New Study: Trans Youth Satisfied 6-10 Years Later With Very Low Loss To Follow Up

The study is the latest in a huge number of studies showing high levels of satisfaction with trans care in the United States, and represents 6-10 years worth of follow-up.

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A new study published in JAMA Pediatrics explores the long-term experiences of transgender youth, focusing on individuals six to ten years after transitioning. The findings show that transgender youth who transition at a young age report high levels of satisfaction with their care. Notably, only 3% of participants discontinued hormone therapy, according to the study's main sample. The research employed innovative methodologies to address “loss to follow-up,” a common issue when participants stop responding to surveys, and utilized a prospective approach. This study is likely to become one of the most significant pieces of evidence countering critics who argue for banning transgender care.

The study began recruiting participants in 2013, with final recruitment completed by 2017. All participants were 12 years old or younger at the time of enrollment. Researchers followed these individuals through their transitions and gender-affirming care, conducting multiple surveys along the way. The survey referenced in this study was issued in 2023. The study included only those who had started gender-affirming care—269 youth in total. Of these, 220 responded to the 2023 survey, and researchers found that just 3% had discontinued care. Additionally, satisfaction rates were extremely high, averaging 6.5 on a 7-point scale, demonstrating that 6 to 10 years after transition, transgender youth remain highly satisfied with their treatment and overall experiences.

One of the most innovative aspects of this study wasn't just its prospective design but how it addressed a common issue known as “loss to follow-up.” Many studies that rely on surveys to collect patient experiences around medical care experience this problem, which occurs when a significant number of participants fail to return surveys. This is a frequent challenge in survey-based research. Critics of transgender care often exploit this issue to dismiss studies showing the positive effects of gender-affirming care, arguing that those who didn’t respond likely had negative experiences, despite no evidence that this is the case.

The study dealt with this problem by utilizing clinical notes, following up directly with a subset of the questions, evaluating patient emails, and even looking at hormone discontinuation rates among those who did not follow up. What they found was that those who did not follow up had very similar continuation rates for gender affirming care to those who did follow up, only around 6% in the secondary sample discontinued hormone therapy. This finding is important, as it will likely neuter further attempts to argue that loss to follow up is a significant issue in research around gender affirming care, which was an argument used by the Cass Review which has been used to crack down on youth and adult care in the United Kingdom.

You can see a comparison of the main sample (those who answered the survey) to the secondary sample (those who did not) here:

Table 3 - JAMA Pediatrics - Levels of Satisfaction and Regret With Gender-Affirming Medical Care in Adolescence

The findings of this study align with other recent research, including a study from Australia that also used innovative methodologies to address the issue of “loss to follow-up.” That study, also published in JAMA Pediatrics, found that only 4% of transgender youth reidentified with their sex assigned at birth. It successfully collected data on 548 of 552 patients by using clinical notes to support its conclusions. Similarly, studies in the United States have reported very low rates of desistance or detransition. A Dutch study also reported comparably low rates, along with many other studies. According to a review of literature by Cornell University, the regret rate for gender-affirming care ranges from 0.3% to 3.8%, depending on the study's methodology.

Within hours of its release, anti-trans activists and bloggers, including Benjamin Ryan, published critiques of the study. They argued that the participants were not representative of transgender youth today, noting that the sample included a higher proportion of individuals assigned male at birth than is typically seen. Critics also pointed out that the population studied was younger and more affluent than average. Additionally, they claimed the follow-up period was still too short, referencing the Cass Review and speculating—with little evidence—that detransition might commonly “take five to 10 years” to occur.

A closer look at the study reveals that a substantial number of respondents—98 in total—were assigned female at birth. While the sample skews young, similar findings were reported in the Australian study, which had a median participant age of 15. Critics of transgender care, like Ryan, seem to continuously push the timeline for follow-up studies further back.

Cass, who Ryan cites, speculates that detransition may take 5-10 years based on conversations with clinicians, but the data that Cass uses does not support this claim well. Cass cites a single study involving 41 adults—an extremely small sample—where 20% discontinued hormones, most of them transgender men. However, stopping hormone therapy among transgender men does not necessarily indicate detransition, as many masculinizing effects do not require ongoing treatment. In fact, half of the patients who discontinued hormones in that study did not detransition but continued to identify as transgender or nonbinary. Cass’s own review only identified 10 cases of detransition out of a sample of 3,000 youth who either began gender-affirming care or were on waiting lists. It’s also important to note that most gender-affirming care is currently blocked for both trans youth and many adults in the United Kingdom.

Claims that longer follow-ups are necessary appear increasingly reactionary, especially as more long-term studies consistently show that transgender individuals maintain their gender identities over time, and future research is likely to do the same as study populations age. Meanwhile, studies like the one recently published in Nature Human Behavior highlight the devastating impacts of anti-trans laws. With a sample size of 61,000 trans youth and a six-year follow-up, this study found that such laws lead to a staggering 72% increase in suicide attempts. This sample size is orders of magnitude larger than those cited by Cass and other anti-trans activists, making the findings even more compelling.

This study is poised to become a cornerstone in affirming the importance of gender-affirming care for transgender youth. Its extended follow-up period and findings that show no significant differences between those who completed follow-ups and those who did not directly rebut common anti-trans arguments. The innovative methodology strengthens the case for previous studies, undermining the assumption that those who fail to follow up regret their care. As more research like this emerges, it becomes increasingly clear that claims questioning the effectiveness of gender-affirming care lack a solid foundation and will continue to fall short.

Correction: A previous version linked to a different study on GLP-1 medications. The correct study can be found here.