Summary

This study reviewed the records of everyone seen at the main Dutch gender clinic in Amsterdam from 1972 to 2015, nearly 6,800 people. Referrals rose about 20-fold, and a smaller share of adults went on to hormones. Among those who had their ovaries or testes removed, the clinic found regret in 0.6% of trans women and 0.3% of trans men. The study is widely cited as showing very low regret. But regret was counted only when someone came back to the clinic and started hormones of their birth sex. About a third of patients stopped coming to the clinic. Regret took about 11 years on average to appear, and almost all cases were people who began treatment before 1998. The authors themselves say their figure may be too low. The low rate is best read as a minimum count of reversals recorded by the clinic.

Key findings

• 6.793 άτομα (4.432 γεννημένοι άνδρες, 2.361 γεννημένες γυναίκες) παρακολούθησαν την κλινική του Άμστερνταμ από το 1972 έως το 2015 και οι αξιολογήσεις ανά έτος αυξήθηκαν 20 φορές, από 34 το 1980 σε 686 το 2015.
• Το ποσοστό των ενηλίκων που ξεκινούσαν ορμόνες μέσα σε 5 χρόνια από την πρώτη επίσκεψη μειώθηκε από σχεδόν 90% (1980) σε 65% (2010).
• Μεταξύ των ενηλίκων που έπαιρναν ορμόνες για τουλάχιστον ενάμισι χρόνο, το 76% των τρανς γυναικών και το 82% των τρανς ανδρών είχε αφαιρέσει τους όρχεις ή τις ωοθήκες του.
• Η μεταμέλεια, που μετρήθηκε ως έναρξη ορμονών του φύλου γέννησης μετά από αυτή την επέμβαση, βρέθηκε στο 0,6% των τρανς γυναικών και στο 0,3% των τρανς ανδρών, 14 άτομα συνολικά.
• Η μεταμέλεια εκφράστηκε μεταξύ περίπου 4 και 22 ετών μετά την έναρξη των ορμονών, κατά μέσο όρο περίπου 11 χρόνια.
• 13 από τα 14 άτομα με μεταμέλεια είχαν ξεκινήσει ορμόνες μεταξύ 1978 και 1997· οι συγγραφείς σημειώνουν ότι οι πρόσφατοι ασθενείς μπορεί να μην έχουν παρακολουθηθεί αρκετά ώστε να φανεί μεταμέλεια.
• Οι λόγοι ταξινομήθηκαν ως «κοινωνική μεταμέλεια», «πραγματική μεταμέλεια» (για παράδειγμα η πεποίθηση ότι η μετάβαση θα έλυνε ζητήματα όπως η ομοφυλοφιλία) ή αίσθηση ότι είναι μη δυαδικοί.
• Οι συγγραφείς αναφέρουν ότι το 36% των ασθενών σταμάτησε να πηγαίνει στην κλινική μετά από αρκετά χρόνια θεραπείας.

Abstract

BACKGROUND: Over the past decade, the number of people referred to gender identity clinics has rapidly increased. This raises several questions, especially concerning the frequency of performing gender-affirming treatments with irreversible effects and regret from such interventions.

AIM: To study the current prevalence of gender dysphoria, how frequently gender-affirming treatments are performed, and the number of people experiencing regret of this treatment.

METHODS: The medical files of all people who attended our gender identity clinic from 1972 to 2015 were reviewed retrospectively.

OUTCOMES: The number of (and change in) people who applied for transgender health care, the percentage of people starting with gender-affirming hormonal treatment (HT), the estimated prevalence of transgender people receiving gender-affirming treatment, the percentage of people who underwent gonadectomy, and the percentage of people who regretted gonadectomy, specified separately for each year.

RESULTS: 6,793 people (4,432 birth-assigned male, 2,361 birth-assigned female) visited our gender identity clinic from 1972 through 2015. The number of people assessed per year increased 20-fold from 34 in 1980 to 686 in 2015. The estimated prevalence in the Netherlands in 2015 was 1:3,800 for men (transwomen) and 1:5,200 for women (transmen). The percentage of people who started HT within 5 years after the 1st visit decreased over time, with almost 90% in 1980 to 65% in 2010. The percentage of people who underwent gonadectomy within 5 years after starting HT remained stable over time (74.7% of transwomen and 83.8% of transmen). Only 0.6% of transwomen and 0.3% of transmen who underwent gonadectomy were identified as experiencing regret.

CLINICAL IMPLICATIONS: Because the transgender population is growing, a larger availability of transgender health care is needed. Other health care providers should familiarize themselves with transgender health care, because HT can influence diseases and interact with medication. Because not all people apply for the classic treatment approach, special attention should be given to those who choose less common forms of treatment.

STRENGTHS AND LIMITATIONS: This study was performed in the largest Dutch gender identity clinic, which treats more than 95% of the transgender population in the Netherlands. Because of the retrospective design, some data could be missing.

CONCLUSION: The number of people with gender identity issues seeking professional help increased dramatically in recent decades. The percentage of people who regretted gonadectomy remained small and did not show a tendency to increase. Wiepjes CM, Nota NM, de Blok CJM, et al. The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. J Sex Med 2018;15:582-590.

Conclusion

The number of people with gender identity issues seeking professional help increased dramatically in recent decades. The percentage of people who regretted gonadectomy remained small and did not show a tendency to increase. (Discussion: the authors add that their findings could underestimate regret because some people might seek reversal elsewhere or experience regret without pursuing reversal, and that with an average time to regret of 130 months it may be too early to examine regret in people who started hormones in the past 10 years.)