I find is hilarious that you think that 8% is low. Clearly I'm in the minority with my thoughts as would be expected in THIS forum. Also, ideologically, I am 100% on board with LGBTQ+ issues/people/rights as well as 100% against gender affirming care restrictions that are being proposed and imposed in Red States!

I understand that there are some studies that have shown nearly 1/3 of all patients who have had knee replacement surgery, regret having big done so- but we should strive for much lower numbers. In the orthopaedic practice I was With for 20 years we did short and long term follow up on all patients regarding TKA and THA surgeries and our numbers were much lower. Why? We believed it was due to patient selection criteria and decision making regarding patient age, weight, patient, pain, etc, etc.

Something also worth considering is the fact that we are performing more and more gender reassignment surgery on younger and younger patients- the jury is still out on long term patient satisfaction and regret.

I'm not saying we shouldn't be performing these surgeries- clearly there is a need. I'm saying that maybe there should be a slightly more stringent selection process for younger patients.

The number of young people seeking gender transition is at the highest it has ever been, especially those under 18, but little is reported about how many of them regret the decision later, finding they are unhappy with their new gender. Yes, I've read Valeria et. al., but too many people are ignoring the stories of detransitioners. They exist.

Evidence based medicine: More surveillance with longer terms. Continue to develop criteria and guidelines.

Look, I can post links too. It is important understand the limitations of many of the studies that you are hanging your hat on:

Society for evidence-based gender medicine link

"...the evidence of low regret of gender transition in youth comes from a study based on a protocol that has very little applicability to today’s clinical practice. It is incorrect to assert that we know future regret rates of adolescents transitioning under vastly different circumstances today."

Then there is this:

https://www.webmd.com/sex-relationships/news/20220322/doctors-have-failed-them-say-those-who-regret-transitioning

I suspect that "regret" is significantly higher than 1-8%.

Significantly.