious puberty) have to take puberty blockers and they have no lasting effect. They just stop the onset of secondary sex characteristics until a more appropriate age. (remember: those hormones control all sorts of changes, including sometimes-painful growth spurts)
- bitshiftfaced 3y ago
  > They just stop the onset of secondary sex characteristics until a more appropriate age. At which point if they still did take puberty blockers at this more appropriate (critical?) age, wouldn't there be permanent effects?
  - falcolas 3y ago
    Transitioning as a child is a series of steps. It starts with social transitioning below age 10. Puberty blockers from around 10 to 15. Hormone treatments from 15 onward. Some opt to continue to top/bottom surgery, usually after the age of 17 (with a parent's consent if under 18). And no. Puberty blockers are well understood (been using for over 50 years), and their use restricted to timeframes where it won't impact the child's development.
    - bitshiftfaced 3y ago

brodouevencode 3y ago

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

eesmith 3y ago
If someone wants a knee surgery because they want to continue their hobby of endurance running, but does not need the surgery for an otherwise normal life, does that surgery count as an objective or subjective need?
falcolas 3y ago
Did you know that most gender affirming surgeries for minors are breast enlargements and reductions for cis girls (born as a girl, not transitioning)?