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 and others (2022) found that 70% of 952 patients from US military families (average age about 19) were still on hormones after 4 years: 81% of trans women but only 64% of trans men.
• Trans men were more than twice as likely to stop, and people who started hormones at 18 or older were about 1.7 times as likely to stop, though the reasons for stopping were not known.
• The author notes that Dutch regret rates after removal of testes or ovaries (0.6% in trans women, 0.3% in trans men) may be too low, because 36% of people were lost to follow-up.
• He cites a survey in which only 24% of detransitioners told their doctors, so counts based on clinic records probably miss many cases.
• He argues that hormones given on consent alone, fewer mental health checks and a shift towards female-born and nonbinary patients make a rise in detransition likely.
• He concludes that older low regret and detransition rates may not apply to today's patients, and calls for research comparing consent-only care with the Dutch team-based approach.

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.