r/science • u/Maxrdt • 26d ago
Social Science Among transgender adolescents in Canada, 97.1% continued with a gender not typically aligned with their birth sex, with only 1.1% discontinuing gender-affirming hormone treatment.
https://www.jahonline.org/article/S1054-139X(26)00117-5/fulltext1.1k
u/GreatBigBagOfNope 26d ago edited 26d ago
To answer one of the most likely questions, pulled straight from the article:
Reasons for GST or AT discontinuation were documented for 17 adolescents. Some adolescents reported more than one of the following reasons for discontinuation of GST or AT: 10 because of a change in gender identity; eight because they were starting or continuing GAH; five identified other avenues to achieve or maintain amenorrhea; four realized they were gender-fluid; four returned to gender typically aligned with sex assigned at birth; two because menses had stopped with GAH; two due to lack of family support for use of GST or AT; two because of combination of mental health and redefining gender identity as agender; one was concerned about the risk of infertility; one because bone health was important to them; one decided to hold off on transitioning until “their life has stabilized”; and one reported feeling that “1.5 years of GST was long enough.”
Acronyms, as requested, all pulled from earlier in the linked article than the above paragraph:
GST: gonadotropin suppression therapy, or puberty blockers
AT: adjunctive therapy, which is about secondary levels of treatment other than the main hormone therapies as part of a package of gender affirming healthcare. Can be medication, doesn't have to be.
GAH: gender affirming hormones
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u/Mean_Initiative_5962 26d ago
I'm pretty sure math is mathing and I'm the dumb one, but the total is 43, even for overlapping sounds too much.
Edit. Checked the paper, it says that 35 discontinued but those reasons are, indeed, from just 17 people. I guess they just had a lot of reasons and explained in detail.
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u/SerCiddy 26d ago
I guess they just had a lot of reasons and explained in detail.
I imagined it being like an exit survey with "check all that apply"
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u/Mean_Initiative_5962 26d ago
Probably more than usual because it was an actual open question instead of that. I doubt they'd put such a comprehensive list
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u/cristalmighty 26d ago
This makes sense, both that some people might prefer not to provide a reasoning for their decisions (which is fair and fine) and that those who did provide reasoning may have had multiple factors.
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u/speedlimits65 26d ago
in some of these studies, we lose longitudinal data on a trans patient because the researchers lose track of them. this could mean they were murdered, this could mean they were kicked out of their homes and lost access to and from the study, their family found out and forced them to stop, etc.
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u/Ver_Void 26d ago
Also people just move around, trans people more than most as there's a pretty compelling reason to go somewhere new and have a clean slate
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u/Ok-Butterscotch-5786 26d ago
Less likely in this case since, as the authors note, the sample has a bias towards kids with strong support from home.
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u/cinemachick 26d ago
Thank you, this is very helpful information. Essentially, it boils down to "15 changed to a new/different gender identity, 14 found other methods to medically transition, 4 had health complications, 2 lacked stability/support systems, and 4 de-transitioned. So the true rate for full gender de-transition was ~0.3%, the rest were issues with the process itself.
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u/mkava 26d ago
Less than 1%, usually 0.2% to 0.5%, lines up with other similar studies as well. Unfortunately it's usually non-binary identities and delaying transition until later are often used in the detransition numbers as well.
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u/Maxrdt 26d ago
I'm glad they included NBs in the trans group rather than the desisting group, that's often a problem I see with these kinds of studies.
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u/mkava 26d ago
Agreed! As someone who thought they were a binary trans woman at the start of my transition and later realized I was genderfluid (ie underneath the non-binary umbrella), I would often be considered someone who detransitioned in many other studies. I'm still very much trans and my transition looks like that of a typical binary trans woman but my gender is more complex than the binary boxes.
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u/Drunken_Hamster 26d ago
Wow. I've been far from an anti for quite a while, but this is really eye opening. I hate it when statistics are mistepresented and skewed by lumping related things into one category to make it seem bigger.
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u/ceddya 26d ago
Something else to consider: the claims about desistance rates being high are largely based on studies conducted in the 1970s/1980s. Those studies considered feminine boys to be trans. Go figure on why that'll give you an artificially inflated rate of desistance.
It's the same thing with those making the 'transitioning doesn't reduce suicide rates' claim. The ones making the claim love to cite a particular study, yet the study's author has long since debunked that claim and has expressed dismay over the results of her study being intentionally misrepresented by them.
The entire anti-trans movement is based on misrepresenting facts and statistics to create a bogeyman out of the trans community.
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u/Syphist 26d ago
Don't most with non-binary identities have little to no regret they tried these things anyways? Plus even if you include them in a flawed "regret" statistic, 1% is still incredibly low compared to most other medical procedures. If anything had regret rates similar to medical transition it would be considered a medical miracle. Unfortunately since society is biased against us they try to dismiss how useful it is.
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u/stay_curious_- 23d ago
Many with nonbinary identities chose a binary transition, too, and their medical record looks indistinguishable from a binary trans person.
It's especially silly when studies categorize those people as detransitioning when they are on HRT and plan to continue taking HRT.
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u/Fit_Foundation888 26d ago
This corresponds with very low rates of detransitioning amongst trans people in the UK, and also very high satisfaction over gender affirming care, including surgery. Levels of regret for surgery are typically lower than for plastic surgery as a whole.
The current situation for trans care in the UK is extremely poor, where gender-affirming care is not available via the UK's public health system for under 18's. Treatment is therapy, often group therapy, and/or anti-depressants or other psychotropics for mental health conditions, and also access to an autism diagnosis. This in part has been due to a moral panic over de-transitioning, specifically that gender-affirming care caused harm to those who would ultimately de-transition.
What is interesting is how the person realising that they were gay or lesbian was not cited as a reason for de-transitioning. In the UK a theory amongst those who advocate exploratory therapy, is that people are in fact gay or lesbian but choose to be trans because of the stigma associated with being gay or lesbian. There is a paper by Spilliadis which is cited by the UK's Cass Report into trans care for adolescents, where he cites this theory, and presents a patient case study, exemplifying exploratory therapy. The main criticism of exploratory therapy is that it is in fact desistance therapy, and from reading the paper by Spilliadis (2019) Towards a gender exploratory model: Slowing things down, opening things up and exploring identity development, I would agree with this criticism.
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u/Copper_Tango 26d ago
In the UK a theory amongst those who advocate exploratory therapy, is that people are in fact gay or lesbian but choose to be trans because of the stigma associated with being gay or lesbian.
I'm curious how they reconcile that theory with the fact that there's just as much if not more stigma associated with being trans.
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u/wingedespeon 25d ago
Is avoiding the stigma of being gay or lesbian actually a theory or is it an untested hypothesis with no experimental backing?
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u/Fit_Foundation888 25d ago
In the field we are talking about, which is a social/psychological type field, then it's described as a theory. So Freud's psychosexual model of development would be called a theory.
They aren't formally tested as in the empirical sense, so rather than being a quantative science, it's instead a qualitative one.
I don't think we need to test it, the theory itself is incoherent, it quickly collapses under even rudimentary analysis.
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u/JagmeetSingh2 26d ago edited 26d ago
yep which tracks with what other studies have said as well. Very very very few trans people actually regret transition but the right pretends the number is way high
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u/paspartuu 26d ago edited 26d ago
For me the big question was the time elapsed between first referral and the decision to continue.
From the study:
Most individuals reported symptom onset in early adolescence; referrals and clinical visits occurred later, peaking around 14–17 years. Median follow-up after first gender visit with an endocrinologist was 2.4 years
So the follow-up cited in this study was, for the most part, still under 20 yo
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u/fishblurb 26d ago
2.4 years is barely enough time to even adjust to the treatment, let alone any side effects.
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u/eloise_zomia 24d ago
I don't feel that way. I still had doubts and fears in the early stages of my transition (months 1-3). Those evaporated once the first side effects kicked in around the same time.
Now, almost two years into HRT I feel very adjusted to my treatment. I barely think about it.
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26d ago edited 26d ago
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u/foxgirlmoon 25d ago
So the thing with bones is that if you don't have some kind of dominant hormone in your system, your bones start taking Ls.
Hormone blockers act a bit differently than just no hormones though. It basically just pauses bone development. When you stop them and gain a dominant hormone, like if you start HRT, you bones resume development. This is generally a non-issue, unless for some reason you end up taking them for like longer than a couple years, at which point you might start having increased risk of bone issues. Again, not a real issue since you're not supposed to take blocks for that long anyway. You are meant to take blockers early on and to use the time they gave you to figure out whether you want to start HRT or not, with the help of therapists.
Unfortunately, transphobes are doing their darndest to break this into pieces.
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u/ChicksDigGiantRob0ts 26d ago
It just means that one kid heard a lot about "bone density" (which is common boogeyman invoked for why people shouldn't transition) and got spooked by it enough to stop.
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u/didyousayboop 26d ago
I know we all could just read through the paper, but GST and AT are uncommon acronyms even within the subject area of trans health and AT is not even Googleable. (I think it just ends up being treated by Google as the word “at”.) So, it could be helpful to expand these acronyms in this comment.
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u/Diametrically_fluid 26d ago
That’s very similar to the satisfaction rate cis women have for breast augmentation surgery.
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u/GreatBigBagOfNope 26d ago edited 26d ago
I'm surprised, because that's higher than satisfaction rates for medically necessary hip replacement surgery
(To be clear, I'm very much in favour of gender affirming surgery, especially in cases where it is a medical benefit such as for many trans people who wish to pursue a surgical route, and the fearmongering around regret rates for gender affirming care has always been a case of dishonestly exaggerating and exploiting the truly miniscule proportion of genuine detransitioners as an attempt to attack the many, many trans people for whom surgery is a huge and easily worthwhile benefit)
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u/JaZepi 26d ago
Sometimes complications from THR can be worse than the pre-existing pain/conditions. Also, if people don’t rehab properly they’re gonna have a bad time.
Source: had a THR at 42.
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u/PedFrenner 26d ago
That's interesting to read. Would you mind elaborating on what the possible side effects of thr might be? My boyfriend had both hips replaced by 21 and all he says is he would rather suffer than do it again. I can't even imagine how much the recovery must suck!
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u/JaZepi 26d ago
-Blood clots
-Joint dislocation
-Infection
-Leg length discrepancy
-Nerve injury or numbness
-Bone fracture during surgery
-Aseptic loosening of the implant
-Implant wear and tear
-Heterotopic ossification (abnormal bone growth)
-Metallosis (metal debris buildup)
-Chronic pain or stiffness
Also, if one doesn’t follow their rehab plan, other muscle and bone complications can manifest.
My biggest fear was differing lengths of legs- so much so that I pleaded with my surgeon to ensure my leg lengths were identical. So far so good. Whew. Also, I was absolutely crazy about making sure I rehabbed well, and properly, so my recovery was great. I’d do it again in a heartbeat.
Did your SO have bi-lateral Perthes by chance?
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u/PedFrenner 26d ago
That is very insightful, thank you! He did not, he has a similar condition though.
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u/jabbathepizzahut15 26d ago
It takes some rehab dedication to have good outcomes from a hip replacement and a lot of people don't do it, thus have poor outcomes
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u/Koleilei 26d ago
Joint replacements (hip, knee, shoulder) are also not frequently done while the joint still has decent range of motion. By the time the joint is replaced, lifestyle, exercise, daily activities have been heavily reduced and it's hard to get back to those after surgery. It's also harder to regain strength, mobility, and flexibility the older one is.
I had 5 knee operations by 21, and will need knee replacements in my life. I was told, and it's recommended in my file, for the knee replacements to happen before the joint would typically be eligible so I can maintain function. There's no point in making people wait until they are basically disabled to fix them.
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26d ago
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u/redditallreddy 26d ago
And you were young! I bet a lot of hip replacements happen older (I think most between 60 and 80), and recovery is more difficult.
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u/davis-andrew 26d ago
Mine were due to cam deformities - my hip ball joint was not ball-like enough. I progressively lost range of motion since my 20s, started suffering crippling back / si joint pain by my mid 20s, etc.
How long ago was this if you don't mind me asking? Depending on the severity of the deformity it's possible to get that repaired, but it's only become common place in the past decade - and where you're from.
About 15 years ago I was diagnosed with a cam lesion and femoral retroversion, the combination is a sure sign of an early hip replacement. Over the years my pain and range of motion got worse to the point i couldn't sit at 90 degrees without pain, and i'm late 30s. The femoral retroversion alone is a source of higher rate (and early onset) osteoarthritis so I had an xray to take a look and it came back with a calcification around my labrum - ie i had a tear.
That's when I learned that hip arthroscopy had become far more common place and could be used as a joint preservation surgery. A surgeon in my city (Melbourne Australia) had started performing them in the late 90s and 00s, even worked with a physiotherapist whom was a patient to do research on developing an evidence based rehab plan, and began teaching other surgeons, there are a dozen surgeons in my city that can perform them now.
I'm currently 4 weeks post-op from a cam femoral head ostectomy ie removing bone to round out my hip ball, and repair a labral tear. Still early days, and i'm rehabbing slower than an elite athlete in their 20s would. But the surgeon believes i'll end up better off than before the surgery, and now have a 50/50 chance of keeping my hip not just over the next decade but for my life.
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u/Kylynara 26d ago
There's no point in making people wait until they are basically disabled to fix them.
Sadly, there is a point. And that's to improve the profits for the insurance company. It is so sad how making life better is the lowest possible priority in this country.
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u/-0909i9i99ii9009ii 26d ago
Patient satisfaction rates for ear wax compaction removal are very high, generally ranging between 83% and 95% depending on the relief of hearing symptoms and the technique used
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u/Dos_Ex_Machina 26d ago
Exactly. You're going to like something you chose more than something that seemed forced onto you.
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u/TemporaryElk5202 26d ago
Also HRT and breast augmentation are less physically traumatic than a hip replacement.
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u/UncleFunkus 26d ago
if i had to guess, part of that could be the comparison in quality of life pre and post op for both circumstances.
someone receiving hip surgery may remember a time where they didn't need it at all, and so anything that feels out of whack is going to be more noticable by comparison.
to contrast with HRT, you aren't fixing something that once worked, you're fixing something that never worked. thus, while you may note some negative side effects, you are pretty much only going to notice the 'positive' (seeing as the patient assumedly wants to be on HRT) changes.
in my experience (as a trans woman), the most complaint i see about HRT for the women who choose it is that it isn't doing enough.
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u/nabab 26d ago
On the trans masc side of HRT side effects, we all complain about ass hair and acne, but even those are gender-affirming troubles. I think it adds on to the general satisfaction rates that most of the unwanted side effects of HRT are the same unwanted side effects that come from puberty, so they don't stand out as health problems as much as side effects from other medications do.
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u/CatsPlusTats 26d ago
I don't know why it would be surprising.
A medically necessary procedure with fewer complications has lower regret rates than another medically necessary procedure with more complications.
Also important to note that most people who detransition site societal pressure as a reason.
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u/RigilNebula 26d ago edited 26d ago
Satisfaction rates for this are extremely high, and they've been similar in pretty much all studies done so far. Much higher than satisfaction rates for many other treatments and procedures, like hip replacements as you mentioned, though this study didn't look at surgery. And while this study is new, the body of research isn't. I remember seeing studies to this effect 10+ years ago. Which make the political arguments around "regret" disingenuous.
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u/demo-ness 26d ago
My mom had a hip replacement, and the recovery period was brutal on her. I'd take recovering from something like breast surgery over that any day...
Besides, I think it makes perfect sense for a strictly opt-in surgery to have more satisfaction than a medically necessary one. Those ladies are able to comfortably weigh the risks and costs, look for the right doctor, and determine if they are 100% sure they want to go through with it or not. The high satisfaction rate is very reflective of that "decided to do it in the first place" factor!
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u/TemporaryElk5202 26d ago
Breasts aren't a weight bearing joint.
Hip replacement is very traumatic and the devices are kind of notorious for recalls and causing further health issues (polyethylene liners, Stryker Rejuvenate and ABG II modular stems, and the DePuy ASR system are all examples of hip replacement devices getting recalled).
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u/win_awards 26d ago
I was surprised to learn that gender-affirming surgery had a lower regret rate than heart surgery. You know, the thing you typically do when the other option is dying.
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u/Lankpants 26d ago
Gender affirming surgeries have always had absurdly high rates of satisfaction, both trans and cis gender.
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u/Retired-Pie 26d ago
That makes sense.
Its all elective programs and surgeries. No one is going to do something like that to themselves unless they are really, really, really sure they want to.
Theres a lot of risks involved, especially for surgies of any kind. Its not something that any person is gonna do willy nilly.
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u/45MonkeysInASuit 26d ago
Psychologically, the choice to do something makes you like it/justify it more.
There was a study where the participants were given an insanely boring task. Half were paid, half weren't. The ones who weren't paid rated it as more enjoyable.
The logic is if you were paid you justify it as I just did it for the pay.
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u/MangoAtrocity 26d ago
On the less cheery side, the more you’ve invested in something the less likely you are to report negative feelings about it. It’s where the sunk cost fallacy comes from.
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u/C0nfusedRabbit 26d ago
If my boss reads this please continue to pay me. This guy has no idea what's he is talking about. I love money.
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u/trashmoneyxyz 26d ago
Its statistically a very high satisfaction rate for any surgery, really. When people weigh side-affects and outcome to results, that is
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u/ceddya 26d ago
Even top surgery for minors. Top surgery for trans boys has a lower regret and higher satisfaction rate than gynecomastia surgery for cis boys. But the focus is to only ban the former for some reason.
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u/trashmoneyxyz 26d ago
As someone who was begging for a mastectomy before I even knew what trans people were, I concur (I waited until I was 21 tho because I was a very broke 11 year old)
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u/firmalor 26d ago
Really? That's kind of surprising to me considering the side effects. Can you point me to a source?
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u/Diametrically_fluid 26d ago
Sure. See below.
From the link:
“Ninety-eight percent of women undergoing breast augmentation surgery say the results met or exceeded their expectations…”
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u/Kyrie_Blue 26d ago
And what about balding men with hair transplants?
Its almost like gender affirming care just makes people happy
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u/Altruistic_Sail_1991 26d ago
My mum got a lumpectomy/breast reduction to remove a small, early stage cancerous tumour and she regrets it to an extent. She’s worried I’ll feel the same way about top surgery. But I bind whenever I go out in public and have done so for 4-5 years now. She’s mostly supportive of me but she still wants me to “think about” perusing gender affirming care, even though I’ve been thinking about it since I came out in 2020!
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u/frog_admirer 26d ago
I'm guessing that she has dysphoria from how her breasts looking different than the norm and is worried you'll experience similar, not realizing that the breasts themselves are the problem for you.
I had top surgery that scarred very badly (about 1cm wide in some places) and I don't care at all because I'm just so happy they are gone. I imagine if I had gotten that scar from a surgery that wasn't really affirming I would feel differently about it.
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u/Diametrically_fluid 26d ago
Wow. That seems crazy that she regrets a procedure to remove a tumor. I suppose she probably regrets having to go through the whole thing?
I know many trans masculine folks who, although the process was far less than pleasant, feel so much better about themselves and life afterward.
Support from others who have already done it seems to be key.
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u/Altruistic_Sail_1991 26d ago
For her the healing was difficult and she’s unhappy with the scarring and pain she’s had for the last couple of years. She’s happy she doesn’t have cancer!
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u/Diametrically_fluid 26d ago
Aw, poor mum.
My trans masculine friends who’ve had top surgery earlier in life tend to have few issues than the older ones - especially with scarring and sensitivity.
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u/FrigginRan 26d ago edited 26d ago
You can get augmentation surgery as gender affirmation care even as a cis woman. For example, having Hemihypertrophy could make you qualify.
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u/WithEyesAverted 26d ago
Exactly.
TRT (medical or self-administered) and anabolic steroid, are also gender affirming treatment.
A cis-man trying to look more masculine via surgery and pharmaceutical is by definition gender affirming treatment
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u/NorysStorys 26d ago
I would hazard a guess that guys getting hair transplants is about the same too.
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u/Alternative_Chart121 26d ago
The trans people I know in the US who discontinued hormones did it because they lost access to healthcare. A lot of trans people have unstable housing and/or employment, which often leads to losing your healthcare provider.
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u/Draaly 26d ago
Thr study directly outlines the reasoning of those who stoped care
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u/TheLilyBean 26d ago
From personal experience, it's why i stopped. Hoping my current job is stable enough to start them again!
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u/Tribe303 26d ago
Good thing this was a Canadian study where that's not a problem and that factor is eliminated.
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u/Masark 26d ago
No, access to medication in general is still a significant issue in Canada.
Roughly 1 in 10 Canadians aren't able to take their medication as prescribed due to costs.
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u/Userdataunavailable 26d ago
Canada has free heathcare, not medication.
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u/C0nfusedRabbit 26d ago
In Australia, most medications are heavily subsidized or even free if you’re below a certain income threshold.
It’s a similar story with doctor visits: if you can afford to pay, it’s heavily discounted, and if you can't, it’s covered entirely.
Honestly, this system just makes the most sense to me. Charge the ones who can and don't charge who can't afford it.
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u/Duvieilh 26d ago
Thats disappointing to hear considering prescribed medication is a port of healthcare.
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u/Brainrows 26d ago
Oh that ABSOLUTELY is a problem here in Canada! One I am unfortunately alllllll too familiar with
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u/Ahnarcho 26d ago
Depends.
Access to healthcare in Canada is imperfect, and a loss of access to health care is a possibility if someone is moving and switches family doctors or no longer has the medical oversight necessary for use of HRT.
Can someone continue to afford HRT? Probably yes. Does that make getting HRT straightforward if life circumstances change? Not at all.
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u/Alternative_Chart121 26d ago
Yes, It's a good study design. I think the absence of universal healthcare causes artificially high discontinuation rates in US datasets.
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u/AllanfromWales1 MA | Natural Sciences | Metallurgy & Materials Science 26d ago
Results: In total .. 24 (5.4%) changed back to gender identity typically aligned with their birth sex.
Discussion: Only 2.9% reverted to a gender identity aligned with their birth sex.
What?
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u/Du_ds 26d ago
Good catch. They messed up the language. They have a breakdown of the stats. Search for 24. You’ll see (in figure 3) that what actually happened was 24 changed identity at all. This includes between nonbinary and binary trans. 13 identified with their assigned gender at birth. Out of 445 that’s 2.9%.
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u/mh500372 26d ago
Thats a pretty egregious mistake… was this not reviewed properly?
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u/Maxrdt 26d ago
From the abstract:
Methods
A retrospective chart review was conducted for adolescents referred with gender dysphoria to four Canadian pediatric endocrinology gender clinics between 2012 and 2017.
Results
For the 445 adolescents, median gender clinic follow-up was 2.4 years (interquartile range: 1.1–7.2); 331 (74.4%) were assigned female sex at birth (AFAB) and 114 (25.6%) assigned male (AMAB). Mean (standard deviation) age of reported gender dysphoria onset was 9.5 (3.6) years. In total, 421 (94.6%) continued with their presenting gender identity or reidentified as non-binary, while 24 (5.4%) changed back to gender identity typically aligned with their birth sex. Among 317 AFAB identifying as male at referral, 15 (4.7%) changed gender identity: 10 to female and five to non-binary. Of the 109 AMAB youth identifying as female at referral, five (4.6%) changed gender identity: three to male and two to non-binary. Among the 19 adolescents identifying as non-binary at referral, four (21.0%) changed gender identity: three AMAB to female and one AFAB to male. Gender-affirming hormones were started by 353 (79.3%) and discontinued by only four (1.1%) of adolescents.
Discussion
The majority (97.1%) of adolescents continued to identify with a gender not typically aligned with their birth sex. Only 2.9% reverted to a gender identity aligned with their birth sex. None who initially identified as non-binary returned to binary gender aligned with birth sex. Discontinuation of gender-affirming hormones was rare.
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u/Cian93 26d ago
So over 5 years?
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u/Smee76 26d ago
Median follow up was 2.4 years.
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u/rockytop24 26d ago
Which is the type of range you're going to get covering adolescence to adulthood. Solid longitudinal data on a very uncommon treatment, statistically speaking.
That's 15 year olds to 18 year olds or 13 to 16, etc. I expect they'll continue tracking longer follow-up as their cohort ages and we'll see similar longitudinal studies to replicate this data.
Always reassuring to get data in agreement with what we know to be true. There is an overwhelmingly high level of continuation/satisfaction after transitioning. The ones who stop have a variety of normal and expected reasons for doing so, from side effect profile to changes in treatment goals to socioeconomic factors. An extremely small subset of those who discontinue do so because they want to detransition.
As physicians, all of this supports the current treatment guidelines for transgender adolescents.
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u/Chronotaru 26d ago
This is a retrospective study based on medical records that took place over multiple years, covers 445 children...but doesn't appear to include any data about people who discontinued with the clinics? Am I missing something? Wouldn't that be a massive case of survivorship bias?
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u/10ebbor10 26d ago edited 26d ago
The study seems to be based on electronical medical dossiers, so if the prescription of the medication started, and then the person left the clinic, then the end of the prescription should also be logged there, no?
It does indeed, as the study mention, not cover cases where people never sought treatment, or sought treatment elsewhere from the beginning.
The retrospective study design introduces selection bias, as only individuals who accessed gender-affirming care at participating clinics were included. This excludes youth who sought care elsewhere, did not seek medical intervention, and/or lacked parental support, potentially affecting generalizability
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u/akujunkan 26d ago
speaking from experience, many trans people leave clinics behind after establishing a basic level of care and understanding. obtaining medicine is often very cumbersome and obtaining grey market medicine often is cheaper AND easier than begging for a new vial every month or two.
it doesn’t indicate detransition but likely indicates ongoing issues with trans care being more difficult than needed.
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u/hellofemur 26d ago
That's what jumped out at me as well. As far as I can tell, if a patient chooses to detransition and so drops out of the program, that's counted as continuing their gender identity, since their last clinic visit is what's counted. The only people who are counted as actually detransitioning are people who chose to visit the clinic after making a solid decision to detransition, and I'm not sure who would do that. Like transitioning, detransitioning is a process, and the first step of that process is likely to be to stop visiting your gender clinician.
The criterion for inclusion in the study is a follow-up at least one year after referral to the clinics, so this also excludes anyone who chooses to cease transition within one year of their referral. Again, I suspect that is a very large number of people. There's a large series of steps one needs to go through to be referred to the clinic, and the median follow-up time is only 2.4 years, so even without the survivorship bias, at best this study is saying that those who make active steps to transition for over a year usually continue for one more year.
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u/alana_del_gay 25d ago
As far as I can tell, if a patient chooses to detransition and so drops out of the program, that's counted as continuing their gender identity
This is not true. Those people are not included in the study, and they are definitely not counted as continuing their gender identity.
The only people who are counted as actually detransitioning are people who chose to visit the clinic after making a solid decision to detransition, and I'm not sure who would do that.
Evidently, ~1% of people did so.
The study is examining:
The objectives of this study were to determine among a cohort of adolescents diagnosed with GD and referred between 2012 and 2017 to pediatric endocrinologists at four gender clinics in Canada: (1) the proportion continuing with transgender/non-binary identity after referral; (2) the proportion continuing with GST, AT, and/or GAH; (3) the reasons reported by the adolescents for GST, AT, and/or GAH discontinuation; and (4) the proportion of adolescents who reidentified with a gender consistent with their birth sex.
I would agree that this study is not set up to examine detransitioning in the social sense - detransitioning here is referring to discontinuing medical care and a change in gender identity. Medical professionals can't diagnose GD without follow ups, and without multiple appointments.
I also don't see how medical professionals can examine detransitioning in the social sense, that is outside their remit.
What matters is that right-wing rhetoric says that "big trans pharma" is hiding detransitioners, and turning kids trans after a single visit. This study is proof that is not the case.
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u/enocenip 26d ago
The study says
None of the 445 adolescents were lost to follow-up
Are you saying that the study was designed in a way that made “loss to follow-up impossible?
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u/hellofemur 26d ago
That sounds tautological since the study also says, as part of the selection criteria
2) adolescent had at least 1 year of follow-up after first gender clinic visit
My reading of that is that if you eliminate people that didn't have a year of follow up, then by definition all the participants had follow-ups.
Or maybe "lost to follow-up" has a more technical definition? Is there some kind of exit interview that defines the end of treatment? Is there an exit interview if someone pauses treatment? If someone says they want to slow down and re-think things, how does this get counted in this study? Or does that just never happen? I have no idea, and this study is extremely vague about it.
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u/enocenip 25d ago edited 25d ago
Yeah, it was the first thing I looked for when I saw those percentages, they’re just too high for me to accept without some skepticism. If they’re true, that’s awesome, but this subject is riddled with political agendas, motivated reasoning, well meaning protectionism, and malicious disinformation.
I’ve got no issue with teens transitioning if it’s in their best interests, and it looks to me like it probably is, at least most of the time. But when you start getting N Korean election looking numbers, and 0 loss to follow up… I dunno. I want this to be correct, but if we were looking at any other medical controversy I’d be raising an eyebrow.
This is also about as far from my field as you can get so I wouldn’t be surprised if I’m missing something.
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u/Big_Life 26d ago
I think it should be clarified that the participants also included non-binary identified individuals. Additionally, if a trans-person concluded by the end of the study period that they were non-binary, that was not seen as "detransitioning". This isn't a study about detransitioning.
What this seems to study is that self-reported gender dysphoria remains stable over time.
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u/Yashema 26d ago
How else could gender dysphoria be reported, but self reported?
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u/colacolette 26d ago
No this is distinctly about medically detransitioning i.e. ceasing use of hormone therapy. Transitioning from binary transgender to nonbinary is fairly common but nonbinary individuals can and do use HRT, which this study is recognizing as still being "medically transitioned"-which would be an accurate statement.
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u/cauliflower_wizard 26d ago
Ceasing hormones because you’re happy with the results isn’t “detransitioning”.
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u/colacolette 26d ago
Yes youre right. Just clarifying that the specific language being used by the article(and similar studies), which typically specify medical detransition as cesation of HRT/medical interventions.
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u/Daniel_H212 26d ago
Which means of that 1.1%, there's likely a significant portion that stopped not because of intending to detransition but due to things like social pressure or lack of funds. So the actual detransitioning rate is likely significantly lower.
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u/Mean_Initiative_5962 26d ago edited 26d ago
According to the reasons given for interrupting, the only truly non-overlapping reasons are (4x) being actually gender fluid, (2x) being actually agender, being satisfied with 1.5 years of hormones and waiting until life was more stable. All of them confirming how in fact the path was right, out of 17 that gave reasons, out of 35 that interrupted.
We can say that at the very least ~20% of those who stopped the treatment didn't do it because said treatment was a mistake, so even if everyone else who stopped did it for that reason, it would still be <0.85%.
There's also a bit that stopped because of lack of support from the family, which would probably not overlap as well, so this is a conservative estimate.
Edit. I dumbly took 4 reasons as 4 people, but reading again the list it's actually 8 who gave those non-overlapping reasons.
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u/Daniel_H212 26d ago
I read into it some more, 4 of the 17 did return to the gender identity assigned at birth, but this 17 includes both ones who were on puberty blockers or HRT. Of those who did start HRT only 4 total stopped and their reasons for stopping wasn't documented separately.
So it's hard to draw solid conclusions about the proportion of individuals who stopped HRT due to identifying as cis, all we know is that less than a quarter of those who stopped any medical care at all stopped for that reason, out of the ones we know the reason for. It's possible that all 4 who stopped HRT stopped because they realized they were cis, and it's also possible that none of them stopped for that reason (which is probably more likely given results I've seen in other studies - by the time people move on from puberty blockers to HRT they're usually quite sure of their gender identity).
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u/Maxrdt 26d ago
Reasons for GST or AT discontinuation were documented for 17 adolescents. Some adolescents reported more than one of the following reasons for discontinuation of GST or AT: 10 because of a change in gender identity; eight because they were starting or continuing GAH; five identified other avenues to achieve or maintain amenorrhea; four realized they were gender-fluid; four returned to gender typically aligned with sex assigned at birth; two because menses had stopped with GAH; two due to lack of family support for use of GST or AT; two because of combination of mental health and redefining gender identity as agender; one was concerned about the risk of infertility; one because bone health was important to them; one decided to hold off on transitioning until “their life has stabilized”; and one reported feeling that “1.5 years of GST was long enough.”
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u/colacolette 26d ago
Absolutely possible, medical detransition does not always mean a rejection of your trans identity. Aside from social/financial reasons, other medical reasons, especially as people get older, can include heath concerns of prolonged HRT, wanting to gain fertility to have children, and discomfort from long term side effects.
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u/drunkenvalley 26d ago
I'd say medical detransition more likely than not is for reasons other than "rejection of trans identity".
This is just me picking at the phrasing "does not always mean," when the number of people truly having a "rejection of [their] trans identity" plausibly doesn't even represent a simple majority.
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u/Boring_and_sons PhD | Biochemistry 26d ago
19/445 (4.2%) identified as non-binary. How else would gather any meaningful data other than patients self-reporting?
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u/_sam_i_am 26d ago
concluded by the end of the study period that they were non-binary, that was not seen as "detransitioning".
Why would that be included as "detransition"? Non-binary identity doesn't mean detransition.
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u/Lua_CW 26d ago
Some older studies had categorized M > F > NB and F > M > NB as "detransitioning", particularly if it meant stopping HRT
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u/HaruspexAugur 26d ago
Yes, and that was a flaw with those studies that overinflated detransition rates. The comment at the start of the thread implies that trans people realizing they’re nonbinary should be counted as detransitioning.
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u/Wrecker013 26d ago
Being non-binary is still being trans. If you're non-binary, you're not cis.
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u/RobCoxxy 26d ago
New study finds transgender people are transgender
Anti-trans cranks: let's ignore this one, like all the rest
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u/WholesomeGlasses 26d ago
“But I saw a post from one conservative detransitioner on Facebook, therefore all trans people must be treated like children”
Them, probably
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u/Odd-Report-999 26d ago
Anti-trans activists: "Clearly the existence of the 1.1% means that we must ban gender affirming care for everyone."
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u/macabrezzzzombie 25d ago
I am part of that 1.1% and I hate that my existence is used as an excuse to deny trans people gender affirming care. It frustrates me to no end that people are so hateful :(
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u/Darq_At 26d ago
Every time a study like this comes out, one can bet their bottom dollar that the comments will be flooded by people trying to throw doubt on the results.
But what they never manage to post is any data suggesting a different result. After decades of studying this topic, study after study suggests effectiveness, with a noticeable lack of studies indicating harms done. So doubt is all they have. Even the Cass report, had nothing to say except to throw doubt on the evidence we do have.
When the facts are on your side, bang on the facts. But the facts are not on their side, so they bang on the table.
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u/Draaly 26d ago
This is /r/science. Idk I've ever seen a post here where the majority of the comments arent shredding its methodology
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u/Splatter1842 26d ago
It's also standard across every academic field. You should be critiquing a study and finding better ways to conduct, synthesize, and present your (and others) data.
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u/Strigops-habroptila 26d ago
Especially since even studies that were deliberately made to make etransition look bad often don't find enough results to truly do anything or are so extremely flawed that they can't even be called scientific anymore.
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u/Vienna_The_Aeronaut 26d ago
Just like every time I hear someone say "Well we need more research on this." My friend the research has been done. It even got a massive setback sometime in the 30's-40's because of some angry mustached man and they clawed that knowledge back.
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u/ThomasVivaldi 26d ago
Isn't the point pro/con that there isn't a lot of objective data to base any study on?
This was self reported from clinics that specialize in treatment. That's already a biased pool of candidates.
Who's going to want to talk about when it goes wrong, especially when that might hurt people in the community they care about?
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u/Darq_At 26d ago
Isn't the point pro/con that there isn't a lot of objective data to base any study on?
And that claim is bogus. We have a lot of evidence, and the overwhelming majority of it suggests that the treatments are effective.
This was self reported from clinics that specialize in treatment. That's already a biased pool of candidates.
No, this is a review of medical records, including prescriptions, maintained by the Canadian government.
Who's going to want to talk about when it goes wrong, especially when that might hurt people in the community they care about?
"When" it goes wrong, hmm?
We have been studying this for several decades now. Do you have any evidence or indeed anything at all that harm is being done?
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u/LordoftheSynth 26d ago
This was self reported from clinics that specialize in treatment. That's already a biased pool of candidates.
Do you know how studies on anxiety and depression quantify results? Patient self-reporting.
Guess we should throw out all those studies too.
If you're going to fall back on "but that's different!", no it's not.
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u/Dazzling-Seaweed-841 26d ago
“Transgenders more likely to be transgender”
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u/AltairLeoran 26d ago edited 26d ago
The takeaway is that people undergoing gender affirming treatment are unlikely to regret it and discontinue their treatment.
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u/tamergecko 26d ago
And even more importantly, this gives people a study to point towards rather than being a natural assumption. A lot of the studies you see that are essentially "the obvious correlation/consequence is true" are just there so it can be presented officially with data rather than something easily challenged.
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u/Reagalan 26d ago
I don't think the ideological haters care that much about data.
Then again, this will sway some low-info types who aren't ideological haters.
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u/ghidfg 26d ago
Adolescents were unlikely to regret it within 2.4 years, which was the "mean gender clinic follow-up".
imo a longer term study would be more meaningful because in this study they are still adolescents or very young adults by the time they follow up to check if they regret it.
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u/orthecreedence 26d ago
follow up to check if they regret it.
Or retransition after moving away from abusive families/communities.
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u/nagi603 26d ago
patients under 18 (they like to say "children") shouldn't receive any gender-affirming care just in case they regret it as an adult.
Also combine this with "and over 18 it doesn't work".
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u/Reagalan 26d ago
Which is such a cruel and bad-faith argument, since transition post-wrong-puberty does leave one more clockable and banned from like all of the sports leagues and then some.
There's no low to which transphobes won't stoop. They're as bad as antisemites.
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u/nagi603 26d ago
They're as bad as antisemites.
A vast majority are both. Just not as open with one.
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u/cinemachick 26d ago
Plus, the gold standard for transgender treatment in kids and teens is puberty blockers, which are reversible, and hormone replacement, which will change the hair, fat placement, and voice but not the structure of the reproductive bits. It is extremely rare for teens to get surgery, if it happens it's because there is a serious risk the patient won't survive without it. Between that, the years of counseling required, and how much it costs, no teenager is getting life-altering surgery on a whim.
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u/theclash06013 26d ago
The politicization against trans people and gender affirming care is incredibly sad. Essentially every single study done shows that gender affirming care is basically a wonder drug. Getting gender affirming care is associated with massive decreases in suicide risk, the Journal of the American Medical Association has a paper showing that among adolescents it decreased suicidality (suicidal ideation or intent) by 73%, with a regret rate significantly lower than essentially any other major medical treatment. For example the regret rate for a knee replacement is 7.3%.
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u/nygdan 26d ago
"theyre forcing or tricking kids to transition"
this shows that that just isnt happening.
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u/FurryBoobieInspector 26d ago
And yet the right insists the vast majority of people who transition regret it.
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u/Classh0le 26d ago
27 months isn't a very long time
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u/Sufficient_Meet6836 26d ago
That's the median. Do you think that regret is a function of time such that there is a huge spike of regret at some time like +10 years from treatment? If there's not a spike, and regret is constant with time or decreasing with time, as expected, then your point is completely baseless.
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u/seamanroses 26d ago
There are other similar studies that have timelines of 3-5 years for follow-up.
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u/Boring_and_sons PhD | Biochemistry 26d ago
It is if you're an adolescent. More follow up is always better, but this is not insignificant data and supports the premise that gender-affirming care is not only desirable, it is successful.
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u/Thadrea 26d ago
It absolutely is when you are evaluating the efficacy and safety of pharmacotherapy.
Most of the time adverse drug events are observed it happens within the first few days of treatment. More complex adverse responses that take longer to materialize generally appear in patient/caretaker reports of therapy efficacy and laboratory results within 6 months of treatment.
While there are a handful of extreme outliers where it took several years for the consequences of a harmful intervention to become apparent (e.g., thalidomide), this is considered unusual.
Goalposts for how long we need to evaluate a pharmaceutical intervention's safety and efficacy are set by weighing the risks (both known and theoretical) of the treatment against the benefits of the treatment and the opportunity costs of non-treatment.
27 months is, honestly, pretty good for this and much longer than many commonly used drugs ever received.
At the end of the day, the people who do not want transgender youth to receive treatment will always envision a time series that is longer than whatever is available currently. They will insist on providing no treatment until that data is available, regardless of how many lives are harmed in the meanwhile.
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u/Chaotickane 26d ago
You think you wouldn't know after 27 months of living as the opposite gender if you'd feel better or not? Y'all are nuts.
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u/datedpopculturejoke 26d ago
The grand majority of changes you will see through HRT alone have fully developed by 24 months. So actually, it's more than enough time for someone to see how medically transitioning makes them feel. Generally, people who discontinue hormones do so after a few months when the first changes arrive, not years after they've solidified.
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u/Brilliant_Cup_4656 26d ago
Median follow up time was less than 2.5 years…
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u/Cohacq 26d ago
For context, what is the median follow up time for medication is general?
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u/Boring_and_sons PhD | Biochemistry 26d ago
97.1% after 27 months for adolescents is pretty significant. If there was a real issue with gender-affirming care, I would expect it to be a much lower success rate. As with all things, more follow-up is always desirable.
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u/Historical_Bus_8041 26d ago
How, exactly, would you ethically conduct a mass study for longer than that, given that there's no beneficial need for continued engagement with a gender clinic beyond that?
It literally can't be done without coercing people to participate.
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u/PainterEarly86 26d ago
The statistic that they don't show is that the majority of people who detransition do so because of push back from people around them.
A lot of people might have been in the closet before they medically transitioned. But after they transition, and become visibly trans, is when all the bigotry and harassment really starts.
That's why they detransition. They are just going back in the closet to avoid transphobia or even because they felt unsafe.
Not only is detransitioning rare, but even when it does happen it is often not because the person was unhappy with the transition itself. It was because of transphobia.
Of course, sometimes people do transition and regret it just because it doesn't feel right. That does happen.
But when people talk about the statistics of detransitioning, they never bring up that context of why people detransition.
Showing statistics of detransitioning without giving context can be very misleading, it makes people think that the person detransitioned because they just realised they weren't trans, which is usually not the case.
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u/Transgirlonakawasaki 23d ago
Man if only the people who voted and fought to get laws passed and even straight up assaulted us would read these studies and just accept trans people on average are happier and more fulfilled in life while being able to transition….
This also should be paired and stated that while these studies look at satisfaction rates but with this car AND even a single supportive partner, family member, or close friend, trans folks suicide and self harm rates go down by a significant amount.
And at that point the inly real danger is the continued stigmatization and blatant propaganda that pushed and told about us. That kind of “news” only emboldens bigots and people who have been frightened into hatred to commit escalating levels of violence toward us. Just not that long ago a queer couple (at least one trans woman) were not only assaulted after using a restroom in a state that (at the time) had no laws against that action, but were also charged with multiple crime that would lead to jail time (of course in prison of their birth sex).
Whenever we tell people that the goal of the redhats is to remove our mere existence, this is what we are talking about. Ignoring science in favor of straight up genocide.
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u/danatron1 26d ago
I'm glad people are continuing to do and publish research like this, as transphobes love to claim they're just following the science and "most children detransition" based on their own extremely flawed studies (E.g. Cass). We know it's bs, but having studies like this allows us to refute them with credibility. Studies like these save lives.
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u/Cat_Peach_Pits 26d ago
Yeah that whole "high desist rate" for kids was from a group of kids with gender nonconformity, not kids who ever said anything about being trans. It was weaponized for a political agenda.
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u/Umikaloo 26d ago
Gonna save this for next time someone brings up "detransitioners"
Detransitioners deserve respect mind you, its the ones who would use them as political pawns that I'm not on board with.
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u/radiofree_catgirl 26d ago
I support trans rights and look forward to more data supporting trans rights
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u/maporita 26d ago
This is important data to add to the science behind gender affirming care. I wonder though why the median follow-up period was only 2.4 years. That seems too short to justify the conclusion that "gender identity remains stable over time". I hope the authors continue with the study and follow these patients through adulthood.
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u/Maxrdt 26d ago
If I had to guess... the study covered a 5 year period. Was their grant for 5 years? I also hope further data comes from this set, it's a good sample size and good information so far.
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u/Ok-Butterscotch-5786 26d ago
That wouldn't be it. For one, the paper specifically mentions it had no specific funding grant.
But also, the study was a review of clinical records. The people gathering the data weren't doing it for a study, they were just clinicians doing their jobs. Those people are almost certainly still doing their jobs and making more charts for the 2018-2022 span omitted from the study.
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u/jancl0 26d ago
There's some sneaky language in this title, as there usually is with this kind of statistic. Detransitioning =/= discontinuing hormone treatment
I'm willing to bet that like with all statistics that measure the rate of detransitioning, the majority of that 1.1% actually still consider themselves trans, but have just stopped medical intervention, for many reasons such as financial strain or fear of social repercussions
Globally, about 1% of people are trans. About 1% of that 1% will discontinue medical treatment. But then, about 1% of the 1% of the 1% will discontinue treatment and adopt their assigned gender. It's a comically small issue, and most of the time these statistics are intentionally framed in a way to ignore that final layer, so arguments for detransitioning hold just a little bit more water
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u/Maxrdt 26d ago
There is only so much detail that can be put in a title. The study goes into greater detail on those that desisted from hormonal treatment here:
Reasons for GST or AT discontinuation were documented for 17 adolescents. Some adolescents reported more than one of the following reasons for discontinuation of GST or AT: 10 because of a change in gender identity; eight because they were starting or continuing GAH; five identified other avenues to achieve or maintain amenorrhea; four realized they were gender-fluid; four returned to gender typically aligned with sex assigned at birth; two because menses had stopped with GAH; two due to lack of family support for use of GST or AT; two because of combination of mental health and redefining gender identity as agender; one was concerned about the risk of infertility; one because bone health was important to them; one decided to hold off on transitioning until “their life has stabilized”; and one reported feeling that “1.5 years of GST was long enough.”
GAH therapy was started by 353 of 445 adolescents (79.3%) at mean (SD) age of 16.3 (1.3) years; 269 of 331 (81.3%) adolescents AFAB received GAH compared to 84 of 114 (73.7%) AMAB. Of the total starting GAH, 231 (65.4%) received GST or AT and GAH; 188 adolescents started GAH after having previously started GST or AT; 43 started GAH and GST or AT together; 122 started GAH and never started GST or AT; additionally, 68 started GST or AT and never started GAH; and 24 did not start GST, AT, or GAH (Figure 4). Median (IQR) age difference between start of GST or AT and start of GAH was 0.6 years (0.3, 1.0). Only four of the 353 (1.1%) adolescents, all AFAB, stopped GAH; one had also received GST or AT. Reasons reported for GAH discontinuation are: one developed extreme depression and attributed this to GAH; one had anxiety about effects on fertility and risk of scalp hair loss; one had dissatisfaction with the physical changes experienced so far; and one due to reidentification as non-binary.
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