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Fact check: Transgender regret rates
Executive Summary
Recent systematic reviews and cohort studies converge on a low prevalence of permanent regret following gender-affirming surgery and medical transition, but estimates vary by study design, population, and outcome measured. Surgical regret is consistently reported near 1–2% in pooled analyses, while hormone discontinuation and detransition are more complex phenomena driven by medical, social, and access-related factors rather than a simple metric of “regret” [1] [2] [3] [4]. Context matters: transfeminine patients appear in some reviews to have higher reported rates of post-surgical regret than transmasculine patients, and many who stop hormones cite side effects or barriers rather than desire to reverse transition [2] [3] [4].
1. Why the headline numbers cluster around one percent — and what that really means
Multiple systematic reviews and meta-analyses place postoperative regret after gender-affirming surgeries at approximately 1% to 2%, with one pooled estimate of 1% from a 2021 meta-analysis and another pooled estimate of 1.94% reported in 2024 [1] [2]. These figures arise from aggregating studies that differ widely in follow-up length, surgical procedures included, geographic setting, and definitions of “regret,” so the pooled estimates reflect an average across heterogeneous datasets rather than a single universal risk. Methodological heterogeneity — including variable follow-up times, loss to follow-up, and different thresholds for reporting regret (clinical reversal versus dissatisfaction) — makes direct comparison with other surgical regret rates imperfect, though the consistent message is a low absolute prevalence in aggregated clinical series [5] [6].
2. Differences by transfeminine versus transmasculine pathways and the implications
Several reviews highlight higher reported regret among transfeminine patients compared with transmasculine patients in pooled analyses, with one review reporting roughly 4.0% for transfeminine versus 0.8% for transmasculine patients [2] [6]. These differences may reflect variations in types of surgeries, sociocultural pressures, access to comprehensive perioperative support, and study sampling rather than innate differences in suitability for transition. The literature also points to psychosocial drivers of regret — difficulties adjusting to a new gender role, ongoing discrimination, and life circumstances — suggesting that regret often reflects postoperative social context as much as surgical outcome [7] [1]. Any interpretation must account for these nonmedical influences on long-term satisfaction.
3. Detransition and hormone discontinuation: nuanced realities, not a single statistic
Longitudinal studies of hormone use and qualitative reviews show that discontinuation of hormones and detransition are distinct outcomes and that many who stop hormones do so for medical side effects, financial or access barriers, or evolving identity rather than clear-cut regret [4] [3]. A 2022 cohort found a 4-year continuation rate of about 70.2% overall, with higher continuation among transfeminine people (81%) than transmasculine people (64%), which some interpret as higher detransition rates among certain groups but which also reflects complexity in real-world adherence and care continuity [3]. Qualitative metasummaries from 2024 emphasize varied motivations and recommended patient-centered psychotherapy and support rather than assuming cessation equals regret [8].
4. Why psychosocial context and measurement choices drive reported causes of regret
Across systematic reviews, the most common reported sources of regret are psychosocial — difficulty living with a new gender role, discrimination, and unmet expectations — rather than purely surgical complications [7] [1]. This pattern indicates that improving preoperative assessment, expectations counseling, long-term psychosocial support, and societal acceptance could reduce regret attributable to life circumstances. Measurement choices matter: studies that classify regret narrowly (surgical reversal only) will report lower rates than those including any expressed dissatisfaction. High-quality prospective follow-up with standardized definitions is the recurring recommended fix to make comparisons meaningful [1] [2].
5. Balancing evidence: what policymakers, clinicians, and patients should take away
The evidence consistently shows low pooled prevalence of surgical regret but highlights substantial heterogeneity and nonmedical drivers of dissatisfaction; hormone discontinuation and detransition require separate attention because many cessations are not expressions of regret [1] [2] [4]. Policymakers and clinicians should avoid extrapolating a single “regret rate” to all populations and instead prioritize longitudinal data collection, standardized outcome definitions, and access to mental-health and social support services that address discrimination and life-course factors linked to regret. Researchers should standardize follow-up and reporting to reduce ambiguity; stakeholders should recognize that numbers alone do not capture the lived complexity documented across studies [5] [8].