It’s a complex question, but we do have some data.
An opinion piece recently came out in the New York Times looking at the ongoing debate on transgender youth. If you’ve read the piece, you might be forgiven for thinking that huge swaths of children are receiving surgery for gender dysphoria, and that many or even most of them regret their transitions. “I realized that I had lived a lie for over five years,” one destransitioning teen told the Times. Members of the trans community who track legislation and critique media coverage called the piece misleading, and even suggested it followed the “climate denier playbook.”
Now, I have no particular stake here. I’m not trans, I don’t work in that area of health care, and I’m a cis man. I am, however, an epidemiologist, and I spend a lot of my time checking scientific facts that are online with the goal of helping people better understand health, science, and how the media covers those things. In this case, one key question arose from the New York Times piece that author Pamela Paul did not really answer: What proportion of people who access medical care to transition genders regret doing so?
You might answer, “Why does anyone care?,” which is, to be honest, not unreasonable. Some proportion of people experience regret for any medical procedure, from chemotherapy to orthopedic surgery. Nonetheless, we don’t see op-eds about the awful risks of hip replacements. It’s inevitable that some percentage of teens who transition will regret it; the real question is whether the medical care is beneficial on the whole—not whether the occasional person later regrets a medical choice they made in their youth.
It’s also important to note that we don’t really care about the crude number of people who regret transition, we care about the rate. If more people choose to transition, then more people, in total, will regret it. If the number of people transitioning goes from (to use arbitrary numbers) 1,000 to 100,000, but the number of people regretting it goes from 50 to 100, then the rate has dropped massively and it’s a very good thing, even though the crude number has doubled.
A good place to start when looking at the rate of regret for people transitioning in modern medical settings is to think about the upper and lower bounds. The highest estimate that I’ve come across is this recent study of people using the U.S. military health care system. It doesn’t deal with regret head-on, though. The authors looked at transgender or gender-diverse people who were using their parent’s or spouse’s military health care to access hormones for gender-related care, and looked at how many of them stopped getting these drugs over a four-year period. At the end of the study, about 30 percent of the people who started accessing hormones through this system stopped, with a lower rate for kids and higher rate for adults.
(They may have gone elsewhere for hormones, though.)
The lowest estimate I’ve seen for regret after gender-related care is based primarily on people who have had gender-affirming surgery. A recent systematic review and meta-analysis—a type of study where the authors aggregate lots of papers into one big estimate—that combined such studies found an overall rate of 1 percent for regret after surgery for both transmasculine and transfeminine surgeries. This echoes other large cohorts which have found that only a tiny proportion of the people who have these surgeries eventually report regretting the procedure.
The issue here is that neither of these extremes are reliable estimates of regret. The 30 percent figure obviously does not map onto regret. Many people stop using their parent or partner’s health care for reasons completely unrelated to transition regret (i.e., divorce). And the studies of surgery in the review are mostly surgeons following up with their own patients, with quite high dropout rates. It’s not surprising that only 1 percent of people report to a surgeon who did an operation that they regret it!
There’s also a problem here about how we define “regret.” One of the biggest studies on transition-related regret was on the Amsterdam gender clinic, including nearly 7,000 people over 43 years. These authors defined “regret” as a patient who came back to the clinic after surgery to access hormones that would reverse their gender transition (and who had this noted in their records). By this definition, less than 1 percent of people regretted their surgery. But this is obviously not a particularly useful definition, because it will miss all of the people who regretted their procedures but went elsewhere for their follow-up care, or simply never got back to the original clinic about their regret.
Perhaps the most useful way to examine regret is to look at the proportion of people who cease their transition and go back to the gender they were originally. A large national study found that 13.1 percent of transgender people participating in the U.S. Transgender Survey reported detransitioning at some point in their lives. I think that’s a fairly reasonable estimate of the rate of people experiencing some measure of regret around their transition experience.
The authors of this study are careful to argue that the 13.1 percent figure isn’t a measure of regret, saying that “these experiences did not necessarily reflect regret regarding past gender affirmation.” Most of them reported that external factors were behind their detransition—a common reason was “pressure from a parent”—and all of them still identified as trans when they took part in the survey.
However, I think that the figure in that study is useful for precisely the reasons discussed in the study itself: Neither detransition nor regret are simple concepts. Transition, as with all social phenomena, is complex. You can stop taking hormones and still be trans. You can regret taking steps that alienate you from your family, even as you wish your family would accept you living how you want to live. You can even regret some aspects of a treatment (any kind of medical treatment!) while being grateful for the knowledge you gained by trying it out. Regret doesn’t always mean that people wish they hadn’t transitioned, it just means that there are some parts of the story that they long to change.
Paul published a short follow-up in the Times pushing back on criticisms of her column, arguing that we simply don’t know how many trans teens will seek medical care and then go on to detransition. It’s true that we don’t have good U.S. data on the number of people who detransition, but other countries have fairly useful, recent papers showing that detransition is quite uncommon. Paul even cited one of these in her piece, although she dismissed it out of hand. It’s possible that we don’t have all the information yet, but we can consider the constellation of evidence that we do have. What’s clear from this evidence is that the vast majority of people do not experience regret, howsoever defined, after transitioning genders. Regret rates are actually much higher for a lot of medical procedures. For example, in the U.S. military study above, 26 percent of children stopped getting hormones through their parent’s insurance after four years; a national British study looking at antidepressant use in children across the country found that half of the kids had stopped taking these medications after just two months.
Ultimately, the question of what proportion of kids or adults regret their transition is only important to a select group: the people who want to transition, and their clinicians. At worst, the rate of regret is still better than other treatments which don’t require national debates over their use, which really begs the question of why anyone who isn’t directly involved with the treatment of transgender people is even weighing in on the topic at all. Indeed, a lot of what I’ve said in this piece has been raised by everyone from journalists to activists to trans folks just trying to live their lives. But as long as columnists are asking questions, maybe I can help by offering answers.
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