Summary

In this short opinion piece, a hormone doctor at Beth Israel Deaconess and Harvard reacts to a US military health study in which about 30% of patients had stopped hormones within four years. He compares this with older figures, such as Dutch regret rates under 1%, which are weakened because 36% of people were lost to follow-up. He also points to surveys of detransitioners, who often never told their doctors. His argument is that care has changed: hormones are easier to get on consent alone, there are fewer mental health checks, and more patients are young, female-born or nonbinary. So old low regret figures may not hold, and detransition is probably rising. He urges full information about permanent effects before treatment, research comparing ways of providing care, and kind support for detransitioners. It is a reasoned expert opinion, not a study.

Key findings

• Roberts m.fl. (2022) fandt, at 70 % af 952 patienter fra amerikanske militærfamilier (gennemsnitsalder omkring 19 år) stadig tog hormoner efter 4 år: 81 % af transkvinderne, men kun 64 % af transmændene.
• Transmænd havde mere end dobbelt så stor sandsynlighed for at stoppe, og personer, der begyndte på hormoner som 18-årige eller ældre, havde cirka 1,7 gange så stor sandsynlighed for at stoppe, selvom årsagerne til at stoppe ikke var kendte.
• Forfatteren bemærker, at hollandske fortrydelsesrater efter fjernelse af testikler eller æggestokke (0,6 % hos transkvinder, 0,3 % hos transmænd) kan være for lave, fordi 36 % af folk gik tabt til opfølgning.
• Han citerer en undersøgelse, hvor kun 24 % af detransitionisterne fortalte deres læger det, så optællinger baseret på klinikjournaler overser sandsynligvis mange tilfælde.
• Han argumenterer for, at hormoner givet alene på samtykke, færre psykiske tjek og et skifte mod kvinde-fødte og ikke-binære patienter gør en stigning i detransition sandsynlig.
• Han konkluderer, at ældre lave rater for fortrydelse og detransition måske ikke gælder for nutidens patienter, og opfordrer til forskning, der sammenligner behandling alene på samtykke med den hollandske teambaserede tilgang.

Conclusion

Irwig concludes that a proportion of transgender and gender-diverse patients discontinue hormone therapy, which endocrinologists may overlook because many who detransition stop attending clinics. Several factors give reason to believe detransition may increase and that low regret rates from earlier populations may no longer apply: rising numbers, the shift to the informed consent model, a likely smaller share receiving adequate mental health evaluation, and a shift toward more patients assigned female at birth and nonbinary. Endocrinologists should ensure patients receive adequate, comprehensive information on benefits and risks, especially irreversible effects. Research should compare outcomes of informed-consent and Dutch-style interdisciplinary models. Care for those who detransition should remain compassionate.