A vast majority of people who started hormone therapy in their youth said they are happy with their decision, results of a new study show. That includes nearly 97% of participants who received testosterone and more than 97% of those who received estrogen.
“In this cohort study of 372 participants who received care at a single multidisciplinary clinic, satisfaction with HT was high and regret and harm were rare,” said the study authors of the research published Monday in the Jama Pediatrics journal. “Decisional regret was slightly higher among youths not currently receiving HT and those identifying on the nonbinary spectrum, but it remained low in absolute terms.”
These findings support the existing standards of care for care, the study authors said.
“Gender-affirming care is the treatment gold standard for gender dysphoria,” the Harvard TH> Chan School of Health said in a 2023 article on the history of gender-affirming care. “It has been endorsed by every major medical association in the U.S., including the American Medical Association, World Professional Association for Transgender Health, American Academy of Pediatrics, American Psychological Association, and the Endocrine Society.”
That article explained that gender-affirming care can come in different forms, from changing gender expression through hair and clothing to hormone treatment and surgeries. Counseling is often a core element of treatment, and these standards of care have roots going back to research by physician Magnus Hirschfeld and others in Germany during the 1920s.
While the Affordable Care Act of 2010 expanded protections for gender affirming care, the current administration of President Donald Trump has a strong stance against gender affirming hormone treatment and surgeries, particularly for children. Last year, Trump issued a presidential action against “chemical and surgical mutilation,” and said “a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions.”
“Countless children soon regret that they have been mutilated and begin to grasp the horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding,” said the document from the White House. “Moreover, these vulnerable youths’ medical bills may rise throughout their lifetimes, as they are often trapped with lifelong medical complications, a losing war with their own bodies, and, tragically, sterilization.”
Authors of the recent study noted that “concerns about regret and harm have led to restrictions on transgender and gender-diverse youths’ access to testosterone or estrogen therapy (ie, hormone therapy [HT]), while empirical data on decisional regret among those initiating HT as youth remain limited.”
Based on the results of their research, only 2.7% of participants said that they regretted the decision to receive HT and 1.9% said that they experienced harm.
Previously, research published in JAMA Network Open journal showed that gender-affirming hormones and puberty blockers also have a beneficial impact on depression and suicide risk in transgender and nonbinary youth. Research published in the LGBTQ Health journal in 2021 also showed that “the vast majority” of transgender and gender diverse people who transitioned “reported that their detransition was driven by external pressures,” and study authors said those people might again seek gender affirming care.
Now, the most recent study provides “the largest study to date to specifically examine satisfaction, regret, and harm among TGD youth who received HT and one of the few studies of TGD youth with follow-up extending beyond the short-term window typical of research focused on mental health outcomes associated with HT,” its authors said.
“The findings also have important implications for clinical care and policy,” they continued. “Namely, the results provide further support for the existing standards of care, do not support efforts to categorically restrict or ban access to HT for TGD youth, and caution against making assumptions about treatment satisfaction, regret, or harm based on demographic or clinical characteristics. Continued longitudinal assessment will further strengthen the evidence base to help ensure that care for TGD youth remains individualized, responsive, and grounded in empirical data.”
