Debunking Professor Winston

On Wednesday morning, Profesor Robert Winston made some wild claims regarding trans people on BBC Radio 4’s “Today” programme. He talked about “horrific” surgeries, extremely high surgical complication rates and linked this to a high level of regret. For those not familiar with the topic this might sound like solid science from a respected personality.

It’s not science.

One possibility is that he’s just clueless about the topic. After all, he’s a fertility rather than gender specialist. Another option is that he’s dishonestly using statistics to engage in scaremongering based on a political, not scientific, viewpoint.

Winston made equally wild claims about cycle lanes causing pollution last year. He didn’t say what paper he was referring to so he couldn’t be fack checked. This time, he sourced his claims the following day via Twitter and the article is available online for a fee.

One of Winston’s statements on Radio 4 was that there are complications in about 40% of trans surgeries. That figure does not appear in the paper. It actually says the complication rate is 32.5%, but we also get into confusion over terminology.

You see the same confusion with “elective” vs “emergency” surgery. These are medical terms with specific meanings not apparent to the layperson, and elective just means it was scheduled in advance, but it can still be life-saving surgery. And if you worry about such things, don’t ever read the patient information leaflet for Ibuprofen. Apparently, it causes heart attacks.

Someone as senior as Winston is no doubt aware of the possibility of confusion when using technical terms. But he wants us to believe trans surgery is terrible, so he abuses this confusion and talks about complications then moves on to “horrific” surgeries. He leads the listener to believe that all complications are “horrific” and many surgeries have unwelcome results.

They don’t.

Most complications are minor, and might not even register with the patient as a complication. For example, nearly half (44%) of the complications in the study are “Meatal Stenosis”. These form the bulk of the 21.7% “reoperation” rate, largely from one German study (The paper is available for free, but contains graphic genital surgery images not suitable for an office environment) It might sounds serious and make it seem like SRS is Germany is very dangerous. However, in lay terms, it means “you probably piss in a funny direction, or dribble a bit”. The fix is minor in most cases and might not even need an operation. The Germans seem to use a two-stage technique, so appear to be unfussed by needing “re-operation” – they have already scheduled a second-stage operation.

Some things can go wrong of course, as with any surgery, but most of the “complications” are in this vein or even more minor.  A bit more bleeding than was expected or some tissue granulation.

Now we get into issues of individual agency. If the patient understands the possible consequences of a treatment and has given informed consent, isn’t that OK? Even with the scary prognosis Winston paints, it’s better than the alternative of a lifetime on Spironolactone or Zoladex. And that’s before we worry about the mental health issues involved.

I am a liberal, and I believe firmly in individual agency. It is entirely possible Winston has a more authoritarian view on this. But without knowing his views on similar issues such as abortion and the right-to-die, I don’t know what his outlook is.

Having planted the scary 40% figure in people’s minds, Winston then goes on to conflates regret with surgical complications. Signal boosting stories of regret and framing the debate to exaggerate regret rates is sadly a common anti-trans media tactic right now. However, trans surgeries have one of the lowest regret rates of any surgery – recent studies report it as being around 1-2%, with a meta-study looking at papers all the way back to 1960 when surgical techniques were less developed still only places the figure at 2.2%. For comparison, surgical regret rates for prostate surgery was a whopping 47% in one study. Another paper found that breast cancer surgery had a 24% regret rate.

Finally, the programme was nominally about trans children.

Children can’t get surgery.

3 comments

  1. When doing a meta-analysis (i.e. a piece of research which combines the results of multiple different studies), one of the key things to be careful of is heterogeneity. In lay terms – you aren’t supposed to compare apples with oranges. If the studies being looked at are too different (in terms of patients being treated, clinical procedures, outcome measures etc), then it may be useful to compare them and discuss them, but it probably is not appropriate to group them together and come up with an overall average result.

    In this case, the largest study included in the meta-analysis reported an 81% complication rate (this was the German study mentioned above), the second largest reported a 20% complication rate, and the third largest reported a 14% complication rate. The difference between an 81% complication rate and a 14% complication rate is huge. There are all sorts of possible reasons (surgical skill, technique, what was defined as a ‘complication’) – but it strongly suggests that this is an apples and oranges comparison, and that coming up with an ‘average’ of 32% is pretty meaningless.

  2. I second sexdrugsmh!
    I’m a trans man and after a lot of research, I underwent the female to male surgery from a clinic in my province. I haven’t undergone complete transition, just the top surgery. But I must say that I’m happy with the result. I have discussed with many trans people who have undergone the surgery from different places. Everyone had different opinions regarding their surgery. Some are happy with their surgery while some are not. It all depends upon the surgeon.
    One should consult an experienced surgeon for undergoing any kind of surgeries. Also, it is not necessary that if a surgeon is experienced then there won’t be any complication. Surgery results can vary according to the person’s body and health condition.

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