By Chad Terhune and Robin Respaut
Dec 22 (Reuters) - No large-scale, long-term studies have tracked the incidence of detransition and regret among patients who received gender-affirming treatment as minors.
Studies that are available yield a wide range of results for various definitions of detransition, regret or continuation of care. Due to their limitations, the studies lack definitive answers. Here is an overview of frequently cited research: Country: Sweden Research institutions: Karolinska Institute, Karolinska University Hospital, Sahlgrenska University Hospital Published: May 2014 Results: The study´s authors said they found a 2.2% regret rate among patients who had gender reassignment surgeries in Sweden from 1960 to 2010.
The researchers found 681 people who filed a government application for https://srikandijepara.com/ a legal change in gender and received surgery, which was available only to patients 18 and older. Among that group, 15 people later reversed their decisions and filed a "regret application" with a national health board.
Limitations: The authors said the regret rate for patients in the last decade reviewed, from 2001 to 2010, may have increased over time. "The last period is still undecided since the median time lag until applying for a reversal was 8 years," according to the study. Far fewer adolescents received gender-affirming medical care prior to 2010.
Also, the assessment phase for patients in the study was much longer than what Reuters found most youth gender clinics in the U.S. offer today. The gender-care specialists in Sweden did approximately one year of evaluation before recommending any treatment, according to the study.
Link to study.
*** Country: Netherlands Research institution: Amsterdam University Medical Center Published: February 2018 Results: This study found a rate of regret of less than 1% among transgender men and women "who underwent gonadectomy," or removal of the testes or ovaries, from 1972 to 2015 in the Netherlands.
The authors found 14 cases of regret out of 2,627 patient cases reviewed. The earliest any of the 14 started hormone treatment was 25. Until 2014, transgender people in the Netherlands had to undergo gonadectomy to change the gender on their birth certificate.
For surgery, patients were required to be at least 18 and on hormone therapy for at least a year. Limitations: The study didn´t report regret among patients who didn´t undergo surgery. Thirty-six percent of patients overall didn´t return to the clinic after several years of treatment and were lost to follow-up.
People treated in the last decade of the study may report regret later. "In our population the average time to regret was 130 months, so it might be too early to examine regret rates in people who started with (hormone therapy) in the past 10 years," the authors wrote.
Link to study.
*** Country: Netherlands Research institution: Amsterdam University Medical Center Published: October 2022 Results: Researchers found that 98% of 720 adolescents who started on puberty blockers before taking hormones had continued with treatment after four years on average.
The authors used a nationwide prescription drug registry in the Netherlands to track whether patients were still taking hormones. Limitations: The researchers didn´t identify the reasons why 2% of patients had stopped treatment. The adolescents in the Netherlands also went through a lengthy assessment process, a year on average, before being recommended for medical treatment.
For that reason, the Dutch researchers say, their results may not be applicable more broadly. "There might be a difference because of that diagnostic phase," said Dr Marianne van der Loos, the study´s lead author and a physician at Amsterdam University Medical Center´s Center for Expertise on Gender Dysphoria.
"If you don´t have that, maybe more people will start treatment and reconsider it later on because they didn´t get help during that phase by a mental health professional."
Link to study. *** Country: United States Research institutions: Children´s Mercy Kansas City, Uniformed Services University, U.S.
Department of Defense Published: May 2022 Results: The authors said that more than a quarter of patients who started gender-affirming hormones before age 18 stopped getting refills for their medication within four years. The study examined 372 children of active duty and retired service members in the U.S.
military insurance system, known as TRICARE. Limitations: It´s unclear why patients stopped their medication because the study only examined pharmacy records. The researchers said the number of patients who stopped hormones is likely an overestimate because they couldn´t rule out that some patients got hormones outside of the military system, perhaps at college or with different health insurance.
The follow-up period for many patients was relatively short. The researchers examined patients enrolled from 2009 to 2018, but 58% of the patients started hormones in the last 22 months of the study.
Link to study. *** Country: United Kingdom Research institutions: University College London Hospitals, Leeds Teaching Hospitals, Tavistock and Portman clinic - National Health Service Trust Published: July 2022 Results: Researchers found that 90 patients, or 8.3%, of 1,089 adolescents referred for gender-affirming care at endocrinology clinics no longer identified as gender diverse, either before or after starting on puberty blockers or hormones.
The review spanned patients who were treated from 2008 through 2021. Limitations: The authors noted the 8.3% figure may be an underestimate because 62 additional patients, or 5.4% of all participants, moved away or didn´t follow up with the clinics.
Link to study.
website *** Country: United States Research institutions: Fenway Institute, Massachusetts General Hospital Published: March 2021 Results: Drawing on the 2015 U.S. Transgender Survey, the authors found that 13.1% of 17,151 respondents had detransitioned for some period of time.
Some of the common reasons respondents provided were pressure from a parent (35.6%), pressure from their community or societal stigma (32.5%), or difficulty finding a job (26.9%). Nearly 16% of respondents cited at least one "internal driving factor, including fluctuations in or uncertainty regarding gender identity," according to the study.
Half of the people who reported detransitioning had taken gender-affirming hormones. Limitations: By design, the authors said, all respondents identified as transgender at the time of survey completion, and the survey wasn´t intended to capture people who detransitioned and no longer identified as transgender.
Link to study.