A recent study published in JAMA Pediatrics and reported by the Washington Post claims that nearly 97 percent of transgender youths who began hormone therapy did not regret their decision after five years. However, critics have raised concerns about the study's methodology, highlighting issues related to missing participants, higher regret rates among those who discontinued treatment, and the potential for bias in both the study design and media coverage.
Explainer Transgender Rights and Policies: A Comprehensive Overview of Ongoing Debates
The debate centers on whether the headline figures accurately reflect the experiences of all individuals who started hormone therapy as minors, or only those who remained engaged with the treatment facility. Critics argue that the study's findings may not be as representative or conclusive as media reports suggest.
Study Participation and Methodology
The study was conducted at a single transgender health facility and initially assessed 839 young people. Of these, 729 consented to participate in the research. Researchers sent annual surveys to 698 individuals, but 297 did not respond, leaving a significant portion of experiences unaccounted for. Among the 401 who did respond, 25 had never received hormone therapy, resulting in a final sample of 376 participants who had actually started hormone treatment. Four of these did not complete the regret scale, so the widely cited 97 percent figure is based on responses from 372 people.
This means that the 97 percent non-regret rate is calculated from a subset of the original groupβthose who both started hormone therapy and responded to the survey. The experiences of the 297 non-respondents, who represent about 43 percent of those surveyed, remain unknown. This gap in data is a central point of criticism, as it is unclear whether non-respondents had different experiences, including potentially higher rates of regret or discontinuation.
Missing Responses and Regret Rates
The Washington Post reported that researchers surveyed 376 people, but critics emphasize that the survey was actually sent to 698 individuals. The lack of information about the non-respondents raises questions about the generalizability of the study's findings. Among the 376 who had started hormone therapy, 65 were no longer taking hormones at the time of the survey. Of those who discontinued treatment, about 14 percent reported regretβa rate much higher than the overall 3 percent figure highlighted in media coverage.
Researchers did not investigate the reasons why participants discontinued hormone therapy. Notably, eight respondents had reverted to identifying as their biological sex, and seven of those accounted for more than half of the 13 participants who reported regret or harm. Written responses from nine participants who experienced regret or harm indicated that most felt unprepared to make an informed decision due to factors such as age, maturity, mental health, or lack of support at the time they began treatment.
Study Design and Potential Bias
Nearly 92 percent of participants began hormone therapy at age 17 or younger, with the average time since starting treatment around five years. However, some participants had started hormone therapy as recently as 1.2 months before the survey, meaning not all had long-term experience with hormone therapy. Critics argue that including participants with such short treatment durations undermines claims about long-term regret rates.
The study was conducted by staff at the same facility providing the treatments, which followed World Professional Association for Transgender Health (WPATH) guidelines. The authors acknowledged that this relationship could discourage former patients, especially detransitioners, from participating in the survey. Participants were paid between $45 and $65 for completing the survey, with funding from a National Institutes of Health project that received over $2.5 million. An earlier version of the findings was presented at a WPATH symposium.
"How much can we possibly know about long-term regret when some participants have barely begun treatment?"
β Soad Tabrizi, Marriage and Family Therapist
Media Coverage and Alternative Findings
The Washington Post quoted Scott Leibowitz, a WPATH board member, in support of the study's conclusions, but did not include critics or alternative perspectives. The study's authors concluded that their findings support current standards of care and oppose categorical restrictions on minors' access to hormone therapy. Critics argue that drawing such policy conclusions from a single-facility study with significant unanswered questions is premature.
Other research cited by advocacy group Do No Harm suggests higher discontinuation rates. For example, a 2022 study of 952 young patients in the U.S. military health system found that nearly 30 percent stopped hormone therapy within four years. Additionally, a separate survey of 100 detransitioners found that only 24 percent informed their providers they had stopped treatment. These findings raise further questions about the representativeness of single-facility surveys and the accuracy of regret rates reported in such studies.
The Washington Post did not address the missing responses or the higher regret rates among those who discontinued treatment. Supporters of the study's conclusions have not publicly responded to these criticisms. As the debate continues, both the study's findings and the media coverage surrounding them remain under scrutiny for their handling of complex and sensitive issues related to transgender health care and informed consent.
