Most Trans Teens Choose to Continue Hormone Therapy

Transgender adolescents rarely choose to discontinue gender-affirming hormone therapy, according to a study in a single hospital.

As of March 2023, 30 states in the United States have restricted access to gender-affirming care or are currently considering laws that would do so. As a result, 146,300 transgender youth have lost or are at risk of losing access to gender-affirming care, according to the UCLA School of Law Williams Institute data.

Those efforts come despite evidence that such care provides substantial mental health benefits for adolescents with gender dysphoria, defined as the distress a person experiences due to a mismatch between their gender identity and sex assigned at birth.

Previous research has shown only a small share of them regret detransitioning. According to a review of 27 studies that include data from nearly 8,000 transgender patients who underwent gender-affirming surgeries, only 1% expressed regret of having the procedure.

The new study published in the Journal of Clinical Endocrinology observed 263 teenagers diagnosed with gender dysphoria who were seen at the pediatric endocrinology clinic between 2016 and 2019. Out of these teens, 82 (31.2%) were prescribed hormones (estradiol or testosterone). Among them were 36 (43.9%) transgender girls, 45 (54.9%) transgender boys, and 1 (1.2%) nonbinary adolescent.

During the three-year study, three participants stopped gender-affirming hormone therapy, but none resumed identifying as their sex assigned at birth. One participant discontinued treatment due to insurance issues, and one stopped hormones to transition to a nonbinary gender. The third participant halted treatment temporarily to conceive a baby.

"In the infrequent cases in which a person discontinues their gender-affirming hormone therapy, it is often due to external factors as opposed to true retransitioning to the sex assigned at birth," says lead researcher Pranav Gupta, M.D., a fellow at Emory University in Atlanta, Ga.

Most care is reversible

There are multiple types of gender-affirming care that can be provided at different stages of life:

• Social affirmation refers to adopting gender-affirming hairstyles, clothing, name, gender pronouns, restrooms and other facilities. It can be provided at any age and is fully reversible.
• Puberty blockers are hormonal medications that work by blocking testosterone and estrogen to pause pubertal development. The medications are taken during puberty, and their effects are fully reversible.
• Hormone replacement therapy helps better align the body with a person's gender identity. Those assigned females at birth are given testosterone, while individuals assigned males at birth receive estrogen. The therapy is available for teenagers 16 years and older with parents' permission and is only partially reversible.
• Gender-affirming surgeries include "top" surgery to create a male-typical chest shape or enhance breasts and "bottom" surgery which is performed on genitals or reproductive organs. Transgender people can also undergo facial feminization surgery and other procedures.

The findings of the study support previous evidence that regret is rare among detransitioning people. Nevertheless, as the study included patients from a single hospital, its findings should be generalized carefully.