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等人（2022年）发现，美国军人家庭的952名患者（平均年龄约19岁）中，70%在4年后仍在使用激素：跨性别女性中为81%，而跨性别男性中只有64%。
• 跨性别男性停药的可能性是两倍多，18岁或以上才开始使用激素的人停药的可能性约为1.7倍，不过停药的原因并不清楚。
• 作者指出，荷兰切除睾丸或卵巢后的后悔率（跨性别女性0.6%，跨性别男性0.3%）可能偏低，因为36%的人失访。
• 他引用了一项调查，其中只有24%的去过渡者告诉了他们的医生，因此基于诊所记录的统计很可能遗漏了许多案例。
• 他认为，仅凭同意就给予激素、心理健康检查减少，以及向出生时为女性和非二元性别患者的转变，使去过渡很可能增加。
• 他的结论是，较早的低后悔率和去过渡率可能不适用于如今的患者，并呼吁开展研究，将仅凭同意的护理与荷兰基于团队的方法作比较。

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.