Academic Studies and Research
Gender medicine is an experimental field with a weak evidence base. Independent systematic reviews have rated the evidence for puberty blockers, cross-sex hormones and surgery as low or very low certainty, while many studies find high rates of co-occurring conditions such as depression, anxiety, autism and trauma among people with gender dysphoria.
This page offers a neutral analysis of every major study and review in the field, with each one's key findings and limitations, grouped by topic and research method.
By topic
Detransition & regret
How many people stop or reverse a gender transition, why they do it, and what they report about the experience.
36 studiesDetransitioner care & support
The medical, psychological and social needs of people who detransition, and the gaps in the services available to them.
11 studiesChildhood desistance
Follow-up studies of gender-dysphoric children, many of whom no longer experience dysphoria after puberty.
10 studiesPuberty blockers
Evidence on suppressing puberty in gender-dysphoric young people, including mental health, bone and fertility outcomes.
13 studiesCross-sex hormones
Outcomes, continuation rates and side effects of testosterone and estrogen treatment.
25 studiesSurgery
Results and complications of gender-related surgeries such as mastectomy and genital surgery.
13 studiesMental health & suicide
Psychiatric outcomes, suicidality and mortality before and after medical transition.
28 studiesAutism, trauma & co-occurring conditions
How autism, trauma and other mental health conditions overlap with gender dysphoria and shape outcomes.
10 studiesRising diagnoses & social influence
The sharp rise in gender dysphoria referrals, the shift toward adolescent girls, and the role of peers and social media.
10 studiesExploratory therapy
Psychological approaches that explore the causes of gender distress before, or instead of, medical intervention.
6 studiesGuidelines & policy
National evidence reviews, clinical guidelines and policy changes in youth gender medicine.
11 studiesMedical ethics & consent
Informed consent, autonomy, and the risk of harm from medical interventions in gender medicine.
5 studiesSex, biology & sport
Research on biological sex, sex differences in the body and brain, and fairness in sport.
7 studiesBy methodology
Systematic & evidence reviews
Systematic reviews, meta-analyses and official evidence reviews that gather and grade all the available research on a question. When done well, the strongest form of evidence.
16 studiesCohort & registry studies
Studies that follow groups of patients over time, often using clinic records or national health registers.
52 studiesSurveys
Questionnaires completed by detransitioners, patients, parents or clinicians.
18 studiesInterviews & qualitative research
In-depth interviews and first-person accounts, analysed for common themes.
4 studiesCase reports
Detailed accounts of individual patients or small clinical series.
6 studiesCommentary & analysis
Expert opinion, ethical analysis, theoretical papers and critiques of existing research.
25 studiesAll studies
Independent Appraisal Rates WPATH's Youth Guidelines Low on Rigour; Only 2 of 8 Assessors Would Endorse Unchanged
Quality of the World Professional Association for Transgender Health Guideline Standards of Care 8: An Appraisal Using the AGREE II Instrument
Yuan Zhang, Dominika Januś, Riittakerttu Kaltiala, Milla Karvonen, Jeffrey J. Ptak, Juan Jose Yepes-Nuñez · Archives of Sexual Behavior· 2026
Eight trained raters scored WPATH's youth-related guideline chapters low on rigour and independence; only two would back them unchanged.
Key Findings
- Care in weighing the evidence scored only 39–47%
- Overall quality was rated about 3.5 to 4 out of 7
- Two raters would back the chapters as they are, three with changes, three not at all
Australia: People Prescribed Cross-Sex Hormones Had 4–9× the Mortality of the General Population, Including Suicide
All-cause and cause-specific mortality among transgender and gender diverse people: a nationwide cohort study in Australia
Karinna Saxby, Sasha Bailey, Dennis Petrie, Brendan J. Nolan · The Lancet Regional Health – Western Pacific· 2026
Australian records on 29,000 people prescribed cross-sex hormones show 4 to 9 times more deaths than the general public, including suicide, but who counts as trans was loosely defined.
Key Findings
- Deaths were 9 times higher (recorded female) and about 4 times higher (recorded male)
- Suicide was about 12 times and 4 times higher than in people seeing a family doctor
- People counted as trans from one prescription; only age was accounted for
Swedish Registry: People Diagnosed With Gender Dysphoria Had Nearly Double the Mortality of Matched Controls
Nationwide estimates of all-cause and cause-specific mortality among individuals with gender dysphoria in Sweden, 2001–2023: a register-based cohort study
Kristen D. Clark, Richard A. White, Sarah S. Jackson, Alkistis Skalkidou, Thomas Frisell, Fotios C. Papadopoulos · EClinicalMedicine· 2026
Among 9,038 Swedes diagnosed with gender dysphoria, deaths were nearly twice those of people the same age from the same area; nothing else was taken into account.
Key Findings
- Death rate about twice that of comparison groups (211 deaths)
- Accidents, violence and suicide were 36% of deaths; suicide not counted alone
- No account taken of mental illness or medical treatment
State Gender-Intervention Bans Show No Teen Suicide Increase
The Effect of State Bans on Gender Interventions for Minors on Teen Suicide Rates
Jay Greene, Ian Kingsbury · Do No Harm (report)· 2026
An advocacy group's report found no rise in teen suicide rates in US states after bans on youth gender treatments, but it could miss a rise among the few teens affected.
Key Findings
- Three methods found no change in teen suicide rates after state bans
- Only 1–3 years of data after the bans so far
- Covers all teens, so a rise among trans teens could be missed
Peer Review Finds Brain-Sex Claims Rest on Flawed Statistics
Flawed methods and overstated conclusions regarding ‘Brain Sex’: a peer review of Kurth et al. (2022)
Colin M. Wright, Adam M. Rochussen, Samuel G. Stagg · Theory and Society· 2026
Critics argue a widely cited 2022 study claiming trans women's brains are shifted toward women's rests on weak statistics and ignores sexual orientation.
Key Findings
- Only 24 people per group, with one unusual result never checked
- With standard checks, the difference from men could be chance
- Sexual orientation, linked to brain structure, was never analysed
Utah Evidence Review Failed Basic Systematic Review Standards
The “Utah Review” of Hormonal Treatments for Gender-Dysphoric Minors: A Methodological Appraisal
Society for Evidence-Based Gender Medicine · Society for Evidence-Based Gender Medicine (report)· 2026
An advocacy group's critique says Utah's 1,051-page review backing youth hormone treatment skipped key steps and looked at fewer than 40% of eligible studies.
Key Findings
- Utah's review analysed under 40% of the studies it judged eligible
- Fertility, regret, detransition and death were not priority results
- The critique comes from an advocacy group and was not peer reviewed
Psychiatric Needs Increase After Gender Transition
Psychiatric Morbidity Among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019: A Register Study
Sami-Matti Ruuska, Katinka Tuisku, Timo Holttinen, Riittakerttu Kaltiala · Acta Paediatrica· 2026
A Finnish national study of 2,083 young people found their need for specialist mental health care stayed high, or rose, after medical transition.
Key Findings
- 45.7% needed specialist mental health care before referral, vs 15% of peers
- Among those who transitioned, care use rose from 10-22% to 55-61%
- Shows links in use of care, not proof that transition caused harm
18% of Trans Men and Nonbinary Adults Reported Chronic Pelvic Pain; Some Developed New Pain After Starting Testosterone
Chronic pelvic pain among transgender men and gender diverse adults assigned female at birth
Diana M. Tordoff, Mitchell R. Lunn, Annesa Flentje, Diana Atashroo, Bertha Chen, Zubin Dastur, Micah E. Lubensky, Matthew Capriotti, Juno Obedin-Maliver · Andrology· 2025
A survey of 2,579 trans men and nonbinary adults found 18% had long-lasting pelvic pain; current testosterone users had slightly lower rates, but some got new pain after starting.
Key Findings
- 18% had pelvic pain lasting 3 months or more
- 16% of testosterone users had it, versus 19% who never used it
- About 1 in 10 developed new pelvic pain after starting testosterone
43% of Detransitioners Say Providers Never Seemed Knowledgeable About Detransition, North American Survey Finds
"Providers had no idea what to do with me": A mixed-methods analysis of detransition/retransition support, care, and information needs among sexual and gender minority individuals
Kirsty Rackliff, Pablo Expósito-Campos, Wren Ariel Gould, David J. Kinitz, Madeline Rosen, S. Rudd, June S. H. Lam, Annie Pullen Sansfaçon, Kinnon Ross MacKinnon · International Journal of Transgender Health· 2025
Survey of 957 North Americans who stopped or reversed a transition: many felt providers knew nothing about detransition, and many avoided health care.
Key Findings
- 43% said providers never seemed to know about detransition
- 58% avoided care; 46% went without care they needed
- Top needs: peer support, informed clinicians, hormone advice
NIH-Funded Blocker Study Finds No Mental Health Improvement Over 2 Years; No Control Group, 37% Missing at 24 Months
Mental and Emotional Health of Youth after 24 months of Gender-Affirming Medical Care Initiated with Pubertal Suppression
Johanna Olson-Kennedy, Ramon Durazo-Arvizu, Liyuan Wang, Carolyn F. Wong, Diane Chen, Diane Ehrensaft, Marco A. Hidalgo, Yee-Ming Chan, Robert Garofalo, Asa E. Radix, Stephen M. Rosenthal · medRxiv (preprint)· 2025
US study of 94 youth on puberty blockers found no measurable change in mental health over 2 years, with no comparison group and 37% of data missing.
Key Findings
- No measurable change in depression or emotional health at 2 years
- No comparison group; 37% missing depression data at 2 years
- Results delayed for years; released only as an unreviewed preprint
Austrian Clinicians Review the 'Rapid-Onset' Theory: Unproven, But Too Important to Dismiss
Gender dysphoria in adolescence: examining the rapid-onset hypothesis
André Leonhardt, Martin Fuchs, Manuela Gander, Kathrin Sevecke · neuropsychiatrie· 2025
A review finds the 'rapid-onset gender dysphoria' idea unproven but plausible enough to deserve serious research drawing on teens, parents and clinicians.
Key Findings
- Authors say the idea should be neither accepted nor dismissed yet
- The main study finding no support may not have measured the right thing
- Calls for long-term studies asking teens, parents and clinicians
Taiwan: Suicide Death Risk 4× Higher in Transgender People — and Still 2.6× Higher Than in Their Own Siblings
Mortality among transgender persons: a Taiwan matched-population and sibling-comparison cohort study
Chih-Wei Hsu, Yang-Chieh Brian Chen, Liang-Jen Wang, Mu-Hong Chen, Yao-Hsu Yang, Chih-Sung Liang, Po-Yen Chen, Edward Chia-Cheng Lai · The Lancet Regional Health – Western Pacific· 2025
In 3,906 trans people in Taiwan, suicide deaths were 4 times those of matched people and 2.6 times their own siblings'; overall deaths were no higher than siblings'.
Key Findings
- Suicide deaths 4 times the public's and 2.6 times their siblings'
- Overall deaths 40% higher than the public's, but no higher than siblings'
- Depression in 41% vs 6%; only 35 suicides in total
US Government Review Finds Very Low-Certainty Evidence for Youth Medical Transition; Major US Medical Groups Dispute It
Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices
U.S. Department of Health and Human Services (contributors: Evgenia Abbruzzese, Alex Byrne, Farr Curlin, Moti Gorin, Kristopher Kaliebe, Michael K. Laidlaw, Kathleen McDeavitt, Leor Sapir, Yuan Zhang) · U.S. Department of Health and Human Services (government report)· 2025
A US government review of 17 evidence reviews finds the evidence for youth gender transition very weak; who wrote it, its independence and its peer review are disputed.
Key Findings
- 17 evidence reviews; evidence of benefit very weak for every treatment
- Authors unnamed until November 2025; 5 had paid legal work
- Two major US medical groups declined to review it
Only 21 of 2,467 Swedes Reversed a Legal Gender Change — But Legal Reversal Captures Only a Fraction of Detransition
Stability After Legal Gender Change Among Adults With Gender Dysphoria
Kristen D. Clark, Richard A. White, Georgios Karamanis, Malin Indremo, Fatih Özel, Alkistis Skalkidou, Thomas Frisell, Fotios C. Papadopoulos · JAMA Network Open· 2025
Of 2,467 Swedes who changed legal gender in 2013–2023, only 21 changed it back, but this captures only a small part of detransition.
Key Findings
- Covered all 7,293 people diagnosed with gender dysphoria in Sweden
- 21 of 2,467 legal changes reversed; about 98% kept them for 10 years
- Misses detransition without paperwork; follow-up was short
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
Elizabeth R. Boskey, Kathryn L. Scheffey, Sarah Pilcher, Ellis P. Barerra, Kerry McGregor, Jeremi M. Carswell, Jessica D. Kant, Jessica Kremen · Journal of Adolescent Health· 2025
Of 1,050 Boston teens on hormones, 93% were recorded as still taking them, but 1 in 5 had not been seen for over a year and follow-up was short.
Key Findings
- 4% stopped without restarting; 2% paused and restarted
- 210 people (20%) unseen for over a year were counted as still on hormones
- Follow-up averaged only about 2.7 years after starting
Why There Are Exactly Two Sexes
Colin M. Wright · Archives of Sexual Behavior· 2025
A biologist argues there are exactly two sexes, defined by whether the body is built to make sperm or eggs, not by chromosomes or hormones.
Key Findings
- Sex is defined by sperm or eggs, not chromosomes or hormones
- Differences of sex development are variations within two sexes, not a third
- An argument, not new data; its core definition is disputed by some
Detransition Rates Unknown: Systematic Review Exposes Critical Gaps in Long-Term Data
Prevalence of detransition in persons seeking gender-affirming hormonal treatments: a systematic review
Eva Feigerlova · Journal of Sexual Medicine· 2025
A review of 15 studies found 1% to 10% detransition in most clinic data, but one US study found about 30% stopped hormones; the evidence is very weak.
Key Findings
- 1% to 7.6% stopped blockers and 1.6% to 9.8% stopped hormones
- One US military study found about 30% stopped hormones within 4 years
- Very weak evidence: short follow-up and differing definitions
Very Low Certainty Evidence: Major Review Questions Mental Health Benefits of Cross-Sex Hormones in Under-26s
Gender affirming hormone therapy for individuals with gender dysphoria aged <26 years: a systematic review and meta-analysis
Anna Miroshnychenko, Sara Ibrahim, Yetiani Roldan, Chan Kulatunga-Moruzi, Steven Montante, Rachel Couban, Gordon Guyatt, Romina Brignardello-Petersen · Archives of Disease in Childhood· 2025
A review of 24 studies on cross-sex hormones for under-26s found mostly very weak evidence on mental health, so benefits and harms remain unclear.
Key Findings
- Evidence on depression and gender distress was mostly very weak
- One study linked hormones to lower depression, but evidence was weak
- About 4% of females on testosterone had a heart or blood vessel event
'Considerable Uncertainty': Systematic Review Finds No Reliable Evidence for Puberty Blocker Benefits
Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis
Anna Miroshnychenko, Yetiani Roldan, Sara Ibrahim, Chan Kulatunga-Moruzi, Steven Montante, Rachel Couban, Gordon Guyatt, Romina Brignardello-Petersen · Archives of Disease in Childhood· 2025
A review of 10 studies on puberty blockers for young people found only very weak evidence, so it is unclear whether they help or harm mental health or bones.
Key Findings
- 10 studies, no fair head-to-head trials; all evidence rated very weak
- Bone density fell behind others the same age after blockers
- Paid for by SEGM; search ended in September 2023
'Do We Want to Know?' Psychoanalyst Exposes Weak Evidence and Urges Exploration Before Medicalization
Do we want to know?
Roberto D'Angelo · The International Journal of Psychoanalysis· 2025
A therapist's account of one teenager, whose trauma surfaced after 18 months of therapy, argues that politics is blocking honest exploration before transition.
Key Findings
- Abuse memories surfaced only after 18 months of therapy
- National reviews in 4 countries found weak evidence for youth gender medicine
- Based on one case, by the head of a group that urges caution
Childhood Trauma, Not True Gender Dysphoria: Finnish Detransitioners Reveal Real Reasons for Transition
Gender Dysphoria and Detransitioning in Adults: An Analysis of Nine Patients from a Gender Identity Clinic from Finland
Kaisa Kettula, Niina Puustinen, Lotta Tynkkynen, Liisa Lempinen, Katinka Tuisku · Archives of Sexual Behavior· 2025
Nine Finnish adults who detransitioned said, looking back, that their transition was driven by childhood trauma and mental health problems rather than gender identity.
Key Findings
- All 9 adults who sought detransition at a Helsinki clinic, 2018 to 2019
- All 7 women had major regret, on average 7 years after diagnosis
- Very high rates of trauma and mental illness; no comparison group
Detransitioned Women Report Unmet Needs: Medical Transition Failed to Resolve Dysphoria
Narratives of Adults Registered Female at Birth who Started a Medical Transition and Later Detransitioned
Jane Lomax, Catherine Butler · Archives of Sexual Behavior· 2025
Six UK women who medically transitioned and later detransitioned said hormones and surgery did not resolve their distress, and that their support needs went mostly unmet.
Key Findings
- Hormones and surgery did not resolve their distress or change their sex
- Worries about testosterone's long-term health effects drove detransition
- Only six similar people, found through detransition networks
Retracted: Norwegian Study Reported 18 Detransitions After Testosterone and 22% Discharged Without Medical Treatment
Treatment trajectories among children and adolescents referred to the Norwegian National Center for Gender Incongruence
Cecilie Bjertness Nyquist, Leila Torgersen, Linda W. David, Trond Haaken Diseth, Kjersti Gulbrandsen, Anne Waehre · Acta Paediatrica· 2025
Retracted for ethics breaches: a Norwegian study of 1,258 referred young people reported 62% started hormones, 97% moved from blockers to hormones, and 18 detransitioned.
Key Findings
- Retracted in July 2026: no ethics approval or patient consent
- 97% of those on puberty blockers moved on to cross-sex hormones
- 18 of 783 on hormones (2.3%) detransitioned, likely an undercount
50-Fold Increase in Gender Dysphoria/Incongruence in English Youth (2011-2021)
Epidemiology of gender dysphoria and gender incongruence in children and young people attending primary care practices in England: retrospective cohort study
Stuart William Jarvis, Lorna K. Fraser, Trilby Langton, Catherine Elizabeth Hewitt, Tim Doran · Archives of Disease in Childhood· 2025
GP records in England show gender dysphoria diagnoses in under-19s rose about 50 times from 2011 to 2021, mostly in girls after 2014, and over half also had anxiety, depression or self-harm.
Key Findings
- Recorded cases rose about 50-fold, from 0.16 to 8.3 per 10,000 young people
- Over half (52.7%) also had a record of anxiety, depression or self-harm
- Counts what GPs recorded, not true numbers, and misses specialist care
Testosterone Review: Uterine Lining Mostly Atrophic or Proliferative, 2.3% Hyperplasia; 35% Polycystic-Appearing Ovaries
Uterine and Ovarian Histopathology After Testosterone for Gender Affirmation: A Systematic Review
Maris K. Toland, Kyra Bonasia, Jessica Bentz, Regina M. DelBaugh, Elaina J. Vitale, Paige N. Scudder, Ella A. Damiano · Transgender Health· 2024
A review of 17 small studies found womb linings were half inactive and half still growing after testosterone; 2.3% had precancerous changes, one had cancer, and none had ovarian cancer.
Key Findings
- Of 522 womb linings, 49% were thin and inactive and 47% still growing
- 2.3% had precancerous thickening; one person had a tiny cancer
- About 1 in 3 had ovaries that looked polycystic
Cass Review Appraisal: Most Youth Gender Guidelines Lack Rigour, With WPATH and Endocrine Society Shaping the Rest
Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)
Jo Taylor, Ruth Hall, Claire Heathcote, Catherine Elizabeth Hewitt, Trilby Langton, Lorna Fraser · Archives of Disease in Childhood· 2024
A Cass Review check of 23 youth gender guidelines found most were not carefully made or independent, with WPATH and the Endocrine Society shaping the rest.
Key Findings
- 23 guidelines rated with a standard quality checklist
- Few were based on a careful review of the evidence
- Only Sweden's and Finland's guidelines were fully recommended
Finland: Higher Suicide Rate in Gender-Referred Youth Explained by Psychiatric Morbidity, Registry Study Claims
All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: a register study
Sami-Matti Ruuska, Katinka Tuisku, Timo Holttinen, Riittakerttu Kaltiala · BMJ Mental Health· 2024
Finnish records of 2,083 gender-referred youth: suicide was rare (0.3%) and higher than in peers, but not clearly so once psychiatric care was accounted for.
Key Findings
- 7 suicides among 2,083 youth (0.3%) vs 0.1% of peers
- About 4 times higher, but not clear after allowing for psychiatric care
- Few deaths; accounting for psychiatric care this way is disputed
39% of Trans Men and Nonbinary People Reported Regret About Fertility Choices After Reproductive-Organ Removal
Fertility preservation choices and decisional regret after gender-affirming surgery in transgender men or gender nonbinary persons
Austin Johnson, Asha B. McClurg, Janine Baldino, Rajeshree Das, Erin T. Carey · F&S Reports· 2024
In a survey of 57 trans men and nonbinary people after removal of the womb or ovaries, 39% regretted their fertility choices; none had frozen eggs.
Key Findings
- 39% had some regret about their fertility choices
- All were given fertility advice per records, but only 30% remembered it
- Only half replied; surgery was about 2.5 years earlier on average
No Mental Health Differences Found for Socially Transitioned Children
Impact of social transition in relation to gender for children and adolescents: a systematic review
Ruth Hall, Jo Taylor, Catherine Elizabeth Hewitt, Claire Heathcote, Stuart William Jarvis, Trilby Langton, Lorna Fraser · Archives of Disease in Childhood· 2024
A review of 11 mostly low-quality studies found no clear mental health difference in children who socially transitioned, with mixed results for teenagers.
Key Findings
- Only 11 studies found, most of them low quality and US-based
- No clear mental health difference for children who socially transitioned
- Two studies linked childhood transition to dysphoria lasting longer
No New Puberty Blocker Studies Met Quality Criteria Since NICE
Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria
Florian D. Zepf, Laura König, Anna Kaiser, Carolin Ligges, Marc Ligges, Veit Roessner, Tobias Banaschewski, Martin Holtmann · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie· 2024
A German update of England's NICE reviews found no new puberty-blocker study good enough to count, and only two small, low-quality hormone studies.
Key Findings
- No new puberty-blocker study since 2020 met NICE's quality standards
- Only 2 small, low-quality hormone studies qualified, both brain scans
- Authors found no sign that dysphoria or mental health clearly improve
Mastectomy Under 26: High Certainty Only for Physical Complications
Mastectomy for Individuals with Gender Dysphoria Younger Than 26 Years: A Systematic Review and Meta-Analysis
Anna Miroshnychenko, Yetiani M. Roldan, Sara Ibrahim, Chan Kulatunga-Moruzi, Kristen Dahlin, Steven Montante, Rachel Couban, Gordon Guyatt, Romina Brignardello-Petersen · Plastic and Reconstructive Surgery· 2024
A review of 39 studies on breast removal surgery in under-26s found good evidence only on surgical complications; evidence on mental health was weak.
Key Findings
- Strong evidence only on complications: no deaths, about 5% thick scarring
- Evidence on mental health, suicide and regret was weak or very weak
- Only 3 of 39 studies compared operated people with anyone else
Gender Identity Disorders Among Young People in Germany: Prevalence and Trends, 2013–2022
Gender Identity Disorders Among Young People in Germany: Prevalence and Trends, 2013-2022
Christian J. Bachmann, Yulia Golub, Jakob Holstiege, Falk Hoffmann · Deutsches Ärzteblatt International· 2024
German insurance records show gender identity diagnoses in young people rose eight-fold in 10 years, but only about a third still had the diagnosis 5 years later.
Key Findings
- Diagnoses rose about eight-fold from 2013 to 2022
- Highest in girls aged 15 to 19, at about 1 in 220
- Only 36.4% still had the diagnosis five years later
Gender-Surgery Patients Had 4–12x More Suicide Attempts Than Controls — But Prior Mental Health Wasn't Controlled
Risk of Suicide and Self-Harm Following Gender-Affirmation Surgery
John J. Straub, Krishna K. Paul, Lauren G. Bothwell, Sterling J. Deshazo, Georgiy Golovko, Michael S. Miller, Dietrich V. Jehle · Cureus· 2024
US health records show adults with past gender surgery had 5 to 12 times more recorded suicide attempts than other patients, but the study cannot show surgery caused this.
Key Findings
- 3.47% had a recorded suicide attempt in 5 years, vs 0.29% of other patients
- Still nearly 5 times higher than matched sterilisation patients
- No trans comparison group and past mental health not considered
Rapid-Onset Gender Dysphoria and Detransition: A Study of 78 Young Adults
Detransition and Desistance Among Previously Trans-Identified Young Adults
Lisa Littman, Stella O'Malley, Helena Kerschner, J. Michael Bailey · Archives of Sexual Behavior· 2024
A survey of 78 US young adults who stopped identifying as trans found most were born female and felt much better after detransitioning.
Key Findings
- 91% were born female and 68% had taken medical steps
- Self-harm fell from 64% while trans-identified to 23% after
- Volunteers found online, recalling the past; no comparison group
Bioethicist Warns: 'Autonomy-Based' Justifications for Pediatric Gender Medicine Put Patients at Risk
What Is the Aim of PEDIATRIC 'Gender-Affirming' Care?
Moti Gorin · Hastings Center Report· 2024
An ethicist argues that a young person's wish for body changes is not enough to justify risky gender treatments without good evidence they improve health.
Key Findings
- England, Sweden and Finland pulled back after reviews found weak evidence
- The original Dutch studies had no comparison group and very different patients
- Right to choose means picking among justified options, not any treatment
Mayo Clinic Preprint Reports Testicular Atrophy in Puberty-Blocked Youth, Questions Full Reversibility
Puberty Blocker and Aging Impact on Testicular Cell States and Function
Varshini Murugesh, Megan Ritting, Salem Salem, Syed Mohammed Musheer Aalam, Joaquin Garcia, Asma J Chattha, Yulian Zhao, David JHF Knapp, Guruprasad Kalthur, Candace F Granberg, Nagarajan Kannan · bioRxiv (preprint, not peer reviewed)· 2024
An unreviewed Mayo Clinic lab study found shrunken testicular tissue in boys on puberty blockers, and child-like tissue after 52 months of treatment, raising questions about reversibility.
Key Findings
- All 16 born-male patients with gender dysphoria had taken puberty blockers
- After 52 months on blockers, over 90% of sperm-forming cells were stuck
- Not peer reviewed; one patient tested in detail; no follow-up after stopping
Landmark NHS Review Finds 'Remarkably Weak' Evidence for Youth Gender Medicine, Urges Holistic, Cautious Care
The Cass Review
Hilary Cass · The Cass Review· 2024
An NHS review found the evidence for puberty blockers and hormones in gender-questioning young people is 'remarkably weak' and urged whole-person care and great caution with medical treatment.
Key Findings
- Only 1 of 50 blocker studies and 1 of 53 hormone studies were high quality
- Puberty blockers should only be given within a research trial
- Its methods are disputed by critics and defended by others
72% of Testosterone Users Reported Pelvic Pain, but Nearly All of Them Had Pelvic Pain Before Starting
Pelvic Pain in Transgender People Using Testosterone Therapy
Sav Zwickl, Laura Burchill, Alex Fang Qi Wong, Shalem Y. Leemaqz, Teddy Cook, Lachlan M. Angus, Kalen Eshin, Charlotte V. Elder, Sonia R. Grover, Jeffrey D. Zajac, Ada S. Cheung · LGBT Health· 2023
An Australian survey of 486 testosterone users found 72% had pelvic pain since starting, but 98% of them had pelvic pain before testosterone too.
Key Findings
- Online survey of 486 people taking testosterone
- 72% reported pelvic pain since starting testosterone
- 98% of those with pain also had pelvic pain before starting
Males Given Puberty Blockers Still Had Low Spine Bone Density Z-Scores After 11+ Years of Estrogen
Bone Mineral Density in Transgender Adolescents Treated With Puberty Suppression and Subsequent Gender-Affirming Hormones
Maria Anna Theodora Catharina van der Loos, Mariska Caroline Vlot, Daniel Tatting Klink, Sabine Elisabeth Hannema, Martin den Heijer, Chantal Maria Wiepjes · JAMA Pediatrics· 2023
Amsterdam follow-up of 75 people given blockers as teens: bone density recovered in females on testosterone, but males' spine density stayed low after more than 11 years.
Key Findings
- 75 adults followed after about 12 years of cross-sex hormones
- In males, spine bone density stayed behind where it was before blockers
- Only about half of those eligible took part; no comparison group
Most Trans Men and Nonbinary People in Study Had Genital Pain During Sex; Testosterone Linked to More Vaginal Pain
Testosterone use and sexual function among transgender men and gender diverse people assigned female at birth
Diana M. Tordoff, Mitchell R. Lunn, Bertha Chen, Annesa Flentje, Zubin Dastur, Micah E. Lubensky, Matthew Capriotti, Juno Obedin-Maliver · American Journal of Obstetrics and Gynecology· 2023
A survey of 1,219 trans men and nonbinary people found 65% had genital pain during sex; testosterone was linked to more desire but also more vaginal pain.
Key Findings
- 65% had genital pain during sex in the past month
- Testosterone was linked to more desire and slightly more vaginal pain
- People on testosterone were no more satisfied with their sex lives
64% of 61 Trans-Care Providers Had Seen Youth Stop Transitioning; Most Noted Mental Health Problems Beforehand
Understanding the experiences of youth who have discontinued a gender transition: Provider perspectives
Annie Pullen Sansfaçon, Tommly Planchat, Morgane A. Gelly, Alexandre Baril, Françoise Susset, Mélanie Millette · Psychology of Sexual Orientation and Gender Diversity· 2023
Survey of 61 clinicians for trans youth: most had seen at least one young person stop transitioning, often with earlier mental health problems and some regret.
Key Findings
- 64% of providers had (or may have) seen a youth stop transitioning
- 59% said the youth had mental health problems before transition
- 41% noted some regret; 40% said the youth returned to birth sex
Canadian Detransitioners Felt Under-Informed Before Treatment and Want Individualised Care With Mental Health Support
Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada
Kinnon R. MacKinnon, W. Ariel Gould, Gabriel Enxuga, Hannah Kia, Alex Abramovich, June S. H. Lam, Lori E. Ross · PLOS ONE· 2023
Interviews with 28 Canadians who stopped or reversed transition: those with regret often felt under-informed, and most wanted tailored care with mental health support.
Key Findings
- 60% moved from a male or female trans identity to nonbinary
- About 1 in 3 expressed regret or mixed feelings
- Both people who started hormones at 15 regretted it
Danish Registry: Suicide Attempts 7.7× and Suicide Deaths 3.5× Higher in Transgender People Over 42 Years
Transgender Identity and Suicide Attempts and Mortality in Denmark
Annette Erlangsen, Anna Lund Jacobsen, Anne Ranning, Alex Lauridsen Delamare, Merete Nordentoft, Morten Frisch · JAMA· 2023
In Denmark, 1980–2021, transgender people had 7.7 times the suicide attempt rate and 3.5 times the suicide rate of others, with no account taken of mental illness.
Key Findings
- Suicide attempts about 7.7 times as common as in other people
- Suicide deaths 3.5 times as common, based on only 12 deaths
- Mental illness and medical treatment not taken into account
Study Reports Near-Zero Regret After Mastectomy — But 41% Didn't Respond and 13 High-Regret Answers Were Excluded
Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy
Lauren Bruce, Alexander N. Khouri, Andrew Bolze, Maria Ibarra, Blair Richards, Shokoufeh Khalatbari, Gaines Blasdel, Jennifer B. Hamill, Jessica J. Hsu, Edwin G. Wilkins, Shane D. Morrison, Megan Lane · JAMA Surgery· 2023
A Michigan survey of 139 adults after gender-related breast removal found almost no regret, but 41% did not reply and 13 high-regret answers were left out.
Key Findings
- Typical answer: full satisfaction and no regret among 139 who replied
- 41% did not reply, and they had been out of surgery longer
- 13 high-regret answers left out; typical follow-up only 3.6 years
Legal Scholar Likens 'Gender-Exploratory Therapy' to Conversion Practices — An Argument Piece With No New Data
Interrogating Gender-Exploratory Therapy
Florence Ashley · Perspectives on Psychological Science· 2023
An argument essay with no data, by a legal scholar, claiming that gender-exploratory therapy resembles conversion therapy and may be unethical.
Key Findings
- An argument essay with no new data
- Asks 16 questions the author openly calls leading
- Author is a long-time campaigner for affirming care
Gender Trajectories of Youth Who Discontinued Transition
A retrospective analysis of the gender trajectories of youth who have discontinued a transition
Annie Pullen Sansfaçon, Élio Gravel, Morgane Gelly, Tommly Planchat, August Paradis, Denise Medico · International Journal of Transgender Health· 2023
Interviews with 20 young people who stopped transitioning found varied journeys shaped by sexual orientation, body discomfort and changing views of their gender.
Key Findings
- Gender identity often kept changing and rarely simply went back to birth sex
- Many linked their transition to same-sex attraction or shame about it
- Some felt new distress about permanent changes after stopping
Researchers Call for End to Politicization—Detransitioners Have Unmet Healthcare Needs
Detransition Needs Further Understanding, Not Controversy
Kinnon Ross MacKinnon, Pablo Expósito-Campos, W Ariel Gould · BMJ· 2023
A BMJ article argues detransitioners are under-studied and poorly served, and calls for 5 to 10 years of follow-up and supportive, non-judgemental care.
Key Findings
- Opinion and research plan, not new data
- Calls for following gender care patients for 5 to 10 years
- Says people who drop out of studies shouldn't be assumed to be fine
Commentary Argues Rising Youth Detransition Signals Iatrogenic Harm in Gender-Affirming Care
Iatrogenic Harm in Gender Medicine
Sarah C. J. Jorgensen · Journal of Sex & Marital Therapy· 2023
An opinion piece argues that rising youth detransition is a sign of harm from gender-affirming care, and that detransitioners need recognition and support.
Key Findings
- Cites studies where 10–30% stopped medical transition within 1 to 4 years
- Says mental health and autism are often not assessed before transition
- Opinion piece with no new data; stopping treatment isn't the same as regret
Permanent Loss: Detransitioned Woman Grieves Inability to Breastfeed After Mastectomy
Breastfeeding Grief After Chest Masculinising Mastectomy and Detransition
Karleen D. Gribble, Susan Bewley, Hannah G. Dahlen · Frontiers in Global Women's Health· 2023
A woman who had her breasts removed during transition, then detransitioned, grieved being unable to breastfeed, and felt let down by maternity staff.
Key Findings
- The type of breast removal she had almost certainly rules out breastfeeding
- Main transgender care guidelines don't mention breastfeeding before surgery
- This is one woman's account, recalled years later
BMJ Investigation: US Claims of Consensus on Youth Gender Care Clash With Weak Evidence and European Caution
Gender dysphoria in young people is rising—and so is professional disagreement
Jennifer Block · The BMJ· 2023
A BMJ investigation found US medical groups back youth gender transition on low or very low quality evidence, while European health authorities moved to restrict it.
Key Findings
- Reviews behind US guidelines rated the evidence low or very low quality
- Sweden, Finland and England moved to restrict medical treatment for minors
- Journalism, not research; the reporter chose the sources
Claims of 'Low Regret' Exposed as Flawed—True Detransition Rates Remain Unknown
The Detransition Rate is Unknown
J. Cohn · Archives of Sexual Behavior· 2023
An opinion piece argues the often-quoted 0.3–0.6% regret rates are unreliable because of short follow-up, many people lost along the way and unlike patients, so true detransition rates are unknown.
Key Findings
- Regret often shows up years later, typically 7.5 to 8 years in Swedish data
- Studies behind 0.3–0.6% regret figures have short follow-up and lost patients
- An opinion piece with no new data; author works with a cautious group
29% of Gender Clinic Youth Change Their Minds About Medical Transition
Shifts in Gender-Related Medical Requests by Transgender and Gender-Diverse Adolescents
Ariel Cohen, Veronica Gomez-Lobo, Laura Willing, David Call, Lauren F. Damle, Lawrence J. D'Angelo, Amber Song, John F. Strang · Journal of Adolescent Health· 2023
Of 68 teens at a US gender clinic who asked for hormones or surgery, 29% changed their request, mostly before any treatment; nonbinary youth changed more often.
Key Findings
- 29% of 68 teens changed their request for hormones or surgery
- Most changes (85%) came before treatment; many later asked again
- Reasons came from clinicians and notes, not the teens themselves
98% of Dutch Youth Who Took Blockers Still Had Hormone Prescriptions — but Follow-Up Ended Around Age 20
Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: a cohort study in the Netherlands
Maria Anna Theodora Catharina van der Loos, Sabine Elisabeth Hannema, Daniel Tatting Klink, Martin den Heijer, Chantal Maria Wiepjes · The Lancet Child & Adolescent Health· 2022
98% of 720 Dutch youth who took puberty blockers and then hormones still had hormone prescriptions, but most were only about 20 and their wellbeing was not measured.
Key Findings
- 704 of 720 (98%) still had a hormone prescription at the end of 2018
- The typical person was only about 19 or 20 when checked
- Only prescriptions were counted, not wellbeing or reasons for stopping
Teen Mastectomies Rose 13-Fold at Kaiser; 0.95% Regret Reported, But Only From Chart Notes Over ~2 Years
Gender-Affirming Mastectomy Trends and Surgical Outcomes in Adolescents
Annie Tang, J. Carlo Hojilla, Jordan E. Jackson, Kara A. Rothenberg, Rebecca C. Gologorsky, Douglas A. Stram, Colin M. Mooney, Stephanie L. Hernandez, Karen M. Yokoo · Annals of Plastic Surgery· 2022
Breast removal surgeries in teens at Kaiser rose 13-fold from 2013 to 2020; surgical problems were few, but regret was only looked for in doctors' notes over about two years.
Key Findings
- 209 teens had surgery; the rate of these operations rose 13-fold
- 7.3% had surgical problems and 10.9% needed a repeat operation
- Regret noted for 2 people, found only in doctors' notes after about 2 years
94% Still Identified as Trans 5 Years After Early Social Transition — But There Was No Comparison Group
Gender Identity 5 Years After Social Transition
Kristina R. Olson, Lily Durwood, Rachel Horton, Natalie M. Gallagher, Aaron Devor · Pediatrics· 2022
5 years after early social transition, 94% of 317 children still identified as trans, but with no comparison group it is unclear whether transition itself played a part.
Key Findings
- 317 children socially transitioned between ages 3 and 12
- After about 5 years, 94% identified as trans, 2.5% as birth sex
- No comparison group; about 60% went on to blockers or hormones
Antiandrogen Cyproterone Linked to 7–19x Higher Meningioma Risk in Danish Registry, With Trans Women Now Most New Users
Cyproterone acetate and risk of meningioma: a nationwide cohort study
Anders Pretzmann Mikkelsen, Iben Katinka Greiber, Nikolai Madrid Scheller, Malene Hilden, Øjvind Lidegaard · Journal of Neurology, Neurosurgery & Psychiatry· 2022
Danish records: cyproterone, a testosterone blocker used by trans women, was linked to 7 to 19 times higher risk of a brain tumour, rising with dose (16 cases).
Key Findings
- About 7 times the risk at lower doses, 19 times at higher
- Trans people were 68% of new users by 2019
- Only 16 cases among users, most of whom were not trans
Detransitioners Often Quit Hormones "Cold Turkey" Without Medical Support, Canadian Interview Study Finds
Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments
Kinnon R. MacKinnon, Hannah Kia, Travis Salway, Florence Ashley, Ashley Lacombe-Duncan, Alex Abramovich, Gabriel Enxuga, Lori E. Ross · JAMA Network Open· 2022
Interviews with 28 Canadians who stopped or reversed transition found sudden, unsupervised stopping of hormones, stigma, and clinicians unprepared to help.
Key Findings
- 28 people interviewed; 27 had medically transitioned
- Many stopped hormones suddenly, with no medical support
- 18 had no regret, 6 regret and 3 mixed feelings; not a true rate
Endocrinologist Warns Older Low Regret Rates May Not Apply as Detransition Rises Under Informed-Consent Care
Detransition Among Transgender and Gender-Diverse People—An Increasing and Increasingly Complex Phenomenon
Michael S. Irwig · Journal of Clinical Endocrinology & Metabolism· 2022
A hormone doctor argues that more people stopping hormones and changes in care mean old low regret rates may not apply, and detransition is probably rising.
Key Findings
- Military study: 70% still on hormones after 4 years
- Dutch low regret rates weakened by 36% of people lost to follow-up
- Predicts more detransition as hormones get easier to access
No Mature Sperm in Any Trans Women Who Started Blockers in Early Puberty; Only 4.7% of 214 Had Sperm at Surgery
Histological study on the influence of puberty suppression and hormonal treatment on developing germ cells in transgender women
Iris de Nie, Callista L. Mulder, Andreas Meißner, Yvonne Schut, Elise M. Holleman, Wouter B. van der Sluis, Sabine E. Hannema, Martin den Heijer, et al. · Human Reproduction· 2022
Of 214 trans women, only 4.7% had mature sperm at surgery, and none who started puberty blockers in early puberty did.
Key Findings
- Mature sperm in only 4.7%, all of whom started in late puberty or later
- None of the 29 who started blockers in early puberty had sperm
- 88% had only immature cells that would need experimental methods
WPATH's SOC-8: Influential Trans Care Guideline Rated Low-Quality, With Age Limits Dropped Under Political Pressure
Standards of Care for the Health of Transgender and Gender Diverse People, Version 8
Eli Coleman, Asa E. Radix, Walter P. Bouman, George R. Brown, Annelou L. C. de Vries, Madeline B. Deutsch, Randi Ettner, Lin Fraser, et al. · International Journal of Transgender Health· 2022
WPATH's 2022 trans care guideline was built on expert agreement, dropped age limits under outside pressure, and was rated low-quality by independent checks.
Key Findings
- 18 chapters by 119 authors, agreed by expert voting
- No full evidence review for teens; strength of evidence not stated
- Age limits removed after pressure from US pediatricians and officials
UK Gender Clinic: 4 Suicides Among 15,000 Young Patients — Rare, but About 5.5 Times the Adolescent Rate
Suicide by Clinic-Referred Transgender Adolescents in the United Kingdom
Michael Biggs · Archives of Sexual Behavior· 2022
Four suspected suicides among about 15,000 UK gender clinic youth (0.03%): around 5.5 times the usual teen rate, but far rarer than survey 'attempt' figures suggest.
Key Findings
- 4 suicides among about 15,000 patients (0.03%) in 2010–2020
- About 5.5 times the usual rate for teens of similar sex mix
- Based on only 4 deaths, with no data on other conditions or treatment
Canadian Clinic Data Find No Support for 'Rapid-Onset' Dysphoria, But Critics Say It Measured the Wrong Thing
Do Clinical Data from Transgender Adolescents Support the Phenomenon of "Rapid Onset Gender Dysphoria"?
Greta R. Bauer, Margaret L. Lawson, Daniel L. Metzger, Trans Youth CAN! Research Team · The Journal of Pediatrics· 2022
Among 173 Canadian clinic teens under 16, recently realising a trans identity wasn't linked to the problems the 'rapid-onset' idea predicts, but critics dispute the measure.
Key Findings
- 173 teens under 16 at 10 Canadian gender clinics
- Recent realisers did not have more mental health diagnoses
- Critics say the measure wasn't tied to puberty, so it missed the point
70% Realized Dysphoria Wasn't Gender-Related: Largest Detransitioner Survey Shows Widespread Unmet Needs
Detransition-Related Needs and Support: A Cross-Sectional Online Survey
Elie Vandenbussche · Journal of Homosexuality· 2022
In an online survey of 237 detransitioners, 70% came to see their gender distress as linked to other issues, and only 18% felt properly supported.
Key Findings
- 70% said their gender distress was linked to other issues
- Only 18% felt they got enough support while detransitioning
- 92% female volunteers from online detransition groups
Sports Medicine Bodies Say IOC's 2021 Trans and DSD Framework Sidelines Testosterone Science
Joint position statement of the International Federation of Sports Medicine (FIMS) and European Federation of Sports Medicine Associations (EFSMA) on the IOC framework on fairness, inclusion and non-discrimination based on gender identity and sex variations
Fabio Pigozzi, Xavier Bigard, Juergen Steinacker, Bernd Wolfarth, Victoriya Badtieva, Christian Schneider, Jeroen Swart, James Lee John Bilzon, et al. · BMJ Open Sport & Exercise Medicine· 2022
Sports medicine federations argue the IOC's 2021 rules on trans and DSD athletes sideline the science on testosterone and leave each sport to set eligibility rules alone.
Key Findings
- Says male-level testosterone is the main driver of sex differences in sport
- Backs keeping testosterone limits for at least 12 months
- Expert opinion only; it reviews no performance data on trans athletes
20% Stop Hormones: UK Audit Finds Over Half Cite Detransition or Regret
Care of Transgender Patients: A General Practice Quality Improvement Approach
Isabel Boyd, Thomas Hackett, Susan Bewley · Healthcare· 2022
A check of 68 trans patients' records at one English GP practice found 1 in 5 who started hormones stopped, over half of them with notes of regret or detransition, and care guidance conflicted.
Key Findings
- 8 of 41 who started hormones stopped; 5 of them had regret or detransition notes
- 76% had anxiety or depression and 54% had self-harmed
- Tiny numbers from one GP practice, based on notes only
30% Discontinuation Rate: Over 1 in 4 Trans-Identified Youth Stop Hormones Within 4 Years
Continuation of Gender Affirming Hormones Among Transgender Adolescents and Adults
Christina M. Roberts, David A. Klein, Terry A. Adirim, Natasha A. Schvey, Elizabeth Hisle-Gorman · The Journal of Clinical Endocrinology & Metabolism· 2022
US military pharmacy records for 952 trans-identified young people and adults show about 3 in 10 stopped hormones within 4 years, more often females on testosterone and those who started as adults.
Key Findings
- About 70% were still filling hormone prescriptions after 4 years
- Females on testosterone were about 2.4 times as likely to stop as males
- Only refills were counted; reasons for stopping and regret are unknown
82% of Trans-Identified Detransitioners Cited External Pressure — But Those No Longer Identifying as Trans Were Excluded
Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis
Jack L. Turban, Stephanie S. Loo, Anthony N. Almazan, Alex S. Keuroghlian · LGBT Health· 2021
A 2015 survey of trans-identified US adults found 13% had ever detransitioned, mostly citing family pressure or stigma, but people who no longer identify as trans were not surveyed.
Key Findings
- 13% of those who transitioned had ever gone back, even briefly
- 83% gave outside pressures as a reason; 16% gave inner reasons
- Detransitioners who no longer identify as trans were left out
Surgeon Survey Puts Gender-Surgery Regret at 0.2–0.3% — Based on 30% Response and Surgeons’ Recollections
Guiding the conversation—types of regret after gender-affirming surgery and their associated etiologies
Sasha Karan Narayan, Rayisa Hontscharuk, Sara Danker, Jess Guerriero, Angela Carter, Gaines Blasdel, Rachel Bluebond-Langner, Randi Ettner, Asa Radix, Loren Schechter, Jens Urs Berli · Annals of Translational Medicine· 2021
Survey of gender surgeons (30% replied) recalled 62 regretful patients out of about 18,000 to 27,000 operated on, a figure that likely misses many cases.
Key Findings
- Only 46 of 154 surgeons replied (30%)
- Surgeons recalled 62 cases of regret, called '0.2–0.3%'
- 42% of known reasons: identity changed or wrong diagnosis
Testosterone Raised Red Blood Cell Levels in Trans Men: 38% Crossed the Male Erythrocytosis Threshold Within 10 Years
Erythrocytosis in a Large Cohort of Trans Men Using Testosterone: A Long-Term Follow-Up Study on Prevalence, Determinants, and Exposure Years
Milou Cecilia Madsen, Dennis van Dijk, Chantal M. Wiepjes, Elfi B. Conemans, Abel Thijs, Martin den Heijer · The Journal of Clinical Endocrinology & Metabolism· 2021
Amsterdam study of 1,073 trans men on testosterone: 11% developed too-thick blood, and the chance reached 38% after 10 years, so lifelong blood checks are advised.
Key Findings
- 11% had too-thick blood on two tests, using male limits
- The chance reached 38% after 10 years and 50% after 14
- Long-acting injections and smoking raised the risk
Children at Sydney Gender Service Had High Rates of Anxiety, Depression, Family Conflict and Maltreatment
Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service
Kasia Kozlowska, Georgia McClure, Catherine Chudleigh, Ann M. Maguire, Danielle Gessler, Stephen Scher, Geoffrey R. Ambler · Human Systems: Therapy, Culture and Attachments· 2021
A Sydney hospital gender service found high rates of suicidal thoughts, anxiety, depression, autism and hard childhoods among its first 79 young patients.
Key Findings
- 79 children aged 8 to 15; 42% had thought about suicide
- Anxiety in 63%, depression in 62%, autism in 14%
- 39% had been abused or neglected; 66% had family conflict
Children With Gender Dysphoria Mostly Showed High-Risk Attachment — Like Children With Other Psychiatric Disorders
Attachment Patterns in Children and Adolescents With Gender Dysphoria
Kasia Kozlowska, Catherine Chudleigh, Georgia McClure, Ann M. Maguire, Geoffrey R. Ambler · Frontiers in Psychology· 2021
Most of 57 children at a Sydney gender service showed high-risk attachment and unresolved trauma, unlike community children but like other mental health patients.
Key Findings
- 57 gender-referred children vs 57 community and 51 mental health patients
- Far more high-risk attachment than community kids; same as mental health group
- 88% had other diagnoses; 5.5 vs 1.7 hard childhood experiences
Tavistock Puberty Blocker Study Found No Psychological Benefit — Yet 98% Went On to Cross-Sex Hormones
Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK
Polly Carmichael, Gary Butler, Una Masic, Tim J. Cole, Bianca L. De Stavola, Sarah Davidson, Elin M. Skageberg, Sophie Khadr, Russell M. Viner · PLOS ONE· 2021
The Tavistock's puberty blocker study of 44 children aged 12–15 found no change in distress, self-harm or gender distress, and 98% went on to cross-sex hormones.
Key Findings
- No improvement in mental health after 1 to 3 years
- Bone density fell behind other teens; side effects were common
- 43 of 44 (98%) went on to cross-sex hormones
Meta-Analysis Reports 1% Regret After Gender Surgery, but Included Studies Had Short Follow-Up and Heavy Attrition
Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence
Valeria P. Bustos, Samyd S. Bustos, Andres Mascaro, Gabriel Del Corral, Antonio J. Forte, Pedro Ciudad, Esther A. Kim, Howard N. Langstein, Oscar J. Manrique · Plastic and Reconstructive Surgery Global Open· 2021
A review of 27 studies (7,928 people) estimated 1% regret after gender surgery, but short follow-up and many people lost track of make this likely an underestimate.
Key Findings
- About 1% regret across 27 studies of nearly 8,000 people
- Follow-up under 1 to 9 years; the largest study lost track of 36%
- A correction was issued, and critics challenged how numbers were taken
Up to a Third of Adolescents on Puberty Blockers Had Abnormally Low Bone Density After Two Years
Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria
Michael Biggs · Journal of Pediatric Endocrinology and Metabolism· 2021
A re-analysis of UK puberty blocker data found that after two years, about a third of 24 teens had abnormally low hip bone density.
Key Findings
- 24 UK teens on puberty blockers for 2 years
- About 1 in 3 had abnormally low hip bone density
- 4 were extremely low; no data on broken bones
Johns Hopkins Review for WPATH: Hormones 'May' Improve Mood and Quality of Life, but All Evidence Was Low-Strength
Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review
Kellan E. Baker, Lisa M. Wilson, Ritu Sharma, Vadim Dukhanin, Kristen McArthur, Karen A. Robinson · Journal of the Endocrine Society· 2021
A WPATH-funded Johns Hopkins review linked hormones to better mood and quality of life, but rated all evidence as low quality and found nothing firm on suicide.
Key Findings
- 20 small clinic studies, none comparing with untreated people
- Every benefit was rated as low-quality evidence
- WPATH, the funder, sought control over what got published
A Follow-Up Study of Boys With Gender Identity Disorder
Devita Singh, Susan J. Bradley, Kenneth J. Zucker · Frontiers in Psychiatry· 2021
Of 139 boys seen for gender distress in childhood and followed to about age 21, 87.8% no longer had it, while 12.2% still did.
Key Findings
- 87.8% (122 of 139) no longer had gender distress by early adulthood
- Most grew up attracted to men or to both sexes
- Seen in an era when childhood social transition was almost unheard of
Reality Check Needed: Detransitioner Testimonies Expose Misinformation on Medical Interventions
Debate: Reality check – Detransitioner's testimonies require us to rethink gender dysphoria
Kirsty Entwistle · Child and Adolescent Mental Health· 2021
A former NHS gender clinic psychologist argues that detransitioners' stories show the need for long-term follow-up and non-medical treatments.
Key Findings
- Calls for long-term follow-up of all young people treated
- Says decisions relied on misleading information about benefits
- Opinion based on personal stories, with no new data
Case Study: Woman Detransitions After 2 Years on Testosterone — Her Analyst Links Dysphoria to Grief and Trauma
Gender Detransition: A Case Study
Lisa Marchiano · Journal of Analytical Psychology· 2021
Case report of a young woman who detransitioned after nearly two years on testosterone. Her therapist links her gender distress to unresolved grief and family trauma.
Key Findings
- Affirmed by a school psychologist; got testosterone after a 30-minute visit
- Her mental health got worse on testosterone, and she stopped
- One case, interpreted by a critic of affirming care
60% Became Comfortable With Birth Sex: Survey of 100 Detransitioners Reveals Why They Stopped
Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners
Lisa Littman · Archives of Sexual Behavior· 2021
In an online survey of 100 detransitioners, 60% had become comfortable with their birth sex, and only 24% told their clinicians they had stopped transitioning.
Key Findings
- 55% felt they weren't properly assessed before transition
- 49% stopped partly over worries about medical complications
- Volunteers found mostly via detransition sites; answers not checked
First-Ever Typology: Detransitioners Need Specialized Healthcare Support
A Typology of Gender Detransition and Its Implications for Healthcare Providers
Pablo Expósito-Campos · Journal of Sex & Marital Therapy· 2021
An ideas paper proposes two types of detransition: no longer identifying as trans ('core'), or stopping transition while still identifying as trans ('non-core').
Key Findings
- Core: no longer trans; non-core: stops transition but still trans
- Built from stories and online sources; the types haven't been tested
- Calls for clinical guidelines and long-term follow-up
Only 56% Complete Treatment: UK Clinic Study Shows High Dropout and Poor Outcomes
Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review
R. Hall, L. Mitchell, J. Sachdeva · BJPsych Open· 2021
Of 175 adults discharged from an English gender clinic, 56% completed treatment, 22% stopped attending and 6.9% detransitioned within a short follow-up.
Key Findings
- 94% of those wanting hormones got them, but only 48% wanting surgery did
- 12 people (6.9%) detransitioned, far above an earlier UK figure of 0.3%
- Short follow-up and notes only, so detransition is likely undercounted
Zucker: Social Transition of Young Children Is a Treatment That Likely Raises Persistence and Could Be Iatrogenic
Debate: Different strokes for different folks
Kenneth J. Zucker · Child and Adolescent Mental Health· 2020
Zucker argues that socially transitioning young children is a treatment likely to make gender distress last, possibly caused by the transition itself, and that parents' views deserve respect.
Key Findings
- Social transition is described as a treatment, not a neutral step
- Predicts gender distress will last far more often after social transition
- An expert's opinion piece with no new data
Amsterdam Clinic, 1972–2017: Suicide Rate 3–4× Population Level, With Deaths at Every Stage of Transition
Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study (1972–2017)
C.M. Wiepjes, M. den Heijer, M.A. Bremmer, N.M. Nota, C.J.M. de Blok, B.J.G. Coumou, T.D. Steensma · Acta Psychiatrica Scandinavica· 2020
Amsterdam gender clinic records from 1972 to 2017: 49 of 8,263 patients died by suicide, 3 to 4 times the national rate, with suicides before, during and after transition.
Key Findings
- 49 of 8,263 patients died by suicide (0.6%)
- In 2013–2017, the suicide rate was about 4 times the Dutch rate
- 16 suicides happened after surgery was finished
Sociologist Argues Detransition Research Should Help Detransitioners, Not Just Count Regret Rates
More than 'canaries in the gender coal mine': A transfeminist approach to research on detransition
Rowan Hildebrand-Chupp · The Sociological Review· 2020
An essay arguing detransition research should help detransitioners rather than only count and prevent regret, and pointing out how regret studies undercount.
Key Findings
- Splits detransition into the act, the identity and a bad experience
- Says regret studies miss people who quietly stop going to clinics
- Calls for interview studies and care plans for detransitioners
AAP's Youth Gender Policy Misrepresented Its Own Citations and Ignored All Child Outcome Studies, Analysis Argues
Transgender and Gender Diverse Children and Adolescents: Fact-Checking of AAP Policy
James M. Cantor · Journal of Sex & Marital Therapy· 2020
An opinion piece arguing the AAP's 2018 child gender policy got its own sources wrong and left out the studies showing most children with gender distress stop wanting to transition.
Key Findings
- Says AAP sources "said the very opposite" of what the AAP claimed
- Says 10 of 11 child follow-up studies were left out of the policy
- One author's critique, not a formal review of the evidence
87% of Dutch Teens on Puberty Blockers Moved On to Cross-Sex Hormones; 3.5% Stopped Because Dysphoria Eased
Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria
Tessa Brik, Lieke J.J.J. Vrouenraets, Martine C. de Vries, Sabine E. Hannema · Archives of Sexual Behavior· 2020
At one Dutch clinic, 87% of 143 teens who started puberty blockers went on to cross-sex hormones; only 3.5% stopped because they no longer wanted to transition.
Key Findings
- 125 of 143 teens (87%) moved on to cross-sex hormones
- 9 stopped blockers; 5 (3.5%) no longer wanted any gender treatment
- No comparison group, and tracking ended when hormones began
Study Claimed Surgery Cut Mental Health Treatment 8% a Year — Its 2020 Correction Found No Benefit vs No Surgery
Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study
Richard Bränström, John E. Pachankis · American Journal of Psychiatry· 2020
A Swedish study claimed mental health treatment fell after gender surgery; a 2020 correction found no advantage for surgery over no surgery.
Key Findings
- Diagnosed people used about 6 times more depression and anxiety care
- Claimed 8% yearly drop in treatment after surgery
- 2020 correction: no advantage for surgery versus no surgery
'The Man I'm Trying to Be Is Not Me': Transition Failed to Resolve Patient's Underlying Trauma
The man I am trying to be is not me
Roberto D'Angelo · The International Journal of Psychoanalysis· 2020
Case report of a trans man whose life fell apart after transition. Long therapy moved past gender to an earlier history of being violated.
Key Findings
- One case: a trans man in crisis after transition
- Therapy uncovered an earlier history of being violated
- No measured results; the author leads a group critical of youth transition
No Protocols Exist for Detransitioners: Clinical Leaders Call for Urgent Research and Services
Debate: The pressing need for research and services for gender desisters/detransitioners
Catherine Butler, Anna Hutchinson · Child and Adolescent Mental Health· 2020
Two psychologists say there is no guidance for helping people who stop or reverse transition, and call for urgent research and support services.
Key Findings
- No clinical guidance existed for people who stop or reverse transition
- Today's patients are younger, more often female and often autistic
- Short opinion piece based on older studies, with no new data
Journal Corrects Landmark Swedish Study: Reanalysis Found No Mental Health Advantage of Gender Surgery
Correction of a Key Study: No Evidence of "Gender-Affirming" Surgeries Improving Mental Health
Society for Evidence-Based Gender Medicine (SEGM) · Society for Evidence-Based Gender Medicine (SEGM)· 2020
A journal corrected a 2019 Swedish study after a new comparison of 1,018 people who had gender surgery and 1,018 who had not found no mental health advantage from surgery.
Key Findings
- Original study linked each year since surgery to less mental health care
- Corrected comparison found no mental health advantage from surgery
- Paper corrected, not withdrawn; source SEGM is a side in the debate
Gender-Nonconforming Kids With Stronger Cross-Sex Identification Were More Likely to Socially Transition Within 2 Years
Predicting Early-Childhood Gender Transitions
James R. Rae, Selin Gülgöz, Lily Durwood, Madeleine DeMeules, Riley Lowe, Gabrielle Lindquist, Kristina R. Olson · Psychological Science· 2019
Among 85 gender-nonconforming children, those who identified more strongly with the other sex were more likely to socially transition within about 2 years.
Key Findings
- 36 of 85 children socially transitioned within about 2 years
- Stronger identification with the other sex predicted transition
- Small, well-off, self-selected group; short follow-up
Trans Women on Hormones Had 4.5x the Blood Clots and More Strokes Than Men; Trans Men More Heart Attacks Than Women
Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy
Nienke M. Nota, Chantal M. Wiepjes, Christel J.M. de Blok, Louis J.G. Gooren, Baudewijntje P.C. Kreukels, Martin den Heijer · Circulation· 2019
Amsterdam study of about 3,900 people on cross-sex hormones: trans women had 4.5 to 5.5 times the expected blood clots and about twice the strokes.
Key Findings
- Trans women: about 4.5 times men's rate of blood clots
- Trans women: about 1.8 times men's rate of stroke
- Trans men: 3.7 times women's heart attack rate, same as men's
Trans Women on Hormones Had 46 Times Male Breast Cancer Risk — Still Below Women's Risk, Dutch Cohort Finds
Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands
Christel J.M. de Blok, Chantal M. Wiepjes, Nienke M. Nota, Klaartje van Engelen, Muriel A. Adank, Koen M.A. Dreijerink, Ellis Barbé, Inge R.H.M. Konings, Martin den Heijer · BMJ· 2019
In 3,489 Dutch transgender people, trans women on hormones got breast cancer about 46 times as often as men (15 cases), still less than women; trans men less than women.
Key Findings
- Trans women: breast cancer about 46 times as common as in men
- Trans women: about a third as common as in women
- Only 15 and 4 cases; key risk factors not measured
Trans Men Reported Heart Attacks at 4.9x the Rate of Women in US Survey — But Hormone Use Was Never Measured
Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population
Talal Alzahrani, Tran Nguyen, Angela Ryan, Ahmad Dwairy, James McCaffrey, Raza Yunus, Joseph Forgione, Joseph Krepp, Christian Nagy, Ramesh Mazhari, Jonathan Reiner · Circulation: Cardiovascular Quality and Outcomes· 2019
In a US phone survey, trans men reported heart attacks far more often than other men and women, but the survey never asked about hormone use or timing.
Key Findings
- Trans men were nearly 5 times as likely as women to report a heart attack
- Trans women were about 2.5 times as likely as women, but not more than men
- Self-reported answers with no data on hormones, so cause is unknown
Slow Down, Open Up: Exploratory Therapy Model Proposed for Gender-Dysphoric Youth
Towards a gender exploratory model: Slowing things down, opening things up and exploring identity development
Anastassis Spiliadis · Metalogos (Systemic Therapy Journal)· 2019
A family therapist proposes a slower, exploratory approach for gender-questioning young people that looks at their wider life and accepts uncertainty before medical decisions.
Key Findings
- A middle path between simply affirming and trying to change identity
- Explores what distress means, including sexuality and family life
- Opinion piece based on one case, with no results data
Extended Assessment at UK Gender Clinic: 12 Teens Dropped Requests for Hormones, 7 No Longer Felt Trans
'Taking the lid off the box': The value of extended clinical assessment for adolescents presenting with gender identity difficulties
Anna Churcher Clarke, Anastassis Spiliadis · Clinical Child Psychology and Psychiatry· 2019
At a UK youth gender clinic, 12 teenagers stopped wanting hormones or blockers during a longer assessment, finding other ways to understand their distress.
Key Findings
- 12 of 128 teens assessed (9.4%) stopped asking for medical treatment
- 7 came to identify with their birth sex; 5 still identified as trans
- Small look-back review by the treating clinicians, no comparison group
Amsterdam Clinic Reports Under 1% Regret After Gonadectomy — But 36% Were Lost to Follow-Up and Regret Took ~11 Years
The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and Regrets
Chantal M. Wiepjes, Nienke M. Nota, Christel J. M. de Blok, Maartje Klaver, Annelou L. C. de Vries, S. Annelijn Wensing-Kruger, Renate T. de Jongh, Mark-Bram Bouman, Thomas D. Steensma, Peggy T. Cohen-Kettenis, Louis J. G. Gooren, Baudewijntje P. C. Kreukels, Martin den Heijer · The Journal of Sexual Medicine· 2018
Records of 6,793 Amsterdam clinic patients (1972–2015) showed regret in under 1% after removal of ovaries or testes, but regret was narrowly defined and many were lost track of.
Key Findings
- Regret after surgery: 0.6% of trans women, 0.3% of trans men
- Regret took about 11 years to show; 13 of 14 started before 1998
- 36% stopped coming to the clinic, so regret may be missed
Chosen Name Use Linked to Less Depression in Trans Youth — But Only 74 Youth, Measured at One Point in Time
Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth
Stephen T. Russell, Amanda M. Pollitt, Gu Li, Arnold H. Grossman · Journal of Adolescent Health· 2018
Among 74 trans youth, using a chosen name in more places was linked to less depression and suicidal thinking, but it was measured once, so cause is unclear.
Key Findings
- 74 trans youth with a chosen name, 3 US cities, 2011–12
- Each extra place using the name: less depression, half the suicidal acts
- Measured once, by self-report: cause and effect not shown
Trans Women on Estrogen Had Higher Rates of Blood Clots and Stroke in Large US Kaiser Permanente Cohort
Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study
Darios Getahun, Rebecca Nash, W. Dana Flanders, Tracy C. Baird, Tracy A. Becerra-Culqui, Lee Cromwell, Enid Hunkeler, Timothy L. Lash, Andrea Millman, Virginia P. Quinn, Brandi Robinson, Douglas Roblin, Michael J. Silverberg, Joshua Safer, Jennifer Slovis, Vin Tangpricha, Michael Goodman · Annals of Internal Medicine· 2018
In about 5,000 trans adults, trans women had more blood clots, and more strokes after starting estrogen, than matched non-trans men and women.
Key Findings
- About 17 extra blood clots per 1,000 trans women after 8 years, compared with non-trans men
- Extra strokes showed up about 6 years after starting estrogen
- Too few cases in trans men to draw any conclusions
Transgender Identity Can Be 'Trans-itory': Psychoanalyst Warns Against Premature Embrace
Trans-itory Identities: some psychoanalytic reflections on transgender identities
Alessandra Lemma · The International Journal of Psychoanalysis· 2018
A psychoanalyst argues from her work with under-18s that taking on a trans identity too early can block deeper understanding of a young person's distress.
Key Findings
- Taking on a trans identity early may cut short exploration
- Calls for even-handed curiosity, and rejects conversion
- An essay with hand-picked cases, not research data
Parent Survey Proposes 'Rapid-Onset Gender Dysphoria' in Teen Peer Groups — A Hypothesis, Not a Validated Diagnosis
Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria
Lisa Littman · PLOS ONE· 2018
A survey of 256 parents, found through websites sceptical of youth transition, proposed that some teens' sudden gender distress is socially influenced. The idea is unproven and disputed.
Key Findings
- 83% of the children were born female; 62.5% had earlier diagnoses
- Only parents were asked, found through sites sceptical of transition
- Corrected in 2019 to stress that ROGD is not a proven diagnosis
Endocrine Society Review: Little Short-Term Bone Density Change on Hormones, but Almost No Fracture Data
Effect of Sex Steroids on the Bone Health of Transgender Individuals: A Systematic Review and Meta-Analysis
Naykky Singh-Ospina, Spyridoula Maraka, Rene Rodriguez-Gutierrez, Caroline Davidge-Pitts, Todd B. Nippoldt, Larry J. Prokop, Mohammad Hassan Murad · The Journal of Clinical Endocrinology & Metabolism· 2017
An Endocrine Society-commissioned review of 13 studies found little short-term change in bone density on hormones, but almost no data on broken bones or teenagers.
Key Findings
- 13 studies of 639 people, none with a proper comparison group
- No bone density change on testosterone; spine density rose slightly on estrogen
- Broken bones checked in only one study; only one study of teenagers
Only 2 of 73 Gender-Clinic Teens Attempted Fertility Preservation Despite Near-Universal Counselling
Low Fertility Preservation Utilization Among Transgender Youth
Leena Nahata, Amy C. Tishelman, Nicole M. Caltabellotta, Gwendolyn P. Quinn · Journal of Adolescent Health· 2017
Records of 73 teens at a US gender clinic: 72 were told hormones could affect fertility, but only 2 tried to freeze eggs or sperm.
Key Findings
- 99% had a recorded talk about fertility risks
- Only 2 of 73 teens tried to freeze eggs or sperm
- 45% planned to adopt; 21% never wanted children
Endocrine Society's Own Review Found Only Low-Quality Evidence on Hormones' Heart Risks, With Few Events Studied
Sex Steroids and Cardiovascular Outcomes in Transgender Individuals: A Systematic Review and Meta-Analysis
Spyridoula Maraka, Naykky Singh Ospina, Rene Rodriguez-Gutierrez, Caroline J. Davidge-Pitts, Todd B. Nippoldt, Larry J. Prokop, M. Hassan Murad · The Journal of Clinical Endocrinology & Metabolism· 2017
Review of 29 studies, paid for by the Endocrine Society: testosterone worsened cholesterol in trans men, but too few heart events were recorded to judge risk.
Key Findings
- Testosterone raised 'bad' and lowered 'good' cholesterol
- 28 of 29 studies only observed patients; few events
- Reviewers rated the evidence low quality
Endocrine Society Backs Puberty Blockers and Hormones for Teens — While Rating Its Own Evidence Low or Very Low
Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline
Wylie C. Hembree, Peggy T. Cohen-Kettenis, Louis Gooren, Sabine E. Hannema, Walter J. Meyer, M. Hassan Murad, Stephen M. Rosenthal, Joshua D. Safer, Vin Tangpricha, Guy G. T'Sjoen · Journal of Clinical Endocrinology & Metabolism· 2017
The Endocrine Society's 2017 guideline backs puberty blockers and cross-sex hormones for teens, while rating its own evidence for them low or very low.
Key Findings
- Blockers at the first signs of puberty; hormones from about 16
- Its own grading rates the evidence for every teen advice low or very low
- Co-backed by WPATH; rated low quality by a 2024 York review
Socially Transitioned Children Self-Reported Near-Typical Mental Health, in a Sample of Supportive, Affluent Families
Mental Health and Self-Worth in Socially Transitioned Transgender Youth
Lily Durwood, Katie A. McLaughlin, Kristina R. Olson · Journal of the American Academy of Child & Adolescent Psychiatry· 2017
Socially transitioned children from supportive, well-off families reported normal depression and self-worth, and slightly more anxiety than other children.
Key Findings
- 63 trans children aged 9–14 rated their own mental health
- Depression was normal; anxiety was slightly higher
- Volunteer families who were supportive and well-off
Do Trans Kids Stay Trans When They Grow Up?
Do trans kids stay trans when they grow up?
James M. Cantor · Sexology Today!· 2016
A blog post listing 11 studies from 1972 to 2013 concludes that roughly 60% to 90% of children with gender distress are no longer trans by adulthood.
Key Findings
- Lists 11 follow-up studies of children seen at gender clinics, 1972 to 2013
- 60% to 90% no longer identified as trans by adulthood; most grew up gay
- A blog post with no formal search or quality check
Finnish Gender Clinic: 87% of Teen Applicants Were Natal Girls and 75% Had Prior Psychiatric Treatment
Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development
Riittakerttu Kaltiala-Heino, Maria Sumia, Marja Työläjärvi, Nina Lindberg · Child and Adolescent Psychiatry and Mental Health· 2015
Finland's first youth gender service saw mostly teens born female, most with serious earlier mental health problems and no gender distress in childhood.
Key Findings
- 87% of the 47 teens were born female
- 75% had earlier specialist mental health treatment
- 26% were autistic; 64% had no gender distress as children
Vaginoplasty Review: 26 Mostly Low-Quality Case Series; Stenosis Commonest Complication; Quality of Life Measured Once
Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques
Sophie E.R. Horbach, Mark-Bram Bouman, Jan Maerten Smit, Müjde Özer, Marlon E. Buncamper, Margriet G. Mullender · The Journal of Sexual Medicine· 2015
A review of 26 mostly low-quality studies on vaginoplasty: narrowing of the new vagina was the most common problem, and quality of life was measured only once.
Key Findings
- 26 studies, mostly low-quality looks back at surgeons' own patients
- 1,461 people had the penile skin method; only 102 the bowel method
- Only one study measured quality of life
Nearly 30% of Adults at an Italian Gender Clinic Met Criteria for a Dissociative Disorder; Symptoms Fell After Hormones
Dissociative symptoms in individuals with gender dysphoria: is the elevated prevalence real?
Marco Colizzi, Rosalia Costa, Orlando Todarello · Psychiatry Research· 2015
About 3 in 10 of 118 adults at an Italian gender clinic met criteria for a dissociative disorder, linked to trauma and depression; symptoms were lower after hormones.
Key Findings
- 29.6% had a dissociative disorder; 0.8% had multiple personalities
- 45.8% reported childhood trauma; 21.2% had attempted suicide
- No comparison group; same patients appear in other papers
Sex Ratio Flipped: Toronto and Amsterdam Teen Gender Clinics Saw Girls Outnumber Boys From 2006
Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria
Madison Aitken, Thomas D. Steensma, Ray Blanchard, Doug P. VanderLaan, Hayley Wood, Amanda Fuentes, Cathy Spegg, Lori Wasserman, et al. · The Journal of Sexual Medicine· 2015
Toronto and Amsterdam gender clinics both saw teen referrals switch from mostly boys to mostly girls (by birth sex) after 2006.
Key Findings
- Both clinics went from mostly boys to mostly girls referred after 2006
- No similar change among teens referred for other problems
- Shows a change in referrals but cannot explain why
41 Trans Men Who Gave Birth After Transition: 61% Had Used Testosterone and Most Conceived With Their Own Eggs
Transgender men who experienced pregnancy after female-to-male gender transitioning
Alexis D. Light, Juno Obedin-Maliver, Jae M. Sevelius, Jennifer L. Kerns · Obstetrics & Gynecology· 2014
An online survey of 41 trans men who gave birth after transitioning: 61% had taken testosterone, 88% used their own eggs, and many found health workers poorly informed.
Key Findings
- 61% had taken testosterone before the pregnancy
- 88% got pregnant with their own eggs
- Only people who got pregnant were asked, so fertility odds are unknown
Swedish Records Show 2.2% Applied to Reverse Sex Reassignment, With Applications Coming a Median 8 Years Later
An analysis of all applications for sex reassignment surgery in Sweden, 1960–2010: prevalence, incidence, and regrets
Cecilia Dhejne, Katarina Öberg, Stefan Arver, Mikael Landén · Archives of Sexual Behavior· 2014
Of 681 Swedes granted legal gender change and surgery in 1960–2010, 2.2% later applied to change back, typically about 8 years after transition.
Key Findings
- 15 of 681 (2.2%) applied to change their legal gender back
- They typically applied 7.5 to 8.5 years after transition
- The 0.3% figure for 2001–2010 reflects too little follow-up
63% of Gender-Dysphoric Children Desisted by Adolescence; Intensity and Social Transition Predicted Persistence
Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study
Thomas D. Steensma, Jenifer K. McGuire, Baudewijntje P.C. Kreukels, Anneke J. Beekman, Peggy T. Cohen-Kettenis · Journal of the American Academy of Child and Adolescent Psychiatry· 2013
Of 127 Dutch children referred to a gender clinic before age 12, 37% still had gender dysphoria as teens; intense early distress, being a girl and social transition were linked to persisting.
Key Findings
- 37% persisted into their teens; 63% did not, mostly judged by not returning
- Girls persisted more often than boys: 50% vs 29%
- Social transition was linked to persisting, especially in boys
Foundational Dutch Blocker Study: Mood Improved but Gender Dysphoria Didn't — No Control Group, Hand-Picked Sample
Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study
Annelou L.C. de Vries, Thomas D. Steensma, Theo A.H. Doreleijers, Peggy T. Cohen-Kettenis · The Journal of Sexual Medicine· 2011
The first Dutch puberty blocker study found mood and behaviour improved in 70 screened teens, but gender distress did not change and there was no comparison group.
Key Findings
- 70 carefully screened teens; all went on to cross-sex hormones
- Depression and behaviour problems fell; gender distress did not change
- No comparison group, and everyone also had psychological support
Suicide Deaths 19 Times Higher After Sex Reassignment Than in Matched Population: 30-Year Swedish Cohort
Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden
Cecilia Dhejne, Paul Lichtenstein, Marcus Boman, Anna L. V. Johansson, Niklas Långström, Mikael Landén · PLOS ONE· 2011
All 324 Swedes who had sex reassignment from 1973 to 2003 died about 3 times as often, and by suicide 19 times as often, as the general public, but there was no comparison with untreated trans people.
Key Findings
- Deaths from all causes were about 3 times higher than in the general public
- Suicide deaths were about 19 times higher, based on 10 suicides
- Not designed to show whether surgery helps or harms
LGBT Young Adults Who Recalled More Family Acceptance as Teens Reported Less Depression and Fewer Suicide Attempts
Family Acceptance in Adolescence and the Health of LGBT Young Adults
Caitlin Ryan, Stephen T. Russell, David Huebner, Rafael Diaz, Jorge Sanchez · Journal of Child and Adolescent Psychiatric Nursing· 2010
LGBT young adults who remembered more family acceptance as teens reported less depression and fewer suicide attempts, in a one-time survey of 245 Californians.
Key Findings
- 245 LGBT adults aged 21–25; only about 9% were trans
- Ever attempted suicide: 31% with high vs 57% with low acceptance
- Based on memory, measured once: cause and effect unclear
Six Hormone-Treated Trans Women Had Female-Range Neuron Counts in a Brain Nucleus — Same Brains as the 1995 Study
Male-to-female transsexuals have female neuron numbers in a limbic nucleus
Frank P. M. Kruijver, Jiang-Ning Zhou, Chris W. Pool, Michel A. Hofman, Louis J. G. Gooren, Dick F. Swaab · Journal of Clinical Endocrinology & Metabolism· 2000
The same Amsterdam team recounted nerve cells in a tiny brain area: six hormone-treated trans women, the same brains as in 1995, had female-range counts.
Key Findings
- Men had about 71% more of these nerve cells than women
- Six trans women were in the female range, the same brains as in 1995
- Hormone effects and adult-only differences leave it unresolved
Famous 'Female Brain' Study Measured Just Six Trans Women — All on Estrogen, Most Castrated, and Never Replicated
A sex difference in the human brain and its relation to transsexuality
Jiang-Ning Zhou, Michel A. Hofman, Louis J. G. Gooren, Dick F. Swaab · Nature· 1995
A famous Nature study found a 'female-sized' brain area in six trans women who had died, but all had taken hormones and no independent team has repeated it.
Key Findings
- The brain area was about 44% larger in men than in women
- It was female-sized in only six trans women, all on hormones
- The male-female difference only appears in adulthood (Chung 2002)
Blanchard Coins 'Autogynephilia': Non-Androphilic Trans Women Reported More Arousal to Imagining Themselves Female
The concept of autogynephilia and the typology of male gender dysphoria
Ray Blanchard · Journal of Nervous and Mental Disease· 1989
Blanchard's 1989 paper coined 'autogynephilia', finding more arousal at imagining oneself as a woman in trans women patients not attracted to men.
Key Findings
- 212 male-to-female patients at one Toronto clinic
- Groups not attracted to men reported more of this arousal
- New questionnaire tested on the same patients; no comparison group
Toronto Clinic Study: Most Non-Androphilic Trans Women Reported Arousal to Cross-Dressing, Versus 15% of Androphilic
Typology of male-to-female transsexualism
Ray Blanchard · Archives of Sexual Behavior· 1985
In 163 Toronto clinic patients, most trans women not attracted to men reported arousal from cross-dressing, versus 15% of those attracted to men.
Key Findings
- 163 male-to-female patients at one Toronto clinic in the 1980s
- 66–88% of groups not attracted to men reported arousal, vs 15%
- Based on one yes/no question, with no comparison group