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How does the rate of transition regret compare between different age groups?
Executive summary
Available studies and reviews show low reported rates of surgical “regret” (often ≤1–3%) in many historical cohorts, but those estimates are limited by selection bias, short follow‑up for younger patients, and loss to follow‑up; several reviewers and investigators warn that true regret and detransition rates—especially by age at transition—remain uncertain [1] [2] [3]. Studies of younger cohorts report different patterns (mean ages in some recent samples ~19–25), and case reports and clinic investigations highlight that some adolescents who had early procedures expressed regret within a few years [4] [5].
1. Reported rates look low — but the methods matter
Meta‑analyses and large clinic series historically report very low surgical regret percentages (often under 1% in classic series), and systematic reviews document substantial improvements in satisfaction after gender‑affirming surgery [1]. However, authors of those reviews and subsequent methodological critiques emphasize that many of the low estimates come from studies with high loss to follow‑up and selective patient screening, which can bias regret downward [1] [2].
2. Younger people figure prominently in the uncertainty
Recent work and commentary stress that younger cohorts today are different from historical adult cohorts: several studies and reviews note the mean age in some contemporary detransition research is around 19.2 years or mid‑20s, and adolescent pathways have expanded in the last decade—raising questions about how regret rates observed in older, heavily screened cohorts apply to minors [4] [3]. Epistemic gaps remain because few large studies have tracked people who began medical transition as adolescents into later adulthood [5].
3. Timing matters: regret can appear years later
Some analyses cite median times to surgical regret of many years (examples of up to 8 years), and other work reports shorter average times (3–6 years) for groups with mixed interventions (puberty blockers, hormones, surgeries), indicating that short follow‑up windows undercount later regret [3]. Reuters and journalistic investigations found individual adolescent cases who expressed regret within 1–2 years after procedures, illustrating that both early and later regret occur [5].
4. Detransition is not the same as regret — age patterns differ
Scholars warn that detransition (stopping or reversing social/medical aspects) and regret are distinct phenomena: many who detransition do so for external pressures (family, social, medical access) rather than a change of heart, and some who report regret do not pursue surgical reversal [6] [7]. Available samples suggest younger people may be over‑represented among those who detransition or who present to detransitioner groups, but comprehensive, age‑stratified incidence data are not yet available in the literature provided [4] [6].
5. Selection, loss to follow‑up, and measurement vary by study
Critiques emphasize that studies claiming very low regret often excluded substantial fractions of initial patients, used clinic‑based samples with rigorous preselection, or measured regret narrowly (e.g., only those who sought reversal surgery), thereby underestimating lived experiences of regret or discontinuation [2] [3] [8]. Conversely, surveys of detransitioners recruited through social media capture different, potentially nonrepresentative populations with higher reported rates [4] [8].
6. What the reporting shows about age comparisons — and what it doesn’t
Available sources document that earlier cohorts (adults screened under stricter protocols) had low reported regret [1], while recent analyses and commentaries raise concerns that regret/detransition could be more frequent among younger or less‑screened groups—but they stop short of providing reliable, comparative rates by age because of inconsistent methods and follow‑up [3] [2] [5]. In short: studies report low absolute regret percentages in many samples, but available reporting does not provide robust, directly comparable age‑stratified rates.
7. Competing interpretations and implicit agendas
Advocates of gender‑affirming care and several clinical bodies point to low reported regret and benefits of treatment; critics and some clinicians highlight methodological flaws and rising numbers of younger patients as reasons for caution—both positions rely on the same imperfect evidence base and sometimes select different studies to support their view [8] [3] [5]. Some outlets emphasize rare adverse cases to argue for restrictions, while others characterize such cases as overrepresented in media relative to their frequency in clinic cohorts [5] [7].
8. Bottom line and data needs
Current literature indicates reported regret is uncommon in many historical cohorts (often cited ≤1–3%), but the evidence does not yet allow a confident, age‑by‑age comparison because of selection bias, variable definitions (regret vs. detransition), and limited long‑term follow‑up of those who began transition as minors [1] [2] [3]. The field needs large, population‑based, age‑stratified longitudinal studies with low loss to follow‑up and clear definitions of regret and detransition to resolve these questions [2] [5].