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

• Översikten inkluderade 15 studier av 3 804 barn och tonåringar och 3 270 vuxna. 14 tittade bakåt på gamla journaler och en följde personer framåt utan jämförelsegrupp.
• Före all behandling ändrade 0,8 % till 7,4 % sin begäran, 1 % till 7,6 % slutade med pubertetsblockerare och 1,6 % till 9,8 % slutade med hormoner.
• En amerikansk militär hälsostudie (Roberts 2022) fann att inom 4 år slutade 19 % av transkvinnorna och 35,6 % av transmännen med hormoner, långt över översiktens huvudintervall.
• Definitionerna varierade mycket, från att inte längre identifiera sig som trans till att helt enkelt gå mer än 90 dagar eller 13 månader utan hormoner.
• Skälen till att sluta var bland annat tvivel på identiteten, men också biverkningar, kostnad, sociala problem, att nå behandlingsmål och att inte följa behandlingen. I en brittisk klinikstudie var orsaken okänd för 10 av 12 som slutade.
• Sammantaget bedömdes evidensen som av mycket låg kvalitet, och de flesta studier följde personer för kort tid eller rapporterade inte uppföljning alls.
• Översikten utelämnade nätenkäter bland detransitionerare, eftersom de som väljer att svara kanske inte är typiska.
• Författaren drar slutsatsen att detransition inte har studerats tillräckligt och efterlyser gemensamma definitioner och långsiktiga studier som följer personer framåt.

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.