The fallacy of the “regret argument”

Image description: Cartoon of Veronica standing by a poster of a pie chart that is mostly colored like the Trans Pride flag
Nous ne regrettons rien.

Image description: Cartoon of Veronica standing by a poster of a pie chart that is 99.6% colored like the Trans Pride flag

Many gatekeepers and platformed transphobes wield the word “regret” in an ill-intentioned way. It’s used as one of their justifications for slowing or blocking trans people’s access to healthcare and legal rights. This is an ugly tactic because it creates an illusion of being motivated by concern, while it’s actually just another weapon for the War in Words that Jay Hulme describes so eloquently here.

If someone comes at you or your partner, friend or family member trying to use “possible regret” as a gatekeeping method, know that they’re not coming from a position of fact or real concern.

The 2015 U.S. Transgender Survey asked over 27,700 non-cisgender people a whole range of questions, including ones about “de-transitioning,” defined as “having gone back to living as [their] sex assigned at birth, at least for a while” (emphasis mine). Only 8% said they had de-transitioned but 62% of those did so only temporarily, meaning the actual figure was less than 5%. More significantly, of the 27,700+ respondents, only 0.4% said they de-transitioned because transition wasn’t right for them. Almost everyone else who de-transitioned cited social issues: pressure from parents, family members and partners; discrimination and harassment; and difficulty getting a job.

In 2018, The Journal of Sexual Medicine published a paper titled The Amsterdam Cohort of Gender Dysphoria Study (1972–2015). It reported on a review of 6,793 patient cases. Focusing on bottom surgery, which not all the patients had undergone, the study found that only 11 of the trans women (0.6%) and 3 of the trans men (0.3%) regretted it. Of those 14 people, 7 classified this as true regret; 5 said it was due to social issues; and two said they were nonbinary rather than trans.

A 2018 paper in Plastic and Reconstructive Surgery – Global Open titled A Survey Study of Surgeons’ Experience with Regret and/or Reversal of Gender-Confirmation Surgeries states that regret after gender-affirming surgery is an exceedingly rare event. They surveyed 46 surgeons, the majority of whom had over 10 years’ experience. They had collectively treated over 22,700 patients. Only 62 of those patients (0.2%) were known to have regretted their surgery, with reasons including a change in gender identity (22 patients), social issues (15 patients) and chronic post-operative pain (14 patients).

I could easily go on. Cornell University pooled data from 56 studies published between 1991 and 2017 and found “a regret rate ranging from .3 percent to 3.8 percent [with regrets] most likely to result from a lack of social support […] or poor surgical outcomes using older techniques.” None of the studies found that gender transition is harmful. Surgical regret is also estimated to be extremely low or non-existent in Dhejne et al. (Swedish study for 1960–2010: 15 people out of 767 people with a significant decline of regrets over time); and De Cuypere et al. (Belgian study for 1986–2001; no regrets expressed by 62 patients). In a survey of 201 respondents by van de Grift et al., only 8 reported dissatisfaction or regret, and it was associated with “preoperative psychological symptoms or self-reported surgical complications.”

We can flip things around and look at satisfaction too. In a review of 1,833 patient cases, Murad et al. reported surgical transition led to significant improvements in gender dysphoria (80% of individuals); quality of life (80%); and psychological symptoms (78%). In a study of 60 patients, Johansson et al. found that 90% reported improved quality of life and relationships.

Facts come from scientifically sound studies with large cohorts and good methodologies. Fallacies come from people who have their own financial, career-building, political or religious agendas. They ignore solid peer-reviewed science and promote junk science and scary stories: literature reviews* that correlate facts without examining cause or dependence; surveys* and interviews* with questions designed to elicit biased responses; eye-catching but manipulative headlines.* Articles passing themselves off as science focus on things that medical transition can’t fix and “prove” that it doesn’t fix them. Opinion pieces focus on “Person A’s dramatic experience!” or “3 people who regretted their choice!” and use those very rare de-transitioning stories as representative of a massive problem that simply isn’t there.

Imagine if we flipped those headlines around and had articles like “6,782 Dutch people who didn’t regret their transition!” or “25,500+ Americans who happily transitioned!” — or even reflected the statistics with ~99 positive transition experience articles for every negative one.

Imagine if we started gatekeeping other life events based on the potential for regret. What if we took the percentage of marriages that end in divorce (estimated at ~39% in the U.S. and ~42% in the U.K. in 2017) as “marriage regret” and blocked or delayed people from access to marriage? What if we used questions about fatigue, stress and worry to interview first-time working parents with no local extended family, then published articles about “baby regret”?

We could restrict ourselves to body alterations. How about using this infographic-heavy survey on “tattoo regret” as a reason to put a 2-year waiting limit on tattoos? I have a tattoo that doesn’t look good. I regret not looking more closely at the artists’ work. Should my individual regret dictate your tattoo access? Should we solely look at Botched! participants as representative of the majority of cosmetic and plastic surgery outcomes?

I’m a scientist. I know a good study when I read the paper; I understand the importance of dependence and causal relationships; and I can spot junk science, biased questionnaires and agenda-based spin. The facts show that medical transition improves quality of life and reduces gender dysphoria for the vast majority of trans people. The science supports transition as a solution and does not support the regret argument.

I’m also a writer. It offends me to see how ill-defined “regret” is in the writings of these prejudiced people. Regret for what, exactly? The transition? Or the challenges within it — most of which are the fault of political policy, prejudice, social issues and access to medicine? It offends me that anyone would use language that makes it sound like they care, all the while advocating for making proven solutions harder to access.

Trans people and their allies need to know the truth about the regret argument: that it has no foundation in science. And if lawmakers, healthcare workers and society as a whole did better by trans people, the already extremely rare cases of regret would be even rarer.

*I’m not linking to any examples because quite frankly, they don’t deserve the clicks. If you want examples, contact me.

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