ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This retrospective cohort study investigated referral closures due to reidentification with birth-registered sex at the Child and Adolescent Health Service Gender Diversity Service in Perth, the sole provider of gender-affirming medical treatment for individuals <18 years in Western Australia. Out of 548 referral closures, 29 reidentified with birth-registered sex. Only 2 did so after having started medical treatment, constituting 1.2% (95% CI, 0.1%-4.4%) of all adolescents who had initiated puberty suppression and 0.8% (95% CI, 0.0%-4.1%) of those who had initiated gender-affirming sex hormone treatment.

A few studies, from the US and Europe, previously investigated treatment continuation in transgender and gender diverse adolescents. They had reported continuation rates for gender affirming sex hormone treatment varying from 74% after 4 years to 98% after a median 3.5 years (IQR 1.5–7.6; range 0.1–20·0) for transfeminine and 2.3 years (1.2–4.8; range 0.0–15.5) for transmasculine individuals (1-3). This study from Australia, which has seen a similar exponential increase in referrals of adolescents for gender affirming care as Europe and the US, found that of adolescents who reidentified with their birth-registered sex, nearly all did so before they started medical treatment. Another recent retrospective cohort study by Gupta et al. from Atlanta, US, found that out of 121 adolescents who started gender affirming sex hormone treatment before age 18 years, only 3 temporarily discontinued treatment and only 1 permanently stopped, but none reidentified with their birth-registered gender and none expressed regret about receiving the treatment (4). Reasons for (temporarily) stopping treatment were bullying, insurance issues, wanting to conceive a baby and transition to a non-binary gender.

Discontinuation of treatment seems uncommon in the Australian and European studies, can have many reasons and is not necessarily associated with retransition or regret. Further research is necessary to better understand retransition and optimise care for those who wish to retransition.

References: 1. van der Loos MATC, Hannema SE, Klink DT, den Heijer M, Wiepjes CM. Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: a cohort study in the Netherlands. Lancet Child Adolesc Health. 2022 Dec;6(12):869-875. doi: 10.1016/S2352-4642(22)00254-1. Epub 2022 Oct 21. PMID: 36273487.2. Butler G, Adu-Gyamfi K, Clarkson K, El Khairi R, Kleczewski S, Roberts A, Segal TY, Yogamanoharan K, Alvi S, Amin N, Carruthers P, Dover S, Eastman J, Mushtaq T, Masic U, Carmichael P. Discharge outcome analysis of 1089 transgender young people referred to paediatric endocrine clinics in England 2008–2021. Arch Dis Child. 2022 Jul 18:archdischild-2022-324302. doi: 10.1136/archdischild-2022-324302. Epub ahead of print. PMID: 35851291.3. Roberts CM, Klein DA, Adirim TA, Schvey NA, Hisle-Gorman E. Continuation of Gender-affirming Hormones Among Transgender Adolescents and Adults. J Clin Endocrinol Metab. 2022 Aug 18;107(9):e3937–e3943. doi: 10.1210/clinem/dgac251. PMID: 35452119.4. Gupta P, Patterson BC, Chu L, Gold S, Amos S, Yeung H, Goodman M, Tangpricha V. Adherence to Gender Affirming Hormone Therapy in Transgender Adolescents and Adults: A Retrospective Cohort Study. J Clin Endocrinol Metab. 2023 Oct 18;108(11):e1236-e1244. doi: 10.1210/clinem/dgad306. PMID: 37246711; PMCID: PMC10583985.