Levels of Satisfaction and Regret With Gender-Affirming Medical Care in Adolescence

Importance: There is a need to improve the evidence base for gender-affirming medical care provided to adolescents, including the experiences of those who have received this care. Objective: To examine rates of satisfaction, regret, and continuity of care in adolescents who received puberty blockers and/or gender-affirming hormones as part of gender-affirming medical care. Design, Setting, and Participants: This survey study used the 2023 online survey wave of an ongoing longitudinal study, the Trans Youth Project, among a community-based sample of transgender youth and their parents initially recruited throughout the US and Canada between 2013 and 2017. The satisfaction and regret data include responses from a youth or their parent representing 87% of the youth aged 12 years or older in the cohort who have received gender-affirming medical care (235 of 269 youths). Of these, 220 completed the 2023 survey (main sample); information about continuity of care was available for all youth. Data analysis was performed from April to August 2024. Exposure: Satisfaction, regret, and continuity of care following puberty blockers or suppression and/or gender-affirming hormones. Main Outcomes and Measures: Self- or parent-reported satisfaction or regret with gender-affirming care and continuation of care. Results: Among the 220 youths in the main sample (mean SD age, 16.07 2.40 years; 30 14% multiracial, non-Hispanic; 18 8% White, Hispanic; 155 70% White, non-Hispanic; 17 8% other race and ethnicity, including Asian, Black Hispanic and non-Hispanic, Hispanic with unknown race, multiracial Hispanic, or Native American; gender at last interaction: 68 31% boys, 132 60% girls, 20 9% gender diverse, eg, nonbinary) and their parents, very high levels of satisfaction and low levels of regret with puberty blockers and gender-affirming hormones as well as high levels of continuation of care were reported. Of these 220 respondents in the main sample, 9 were regretful of having received blockers (n = 8) and/or hormones (n = 3; 2 of these individuals reported regret with both), of whom 4 have stopped all gender-affirming medical care and 1 has continued to receive blockers but plans to stop. The 4 others have continued care, suggesting that regret is not synonymous with stopping care. Conclusions and Relevance: The findings suggest that youth accessing puberty blockers and hormones as part of gender-affirming care tend to be satisfied with and not regretful of that care several years later. While regret was rare, these experiences need to be better understood.