Summary

This study used US military health insurance pharmacy records to see how many people who started cross-sex hormones kept refilling them. Of 952 patients, mostly young children of service members, an estimated 70% were still refilling at four years, so roughly three in ten stopped. Females taking testosterone were about 2.4 times as likely to stop as males taking oestrogen. People who started as adults stopped more often than those who started as minors (about 36% vs 26%). The authors say this should reassure people worried about whether minors can agree to hormones. That conclusion goes beyond the data. The study counted prescription refills, not regret, wellbeing or detransition. It could not see why anyone stopped or whether they got hormones elsewhere. And most patients were followed for a short time, so the four-year figures rest on relatively few people.

Key findings

• Μετά από 4 χρόνια, εκτιμάται ότι το 70% εξακολουθούσε να παίρνει συνταγές ορμονών μέσω της στρατιωτικής ασφάλισης, άρα περίπου 3 στους 10 είχαν σταματήσει.
• Το 81% των ανδρών που έπαιρναν οιστρογόνα συνέχισε, έναντι 64% των γυναικών που έπαιρναν τεστοστερόνη. Οι γυναίκες με τεστοστερόνη είχαν περίπου 2,4 φορές μεγαλύτερη πιθανότητα να σταματήσουν.
• Το 74% όσων ξεκίνησαν ως ανήλικοι συνέχισε, έναντι 64% όσων ξεκίνησαν ως ενήλικες. Όσοι ξεκίνησαν ως ενήλικες είχαν περίπου 1,7 φορές μεγαλύτερη πιθανότητα να σταματήσουν, ενώ περίπου 1 στους 4 ανηλίκους σταμάτησε μέσα σε 4 χρόνια.
• Η διακοπή ορίστηκε ως η απουσία νέας συνταγής για πάνω από 90 ημέρες μετά το τέλος της τελευταίας προμήθειας, ενώ το άτομο εξακολουθούσε να χρησιμοποιεί άλλες στρατιωτικές υπηρεσίες υγείας (κατά μέσο όρο για 324 ακόμη ημέρες).
• Το οικογενειακό εισόδημα (εκτιμώμενο από τον βαθμό του στρατιωτικού), ο οικογενειακός ρόλος και η αλλαγή του 2016 στην επίσημη ασφαλιστική κάλυψη δεν έκαναν μετρήσιμη διαφορά στο αν οι άνθρωποι συνέχιζαν.
• Η μελέτη δεν κατέγραψε λόγους διακοπής και δεν είχε πληροφορίες για μεταμέλεια, αποχώρηση από την αλλαγή φύλου, ψυχική υγεία ή ικανοποίηση, επομένως η συνέχιση των ορμονών δεν μπορεί να ερμηνευτεί ως απόδειξη οφέλους.
• Οι αριθμοί αυξήθηκαν απότομα μέσα στη δεκαετία: το 58% των ασθενών είχε το πρώτο ραντεβού σχετικά με το φύλο τους τελευταίους 22 μήνες της μελέτης.

Abstract

Introduction: Concerns about future regret and treatment discontinuation have led to restricted access to gender-affirming medical treatment for transgender and gender-diverse (TGD) minors in some jurisdictions. However, these concerns are merely speculative because few studies have examined gender-affirming hormone continuation rates among TGD individuals. Methods: We performed a secondary analysis of 2009 to 2018 medical and pharmacy records from the US Military Healthcare System. We identified TGD patients who were children and spouses of active-duty, retired, or deceased military members using International Classification of Diseases-9/10 codes. We assessed initiation and continuation of gender-affirming hormones using pharmacy records. Kaplan-Meier and Cox proportional hazard analyses estimated continuation rates. Results: The study sample included 627 transmasculine and 325 transfeminine individuals with an average age of 19.2 ± 5.3 years. The 4-year gender-affirming hormone continuation rate was 70.2% (95% CI, 63.9-76.5). Transfeminine individuals had a higher continuation rate than transmasculine individuals 81.0% (72.0%-90.0%) vs 64.4% (56.0%-72.8%). People who started hormones as minors had higher continuation rate than people who started as adults 74.4% (66.0%-82.8%) vs 64.4% (56.0%-72.8%). Continuation was not associated with household income or family member type. In Cox regression, both transmasculine gender identity (hazard ratio, 2.40; 95% CI, 1.50-3.86) and starting hormones as an adult (hazard ratio, 1.69; 95% CI, 1.14-2.52) were independently associated with increased discontinuation rates. Discussion: Our results suggest that >70% of TGD individuals who start gender-affirming hormones will continue use beyond 4 years, with higher continuation rates in transfeminine individuals. Patients who start hormones, with their parents' assistance, before age 18 years have higher continuation rates than adults.

Conclusion

In our study, transmasculine individuals were more likely to discontinue use of gender-affirming hormones during the first 4 years of use than transfeminine individuals. We also found that individuals who start gender-affirming hormones before reaching the age of legal majority are less likely to subsequently discontinue use when compared with individuals who start hormones after becoming a legal adult. If replicated in future studies, the improved continuation rate among patients who are not legal adults at the time of treatment should provide some reassurance to those concerned about the ability of minors to provide informed assent to use of gender-affirming hormones. A higher continuation rate among minors could also be used to inform the actions of legislators and judges who wish to prohibit gender-affirming treatment for minors to protect them from the consequences of health care decisions they make with the assistance of their parents and health care providers.