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When you know someone who's undergone sex-reassignment surgery, the possibility of regret may feel like the proverbial elephant in the room. But what is the prevalence of regret, and why does regret occur?

With the release of Renee Richards' latest book, No Way Renee: The Second Half of My Notorious Life, the topic of transsexual regret has once again come out of the closet. Her book is primarily the story of her family, career, tennis, and social life. Yet in a pre-release interview with The New York Times, the reporter asked Richards if she regrets having had sex-reassignment surgery. And even though Richards said no, the headline was "The Lady Regrets." Why is there such curiosity about whether post-op transsexuals regret their surgery?

As background, transsexual people are but one part of the very diverse group under the transgender umbrella. Many transgender people actually do not undergo a gender transition. But a transsexual person, on the other hand, feels so strongly about having a gender identity at odds with his or her anatomy that he or she seeks medical intervention or physical change. Some transsexual people do not need sex-reassignment surgery (SRS) to resolve the incongruity, while others desire it but cannot afford it.

Renowned trans woman Lynn Conway, professor emerita at the University of Michigan, estimates that one in 2,500 U.S. citizens has undergone male-to-female SRS (there is no contemporary statistic available for female-to-male SRS). As one who is included in Conway's statistic, I am used to fielding the question about "regret." Societal taboos about crossing the gender binary make any transition seem remarkable, and so the fact that someone made a seemingly permanent change (i.e., surgery), then might have regretted it, is positively tabloid news. (By the way, I don't regret mine.)

But how often does it happen that someone regrets having had SRS? Research has been scarce because of the stigma of studying transgenderism and because most of the necessary subjects (transsexual individuals) have been highly closeted until only recently. The only contemporary research I could find, a 2002 paper in the International Journal of Transgenderism citing a 1992 study, observed that "the incidence of postoperative regret is generally extremely low...less than 1% in female-to-males and 1-1.5% in male-to-females." That's pretty low. Why the concern?

Some may view as an unmitigated disaster the possibility that anyone--even one single person--had his penis "cut off" or her breasts removed and then regretted it. Because of this, trans people must undergo one of the most rigorous evaluations of any medical procedure in order to qualify for SRS. This evaluation, unfortunately, favors those who can best convince "the system" of their need; thereby it occasionally disqualifies some who need the surgery while qualifying some who don't.

Others may reject the SRS-regret statistics as being improbably low. If a story of one person's regrets makes the headlines, you worry that there must be other stories, right? You may even know a transgender person who is unhappy about some aspect of his or her life and assume that aspect is their SRS.

But the worriers need to look at the big picture. Any gender transition, whether it involves surgery or not, is a major life change. It impacts details of your daily life far beyond the wearing of a different wardrobe, especially if it includes the loss of ties to loved ones, loss of work, or the need to move. Transgender people respond to any major change just like the population at large does. Some navigate change with incredible resilience, many have their ups and downs, and a few are positively consumed by it.

Transitioning also makes you a member of a minority group, perhaps for the first time. Like racial and ethnic minorities, transgender people often cannot hide their "uniqueness" and as a result can face discrimination in employment, housing, education, and public accommodation. Of course, if you are a transgender person and a member of a racial or ethnic minority, expect your challenges to be compounded.

As an LGBT person you also have a problem unique to our minority group. That is, few (if any) members of your family share your status. In a racial or ethnic minority at least the family stands with you as a minority, while as an LGBT individual family solidarity is not assured. In fact, one or more family members may even become the most ardent "opponent(s)" of your transition, out of supposed love and concern for you.

There are also challenges unique to a gender transition. For male-to-female, it can be frustrating to experience the loss of male privilege. I'm also guessing that Renee Richards's brash personality probably played better in her former life. For female-to-male, it may be disheartening to see how women you don't know now avoid your glance and keep their distance from you. And transitioners in either direction may find sexual intimacy more elusive.

Finally, there are challenges specific to hormone therapy and surgery. Medical surveillance is essential. But it's often not easy to find care that is both transgender-aware and welcoming. And if you do find suitable transgender health care, you may have trouble affording it because insurance generally does not cover it.

In spite of all of these challenges, most people who transition genders remain resolved that living in one's perceived gender is an imperative, not a choice. Many will have regrets about the consequences of their transition, but few will regret the transition itself. In the unusual case where the consequences were overwhelming enough to prompt a "de-transition," the return to the old gender is seldom satisfactory either.

Sadly, many of these consequences are the direct result of the lack of awareness of and misconceptions of transgender people by friends, families, colleagues, and others--misconceptions that led to Largo, Fla.'s recent vote to dismiss its longtime and capable city manager before he had even started his gender transition. For as long as shameful stories like that are in the news, I promise I'll keep writing.

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Joanne Herman