Summary

Doctors at a large US children's gender clinic reviewed records of 1,050 teens who had taken cross-sex hormones for at least six months. At their most recent contact, 93% were recorded as still taking hormones, 2% had paused and restarted, and 4% had stopped. Only five people (0.5%) stopped because they again identified with their birth sex. Others mostly stopped because they had reached the body changes they wanted, or had trouble getting or taking hormones. The authors conclude stopping is rare and should not be assumed to mean regret or detransition. But the figures only show short-term use of hormones in one clinic's records. About 1 in 5 patients had not been heard from for over a year, yet were counted as still on hormones. Average follow-up was under three years. And people who detransition often do not tell their original clinic.

Key findings

• من بين 1,224 مراهقاً بدؤوا الهرمونات في مستشفى بوسطن للأطفال بين يناير 2007 وديسمبر 2022، أُدرج 1,050 لأن لديهم تشخيص كرب جندري وتناولوا الهرمونات ستة أشهر متواصلة على الأقل.
• عند آخر اتصال، سُجل أن 973 (93%) ما زالوا على الهرمونات، وأن 20 (2%) توقفوا أكثر من ثلاثة أشهر ثم استأنفوا، وأن 37 (4%) توقفوا دون استئناف.
• توقف خمسة أشخاص (0.5%) لأنهم عرّفوا أنفسهم بجنسهم عند الولادة مجدداً؛ ويصف المؤلفون هذا بأنه أقل من 1%.
• من بين الـ 37 الذين توقفوا، قال 14 إنهم بلغوا التغيرات الجسدية التي أرادوها؛ وكانت صعوبة الحصول على الهرمونات أو مواصلتها الأسباب الرئيسية الأخرى، بحسب المؤلفين وافتتاحية نُشرت معها.
• لم يُسمع من 210 من الـ 973 المحتسبين على الهرمونات منذ أكثر من سنة، دون أي سجل بانتقالهم إلى طبيب آخر (كان عمرهم المعتاد عند آخر زيارة نحو 20).
• كانت المتابعة قصيرة: تذكر الافتتاحية أن النتائج قيست بعد نحو 2.7 سنة في المتوسط من بدء الهرمونات.
• يوصي المؤلفون بأن تسأل الأبحاث المستقبلية لماذا يتوقف الناس، بدلاً من افتراض التراجع عن التحول أو الندم.

Abstract

Purpose: To understand the rate of, and reasons for, discontinuation of gender-affirming hormones (GAH) in transgender adolescents.

Methods: Retrospective cohort study of individuals starting GAH between January 2007 and December 2022. Individuals were included if they were diagnosed with gender dysphoria, were prescribed GAH, and took GAH continuously for a minimum of 6 months. Of 1,224 individuals who started GAH, 1,050 met the eligibility criteria for this analysis. The primary study outcome was the status of GAH use at last communication. We also assessed gender identity at the time of GAH discontinuation and reasons for discontinuation among individuals who discontinued GAH for periods of 3 months or longer.

Results: Of 1,050 eligible individuals, 973 (93%) had been on GAH continuously at last contact, 20 (2%) had discontinued GAH for greater than 3 months then restarted hormones, and 37 (4%) had discontinued GAH without restarting hormones. Of those who discontinued hormones without restarting, 5 (0.5%) individuals did so because they reidentified with the gender associated with their sex assigned at birth. This represents less than 1 percent of the cohort.

Conclusions: In a large cohort of transgender adolescents seeking GAH, persistent discontinuation of hormones was rare and primarily reflected having accomplished gender expression goals or difficulties accessing or taking hormones - rather than individuals reaffirming a gender identity associated with their assigned sex at birth. It is important for future research on individuals who discontinue GAH to evaluate the reasons for discontinuation and not to make assumptions about detransition and/or regret.

Conclusion

In a large cohort of transgender adolescents seeking GAH, persistent discontinuation of hormones was rare and primarily reflected having accomplished gender expression goals or difficulties accessing or taking hormones - rather than individuals reaffirming a gender identity associated with their assigned sex at birth. It is important for future research on individuals who discontinue GAH to evaluate the reasons for discontinuation and not to make assumptions about detransition and/or regret.