How do regret rates differ between gender-affirming hormone therapy and surgery?
Executive summary
Recent systematic reviews and large studies of post‑operative outcomes report regret after gender‑affirming surgery (GAS) at about 0.3%–2% depending on methodology and cohort, with multiple reviews clustering around ~1% or lower [1] [2] [3]. Reporting on regret after gender‑affirming hormones (and puberty blockers) is sparser in the provided set; adolescent hormone studies report high satisfaction and low reported regret in survey data but critics say longitudinal rates are uncertain because of methodological limitations and attrition [4] [5].
1. What the surgical literature says: very low measured regret
Large systematic reviews and meta‑analyses of GAS find regret proportions that are small—commonly reported near 1% or lower. A pooled meta‑analysis including thousands of patients reported pooled regret at about 1% (95% CI <1%–2%) with transfeminine regret ~1% and transmasculine <1% [1]. Other reviews and a 2024 American Journal of Surgery paper conclude regret after GAS is less than 1% and characterize regret as uncommon compared with many other elective surgeries [6] [7]. Single‑center and specialty‑journal cohort analyses have reported similarly tiny proportions (for example, a report claiming 99.7% of patients did not regret surgery) but methodological differences between studies matter [2].
2. Variation between studies: methods, follow‑up and denominator problems
Reported regret rates vary because studies use different methods: some are systematic reviews pooling many centers, some are single‑center cohorts, and some use cross‑sectional survey instruments that may undercount people who left care or didn’t respond. For example, one US‑focused review reported a pooled prevalence of 1.94% and noted regional and procedural heterogeneity [3]. Critics argue that many clinics’ low regret estimates come from studies that omit patients lost to follow‑up or lack long‑term tracking, which can bias rates downward [5].
3. Hormone therapy: less direct, less complete data in provided sources
Among the provided sources, quantitative regret rates specific to gender‑affirming hormone therapy are not well documented. A JAMA Pediatrics study in the corpus examines satisfaction/regret in adolescents who received puberty blockers and/or hormones but the excerpted material does not give a clear pooled regret percentage in these search results [4]. Commentaries and reviews emphasize that hormone therapy is typically part of a longer pathway (psychotherapy, real‑life experience, then hormones and/or surgery) and that regret after hormones has been less systematically quantified in the cited material [8] [9]. Available sources do not mention a definitive, comparable regret percentage for hormone therapy matching those surgical meta‑analyses.
4. Detransition, attrition and contested interpretations
Some analysts highlight higher estimates of detransition or discontinuation in certain cohorts and warn that attrition from clinics and variable definitions of “regret” or “detransition” can mask true rates [5]. SEGM critiques in the set argue that widely cited low‑regret conclusions sometimes exclude those who stopped attending clinics [5] [10]. Others emphasize that regret is multifactorial—linked to surgical complications, unmet expectations, social stigma, or changes in identity—and that reversals are rare but consequential [8] [7].
5. How to compare hormones vs surgery responsibly
Comparisons should account for key differences: GAS is typically a one‑time, often irreversible procedure with surgical risks; hormone therapy is longitudinal, may be paused or stopped, and has different risk profiles. The surgical literature provides several pooled estimates (roughly 0.3%–2% depending on study), whereas the provided material does not offer a similarly robust pooled estimate for regret after hormone therapy [1] [3] [4]. Therefore, direct numerical comparison is constrained by gaps in available reporting in this document set—available sources do not mention a single, comparable regret percentage for hormones.
6. Implications and open questions
The literature in these search results converges on the conclusion that measured regret after GAS is low in many cohorts but disputed on methodological grounds; some reviews report <1% while at least one US‑focused analysis reported ~1.9% [1] [3] [6]. For hormones, the provided sources document satisfaction studies but lack a definitive pooled regret rate and note concerns about long‑term follow‑up and representativeness [4] [5]. Future clarity requires standardized definitions of regret, prospective tracking with minimal loss to follow‑up, and parallel long‑term studies of hormonal pathways to allow apples‑to‑apples comparison [8].
Limitations: This analysis uses only the documents you provided; claims beyond those documents are not asserted.