Op-Ed: Transition and Gender-Affirming Care Is Well-Documented Medical Fact

We at Centre LGBT+ are concerned about an upcoming visit to our community from an anti-transgender activist who espouses a dangerous narrative about the trans community and the experience of “de-transitioning.”

We would like to present a research-supported look at the experiences of transgender people, their medical care and why some trans people de-transition.

Gender-affirming care — which ranges from social transition steps that include simply calling someone by their correct name and pronouns, to medical treatments including hormone replacement therapies and surgery — is medical fact validated by every major medical association. The American Medical Association, American Academy of Pediatrics, American Psychiatric Association, World Health Organization and many, many more all recognize gender affirming care as medically necessary, life-saving, life-affirming treatment for transgender people.

It is important to explicitly clarify that transness itself is a not a medical issue that requires “fixing.” Instead, gender affirming care aims to treat “dysphoria” by helping trans people align their bodies with who they truly are, as best fits their unique sense of self and transition goals. Instead of dysphoria, some people prefer to focus on gender “euphoria”— a feeling of joy and correctness that comes with their true gender. Every individual’s transition experience, goals, and needs will vary, but transition, understanding, and support are universally recognized as the appropriate care for transgender people.

Research has consistently found extremely high rates of satisfaction with gender affirming medical care, including hormone replacement therapies and surgery.

The 2022 U.S. Transgender Study, compiling insights from over 92,000 respondents, found that the overwhelming majority of individuals receiving hormone replacement therapy — 98% — report their transition has made them more satisfied with their life.

Furthermore, research published in 2022 from the Stanford University School of Medicine explicitly found that starting gender-affirming hormone treatment in adolescence is linked to better mental health for trans people than waiting until later in adulthood.

A 2023 study published in the Journal of the American Medical Association (JAMA), notes that the regret rate for gender-affirming surgery is estimated at 1% — with not a single respondent to their study having requested or undergone a reversal of their gender-affirming procedure. They also found that trans individuals who received gender-affirming surgery reported lower rates of both depression and anxiety, contributing to greater overall well-being and positive mental health outcomes.

Other examinations of available research have found similar results. A review of 27 scientific studies, published in 2021 in the Journal of the American Society of Plastic and Reconstructive Surgery, confirmed that the regret rate for gender affirming surgery is 1%.

As an illustrative comparison, regret for knee replacement surgery ranges as high as 30% of patients. One might notice that there is no coordinated political action to ban knee surgery, and no touring speakers on the dangers of knee surgery, despite being up to 30 times more likely to negatively impact patients than gender-affirming procedures.

It is worth noting that gender affirming care for youth almost exclusively takes the form of social transitioning and hormone treatments, with surgeries being rarely performed. A 2023 study published in JAMA found that about 92% of gender affirming surgeries are performed on individuals who are 18 or older, with less than 8% performed on individuals younger than 18 years old.

So with gender affirming medical care being associated with extremely high rates of satisfaction, greater life satisfaction and well-being, and reduced levels of anxiety and depression, why do some transgender people de-transition?

Well, most don’t. The U.S. Transgender Survey has found that only 8% of people detransition, and that the majority of those who do de-transition ultimately resume their transition later in their life.

This minority of trans people who de-transition do so — simply put — because society collectively is often not very kind to transgender people. The top four reasons for de-transitioning reported in the U.S. Transgender Survey are 1) pressure from a parent, 2) transitioning was too hard, 3) they faced too much harassment and discrimination, and 4) they had trouble getting a job.

Similarly, a 2021 study found that over 82% of individuals who de-transitioned did so because of external pressure, lack of acceptance, social stigma, and instances of violence and harassment.

To recap: gender affirming care is overwhelmingly associated with extremely high levels of satisfaction and better mental health outcomes. Those who de-transition are a small minority. Those who de-transition and remain de-transitioned are an even smaller minority. Those who de-transition and remain de-transitioned for reasons other than being treated poorly for being trans are an even smaller minority still, representing the smallest possible sliver of transgender experience.

Yet despite representing the smallest possible fraction of trans experience, “de-transitioners” like the speaker visiting our community wield an outsized influence on public discourse around transgender rights and gender-affirming care — often spearheading or supporting attempts to restrict or ban the medical care that is endorsed by every professional medical organization.

Centre LGBT+ encourages all members of the local transgender, nonbinary, and gender nonconforming communities (as well as their allies, friends, and families) to find community and solidarity through the resources we offer. We offer a gender identity support group, a support group for those questioning or developing their gender identity, and a support group for families. We also offer a wide range of social groups for LGBT+ folks of all identities and ages to make friends and find community. We also offer trainings to businesses, congregations, and community groups who want to learn more.

Please visit centrelgbtplus.org or reach out to us at info@centrelgbtqa.org to learn more about the resources we offer and how you can help support our local LGBT+ community.

This commentary was authored by the members of the Centre LGBT+ Board.