Rates of discontinuation and regret in trans and gender diverse adolescents receiving puberty blockers and hormone therapy: a systematic review

Background Concerns about treatment discontinuation and regret are frequently cited to justify bans or restrictions on gender-affirming care for adolescents. However, there has not been a systematic review of the rates of and reasons for treatment discontinuation and regret for adolescents receiving puberty blockers and gender-affirming hormones (GAH). Methods MEDLINE, EMBASE, PsycINFO, and PubMed were searched for studies published before November 21, 2024 that described treatment discontinuation and/or regret in individuals who received gender-affirming medical care with puberty blockers and/or GAH aged 18 years or younger. Findings 27 studies met inclusion criteria. For puberty blockers, the median discontinuation rate was 4.5% (interquartile range (IQR): 1.6%–7.6% = 6.0%). For GAH, the median discontinuation rate was 1.9% (IQR: 0%–3.3% = 3.3%). Discontinuing these treatments occurred for a range of reasons, few of which indicate harm had occurred, and was only infrequently associated with a change in gender identity. For puberty blockers and GAH, the overall regret rate was 1.2% (11 cases of 916) and 0.6% (6 cases of 1033) respectively. No reasons were reported for the cases of regret identified. Interpretation The vast majority of adolescents who begin puberty blockers or GAH as part of pediatric gender care continue treatment. When treatment is discontinued, this decision can be for a range of reasons and is not typically associated with a change in gender identity. Current evidence does not support claims that regret is prevalent for trans adolescents that access puberty blockers or GAH.