Call it a match made in heaven. The Journal of the American Medical Association has a penchant for publishing non-rigorous research, and CNN has an insatiable appetite for promoting it. Their latest rendezvous comes by way of a study that sets out to assess regret and overall levels of satisfaction among people who elected to undergo mastectomies as part of a gender transition. The study appeared on August 9, and CNN ran an article on it within hours of its publication.
The results of the study sound remarkable. “The median satisfaction score was 5 on a 5-point scale, with higher scores indicating higher satisfaction. The median decisional regret score was 0 on a 100-point scale, with lower scores indicating lower levels of regret.” Put differently, most respondents gave the best possible ratings when it comes to their feelings of satisfaction or regret.
As is often the case with research guided by political agendas, however, the devil is in the details, or lack thereof. When it comes to so-called gender-affirming care, the salient policy questions concern the ethics and efficacy of performing irreversible medical treatments on adolescents. The study does not specifically address pediatric gender medicine, but it concludes that the results “affirm the overwhelmingly low levels of regret following gender-affirming surgery.” It was CNN that used the study to criticize state age restrictions, without ever mentioning that the study provides no information about pediatric outcomes.
The influential activist organization World Professional Association of Transgender Health (WPATH) did not recommend mastectomy for minors until 2012. While a small number of mastectomies might have been performed on minors before that time, that dates to 2013 show that the incidence of “gender-affirming” mastectomies on minors increased 13-fold between 2013 and 2020. This trend suggests that the vast majority of “gender-affirming” mastectomies on minors were performed after WPATH issued their guidance. However, the surgeries documented in the JAMA study occurred between January 1990 and February 2020, so the sample presumably would have included a small composition of adolescents compared with current realities. The researchers might have addressed this problem by disaggregating the results by age group, but they did not do this. Ultimately, it’s impossible to discern pediatric outcomes within their sample.
Worryingly—and tellingly—the authors also never address the recent meteoric growth in the number of individuals who identify as a different gender; nor do they observe that this rapid growth has been particularly acute among females. In other words, the profile of individuals undergoing a sex-change mastectomy is different from just a few years ago: much younger, and much more impressionable and vulnerable to the false promises of gender ideology.
While the study provides no information about pediatric outcomes, it oversells findings within adult patients. Among the 235 patients eligible for the study, only 59.1 percent participated in surveys. It’s entirely possible that the sentiments of those who elected to respond are very different from those who did not, a phenomenon known as nonresponse bias. The study also provides no information about why individuals were lost to follow-up. This fact raises the possibility—one that manifested in a New England Journal of Medicine study earlier this year—that suicides are treated as missing data.
Despite these obvious shortcomings, CNN not only relayed but exaggerated the study’s findings and presented them without their full context. It also incorrectly stated that “Most US medical centers follow guidelines from the World Professional Association for Transgender Health,” which requires that patients “have to be the age of majority and have significant medical or mental health concerns that are reasonably well-controlled at the time of surgery.” In fact, WPATH sets no minimum age for mastectomies, and hundreds of sex-change mastectomies (euphemistically dubbed “top surgery”) are performed on adolescents every year, including on detransitioner and Do No Harm patient advocate Chloe Cole.
Americans are waking up to the ugly truth about gender ideology and medicine. Unfortunately, there are still too many people determined to look the other way.