What informed consent means in gender medicine

Informed consent is a medical ethics principle: before any treatment, the patient must understand what they are agreeing to — the benefits, the risks, the alternatives, and the uncertainties. In gender medicine, the informed consent model allows adults to access hormones without a mental health assessment or referral, based on the patient's own declaration of gender identity.

The model was designed to reduce gatekeeping and speed up access. Detransitioners argue it has gone too far — that consent is often not informed, that risks are minimised, and that vulnerable people are being harmed.

What detransitioners describe

Rushed access without assessment

I picked up my T in a crazed, very obviously unwell state literally right after my first appointment. No mental health screening and barely any family health history screening. Was told multiple times that "most things are reversible." And they upped my dosage with every maintenance visit without checking levels. Horrendous shit. —brokencomputerparts, detrans female.

I started hrt at 14 after seeing a therapist for less than 3 months and going to two appointments at a clinic. They read through an informed consent packet with me, but saying "this can cause vaginal atrophy" with no further explanation to a middle schooler doesn't seem sufficient. I got the letter and had the consultation for my mastectomy around a month later, and my consultation with the surgeon was around 15 minutes long. No talk of hormonal imbalance, early menopause (which can cause a whole slew of other issues including dementia), or inability to breastfeed or feel anything for the rest of my life. —cassie-darlin, detrans female.

I was given the go ahead for hormones at 15 (despite being very open and forthcoming about traumas and self-harm), was later diagnosed with BPD, and developed PCOS so severe I had to have everything yanked out to stop the pain (and at no point was considering stopping taking the hormones causing it ever brought up with me). Now I'm on synthetic hormones and other medications for the rest of my life, my body is ruined, my depression has multiplied a thousandfold, and I'll never be able to undo the damage that has been done. Like you, I was never warned about any of this. —NumericalSystem, detrans female.

Risks minimised or omitted

Informed consent is bullshit, they don't explain the negative effects that injecting a body with the opposite sex's hormones comes with. And I send my sympathies to you as an adult who went through this, but as a teenager who also went through informed consent it's so messed up. I signed off on a paper that stated that these were experimental drugs and had no long term research at THIRTEEN. —shloogmo, detrans female.

They didn't tell me the common risks/side effects associated with testosterone. They also told me if I regretted … surgery I could get fake boobs. I was 16, I didn't know that my healthcare wouldn't cover that and I didn't know fake boobs came with risks. —Pinkafoo, detrans female.

I got no papers. They told me that I should make sure I accept a possibility of infertility, and that is it. They didn't inform me of any possible negative effects. They didn't tell me anything to look out for. —lgbtpcos, detrans female.

Even professionals don't know the full risks

I was 17 when I started … My endo gave me a pamphlet of the aesthetic changes that would happen, and some of the health concerns (blood pressure, acne, different mood) and admitted that they didn't know the full health consequences that comes with giving a female testosterone. They admitted that and I accepted it because at that point, my distressed 17 year old self didn't care … Now I am of the opinion … that the health concerns are much greater than anyone could have initially imagined … No one can have informed consent because even the professionals are not fully informed on what HRT does to their patient. —watching_snowman, detrans female.

This was so painful and sad to read, I could have written this almost word for word. … What was done to us is frankly disgusting. We desperately needed help, and instead we were pushed towards mutilation and making ourselves sicker than we ever would have been had we just been left alone. —NumericalSystem, detrans female.

What the research shows

A 2021 survey of 100 detransitioners found that 55% felt their initial evaluation was inadequate, and nearly half said counselling was overly positive about benefits while downplaying risks (Littman 2021).

A 2023 survey of 78 detransitioners found that the majority felt inadequately informed about risks and alternatives during the informed consent process (Littman et al. 2024).

A 2022 UK primary care audit found that up to two-thirds of transgender patients did not receive all recommended monitoring, and that 20% stopped hormones — with over half citing detransition or regret (Boyd, Hackett & Bewley 2022).

A 2025 Finnish study found that all nine detransitioners retrospectively reported that their initial transition was driven by unresolved psychological stressors — and that thorough psychological evaluation should precede irreversible interventions (Kettula et al. 2025).

A 2023 commentary argued that the gender-affirmation model is causing iatrogenic harm — harm caused by the medical treatment itself — and called for detransitioners to be recognised as survivors of that harm (Jorgensen 2023).

The evidence gap

A 2023 paper argued that the detransition rate is simply unknown — that studies claiming very low regret rates (0.3–0.6%) are unreliable due to short follow-up periods, high loss to follow-up, and non-representative samples (Cohn 2023).

A 2024 systematic review found that detransition has been "insufficiently investigated," with heterogeneous definitions, short follow-up, and very low quality evidence overall (Feigerlova 2025).

If the rate of detransition is unknown, then informed consent is impossible. You cannot consent to a risk that has not been quantified.

The core problem

Informed consent requires three things:

1. Information — the patient is told the risks, benefits, and uncertainties.
2. Comprehension — the patient understands that information.
3. Voluntariness — the patient is not coerced.

Detransitioners describe failures at all three levels. Risks were minimised or omitted. The word "reversible" was used loosely. And the social pressure to transition — from online communities, from peers, from the promise of a fresh start — undermined voluntariness.

I sort of agree. While I do wonder what your story is with detransitioning, I do find it a bit staggering these people never looked into what they were doing before they did it. Before my appointment for HRT I already knew what I would be at risk for. The informed consent form was essentially an old friend by the time I signed it. Something that so drastically changes your body should be understood before you just go "inject me doc." —WettWednesday.

This is a fair point — and it highlights the difference between adults who research thoroughly and minors or vulnerable adults who are rushed through. The problem is not that informed consent exists. The problem is that it is often not actually informed.

What would real informed consent look like?

Based on detransitioners' accounts and the research:

• Honest risk disclosure. Not "most things are reversible" — but a clear list of what is and is not.
• Mental health assessment. Not gatekeeping — but understanding what is driving the distress before treating it.
• Time. No hormones on the first visit. No surgery letters after two sessions.
• Acknowledged uncertainty. "We don't know the long-term effects" is more honest than "this is safe."
• Discussion of alternatives. Therapy, waiting, social changes, addressing underlying issues.
• Discussion of detransition. Not "no one detransitions" — but "some people do, and here is what that looks like."

Related pages

• Gender exploratory therapy — the alternative to affirmation
• Detransition — why people reverse transitions
• DIY hormones — black-market access and its risks
• Puberty blockers — evidence and perspectives
• Top surgery regret — what surgical regret looks like

References

• Littman (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of Sexual Behavior. study page, source.
• Littman, O'Malley, Kerschner & Bailey (2024). Detransition and Desistance Among Previously Trans-Identified Young Adults. Archives of Sexual Behavior. study page, source.
• Boyd, Hackett & Bewley (2022). Care of Transgender Patients: A General Practice Quality Improvement Approach. Healthcare. study page, source.
• Kettula et al. (2025). Gender Dysphoria and Detransitioning in Adults: An Analysis of Nine Patients from a Gender Identity Clinic from Finland. Archives of Sexual Behavior. study page, source.
• Jorgensen (2023). Iatrogenic Harm in Gender Medicine. Journal of Sex & Marital Therapy. study page, source.
• Cohn (2023). The Detransition Rate Is Unknown. Archives of Sexual Behavior. study page, source.
• Feigerlova (2025). Prevalence of detransition in persons seeking gender-affirming hormonal treatments: a systematic review. Journal of Sexual Medicine. study page, source.