A frequent refrain against allowing trans youth bodily autonomy is that they are “too young” to make “permanent changes” to their bodies. Aside from stigmatizing trans bodies in favor of cis ones—after all, all youth make “permanent changes” to their bodies during puberty, but some changes are seen as natural while others are seen as undesirable—this argument simply does not line up with the research into gender identity.
Research undertaken by Daniel L. Metzger and colleagues is the latest in a long line of studies demonstrating that, far from not knowing who they are, trans youth have a very firm grasp of their gender identity. It builds on research by Kristina R. Olson finding very low rates of detransition among trans youth, and research by Michael Zaliznyak demonstrating that the decision to come out and begin medical transition is an extremely slow one that usually requires years of gradual processing and sustained effort.
Metzger and his team followed 445 trans adolescents for a median period of 2.4 years, finding that only 2.9% of them switched their gender identity back to one that aligned with their birth sex; the remaining 97.1% retained a trans identity. What’s more, of those who initiated gender-affirming medical care, only a miniscule 1.1% of them chose to discontinue it, and none for reasons of reidentifying with their birth sex. This research puts the lie to the idea that massive amounts of trans youth will regret their transitions.
It also puts the lie to another myth—namely, that trans youth are being rushed into medical treatment that they will regret. In fact, in the study period only 79.3% of the youth initiated hormone replacement therapy, meaning that 1 in 5 of them chose to make no medical interventions at all.
Furthermore, the average age that the youth realized they had gender dysphoria was 9.5 years, yet the average age of first hormonal treatment was 16.3 years. This nearly seven-year gap, plus the fact that such a large chunk of the youth chose to not make a medical transition at all, shows that they are certainly not being rushed into anything.
In order to produce these findings, Metzger and colleagues retrospectively analyzed the date from 4 of Canada’s 10 trans youth clinics, covering the period from 2012 to 2017. These clinics treated the youth in accordance with guidelines laid out by the Endocrine Society and the World Professional Association for Transgender Health (WPATH), widely considered authorities on the subject of trans adolescents. Notably, the latter body is currently being sued by the Trump Administration for “misleading” youth and their families, yet if that was the case, certainly some of the 445 youth reviewed in this study would have complained.
Metzger et al. note that the low rate of reidentification as cisgender is in line with other studies of trans youth, which found similarly miniscule rates of detransition:
[Gender-affirming hormones (GAH) were] started by 79.3% in our study, with only four of 353 adolescents choosing to stop GAH, similarly reported by earlier studies. The Dutch cohort study found that 98% of 720 adolescents who had started GAH in adolescence continued to use GAH at a median age of 20 years. Similarly, in 2022, Butler found that 5.3% of their UK youth cohort stopped either [puberty blockers] or GAH. An online survey of 3,937 adults and adolescents (with 75.5% from Canada and 24.5% from the United States) at the mean age of 21.1 (SD 4.1) years found that 16.8% of those who had started gender-affirming medical care had discontinued treatment at least once for reasons including being older, health, having non-binary or “other” gender identity, change in gender identity, treatment side effects, living in the United States, or cost. Of those who discontinued gender-affirming medical treatment, 80.2% reported that they currently identify as transgender or gender-diverse. [Note, this would be a “detransition” rate of 3%.]
Metzger’s research is important, as it rebuts one of the key findings of the Cass Review, namely that the guidelines promulgated by the Endocrine Society and WPATH are of “low quality.” If these guidelines were of such a poor nature, certainly the clinics employing them would have had more dissatisfied customers.
It also rebuts the Cass Report’s finding that there is no research on long-term effects of hormonal interventions on trans youth. As this and other long-term studies are finding, trans youth are quite satisfied with the care they receive, enough so that only a remarkably tiny amount of them choose to discontinue it.
The low regret rate among trans youth can be contrasted with other medical treatment commonly given to youth. For instance, surgeries given to feminize the genitals of girls born with congenital adrenal hyperplasia (which can cause the clitoris to enlarge and the labia to fuse, giving characteristics that appear more masculine). Fully 1/3 of caregivers came to regret their decision to subject their child to this surgery, yet such procedures are specifically allowed by laws written to ban trans youth from receiving medical care. These facts point to the undeniable truth that these laws are less about protecting youth from medical mistreatment than they are about preventing trans adolescents from being able to live as they choose.
Attacks on trans youth—and the trans community more widely—continue. The Federal Trade Commission is currently being weaponized to debilitate WPATH, and Trump’s Executive Orders continue to frighten hospitals into stripping care from trans patients. It is important to continue sharing research finding that gender-affirming medical care has among the lowest regret rates of any medical care in existence (it’s commonly noted that regret rates for other kinds of surgeries are many times higher), and that trans youth clearly know their own identities. Eventually these facts will prevail over the misinformation that has swayed so many to the anti-trans side.
Veronica Esposito (she/her) is a writer and therapist based in the Bay Area. She writes regularly for The Guardian, Xtra Magazine, and KQED, the NPR member station for Northern California, on the arts, mental health, and LGBTQ+ issues.
