Summary

Low regret figures such as 0.3–0.6% are often quoted to show that detransition is rare. In this opinion piece, J. Cohn argues that the true rates are unknown. He sets four conditions for a sound study: long enough follow-up (published times to regret range from about 3 to over 10 years), few people lost along the way, clear definitions and suitable measures, and patients like today's, who are mostly teenage girls. None of the studies in a 2021 review of surgery regret followed at least 85% of people for 8 or more years. Studies reporting higher rates fail the same tests. It is a useful checklist for reading regret studies, but it offers argument, not new data. Some of its cut-offs are judgement calls, and the author works with SEGM (the Society for Evidence-Based Gender Medicine), which urges caution in youth gender medicine.

Key findings

• Cohn trdi, da stopnje prenehanja, detranzicije in obžalovanja po medicinskem zdravljenju, povezanem s spolom, niso znane. Ne trdi, da so resnične stopnje visoke ali nizke.
• Pogosto navajane številke obžalovanja 0,3–0,6 % izhajajo predvsem iz odraslih, zdravljenih po starejših, strožjih pravilih, ne iz današnjih bolnikov, ki so spolno stisko večinoma prvič občutili kot najstniki in so večinoma ženske.
• Objavljeni časi do obžalovanja ali detranzicije so dolgi: od približno 3 let v anketi detranzicionarjev do skoraj 11 let v povprečju po odstranitvi mod ali jajčnikov v nizozemskih podatkih, s tipičnimi časi približno 7,5 do 8 let v švedskih podatkih.
• Ob uporabi skrbnega minimuma 8 let nobena od študij v pregledu obžalovanja po operacijah iz leta 2021 (Bustos in sodelavci) ni spremljala vsaj 85 % bolnikov in vseh spremljala 8 let ali več.
• Študije, ki štejejo le ljudi, ki še obiskujejo kliniko za spol, ali anketirajo le ljudi, ki se še vidijo kot trans, zgrešijo cele skupine, ki obžalujejo ali detranzicionirajo. V eni anketi je le približno četrtina detranzicionarjev povedala svojemu kliniku.
• Študije, ki poročajo višje stopnje, na primer skoraj 30 % prenehanja hormonov v štirih letih v podatkih ameriške vojske, prav tako ne dosegajo istih standardov.
• Cohn zaključuje, da bi morali ljudem, ki razmišljajo o medicinski tranziciji, povedati, da je verjetnost obžalovanja ali detranzicije neznana, kot del privolitve v zdravljenje.

Conclusion

The detransition rate is unknown. Existing studies claiming low regret or detransition rates (0.3-0.6%) are unreliable due to methodological flaws including: insufficient follow-up time (often shorter than observed median times to regret of 7.5-8 years), high loss to follow-up, inappropriate measurement instruments, and non-representative samples that differ from current patient populations. The frequently quoted extremely low rates are based on studies with adults who underwent extensive screening under older protocols, not the current adolescent-onset cohort with different characteristics. Until properly designed long-term studies are conducted with adequate follow-up duration, small loss to follow-up, appropriate definitions and measurement tools, and relevant samples, the true rates of discontinuation, detransition, and regret cannot be determined. This uncertainty should be communicated to patients and families as part of informed consent for gender-affirming medical interventions.