I've been looking over the results as they've been released. And with my bare two years of experience. (yes, it's been two years this month now!), what is being reported dovetails with experience nicely.
I think your theory on surgery bottlenecks has some merit to it. Yes, there is (for now) more access to surgical options and more and more insurance companies are paying for it (and some states mandate coverage still). But there is a wait time that can be daunting. I'll use my own experiences so far to illustrate:
From initial request for orchiectomy (August 2024) to consultation (January 2025) was five months. From consultation to proceedure (April 2025) was an additional three months.
There are 3-4 good surgeons in the region doing FFS. The top one doesn't make many forms of insurance. The second top rated one is who I have scheduled. From initial request (August 2024) to consultation (January 2025) was five months. Second consultation was March 2025, so two more months. Insurance approval for *most* of it was in May 2025, and the parts that have been denied are being appealed. Date of surgery is scheduled for November 2025. So 15 months for he best surgeon in the region that takes my insurance.
As for GRS? I decided that yes, I want to go that route in December 2024. Did my homework, and decided on the type I want (PPV). Insurance will only approve in the region, and there is *ONE* place doing that in a 400 mile range. Got the referral in March 2025, did the paperwork, and I have a consultation for my initial appointment.....for October 2026. 19 months later, and up to 3 years wait time. Even if I "settled" for my second or third choice options, I'm still looking at 2-4 years wait time.
Add to that there is now a push to get as much done NOW while you still can and yeah....bottlenecks and wait times are insane.
We saw the exact same bottleneck problem in 2020-21 with therapy intake and HRT intake, so it only makes sense that there's a huge bottleneck at surgery now, too.
And congratudolances on the surgeries... And wait times.
In Australia we definitely have huge bottle-necks particularly around bottom surgery (both MTF and FTM) with only 7 or so surgeons available between MTF and FTM. Unlike USA we have to pay nearly the entire amount out of pocket as private insurance does not cover it and Medicare does not either.
There has been reports of GCS/SRS surgeries will be covered in the future (mid next year) under Medicare, but with so few surgeons the already 2 year waiting is will blow out even further.
I do have one (set of) question(s): You said "Basically nobody who starts HRT or gets a gender-affirming surgery regrets it. One percentage point or less for all regrets in either case". But you also said that it's a survey of trans people. How strictly was the latter followed? Because perhaps those who regretted it no longer identify as trans and therefore were not captured by the survey. (You mentioned detransition, so maybe I'm misunderstanding and detrans people were included? Or perhaps the only detransitioners who were included were those who went on to retransition?) It seems that this could in particular be effected by snowball sampling, since it seems that the trans and detrans communities are pretty separate these days, and maybe it didn't cross over. Any thoughts on any of this?
Snowball sampling means we can't extrapolate lots from this data--you're correct in that. The issue here is that detransitioners in general are an incredibly hard group to sample. We're talking a fraction of a fraction of a percent; from the data in the survey, about 4% of the 1 in 9 who'd ever detransitioned did so because they realized they weren't trans after all, which would be our target demographic here. That's about 0.44% of a population that's somewhere in the vicinity of 1.6% of the population.
Or, if we math it out: there's only about 24,000 eligible detransitioners to study in the entire United States, which has a population of 347 millionish. We're not even at needle in a haystack here--we're at needle in a forty-acre wheat field. Rounding up, say, 500 of these folks to get a genuinely representative sample is basically a statistical impossibility, especially since most of them will have had no contact with gender-affirming care, from which we could get things like contact information.
To talk about the regret rate stuff, though, we've actually done a lot of research on regret after surgery/HRT, and for the last thirty years, give or take, those less-than-1% numbers have done nothing but *drop*. Those are samples that are much more achievable, because regardless of identity, we then have records and contact information for the people who had this procedure or that, and can do follow-up surveys. I'd consider the regret rate data pretty ironclad at this point.
I'm newly working on exploring a transfemme demigirl identity (so another in the AMAB nonbinary bucket, unless I change my mind some more) and it's actually kind of fun! Though I'm not regularly out and about as Ann yet...it should be fine where I live though, very blue. I do have kids who live in a very red area though!
It's just too soon for me to have much to add regarding the survey, but I was able to get a gender therapist right away to help me navigate things. The gender clinic, well it's only been like a week and a half from getting the referral from my primary that I needed (I tried calling like the website said and they were like "nah, we need a referral" which primary care gave them without a real hassle. But I have some issues where I could use more expert advice vs. a standard informed consent place. (or maybe message my current endocrinologist and see if he'll support HRT instead? Might be a back door?)
p.s. I posted on another article as my alt "Tina Kay"/"Tina Ann" but decided Tina still wasn't quite right and keeping 2 separate sets of everything was just too much! Won't delete the other account and its subscriptions though but will continue writing weeklies on this one.
Hi, Ann! And yeah, there are definitely a few conditions that require more careful attention than normal, the most common of which is diabetes, and if that's your reality, getting advanced help is always the right move!
And take your time! There's no rush on any of this unless you decide there is! 💜
I love the perspective on the sampling and methods; that’s not something I would have picked up on by myself. I’m a nonbinary transfeminine person and I had been maybe reading some things into the survey that perhaps I shouldn’t have, given what you had to say about the study’s possible level of representation. So very useful to hear, and I appreciate you taking the time to not only analyze that aspect of the study but also explain it to the rest of us.
Thank you! It's also possible that transfem enbies really are a smaller slice of the pie, of course, but I'm always suspicious of special pleadings without strong evidence. The sheer scale of transmisogyny in the world seems such a better explanation for the data.
Great read to wake up to! Love your work and your writing <3
Small typo noticed under Messy data points when it comes to age: "If you're poorer, you can* see a doctor as often..." I would assume is supposed to read *can't
I've been looking over the results as they've been released. And with my bare two years of experience. (yes, it's been two years this month now!), what is being reported dovetails with experience nicely.
I think your theory on surgery bottlenecks has some merit to it. Yes, there is (for now) more access to surgical options and more and more insurance companies are paying for it (and some states mandate coverage still). But there is a wait time that can be daunting. I'll use my own experiences so far to illustrate:
From initial request for orchiectomy (August 2024) to consultation (January 2025) was five months. From consultation to proceedure (April 2025) was an additional three months.
There are 3-4 good surgeons in the region doing FFS. The top one doesn't make many forms of insurance. The second top rated one is who I have scheduled. From initial request (August 2024) to consultation (January 2025) was five months. Second consultation was March 2025, so two more months. Insurance approval for *most* of it was in May 2025, and the parts that have been denied are being appealed. Date of surgery is scheduled for November 2025. So 15 months for he best surgeon in the region that takes my insurance.
As for GRS? I decided that yes, I want to go that route in December 2024. Did my homework, and decided on the type I want (PPV). Insurance will only approve in the region, and there is *ONE* place doing that in a 400 mile range. Got the referral in March 2025, did the paperwork, and I have a consultation for my initial appointment.....for October 2026. 19 months later, and up to 3 years wait time. Even if I "settled" for my second or third choice options, I'm still looking at 2-4 years wait time.
Add to that there is now a push to get as much done NOW while you still can and yeah....bottlenecks and wait times are insane.
We saw the exact same bottleneck problem in 2020-21 with therapy intake and HRT intake, so it only makes sense that there's a huge bottleneck at surgery now, too.
And congratudolances on the surgeries... And wait times.
Thank you. 2nd HRTversary next month, and I was just hooded with my masters degree.
It has been an AMAZING two years. And I've only just started. I LOVE who and what I am.
Thanks for posting.
In Australia we definitely have huge bottle-necks particularly around bottom surgery (both MTF and FTM) with only 7 or so surgeons available between MTF and FTM. Unlike USA we have to pay nearly the entire amount out of pocket as private insurance does not cover it and Medicare does not either.
There has been reports of GCS/SRS surgeries will be covered in the future (mid next year) under Medicare, but with so few surgeons the already 2 year waiting is will blow out even further.
Oh gosh that's really rough. 🫂
At least HRT is quite cheap here by comparison and even afford if unemployed
Thanks for the post. Very interesting.
I do have one (set of) question(s): You said "Basically nobody who starts HRT or gets a gender-affirming surgery regrets it. One percentage point or less for all regrets in either case". But you also said that it's a survey of trans people. How strictly was the latter followed? Because perhaps those who regretted it no longer identify as trans and therefore were not captured by the survey. (You mentioned detransition, so maybe I'm misunderstanding and detrans people were included? Or perhaps the only detransitioners who were included were those who went on to retransition?) It seems that this could in particular be effected by snowball sampling, since it seems that the trans and detrans communities are pretty separate these days, and maybe it didn't cross over. Any thoughts on any of this?
That's a fair question.
Snowball sampling means we can't extrapolate lots from this data--you're correct in that. The issue here is that detransitioners in general are an incredibly hard group to sample. We're talking a fraction of a fraction of a percent; from the data in the survey, about 4% of the 1 in 9 who'd ever detransitioned did so because they realized they weren't trans after all, which would be our target demographic here. That's about 0.44% of a population that's somewhere in the vicinity of 1.6% of the population.
Or, if we math it out: there's only about 24,000 eligible detransitioners to study in the entire United States, which has a population of 347 millionish. We're not even at needle in a haystack here--we're at needle in a forty-acre wheat field. Rounding up, say, 500 of these folks to get a genuinely representative sample is basically a statistical impossibility, especially since most of them will have had no contact with gender-affirming care, from which we could get things like contact information.
To talk about the regret rate stuff, though, we've actually done a lot of research on regret after surgery/HRT, and for the last thirty years, give or take, those less-than-1% numbers have done nothing but *drop*. Those are samples that are much more achievable, because regardless of identity, we then have records and contact information for the people who had this procedure or that, and can do follow-up surveys. I'd consider the regret rate data pretty ironclad at this point.
Thank you!
Hi Zoe!
First of all, I love your texts, I learned a lot about myself from them!
Found another typo, in the rapidfire Paragraph, point 2, second sentence:
"That puts us at mugh higher risk.." mugh->much
Thanks!
Hi Zoe!
I'm newly working on exploring a transfemme demigirl identity (so another in the AMAB nonbinary bucket, unless I change my mind some more) and it's actually kind of fun! Though I'm not regularly out and about as Ann yet...it should be fine where I live though, very blue. I do have kids who live in a very red area though!
It's just too soon for me to have much to add regarding the survey, but I was able to get a gender therapist right away to help me navigate things. The gender clinic, well it's only been like a week and a half from getting the referral from my primary that I needed (I tried calling like the website said and they were like "nah, we need a referral" which primary care gave them without a real hassle. But I have some issues where I could use more expert advice vs. a standard informed consent place. (or maybe message my current endocrinologist and see if he'll support HRT instead? Might be a back door?)
p.s. I posted on another article as my alt "Tina Kay"/"Tina Ann" but decided Tina still wasn't quite right and keeping 2 separate sets of everything was just too much! Won't delete the other account and its subscriptions though but will continue writing weeklies on this one.
Hi, Ann! And yeah, there are definitely a few conditions that require more careful attention than normal, the most common of which is diabetes, and if that's your reality, getting advanced help is always the right move!
And take your time! There's no rush on any of this unless you decide there is! 💜
I love the perspective on the sampling and methods; that’s not something I would have picked up on by myself. I’m a nonbinary transfeminine person and I had been maybe reading some things into the survey that perhaps I shouldn’t have, given what you had to say about the study’s possible level of representation. So very useful to hear, and I appreciate you taking the time to not only analyze that aspect of the study but also explain it to the rest of us.
Thank you! It's also possible that transfem enbies really are a smaller slice of the pie, of course, but I'm always suspicious of special pleadings without strong evidence. The sheer scale of transmisogyny in the world seems such a better explanation for the data.
Another small typo, second paragraph, fourth sentence. I believe “distructful” should be “distrustful”.
Got it! Thanks!
Great read to wake up to! Love your work and your writing <3
Small typo noticed under Messy data points when it comes to age: "If you're poorer, you can* see a doctor as often..." I would assume is supposed to read *can't
again great to see you post c:
Thank you! Corrected!
I was just out of town until yesterday, so instead of having a week to research and proof the article, I had an afternoon. 😅
Hi Zoe!
First of all, I love your texts, I learned a lot about myself from them!
Found another typo, in the rapidfire Paragraph, point 2, second sentence:
"That puts us at mugh higher risk.." mugh->much