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Study suggests discontinuation of gender-affirming hormones in those who start treatment as adolescents is rare

98% of adolescents with gender dysphoria who initiated gender-affirming hormone treatment as adolescents continued use at follow-up.

Photo by Kamaji Ogino from Pexels.com

Among individuals treated at a gender identity clinic, those who used puberty suppressing treatment before the age of 18 and then started gender-affirming hormones, 98% (704 out of 720) continued use at follow-up, according to an observational study published in The Lancet Child & Adolescent Health journal.

Puberty suppression and gender-affirming hormone treatment for people under 18 years old has recently become a subject of public debate and in some countries legal measures have been taken to ban or limit its use, such as in the USA and UK. Although short-term studies have demonstrated the beneficial effects of puberty suppression treatment for adolescents’ mental and physical health, long-term follow-up data are lacking.

Included in the study were 720 people, of whom 31% (220) people were assigned male at birth (AMAB) and 69% (500) assigned female at birth (AFAB). For AMAB people, the median age was 14 years old when starting puberty suppressing treatment and 20 years old at the end of follow-up. For AFAB people, the median age was 16 when starting puberty blockers and 19 years old at the end of follow-up.

Out of 720 individuals in the study, 704 continued using gender-affirming hormones until follow up– amounting to 98% of individuals continuing hormone therapy.

Regarding the 2% (16 out of 720) of people no longer using gender-affirming hormones, it remains unknown whether they stopped using hormones because they regretted transitioning or changing their gender. The authors stress there are several plausible explanations, including lack of knowledge on the importance of continuing hormone treatment after gonadectomy (surgical removal of either the testes or the ovaries), or participants with non-binary gender identity only wanting to use hormone treatment for a short period of time. The authors recommend that future research should identify reasons why a small number of people who initiate this treatment as adolescents subsequently stop taking gender-affirming hormones.

The study did not identify any factors associated with a higher chance of stopping gender-affirming hormone treatment. The individuals’ age or the year when they first visited the clinic, when they started puberty supressing treatment, when they started gender-affirming hormone treatment, and whether they had undergone a gonadectomy were not associated with discontinuation.

An increase in referrals of AFAB individuals to this gender identity clinic after 2012 had been documented, so whether discontinuation rates were different before this year compared to afterward was also investigated. The results suggest that there is no difference between continuation rates before 2012 compared to afterwards.

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