Summary

This review looked for studies measuring how often people who had asked for or started puberty blockers or cross-sex hormones later reversed course. It included 15 clinic, registry and insurance studies covering about 7,000 people. Most reported low figures, usually under 10%. But nearly all studies looked back at old records, used different meanings of detransition, and followed people for a short or unknown time. They also did not separate a change in identity from stopping because of cost, side effects or other reasons. One US military health study found about 30% stopped hormones within 4 years, a figure the review's headline range leaves out. The author concludes detransition has not been studied enough and calls for long-term studies that follow people forward. The ranges are best read as minimum figures from short follow-up, not reliable rates.

Key findings

• 검토에는 어린이·청소년 3,804명과 성인 3,270명에 대한 연구 15건이 포함되었습니다. 14건은 오래된 기록을 되돌아본 것이었고 1건은 비교 집단 없이 사람들을 시간 순으로 추적했습니다.
• 어떤 치료 전에도 0.8%~7.4%가 요청을 바꿨고, 1%~7.6%가 사춘기 차단제를 중단했으며, 1.6%~9.8%가 호르몬을 중단했습니다.
• 미국 군 건강 연구 하나(Roberts 2022)에서는 4년 안에 트랜스 여성의 19%와 트랜스 남성의 35.6%가 호르몬을 중단했는데, 이는 검토의 대표 범위를 크게 웃돕니다.
• 정의는 크게 달랐으며, 더 이상 트랜스로 정체화하지 않는 것부터 단순히 호르몬 없이 90일 또는 13개월을 넘기는 것까지 있었습니다.
• 중단 이유에는 정체성에 대한 의심뿐 아니라 부작용, 비용, 사회적 문제, 치료 목표 달성, 치료를 이어가지 못한 것이 있었습니다. 영국의 한 클리닉 연구에서는 중단한 12명 중 10명의 이유를 알 수 없었습니다.
• 전반적으로 근거는 매우 낮은 품질로 평가되었고, 대부분의 연구는 사람들을 너무 짧게 추적했거나 추적을 아예 보고하지 않았습니다.
• 검토는 디트랜지셔너에 대한 온라인 설문을 제외했는데, 응답하기로 선택한 사람들이 전형적이지 않을 수 있기 때문입니다.
• 저자는 디트랜지션이 충분히 연구되지 않았다고 결론짓고 공통의 정의와 사람들을 시간 순으로 추적하는 장기 연구를 요구합니다.

Abstract

Background: Despite recent evidence of the benefits of gender-affirming medical procedures, data in the literature indicate emerging demands of detransition and regrets while suggesting potential sources of bias in different datasets, including a nonconsensual definition of detransition. Aim: The present systematic review aims to summarize the existing research regarding the prevalence of detransition in transgender persons who requested or started receiving gonadotrophin-releasing hormone analogs (GnRHa) and/or gender-affirming hormonal therapy (GAHT). Methods: A systematic literature search (CINAHL Plus, Cochrane Library, Google Scholar, MEDLINE, Web of Science, Sage Journals, Science Direct, Scopus) for quantitative studies was conducted up to May 2024. All eligible studies were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement. The risk of bias was assessed using the National Institute of Health quality assessment tool. The present analysis follows the PRISMA statement for systematic review articles and the synthesis without meta-analysis recommendations. Outcomes: The primary outcome was the point-prevalence proportion of detransition events as a percentage in the population of transgender persons who were considered eligible for treatment or had initiated GnRHa and/or GAHT. Results: Fifteen observational studies involving 3804 children and adolescents and 3270 adult participants were included in the 3212 screened studies. Five studies reported a change in request before starting GnRHa, five studies reported GnRHa discontinuation, and nine studies reported GAHT discontinuation. The point-prevalence proportions of shifts in requests before any treatment ranged from 0.8-7.4%. The point-prevalence proportions of GnRHa discontinuation ranged from 1-7.6%. The point-prevalence proportions of GAHT discontinuation ranged from 1.6-9.8%. All of the included studies were heterogeneous regarding definitions of detransition used and the study design: their numbers were too small to be statistically relevant, their time frame was insufficient, they did not use patient-level data, or they did not consider confounding factors. Clinical implications: Quality measurement tools are needed, as are monitoring standards, and both are important for health outcomes and guarantee the attention of health care providers and policy-makers. Strengths and limitations: The unique features of this analysis are its restrictive inclusion criteria compared with those of previous reviews, such as a strict definition of detransition and a focus on empirical studies only. However, most of the studies were retrospective and unblinded, and most were not sufficiently powered to detect detransition rates. Conclusion: Taken together, the results of the present analysis show that detransition in persons undergoing gender-affirming treatment has been insufficiently investigated, highlighting the need for long-term follow-up studies.

Conclusion

This review provides the point-prevalence proportions of detransition among persons who sought hormonal treatments (GnRHa and/or GAHT). Taken together, the results of the present analysis indicate that detransition in persons undergoing gender-affirming treatment has been insufficiently investigated. Quality measurement tools are needed, as are long-term follow-up and monitoring standards. The present study highlights the need for well-designed prospective studies to evaluate the number of transgender persons experiencing detransition after starting GnRHa and/or GAHT and associated factors and to detect individuals at a greater risk of detransition. These data are important for health outcomes and to guarantee the attention of health care providers and policy makers.