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）發現，來自美國軍人家庭的 952 名患者（平均年齡約 19 歲）中，有 70% 在 4 年後仍在使用荷爾蒙：跨性別女性為 81%，跨性別男性只有 64%。
• 跨性別男性停藥的可能性超過兩倍，18 歲或以上才開始使用荷爾蒙的人停藥的可能性約為 1.7 倍，不過停藥的原因並不清楚。
• 作者指出，荷蘭切除睪丸或卵巢後的後悔率（跨性別女性 0.6%，跨性別男性 0.3%）可能偏低，因為有 36% 的人失去了追蹤。
• 他引用一項調查，其中只有 24% 的去過渡者告訴過他們的醫師，因此根據門診紀錄的計算可能漏掉許多個案。
• 他主張，僅憑同意就提供荷爾蒙、心理健康檢查減少，以及轉向出生時為女性和非二元性別的患者，使去過渡的增加成為可能。
• 他的結論是，較舊的低後悔率和去過渡率可能不適用於今天的患者，並呼籲進行比較僅憑同意的照護與荷蘭團隊式做法的研究。

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.