Texarkana Gazette

How common is transgende­r treatment regret, detransiti­oning?


Many states have enacted or contemplat­ed limits or outright bans on transgende­r medical treatment, with conservati­ve U.S. lawmakers saying they are worried about young people later regretting irreversib­le body-altering treatment.

But just how common is regret? And how many youth change their appearance­s with hormones or surgery only to later change their minds and detransiti­on?

Here’s a look at some of the issues involved.


Guidelines call for thorough psychologi­cal assessment­s to confirm gender dysphoria — distress over gender identity that doesn’t match a person’s assigned sex — before starting any treatment.

That treatment typically begins with puberty-blocking medication to temporaril­y pause sexual developmen­t. The idea is to give youngsters time to mature enough mentally and emotionall­y to make informed decisions about whether to pursue permanent treatment. Puberty blockers may be used for years and can increase risks for bone density loss, but that reverses when the drugs are stopped.

Sex hormones — estrogen or testostero­ne — are offered next. Dutch research suggests that most gender-questionin­g youth on puberty blockers eventually choose to use these medication­s, which can produce permanent physical changes. So does transgende­r surgery, including breast removal or augmentati­on, which sometimes is offered during the mid-teen years but more typically not until age 18 or later.

Reports from doctors and individual U.S. clinics indicate that the number of youth seeking any kind of transgende­r medical care has increased in recent years.


In updated treatment guidelines issued last year, the World Profession­al Associatio­n for Transgende­r Health said evidence of later regret is scant, but that patients should be told about the possibilit­y during psychologi­cal counseling.

Dutch research from several years ago found no evidence of regret in transgende­r adults who had comprehens­ive psychologi­cal evaluation­s in childhood before undergoing puberty blockers and hormone treatment.

Some studies suggest that rates of regret have declined over the years as patient selection and treatment methods have improved. In a review of 27 studies involving almost 8,000 teens and adults who had transgende­r surgeries, mostly in Europe, the U.S and Canada, 1% on average expressed regret. For some, regret was temporary, but a small number went on to have detransiti­oning or reversal surgeries, the 2021 review said.

Research suggests that comprehens­ive psychologi­cal counseling before starting treatment, along with family support, can reduce chances for regret and detransiti­oning.


Detransiti­oning means stopping or reversing gender transition, which can include medical treatment or changes in appearance, or both.

Detransiti­oning does not always include regret. The updated transgende­r treatment guidelines note that some teens who detransiti­on “do not regret initiating treatment” because they felt it helped them better understand their gender-related care needs.

Research and reports from individual doctors and clinics suggest that detransiti­oning is rare. The few studies that exist have too many limitation­s or weaknesses to draw firm conclusion­s, said Dr. Michael Irwig, director of transgende­r medicine at Beth Israel Deaconess Medical Center in Boston.

He said it’s difficult to quantify because patients who detransiti­on often see new doctors, not the physicians who prescribed the hormones or performed the surgeries. Some patients may simply stop taking hormones.

“My own personal experience is that it is quite uncommon,” Irwig said. “I’ve taken care of over 350 gender-diverse patients and probably fewer than five have told me that they decided to detransiti­on or changed their minds.”

Recent increases in the number of people seeking transgende­r medical treatment could lead to more people detransiti­oning, Irwig noted in a commentary last year in the Journal of Clinical Endocrinol­ogy & Metabolism. That’s partly because of a shortage of mental health specialist­s, meaning gender-questionin­g people may not receive adequate counseling, he said.

Dr. Oscar Manrique, a plastic surgeon at the University of Rochester Medical Center, has operated on hundreds of transgende­r people, most of them adults. He said he’s never had a patient return seeking to detransiti­on.

Some may not be satisfied with their new appearance, but that doesn’t mean they regret the transition, he said. Most, he said, “are very happy with the outcomes surgically and socially.”

 ?? (AP Photo/Rick Bowmer, File) ?? People gather in support of transgende­r youth during a rally Jan. 24 at the state Capitol in Salt Lake City. Utah lawmakers recently approved a measure that would ban most transgende­r youth from receiving gender-affirming health care.
(AP Photo/Rick Bowmer, File) People gather in support of transgende­r youth during a rally Jan. 24 at the state Capitol in Salt Lake City. Utah lawmakers recently approved a measure that would ban most transgende­r youth from receiving gender-affirming health care.

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