Summary

In this short opinion piece, a hormone doctor at Beth Israel Deaconess and Harvard reacts to a US military health study in which about 30% of patients had stopped hormones within four years. He compares this with older figures, such as Dutch regret rates under 1%, which are weakened because 36% of people were lost to follow-up. He also points to surveys of detransitioners, who often never told their doctors. His argument is that care has changed: hormones are easier to get on consent alone, there are fewer mental health checks, and more patients are young, female-born or nonbinary. So old low regret figures may not hold, and detransition is probably rising. He urges full information about permanent effects before treatment, research comparing ways of providing care, and kind support for detransitioners. It is a reasoned expert opinion, not a study.

Key findings

• Roberts dan lainnya (2022) menemukan bahwa 70% dari 952 pasien dari keluarga militer AS (usia rata-rata sekitar 19 tahun) masih memakai hormon setelah 4 tahun: 81% wanita trans tetapi hanya 64% pria trans.
• Pria trans lebih dari dua kali lebih mungkin berhenti, dan orang yang memulai hormon pada usia 18 tahun atau lebih sekitar 1,7 kali lebih mungkin berhenti, meskipun alasan berhenti tidak diketahui.
• Penulis mencatat bahwa angka penyesalan Belanda setelah pengangkatan testis atau ovarium (0,6% pada wanita trans, 0,3% pada pria trans) mungkin terlalu rendah, karena 36% orang hilang dari tindak lanjut.
• Ia mengutip survei yang hanya 24% orang yang berhenti transisi memberi tahu dokter mereka, sehingga penghitungan berdasarkan catatan klinik kemungkinan melewatkan banyak kasus.
• Ia berargumen bahwa hormon yang diberikan hanya dengan persetujuan, pemeriksaan kesehatan mental yang lebih sedikit, dan pergeseran ke arah pasien terlahir perempuan dan non-biner membuat peningkatan berhenti transisi mungkin terjadi.
• Ia menyimpulkan bahwa angka penyesalan dan berhenti transisi rendah yang lebih lama mungkin tidak berlaku untuk pasien masa kini, dan menyerukan penelitian yang membandingkan perawatan hanya dengan persetujuan dengan pendekatan berbasis tim ala Belanda.

Conclusion

Irwig concludes that a proportion of transgender and gender-diverse patients discontinue hormone therapy, which endocrinologists may overlook because many who detransition stop attending clinics. Several factors give reason to believe detransition may increase and that low regret rates from earlier populations may no longer apply: rising numbers, the shift to the informed consent model, a likely smaller share receiving adequate mental health evaluation, and a shift toward more patients assigned female at birth and nonbinary. Endocrinologists should ensure patients receive adequate, comprehensive information on benefits and risks, especially irreversible effects. Research should compare outcomes of informed-consent and Dutch-style interdisciplinary models. Care for those who detransition should remain compassionate.