Perceived outcomes and barriers to gender-affirming hormone therapy among transgender and gender-diverse individuals by hormone therapy duration

Background Gender-affirming hormone therapy (GAHT) is often continued long-term, but little is known about the experiences of transgender and gender-diverse (TGD) individuals outside Western countries. We aimed to investigate satisfaction, regret, and barriers to GAHT in South Korea.Methods A cross-sectional study was conducted from 2024 to 2026 using survey data from a multicenter cohort study involving eight medical institutions providing gender-affirming care in South Korea. TGD adults receiving GAHT were included. The exposure was therapy duration, categorized as <1, 1–<2, 2–<5, and ≥5 years. The outcomes included satisfaction, regret, self-perceived outcomes, re-transition experiences, and barriers to GAHT.Results Among 1,076 participants, the median (interquartile range) duration of therapy was 2.1 (0.3–5.2) years. Overall, 91.1% of respondents were satisfied with GAHT, including 91.4% in the ≥5-year group. Overall, 80.8% reported no regret, including 84.5% in the ≥5-year group. In the ≥5-year group, a higher proportion reported improvements than <1 year group in quality of life (from 73.7% to 88.1%), self-esteem (from 74.5% to 84.5%), and mental health (from 77.8% to 85.8%). The ≥5-year group reported lower stigma and social barriers, such as difficulties in social participation (from 27.7% to 18.8%) and opposition from family and friends (from 25.5% to 14.5%), but greater structural barriers, such as time constraints (from 43.3% to 67.7%), geographic inaccessibility (from 47.9% to 58.1%), and financial burden (from 45.8% to 52.8%).Conclusions Most TGD individuals who were undergoing GAHT, including long-term GAHT recipients, reported high satisfaction and minimal regret. TGD individuals with longer GAHT durations reported lower levels of stigma and social barriers, but higher levels of structural barriers. To enable TGD individuals who are satisfied with GAHT to continue long-term treatment, efforts to alleviate structural barriers such as reducing costs and increasing the number of providers are necessary.