93% Were Still on Hormones at Last Clinic Contact — But 1 in 5 Had Been Lost to Follow-Up

A Retrospective Cohort Study of Transgender Adolescents Gender-Affirming Hormone Discontinuation

Cohort & registry studies Detransition & regret Cross-sex hormones

Authors: Elizabeth R. Boskey, Kathryn L. Scheffey, Sarah Pilcher, Ellis P. Barerra, Kerry McGregor, Jeremi M. Carswell, Jessica D. Kant, Jessica Kremen
Journal: Journal of Adolescent Health
Year: 2025
Source: jahonline.org/article/S1054-139X(24)00554-8/abstract

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

Of 1,224 teens who started hormones at Boston Children's Hospital between January 2007 and December 2022, 1,050 were included because they had a gender distress diagnosis and took hormones for at least six months straight.
At last contact, 973 (93%) were recorded as still on hormones, 20 (2%) had stopped for more than three months and restarted, and 37 (4%) had stopped without restarting.
Five people (0.5%) stopped because they again identified with their birth sex; the authors describe this as less than 1%.
Of the 37 who stopped, 14 said they had reached the body changes they wanted; trouble getting or keeping up with hormones were the other main reasons, according to the authors and an editorial published alongside.
210 of the 973 counted as still on hormones had not been heard from for more than a year, with no record of moving to another doctor (their typical age at last visit was about 20).
Follow-up was short: the editorial reports results were measured on average about 2.7 years after starting hormones.
The authors recommend that future research ask why people stop, rather than assume detransition or regret.

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.

Methodological limitations

Many lost from view but counted as still on hormones: 210 of the 973 reported as still on hormones (20% of the group) had not been heard from for more than a year. Whether they still take hormones, or how they identify, is unknown. So 93% is the highest the true figure could be.
Short follow-up: Average follow-up was about 2.7 years (Olson, 2025 editorial). In published surveys, detransitioners say they identified as trans for several years before stopping (5.4 years on average in Littman et al., 2024). So later stopping is likely missed.
One clinic's records only: Stopping and reasons came from one hospital's files. People who stop often do not tell their doctor (only 27% of detransitioners in Littman et al., 2024 told their clinician). Those who moved, aged out, or switched to adult or private care may not show up.
Measures hormone use, not wellbeing or regret: The study only checked whether hormones continued. It did not measure mental health, satisfaction, regret or identity. Staying on hormones does not by itself show benefit.
Early stoppers left out: Requiring six months of continuous use excluded 174 of 1,224 who started, including anyone who stopped early. This makes the stopping rate look lower.
Short breaks not counted: Only stops of three months or longer counted. Shorter breaks, irregular use and lower doses were not captured.
Reasons taken from doctors' notes: Why people stopped, and how they identified, came from clinical notes. These depend on what patients chose to tell doctors and how it was written down. No one was formally interviewed.
May not apply elsewhere: Patients were treated at a large, well-funded university clinic with assessment by several specialists. Results may not apply to other clinics, clinics that prescribe on request, or other countries.
Long, changing time span: Starts run from 2007 to 2022, when the kinds of patients and clinic practice changed a lot. The summary does not report results separately by period.
Clinic judging its own care: All authors work in Boston Children's Hospital departments (hormones, gynaecology, psychiatry) that provide this treatment. The clinic is reporting on its own care, with no independent check.

detrans.ai

Summary

Key findings

Abstract

Conclusion