Few Teens Regret Gender-Affirming Medical Care, Survey Shows

Most adolescents who started gender-affirming medical care didn’t regret it, according to survey responses from participants in the Trans Youth Project.

Out of 220 youths, only nine (4%) said they had some level of regret for having received puberty blockers and/or gender-affirming hormones, reported Kristina R. Olson, PhD, of Princeton University in New Jersey, and colleagues. Of these nine, four have continued gender-affirming medical care, four have stopped care, and one is continuing care but plans to stop.

“In other words, regret was not always associated with stopping care, although those changes could occur later,” Olson’s group pointed out in JAMA Pediatrics.

In general, most youths who received gender-affirming medical care or their parents said they were “extremely happy” with their care, with a median satisfaction score of 7 (on a scale of 1-7).

“I was not surprised by the general direction of the findings because, by the time we analyzed the data, I’d met so many young people who have received and been satisfied with gender-affirming medical care,” Olson told MedPage Today, “but I was surprised by just how many people felt so satisfied. It became clear to me that this was not a rare or exceptional circumstance, but that the overwhelming majority of youth receiving this care were happy with it.”

“I hope that doctors, particularly those who do not provide gender-affirming medical care, will gain more insight into this care,” she said. “There’s a lot of false information floating around on this topic, which is part of why we need studies that systematically track youth receiving gender-affirming medical care over time.”

“Yes, there are some rare cases where youth have regretted care — and we want to understand and support those youth — but we are seeing very high numbers of youth who are satisfied with their care,” she added.

Most prior studies up until this point have focused on whether transgender people who begin gender-affirming medical care continue to identify as transgender several years later. Olsen pointed out that this study instead “provides more direct indication” that youth are highly satisfied with this care and that very few regret having begun this care or wish they had not begun care.

Gender-affirming care for youth has been at the center of national debate for the last several years. Currently, 25 states have restrictions on gender-affirming care for youth, despite several leading medical organizations including the American Academy of Pediatrics, the Endocrine Society, and the American Medical Association advocating to protect the practice.

Olson pointed to another recent study that found similar levels of satisfaction among youths receiving gender-affirming care. “This is important because it indicates that our findings are replicable,” she said. “We should have more confidence in findings that replicate across samples and that use different approaches. That study, for example, came from a clinic, while our sample is a community-based sample.”

For the survey study, a sample of 220 youths were pulled from the ongoing Trans Youth Project — a longitudinal study of transgender youth and their parents initially recruited throughout the U.S. and Canada between 2013 and 2017. Mean age was 16 years, and 70% were white. Participants were an average age of 11 when starting puberty blockers and 13 when starting gender-affirming hormones.

At last interaction, 31% were boys, 60% were girls, and 9% were gender-diverse or nonbinary.

Most said the timing of starting gender-affirming care was just right or they wished it began earlier (94% of youth on blockers and 94% of their parents; 96% of youth on hormones and 100% of their parents). Up to 6% of respondents for each intervention said they wished they had accessed this aspect of gender-affirming medical care either later or never.

Most of the youths represented in the study were white and from higher-income backgrounds, limiting the generalizability of the findings. The researchers also noted that their research question didn’t differentiate between different types of regret, such as regret about having received the treatment, regret about the process or outcome, or regret about the social implications.

“Based on participants’ responses to the other questions, including their open-ended answers, we observed some individuals who expressed regret over having begun treatment at all and some individuals who expressed regret about an aspect of the process of care, such as an adverse effect or developmental delay relative to their peers,” they wrote.

They suggested that future research on the topic delve deeper into different aspects of regret.

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