- A study published in The Lancet Child and Adolescent Health indicates that it is extremely rare for people who start gender-affirming hormone treatment in adolescence to discontinue treatment.
- Health care providers believe the study dispels the myth that detransition is rampant.
- Providers hope the study offers more reason to validate youth seeking gender-affirming treatment. They shared other ways communities can show support for a population at higher risk for poor mental health outcomes.
People who start gender-affirming hormone treatment during adolescence rarely stop, according to a new studio published in The Lancet Child and Adolescent Health.
The study, the largest to date, indicated that 98% or 704 of 720 participants who began gender-affirming hormone treatment during adolescence were still receiving it at a follow-up appointment.
Although the study was conducted by researchers in the Netherlands, it comes at a critical time in the debate over care for gender-affirming hormones in the United States.
The first trial in the US for a statewide ban on gender-affirming care started last week.
The case, Brandt v. Rutledge, is in response to Arkansas’ first-of-its-kind ban on gender-affirming care in 2021.
three states (Alabama, Texas, and Arizona) followed, with more than a dozen others considering similar legislation.
the American Academy of Pediatrics (AAP) He filed briefs to fight the Arkansas ban and has said he is reaching out to lawmakers to “raise concerns about harmful legislation.”
“It’s very controversial, especially in the US, as some believe that children and adolescents don’t have the capacity to really understand what gender they should be and any discomfort they feel with their bodies is potentially temporary,” she says. Dr Zishan Khanchild, adolescent and adult psychiatrist Mental health. “However, this study suggests that this is not really true for the vast majority of people who take the more extreme measures of stopping puberty and starting gender-affirming hormone therapy.”
Other to studypublished in Pediatrics in July, it also highlighted the rarity of changing gender identity.
He indicated that 94% of the 317 participating patients maintained their gender identity at a five-year follow-up.
According to data compiled by Reuters and Komodo Health, Inc., the percentage of children ages 6 to 17 diagnosed with gender dysphoria nearly tripled to 42,000 between 2017 and 2021.
Experts say that for them, access to gender-affirming hormone treatment can be lifesaving, and they hope this study will help confirm the need for it.
The researchers evaluated medical records from a gender identity clinic in Amsterdam. All 720 participants were using puberty suppression treatment for at least three months before using gender-affirming hormones. They started this treatment to suppress puberty before they were 18 years old.
Of the participants, 31% (220) were assigned male at birth. These individuals had a median age of 14 years when they started puberty suppression therapy and a median age of 20 years after follow-up. The other 69% (500) participants were assigned female at birth and had a median age of 16 years when they began puberty suppression therapy. Their median age was 19 years after follow-up.
The researchers wrote that the time between the start of treatment and follow-up varied by patient and stressed caution in interpreting the data from the shorter intervals. Still, Khan thinks the results are significant.
“What this study shows is that the vast majority of adolescents who make the difficult decision to transition from the gender they were assigned at birth are really committed and in it for the long term,” he says. “This is not just a silly phase that they are going through and a period of time that they will go through because they are not comfortable with the natural changes that every human being goes through going through puberty.”
But what about the 2% who chose to discontinue gender-affirming hormone therapy before follow-up?
The researchers write that they’re not sure why the patients discontinued hormone treatment, noting that it’s unclear if they regretted the decision to transition. They emphasized that there could be many explanations, such as:
- lack of awareness about the need to continue receiving hormonal treatment after a gonadectomy, which is the surgical removal of the testicles or ovaries
- Individuals with non-binary identification who wanted to use hormone treatment for a short period.
“Non-binary has come into use and light more recently,” he explains. Dr. Jennifer Osipoff, FAAP, a pediatric endocrinologist at Stony Brook Children’s Hospital. “Someone who is a trans man who stops taking testosterone may not stop taking it because he doesn’t want to be a man. They may have achieved the masculinization they were hoping to get, like facial hair. It doesn’t mean they weren’t happy with their decision.”
Osipoff agrees that it’s important to do more research on why a small percentage of people stop doing it.
Research published in 2021 he suggested that the reasons for detransition were largely external and included financial, family, and social stigma.
“Some may stop because of the transphobic climate in our society today,” lee phillipsEdD, LCSW, CST, psychotherapist.
Gender-affirming hormone treatment falls under a broader umbrella than gender-affirming care.
Osipoff says gender-affirming care varies by person and can also include providers and surgery using their correct pronouns and names.
The use of hormonal treatments in adolescents has been at the center of controversy in the legal and medical communities. Puberty blockers can delay gender expression features that a young patient may not want, such as:
- breast development
- widening of the hips
- facial hair
- deep voice
Dr. Michelle Forciera FOLX Health Physician, highlights that puberty blockers are reversible. Although it’s rare for teens to change their minds, they can.
“A child can take these medications and stop taking them with no future or lifelong consequences,” she says. “They give youth and parents time to catch up and learn more about their gender identity, understand gender care options, and make careful decisions about their current and future gender identity.”
Research indicates that an adolescent who receives gender-affirming hormone treatment has better mental health outcomes, including a study published in 2022.
In the meantime, a 2020 study conducted by Pediatrics indicated that adolescents who received gender-affirming medical care later in puberty were more likely to have poorer mental health, including depression, and to commit self-harm than their peers who started earlier.
“A lot of young people are relieved when they know they don’t have to go through or continue to go through the wrong puberty,” says Forcier. “They no longer have to look at and live in a body that is going through irreversible changes that mark them physically and socially as being in the body of the wrong gender. With that relief, we can see a reduction in mental health issues like anxiety, depression, suicidality, difficulty concentrating, and difficulties at home and school.”
Forcier and Osipoff say there is some concern about temporary declines in bone mineral density.
A 2020 study suggested that transgender youth in early puberty had lower bone mineral density, but the authors said low calcium intake and physical activity might play a role.
The statistics on mental health and gender-incongruent adolescents are grim.
A 2018 review pointed to research indicating that nearly a third of transgender teens had attempted suicide.
Anxiety and depression are also more common in trans youth than cisgender youth. Non-health care providers can’t administer gender-affirming hormone treatments, but experts share that they can help in other ways, including:
- using the correct pronouns and nouns
- ensure adolescents with gender dysphoria have access to mental health care
- supporting families of youth with gender dysphoria
- increased representation of gender-incongruent individuals
- be anti-transphobic
A small study of 2018 of 129 transgender youth indicated that using a transgender person’s chosen name reduced mental health risks.
Forcier suggests asking everyone about pronouns be normalized so that the burden doesn’t fall on trans and non-binary people.
“When you introduce yourself in conversation, offer and include your name and affirmed pronouns as part of those conversations. Ask others what nouns and pronouns they use,” says Forcier.
Using pronouns on name tags, office doors and social media accounts is also helpful, Forcier adds.
Although gender-affirming hormone treatment may lead to better mental health outcomes, Osipoff stresses that trans and non-binary youth are at higher risk for suicide, depression, and anxiety.
Connecting with a mental health provider who specializes in transgender care can help them navigate their treatment during their gender journeys.
Treatment and support can also help parents and family members.
“It’s important to find support in the community,” Phillips says. “This helps the parent or parents or caregivers feel less alone.”
phillips suggests genderspectrum.orgwhich hosts free online groups for tweens, teens, parents and caregivers.
Forcier advises people to include images and stories about diverse identities in stories, newsletters, and brochures. School officials and other adults can join or support LGBTQ pride events and organizations like Gay Straight Alliances (GSA) so that transgender and non-binary youth feel less isolated.
Finally, Forcier says it’s imperative to eliminate internal and external bias.
“Calling out, correcting, or stopping others who use biased language or discriminate against a TGD person is also important to creating safe spaces for our youth in our communities,” says Forcier.
